The Best Exercise to Lower Your Blood Pressure? It's Not What You Think It Is

Aerobics aren't the only way to beat high blood pressure. A Columbia cardiologist discusses squats and other isometric exercises for heart health.

October 26, 2023

Arun Manmadhan, MD wearing a suit and tie. — Arun Manmadhan, MD

What's the best exercise to fight hypertension, also known as high blood pressure? According to a recent study: bridges, planks, squats, and other isometric exercises.

“Controlling and preventing the development of high blood pressure is a critical pillar of overall health,” says cardiologist Arun Manmadhan, MD. “This study was an analysis of over 15,000 people in 270 clinical trials from 1990 to 2023. That's very large. It found that almost all forms of exercise training led to lower blood pressure, but interestingly, the most effective form of exercise was isometric exercise training.”

Isometric exercises are the ones when you hold still. They engage a particular muscle without movement, do not stress joints, and are considered low-intensity.

We asked Manmadhan, an expert in hypertension, sports cardiology, and heart disease, to tell us more. Here’s what he said:

Why is it important to keep blood pressure low?

Chronic high blood pressure can lead to the development of a variety of very serious medical conditions, including heart attacks, strokes, heart failure, and chronic kidney disease. Ultimately, maintaining a healthy blood pressure can lead to a longer and healthier life.

What are the traditional suggestions/ways to lower blood pressure?

In general, maintaining a healthy lifestyle with plenty of exercise and a balanced diet that is low in sodium, like the DASH diet, and processed food intake is advised to prevent hypertension.

The American Heart Association recommends 150 minutes (about 2 and a half hours) of moderate-intensity exercise or 75 minutes of vigorous aerobic activity.

If, despite this and with more intensive lifestyle interventions, blood pressure remains elevated, medications are often used to help lower blood pressure.

What’s the relationship between exercise and blood pressure?

Having an active lifestyle with plenty of exercise is critical to maintaining healthy blood pressure levels.

Exercise works in dozens of scientifically proven ways to lower blood pressure, including:

lowering inflammation in the body.
improving the function of the lining of the blood vessels (endothelial function), which leads to more relaxed arteries.
improving the physiological and psychological response of the body to stress.
improving the overall efficiency of the heart.

How can the findings from this new study help people?

Isometric exercise training is a form of strength training where the muscles are contracted without any significant movement of the joints (i.e. holding a wall squat, planks, holding a yoga pose).

The results of this study add yet another option for people to control and maintain a healthy blood pressure. For people who may not want to engage in vigorous aerobic exercise or are unable to, isometric exercises are now a great option with good evidence to back it up. It’s also a great way to vary your workout routine, which is also good for overall health.

Do you already or will you now suggest isometric exercise to your patients?

Yes. I do recommend patients engage in both aerobic activity and various forms of strength training as part of a way to stay healthy and prevent cardiovascular disease. The findings of this study will prompt me to recommend isometric exercise training more specifically, especially in patients who already have borderline or mildly elevated blood pressure.

Note that while doing isometric exercises—when the muscle is in its contracted state—the blood pressure can rise quite significantly temporarily. If someone has uncontrolled high blood pressure to begin with, or other pre-existing cardiovascular conditions, it may not be the safest or most optimal mode of exercise.

Talk to your doctor to determine what’s best for you.

The Top Three Isometric Exercises to Lower Blood Pressure

Talk to your doctor or other healthcare provider if you’re wondering if these exercises are good for you, especially if you have an injury or pre-existing cardiovascular condition.

If these are new exercises for you, to minimize the risk of injury, it is a good idea to have expert supervision when you start to make sure that your form is good.

The following isometric exercises were specifically studied in the paper. There are many other forms of isometric exercises likely to have similar cardiovascular benefits.

Wall squat (AKA wall sit): Lean back and shoulders against a wall, squat down, hold.

Leg Extension: While in a seated position, extend your legs to full extension and hold the legs in this position till

Handgrip: Hold a ball or a gripper and squeeze as hard as you can for 10-15 seconds and repeat for 3-4 sets.

What does everyone ask about blood pressure, and what do you say?

Can I control my blood pressure without medications?

If blood pressure is only borderline or mildly elevated, I usually tell patients that with careful attention to their diet, regular exercise, and a healthy weight, blood pressure can come down and be well controlled. However, everyone is different, and sometimes due to various factors, some people will need medications.

Medications work in addition to, and are never a substitute for, lifestyle changes.

What is one thing you wish everyone knew about exercise and blood pressure?

Finding time and motivation to exercise can be enormously challenging. Even the thought of allocating 30 to 45 minutes to exercise can discourage people from even starting.

If that sounds familiar, start by aiming to work out just 5 to 10 minutes a day. Even just a few minutes is enormously beneficial and better than doing nothing. Movement is medicine!

Arun Manmadhan, MD, is an Assistant Professor of Medicine at the Vagelos College of Physicians and Surgeons at Columbia University and an Attending Physician at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center.