What is the best exercise for lowering blood pressure?

We explored the topic of treating and reversing hypertension, or high blood pressure (BP), through an integrative and functional medicine approach in a previous blog. In this blog, we focus on how different types of exercises can lower blood pressure.

“Why is this important, if I am already taking a blood pressure medication?” some may ask. While pharmacologic therapy is an effective way to lower blood pressure, medication usage is associated with potential side effects, such as lower leg swelling (in the case of medications called calcium-channel blockers), dehydration (in the case of diuretic medications or “water pills”), high potassium levels in the blood (in the case of medications called ACE inhibitors), depression, fatigue, mood swings, problems with memory and concentration, and sexual dysfunction (in the case of medications called beta blockers). Higher long-term financial expenses are another concern. Keep in mind, though, that when attentively managed, pharmacologic therapy is tolerated well by many people.

Because of these potential concerns, non-pharmacologic approaches such as exercise play an important role in the prevention and treatment of hypertension, in addition to Food as Medicine (also called Food Is Medicine). In people with normal blood pressure or increasingly higher blood pressure, lifestyle interventions are “critically important strategies to slow the increase in BP and delay or prevent the onset of hypertension,” as the American College of Cardiology/American Heart Association 2025 hypertension guideline emphasizes (1). Once hypertension is diagnosed, lifestyle strategies can reduce blood pressure, reduce medication requirements, slow progression, and prevent cardiovascular events and mortality.

How much do different types of exercise lower blood pressure?

Exercise has been well documented to confer cardiovascular health benefits and improve long-term survival (2, 3). For the purpose of lowering blood pressure, aerobic exercise (such as walking, cycling, and running) had remained the primary recommended mode of exercise for years, mostly as a result of older research data that did not include more novel exercise modes, such as high-intensity interval training (HIIT) and isometric exercise training. New data have also become available on the role of resistance training alone and combined resistance and aerobic training in blood pressure reduction.

HIIT involves short bouts of high-intensity activity alternating with brief periods of low-intensity activity or rest. Isometric exercise involves static contraction of muscles without moving the joint(s), holding a single position, such as isometric handgrip (static handgrip), isometric leg extension (leg extension hold), and isometric wall squat (wall sit).

Let’s delve into the results of the most comprehensive study to-date that examined how different exercise modes affect blood pressure. This study, published in the British Journal of Sports Medicine in 2023, was a meta-analysis (a study of studies) that incorporated the data from 270 randomized controlled trials and more than 15,000 study participants in total (4). The researchers looked at the following categories of exercise:

• Aerobic exercise training

• Resistance training

• Combined training (aerobic and resistance)

• High-intensity interval training (HIIT)

• Isometric exercise training

For finer details, the researchers also analyzed specific subgroups within exercise categories: walking, running, and cycling (as subgroups of aerobic exercise training), sprint interval training (short bursts of maximal-intensity intervals) and aerobic interval training (4 x 4 min. intervals) (as subgroups of HIIT), and isometric handgrip, isometric leg extension, and isometric wall squat (as subgroups of isometric exercise training).

What the researchers found was that all types of exercise resulted in blood-pressure lowering, but some types of exercise reduced blood pressure more effectively than others. Here are the results showing exactly how much each type of exercise, when compared with the control group, lowered systolic blood pressure (SBP) and diastolic blood pressure (DBP) (the top and bottom numbers in a blood-pressure reading). (The units of BP are mm Hg, pronounced “millimeters of mercury.” They are left out below for visual clarity.)

Overall reduction in SBP / DBP:

Aerobic exercise training: 4.49 / 2.53

• Walking: 2.85 / 1.44

• Cycling: 6.88 / 3.2

• Running: 6.83 / 5.67

Resistance training: 4.55 / 3.04

Combined training (aerobic and resistance): 6.04 / 2.54

High-intensity interval training: 4.08 / 2.50

• Sprint interval training: 5.26 / 3.29

• Aerobic interval training: results were not statistically significant

Isometric exercise training: 8.24 / 4.00

• Isometric handgrip: 7.10 / 3.46

• Isometric leg extension: 10.05 / 4.23

• Isometric wall squat: 10.47 / 5.33

  
  

