Exercise might just be as effective as prescription medicine a study published online in the British Journal of Sports Medicine describes.
However, the data for the study came from pooled sources and there has been no direct head to head comparative trials of exercise and blood pressure lowering drugs, say the researchers.
The authors of the study were keen to point out that patients on blood pressure lowering medication shouldn’t ditch the drugs just yet, but should definitely consider increasing moderate exercise.
It is shown that exercise can lower the amount of pressure in the heart's arteries when the heart is beating.
Don't ditch your meds just yet
Systolic blood pressure is the top number in a blood pressure reading. However, what is unclear is how exercise compares to medication as there have not yet been any head to head clinical trials.
To try and compare anyway the researchers pooled data from 194 clinical trials looking at the impact of drugs on lowering systolic blood pressure and 197 trials looking at the impact of structured exercise. In total the studies involved 39,742 people.
Exercise may be equally as effective as medication
The trials defined structured exercise as :
-endurance, to include walking, jogging, running, cycling and swimming, high-intensity interval training;
-dynamic resistance, to include strength training, isometric resistance, such as the static push-up (plank);
-and a combination of endurance and resistance.
The analysis of the data was looked at in three different ways. First, all types of exercise were compared to all classes of blood pressure lowering drugs.
Then different types of exercise were compared to with different types of blood pressure lowering drugs and finally, different intensities of drugs were compared with different drug doses.
These analyses were then repeated but with participants with high blood pressure as the other trials contained mainly healthy people without diagnosed blood pressure issues.
Initially, the results showed that blood pressure was lower in those on medication.
But when the analyses were down on the high blood pressure group it was shown that exercise seemed to be just as effective as most drugs.
The researchers also found "compelling evidence that combining endurance and dynamic resistance training was effective in reducing [systolic blood pressure]."
Prescription medication set to rise
The authors of the study show evidence that the number of prescriptions for drugs to lower blood pressure is on the rise in the UK.
In England, the number of adults prescribed with such medication increased by 50% from 2000 to 2016.
This is likely to continue especially as major clinical practice guidelines have recently lowered the threshold for high systolic blood pressure to 130 mm Hg.
The researchers acknowledge that an increase in exercise isn’t possible for everyone as high blood pressure is often associated with other chronic illness that makes movement difficult.
We don't think, on the basis of our study, that patients should stop taking their antihypertensive medications," says lead author Dr. Huseyin Naci, Department of Health Policy, London School of Economics and Political Science, in a linked podcast.
"But we hope that our findings will inform evidence-based discussions between clinicians and their patients," he adds.
When questioned about whether doctors should be prescribing exercise to patients with high blood pressure, Dr. Huseyin Naci is keen to point out that consistency and safety are key for exercise to have benefits to patients.
"It's one thing to recommend that physicians start prescribing exercise to their patients, but we also need to be cognizant of the resource implications and ensure that the patients that have been referred to exercise interventions can adhere to them and so really derive benefit," he emphasizes.