Strength training and blood pressure

Ask the doctor

Q. I take medication for high blood pressure. I’ve heard that weight lifting can elevate your blood pressure, so should I avoid that type of exercise?

A. If you have well-controlled blood pressure and are otherwise healthy, most types of strength training — which includes weight lifting — are generally considered not only safe but beneficial for your overall health. You should take precautions, however.

But let’s start with some definitions. Strength training (also called resistance training) refers to any exercise that works your muscles against an opposing force. You can train your muscles using your own body’s weight or equipment such as elasticized bands, dumbbells and other free weights, or specialized machines.

These muscle-building exercises may be dynamic or isometric. Dynamic exercises are those in which you move your muscles and joints, such as a biceps curl or a squat. Isometric exercises are performed against an immovable object, such as a wall or the floor, and include things such as planks or wall sits (see photo).

When you perform any type of exercise — whether it’s aerobic, strength training, stretching, or even balance exercises — both your blood pressure and heart rate increase to meet the greater demand for oxygen from your muscles. Some research suggests that during exercise, isometric exercise may boost blood pressure more than dynamic exercise, but the evidence isn’t conclusive. However, it’s clear that just as with aerobic or endurance exercise (such as walking, jogging, cycling, or swimming), strength training can help lower your blood pressure if you do it consistently.

Most adults should do strength training exercises at least two days a week, according to the federal activity guidelines. Beginners should start with exercise bands or light hand weights. If you’re more experienced, weight machines are a good option. Use a weight that’s challenging but manageable. The general advice is to start with a single set of eight to 12 repetitions (reps) and then gradually build up to three sets over time. Rest for at least a minute between each set.

However, people who have high blood pressure, especially if it’s not optimally controlled, should be cautious about any movements that involve lifting very heavy weights—not just loaded barbells at the gym, but also heavy furniture or boxes of books. That’s because the sudden, intense effort can cause your blood pressure to spike—especially if you hold your breath, which people sometimes do in an attempt to increase their effort. During strength training exercises, be sure to exhale as you lift, push, or pull, and inhale as you release. Counting out loud as you lift and release can help you remember to keep breathing.

— Deepak L. Bhatt, M.D., M.P.H.
Editor in Chief, Harvard Heart Letter