The ability of aerobic exercise to reduce systolic (top number) blood pressure has long been established. Reductions in blood pressure have been shown to reduce an individual’s risk for chronic diseases including heart disease and ischemic events such as stroke and heart attack. Reducing an adult’s high blood pressure is an aim of many primary care physicians. Commonly utilized medication classes including beta blockers, calcium channel blockers, diuretics, and ace inhibitors are commonly prescribed to effectively reduce high blood pressure. Exercise, although shown to be an effective treatment for 26 chronic diseases, remains underutilized by both patients and physicians prompting many medical groups to adopt “exercise is medicine” platforms to raise awareness. A recent review of the evidence compared the effectiveness of medications and exercise on blood pressure.
The British Journal of Sports Medicine published a review of the medical literature including 391 randomized controlled trials (Naci et al. 2018). These trials included both exercise (10,491 participants) and blood pressure medications (29,281 participants, but unfortunately no trials compared the two interventions against one another. Interestingly, only 56 of the available trials (3508 participants) on the benefits of aerobic exercise on blood pressure were performed in patients with high blood pressure (systolic > 140 mmHg). When authors combined the data of all participants (high blood pressure or normals) they found blood pressure medication was more effective than exercise for lowering blood pressure. Conversely, and importantly, when authors pooled the data of only patients with high blood pressure they found exercise was equally effective to most blood pressure medications (beta blockers, ACE inhibitors, and diuretics). The authors of the review called on researchers to produce more head to head randomized trials between exercise and medications, as well as, stronger methodology to reduce the risk of bias and validity errors. Patients are advised to speak with their physician before making any changes to their medications or beginning an exercise program.