Approximately 57% of the adult population is estimated to have hypertension (resting blood pressure > 140/90) or pre-hypertension (Ostchega et al). We’ve all been told that aerobic exercise is a great way to lower blood pressure. However, there is more concern surrounding resistance training especially in individuals with high blood pressure. Given that resistance training causes a rise in both systolic (top number) and diastolic (bottom number) blood pressure when lifting, some individuals have avoided resistance training for fear of excessive rises in blood pressure. In fact, one study (McDougall, et al.) which measured the blood pressure response to maximal and near maximal leg press exercises in bodybuilders reported maximal values of 480 mm Hg and 350 mm Hg for systolic and diastolic blood pressure, respectively.

Given that hypertension is the primary risk factor for stroke, this concern is justified. However, studies suggest that a resistance training program can be part of a healthy lifestyle even for hypertensives. One study (Kelley & Kelley) analyzed the results of 11 studies which investigated the effect of resistance training on resting blood pressure. Researchers studied 320 subjects with normal blood pressure and hypertension and reported a decrease of 3 mm Hg in both systolic and diastolic blood pressure after at least 4 weeks of resistance training. Another study (Melo et al.) reported a decreased resting blood pressure for 10 hours following a low-intensity resistance training program in hypertensive women taking blood pressure medication. In this study, subjects lifted 40% of their 1 Repetition Maximum (1 RM) performing 3 sets of 20 repetitions.

These and other studies demonstrate that resistance training can be part of an exercise program for hypertensives if performed appropriately. It is important to ask your physician if resistance training is appropriate for you and to find out about any restrictions you may have. The blood pressure response to resistance training depends on a number of factors including the amount of muscle mass recruited, breathing technique, amount of resistance lifted, number of repetitions, speed of lifting and rest between sets. Below are recommendations for resistance training programs for hypertensives (Sorace et al).

1. The more muscle mass used during a resistance training exercise, the greater the blood pressure response. Performing exercises like leg press, leg extensions or chest press using both legs or arms together will increase blood pressure more than single leg/arm exercises. However, if you have low back problems or other musculoskeletal problems, check with your trainer or therapist to determine if single leg/arm exercises may aggravate your condition.
2. The more weight lifted, the greater the blood pressure response.  Avoid maximal or near maximal lifts. An initial resistance of 30-40% of 1 RM for upper body and 50-60% of 1 RM for lower body exercises is an appropriate place to start. One RM strength testing, however, may not be appropriate for hypertensives during the initial stages of a resistance training program. It is best to wait for 4-8 weeks to see how an individual responds to a low-intensity resistance training program before 1 RM testing is performed. In this case, a subjective rating of 11–13 (fairly light to somewhat hard) on the 6-20 Rating of Perceived Exertion scale can be used to determine how much resistance to use. Resistance can be increased to 70-75% of 1 RM if your goal is to increase muscular strength and your blood pressure response to exercise is good.
3. The more repetitions performed, the greater the blood pressure response. Blood pressure will increase with the number of repetitions performed. Peak values are reached at the end of a set to exhaustion even with light loads. For this reason, hypertensives should avoid sets to failure. When effort becomes maximal at the end of a set, blood pressure will be highest. Start with one set and gradually progress to three submaximal sets depending on your goal. Each muscle group should be trained two days per week.
4. The speed of lifting is also important. Blood pressure is lowest when lifting at controlled speeds but not too slow. Very slow lifting speeds result in greater blood pressure elevations.
5. Rest between sets also affects the blood pressure response. When rest between sets is 30-60 seconds, blood pressure tends to increase with successive sets. However, when rest was 90 seconds or greater, blood pressure was not significantly elevated during successive sets. Rest periods of 90 seconds or greater are recommended for hypertensives.
6. Another factor which plays a key role in minimizing the blood pressure response to exercise is breathing technique. Breath holding is not recommended as this can lead to the Valsalva maneuver. During this maneuver, the individual attempts to exhale but blocks their airway so that air is not expelled which leads to large, rapid increases in blood pressure. This is a common response when we lift anything heavy. Proper breathing technique keeps the airway open throughout the lift, exhaling as the weight is lifted (exertion or hardest part of the lift) and inhaling as the weight is lowered.

If resting blood pressure is 180/110 mm Hg or higher, resistance training should not be performed (Sorace et al.). Hypertensive individuals with systolic blood pressures between 160–179 and diastolic blood pressures between 100-109 mm Hg should consult with their doctor before starting a resistance training program. In fact, it is a good idea for all hypertensive individuals to check with their doctor before starting a resistance training program especially if you are planning to use heavy loads.

In the beginning, it is important for hypertensives to have their blood pressure checked before and after each resistance training session to determine the effect of the program on their resting blood pressure. Taking a blood pressure measure during a lower body seated resistance training exercise is helpful in assessing blood pressure increases during exercise.

If you are taking a blood pressure medication, use caution when moving to a standing or seated position after completing an exercise. Sudden changes in body position can lead to a rapid drop in blood pressure which can cause dizziness.

What are you waiting for? Ask your doctor about a resistance training program and get started on the road to optimal health today!

Kelley, G.A. & Kelley, K.S. (2000). Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trials. Hypertension, 35, 838-843. Melo, C.M., Alencar, F., Tinucci, T., et al. (2006). Postexercise hypotension induced by low-intensity resistance exercise in hypertensive women receiving captopril. Blood Pressure Monitoring, 11(4), 183-189. McDougall, J.D., McKelvie, R.S., Moroz, D.E. et al. (1958). Journal of Applied Physiology, 58(3), 785-90. Ostchega, Y., Yoon, S.S. & Hughes, J.L. (2008). Hypertension awareness, treatment, and control – continued disparities in adults: United States, 2005-2006.  NCHS data brief no. 3. Hyattsville, MD: National Center for Health Statistics: 2008. Available at http://cdc.gov/nchs/data/databriefs/db03.pdf Sorace, P., Churilla, J.R. & Magyari, P.M. (2012). Resistance Training for Hypertension. ACSM’s Health & Fitness Journal, 16(1), 13-17.