Exercise produces larger blood-pressure reductions in people who already have hypertension than those who don’t

The researchers also investigated whether exercise affected people with hypertension to a different degree than people with normal blood pressure at baseline. The study did, in fact, show that in people with hypertension, exercise improved blood pressure to a greater extent than in people with normal blood pressure. For example, aerobic exercise lowered systolic BP by 7.74 points (mm Hg) in people with hypertension, while it lowered systolic BP by 3.60 points in people with normal blood pressure. Isometric exercise lowered systolic BP by 9.22 points in people with hypertension and 6.65 points in people with normal BP. So, the take home point here is that in people with hypertension, all types of exercise training resulted in  even larger BP reductions than they did in people with normal blood pressure—this is a good thing.

Which modes of exercise are the most effective for reducing blood pressure?

When the various exercise modes were compared with each other and ranked by the degree of effectiveness in lowering systolic BP, isometric exercise training was the most effective, followed in order by combined training (aerobic and resistance), resistance training, aerobic exercise training, and high-intensity interval training. When specific types of exercise were compared, isometric wall squat was the most effective, followed in order by isometric leg extension, isometric handgrip, cycling, running, combined training, sprint interval training, “other aerobic,” resistance training, aerobic interval training, and walking.

This, of course, does not mean that walking is not effective for lowering blood pressure. It just means that if you are exercising with the goal of lowering blood pressure, and you want to choose the most effective form of exercise for this purpose, or if you have limitations in the types of exercise you can do or just don’t have enough time, then isometric exercise training could be your first choice. However, if you enjoy walking, or you can only walk instead of cycling, for example, then continue walking, as it has many other benefits beyond blood pressure reduction.

Combined training (aerobic and resistance) was previously considered to have inconclusive data as a result of insufficient evidence, but this study has provided large-scale data that established combined training as an effective exercise mode in lowering blood pressure.

High-intensity interval training is a novel intervention for blood pressure reduction, and it did produce clinically relevant reductions in both systolic BP and diastolic BP in this study. However, it ranked as the least effective exercise mode for systolic BP reduction.

(A side note about the interpretation of the data from this study of studies: While isometric exercise training came out on top in this study, the comparisons to other exercise modes were indirect. In other words, the comparisons to other exercise modes were possible only because of advanced statistical techniques used in this study. The results were not derived from direct, head-to-head comparisons with other exercise modes; such research designs may be incorporated into future clinical trials. Nevertheless, to date, this study is the most comprehensive in scope in examining the effects of different modes of exercise training on blood pressure reduction.)

What is the best exercise for lowering blood pressure?

So in summary, all exercise modes—aerobic exercise training, resistance training, combined training, high-intensity interval training, and isometric exercise training—are significantly effective in lowering resting systolic and diastolic blood pressures. Isometric exercise training is the most effective mode for lowering blood pressure, and compared with isometric handgrip and isometric leg extension, isometric wall squat is the most effective. However, for any individual, the best exercise for lowering blood pressure is the one that you would enjoy doing and be able to do on a daily or regular basis, in order to reap the benefit of blood pressure reduction.

Now a brief caveat (because I have seen lifestyle interventions work very effectively in lowering blood pressures time and again!): Before starting a routine exercise training program, consult your physician about your treatment of hypertension and about the types of exercise that are suitable for you. As your blood pressure improves, your blood pressure medications may need to be reduced to avoid low blood pressure, which can be dangerous. Follow up with your physician more frequently during this period of time in order to ensure that your medication dosages are adjusted or tapered off based on your blood pressure levels.

References

1. Writing Committee M, Jones DW, Ferdinand KC, Taler SJ, Johnson HM, Shimbo D, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;152(11):e114-e218.

2. Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017;390(10113):2643-54.

3. Wang Y, Nie J, Ferrari G, Rey-Lopez JP, Rezende LFM. Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults. JAMA internal medicine. 2021;181(2):203-11.

4. Edwards JJ, Deenmamode AHP, Griffiths M, Arnold O, Cooper NJ, Wiles JD, et al. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. Br J Sports Med. 2023;57(20):1317-26.