Blood Pressure: Low Impact Isometric Exercises May Lower Your Risk

Is low-impact exercise as effective as medication?

A meta-analysis, recently published in the British Journal of Sports Medicine, systematically reviewed existing research on a variety of exercise programs and found that isometric exercise had the most pronounced effect.

“While various different forms of exercise reduce blood pressure, isometric appears superior. This work encapsulates a body of isometric exercise training literature that has been building over the last two decades,” Dr. Jamie O’Driscoll, a Professor in cardiovascular physiology at Canterbury Christ Church University and senior author of the study, told Healthline.

O’Driscoll and his team took a deep dive into the literature about the effects of different exercise programs on blood pressure: reviewing 270 randomized controlled trials, with nearly 16,000 participants, published between 1990 and 2023.

The study looks at five different modes of exercise: aerobic exercise training, dynamic resistance training (weight-lifting), combined training (utilizing both weight-lifting and aerobic exercise together), high-intensity interval training, and isometric exercise.

While all exercises improve blood pressure, some are clearly more effective than others.

“[The study] demonstrates a potential superiority in blood pressure lowering effects with isometric versus the ‘traditional’ recommendation of aerobic exercise. The authors continue to find that exercise is about as effective as a single blood pressure pill to lower high blood pressure,” Dr. John Osborne, MD, Ph.D., volunteer expert for the American Heart Association and Founder and Director of State of the Heart Cardiology, told Healthline. Dr. Osborne was not affiliated with the research.

Different forms of exercise had varied effects on blood pressure

The study looked at the effects of exercise on both systolic blood pressure — the “top” number of a blood pressure reading, which refers to the amount of pressure exerted when the heart is contracted, and diastolic blood pressure, the “bottom” number, when the heart is relaxed.

Categorically, isometric exercises were most effective at reducing systolic blood pressure, lowering it by 8.24 mmHg; followed by combined training (6.04 mmHg). HIIT, while still significant, was the least effective at 4.08 mmHg; aerobic exercise and resistance training landed in the middle of the pack with 4.49 mmHg and 4.55 mmHg respectively.

For diastolic blood pressure, isometric exercise remained the most effective (4.0 mmHg), this time followed by resistance training (3.04 mmHg), combined training (2.54 mmHg), aerobic exercise (2.53 mmHg), and finally HIIT (2.50 mmHg).

Choice of exercise activity also played a significant role in affecting blood pressure. Walking was the least effective aerobic exercise, compared to running and biking.

Isometric wall-sitting was not only the most effective isometric exercise but by far the most effective exercise of all those observed for improving both diastolic and systolic blood pressure.

How isometric exercise fits into heart disease prevention

The American Heart Association and the Centers for Disease Control and Prevention both recommend 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week for adults. They also recommend two days or more per week of strength training.

However, according to O’Driscoll, it may be time to update these recommendations with more specifics about other forms of exercise that people should consider to lower blood pressure.

“The findings of this study should encourage future guidelines to provide support of isometric exercise training, complementary to other modes of exercise, in the management of resting blood pressure,” he told Healthline.

As far as exercise science goes, both HIIT and isometric exercise are relatively novel, compared to things like aerobic exercise and weight-lifting. Therefore, there’s just not that much data available on them. Fitness and exercise habits change too, so it’s important that guidelines reflect new science and new trends.

“I think this is a very important study that further lends credence to the idea that other forms of exercise, beyond the usually recommended aerobic exercise promulgated in prior guidelines, have significant value for blood pressure lowering, and, potentially, may offer ever greater benefits for lowering of blood pressure and controlling hypertension,” said Osborne.

Isometric exercise may also be important to help open up new avenues for individuals to explore exercise. While everyone likely knows the benefits of getting out for a jog a few times a week, the proposition can be daunting, particularly to individuals with joint problems. By comparison, isometric exercise is generally pretty simple.

Unlike traditional, isotonic, exercise, which forces muscles to contract — think about curling a weight with your bicep or pedaling a bicycle — isometric exercises are done in a static position, keeping tension on the muscle; wall-sitting, planks, and leg lifts are all common isometric exercises. It’s easy to start an isometric exercise routine because it rarely, if ever, requires any equipment or space.

O’Driscoll recommends wall-sitting for anyone interested in trying isometric exercise. However, make sure to check with your physician before starting any new exercise routines. The most common protocol for the exercise is four sets of 2-minute contractions, separated by 1-4 minute rest, three times per week. That’s just twelve minutes per day to improve your blood pressure.

Despite its benefits, experts caution that isometric exercise should be additive or supplemental; it shouldn’t replace other parts of your exercise routine.

“Isometric exercise gives people another alternative that might be more appealing or maybe it’s something they feel it’s more achievable for them. I just think we have to be a little careful if that became your only means of exercise,” Dr. Michael Fredericson, MD, Professor of Orthopaedic Surgery and Director of Physical Medicine and Rehabilitation at Stanford University told Healthline. Dr. Fredericson was not involved in the research.

The Bottom Line

A new study finds that static, isometric exercises may be more effective at improving blood pressure than “traditional” aerobic exercise.

Heart disease remains the number one killer in the United States, and high blood pressure is a leading contributor.

Elevated blood pressure can damage the heart and put individuals at risk for a number of deadly conditions, including diabetes, heart attack, and stroke.

Doctors frequently recommend lifestyle changes like eating a healthy diet and engaging in exercise to mitigate risk.