Tackling high blood pressure...by sitting?

We're not talking about cosy lounging on the sofa however, but a rather challenging sit-against-the-wall technique.

What types of training are there?

Aerobic exercise training includes endurance sports such as walking, cycling and jogging.
Dynamic/isotonic strength training involves shortening the muscles. Examples are squats or push-ups.
In contrast, in static/isometric strength training, the muscles are only tensed and held, such as in forearm supports or wall sits.
Combined training combines endurance and strength training.
High-intensity interval training (HIIT) consists of intensive training units with short recovery phases, such as short sprints.

What exercise is recommended by the guidelines, for high blood pressure?

The current guidelines explicitly recommend aerobic endurance training to lower blood pressure. It has been well studied and has a proven antihypertensive effect. However, newer, less evaluated forms of training such as isometric training and HIIT have not yet been taken into account. The recommendations may therefore be outdated.

In a large-scale network meta-analysis (DOI: 10.1136/bjsports-2022-106503) of 270 randomised controlled trials with a pooled sample size of 15,827 participants, the researchers led by Jamie Edwards compared all sporting activities in terms of their antihypertensive effect. The training period was at least two weeks. Blood pressure was categorised as follows in accordance with the European professional societies.

Normotension: < 130/85 mmHg
Prehypertension: 130-139/85-89 mmHg
Hypertension: > 140/90 mmHg

By how many mmHg can blood pressure be reduced?

Isometric training (including wall sitting) had the strongest effect. It lowered systolic blood pressure (SBP) by an average of 8.24 mmHg and diastolic blood pressure (DBP) by 4.00 mmHg (p<0.001). In contrast, classic aerobic training only achieved a reduction of 4.49 mmHg systolic and 2.53 mmHg diastolic (p<0.001). Dynamic strength training (-4.55/-3.04 mmHg, p<0.001), combined training (-6.04/-2.54 mmHg, p<0.001) and high-intensity interval training (-4.08/-2.50 mmHg, p<0.001) also failed to match the results of the holde exercises.

However, the researchers wanted to find out more and divided the individual training categories into further subgroups. In this secondary analysis, two activities performed best: running and - again - wall sitting.

Finally, a so-called SUCRA analysis (surface under the cumulative ranking curve) was used to determine the ranking of the training types. This involves determining the cumulative probability for each intervention that it is the most effective means of achieving the desired endpoint (in this case SBP). Here too, wall sitting and similar, came out on top with 98.3 per cent, followed by combined training (75.7 per cent), dynamic resistance training (46.1 per cent), aerobic training (40.5 per cent), and HIIT (39.4 per cent).

Which strategy is particularly effective for high blood pressure?

Any form of exercise has a positive effect on blood pressure. However, isometric strength training appears to be the most effective. According to the authors, this should be taken into account in future recommendations for the prevention and treatment of arterial hypertension. And you could already encourage your hypertensive patients to sit against the wall.

Source

Edwards JJ 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;57:1317–1326. doi:10.1136/bjsports-2022-106503