Exercising with low blood pressure: Advice and precautions

If you have low blood pressure, exercise may cause you to feel lightheaded or dizzy, especially under certain circumstances. But taking a few simple precautions and possibly switching up your exercise routine can help you exercise safely.

Blood pressure refers to the force of blood on the walls of your blood vessels as it circulates through your body. An optimal blood pressure reading is less than 120/80 mm Hg. But if your blood pressure is consistently below 90/60 mm Hg, that’s considered low blood pressure, also known as hypotension. Healthy, active people with low blood pressure usually have no symptoms. But older adults with hypotension and other health conditions may have symptoms such as dizziness, blurred vision, fatigue, confusion, or even fainting — especially during or soon after they exercise.

How exercise affects blood pressure

When you exercise, your heart beats faster to deliver oxygen-rich blood to your muscles. As a result, your blood pressure also rises. But after you stop exercising, your blood pressure naturally falls, a phenomenon known as post-exercise hypotension.

 “Post-exercise hypotension can reduce the amount of blood moving back to your heart and brain and make you feel dizzy or lightheaded, especially if your blood pressure is low to begin with,” says Lauren Mellett, a physical therapist and cardiopulmonary specialist who manages the Harvard-affiliated Brigham and Women’s Cardiac Rehabilitation Program in Foxborough, Mass. Rapid postural changes during exercise can also trigger those symptoms, she adds.

Tips for exercising with low blood pressure

Two simple habits can help people with low blood pressure exercise safely. First, make sure you stay well hydrated, which helps replenish any fluid you lose from sweating. Dehydration can worsen low blood pressure. Simply drinking a big glass of water right before you exercise isn’t sufficient, says Mellett. “It’s much better to drink small amounts of water throughout the day, which is a more effective way to stay hydrated,” says Mellett. Bring a water bottle to take small sips during your workout, she adds.

Second, cool down gradually after any exercise that raises your heart rate. Don’t stop moving abruptly, especially if you’re standing upright. After a workout, your blood vessels are open and dilated, so blood will tend to pool in your feet and legs. “When you stop moving your muscles, that also slows down the return of blood flow back to your heart,” explains Mellett. When you’ve finished your workout, gradually slow your movements over a period of at least five minutes — or longer if you notice any symptoms. Doing so will give your nervous system time to recover and tighten your blood vessels, thereby raising your blood pressure and increasing blood flow up to your brain.

Best types of exercise if you have low blood pressure

Certain types of exercise may be safer than others, especially if your blood pressure falls and you feel dizzy after you exercise in an upright, standing position. “Doing seated exercise, such as using a recumbent stationary bicycle or a rowing machine, prevents the blood pressure dip caused by blood pooling in your legs,” says Mellett.

Swimming, which puts your body in a horizontal position, offers the same advantage. In addition, the pressure of water on your body gently pushes blood and fluid from your arms and legs back towards the center of your body and heart. As a result, your heart pumps more blood per beat, making it more efficient.

You might also need to adapt your strength-training routine, says Mellett. Instead of standing during upper body exercises (such as overhead presses and biceps curls), sit on a stool or chair. Be cautious while doing deep squats or any other exercise that involves quickly moving your body from a lower to higher position, she advises. Also, avoid movements or poses (as in yoga) that place your head below your heart. The rush of blood toward and then away your head as you come in and out of the pose can lead to dizziness.

If your workout combines floor exercises (done kneeling, sitting, or lying on the floor) with standing exercises, don’t alternate between the two. Instead, complete all the floor exercises first, then move slowly as you transition to standing, pausing in a seated or kneeling position if needed.

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