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REVIEW

CURRENT
OPINION Physical activity and fitness for the prevention
of hypertension
Esmée A. Bakker a,b, Xuemei Sui c, Angelique G. Brellenthin d,
and Duck-chul Lee d

Purpose of review
The aim of this review is to evaluate the most recent literature about the role of physical activity, exercise,
and fitness in hypertension prevention.
Recent findings
Strong evidence indicates that performing moderate-to-vigorous physical activity, particularly aerobic
exercise, and improving cardiorespiratory fitness (CRF) reduce blood pressure (BP) levels and lower
hypertension incidence. Although evidence is limited, performing resistance exercise or improving muscular
strength appears to be associated with a lower incidence of hypertension. Furthermore, reducing sedentary
time or replacing sedentary time with physical activity might lower BP.
Summary
To lower the risk of hypertension, promoting physical activity and improving fitness, especially CRF, should
be encouraged. More research is needed to determine the effects of sedentary behavior, resistance
exercise, and muscle strength on the development of hypertension across diverse populations and settings.
Future studies should focus on dose–response relationships of exercise and physical activity with the
development of hypertension to determine the minimal and optimal amount of exercise and physical activity
for hypertension prevention.
Keywords
blood pressure, cardiorespiratory fitness, exercise, hypertension, muscular strength, sedentary behavior

INTRODUCTION week for additional health benefits [7,8]. However,

High blood pressure (BP), also known as hyperten-
sion, is the leading risk factor for the global burden
of disease and mortality. Hypertension contributes
to 9.4 billion deaths each year [1,2] due to increased
risk of coronary heart disease, stroke, congestive
heart failure, and end-stage renal disease [3 ].
&&
Therefore, preventing the development of hyperten-
sion is a global public health focus [1]. Poor diet,
physical inactivity, and excess intake of alcohol are
important modifiable causes of hypertension, impli-
cating lifestyle interventions as potential solutions
&&
for preventing hypertension [3 ]. Regular physical
activity or exercise is recommended to prevent
&&
hypertension [2,3 ,4] and to improve longevity
[5,6]. The WHO and US government physical activ-
ity guidelines recommend 150 min/week of moder-
ate-intensity or 75 min/week of vigorous-intensity
aerobic activities to maintain and improve health.
In addition, the physical activity guidelines recom-
mend to combine aerobic physical activity with
muscle-strengthening activities for at least 2 days/
the optimal prescription of different types of physi-
cal activity for the prevention of hypertension is still
unknown. Therefore, the aim of this review is to
discuss the most recent evidence regarding the role
of physical activity and fitness in the prevention of
hypertension. We will include the results of obser-
vational studies as well as randomized controlled
trials (RCT) of exercise.
a
Department of Physiology, Radboud University Medical Center, Nijme-
gen, The Netherlands, bResearch Institute for Sports and Exercise
Sciences, Liverpool John Moores University, Liverpool, UK,
c
Department of Exercise Science, University of South Carolina, Colum-
bia, South Carolina and dDepartment of Kinesiology, Iowa State Univer-
sity, Ames, Iowa, USA
Correspondence to Duck-chul Lee, PhD, Department of Kinesiology,
Iowa State University, 103H Forker Building, 534 Wallace Road, Ames,
IA 50011-4008, USA. Tel: +1 515 294 8042; fax: +1 515 294 8740;
e-mail: dclee@iastate.edu
Curr Opin Cardiol 2018, 33:000–000
DOI:10.1097/HCO.0000000000000526

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Hypertension
KEY POINTS
 Even small amounts of physical activity reduce the risk
of hypertension, whereas higher levels of physical
activity and CRF further decrease the risk of
hypertension.
 Research recommends to exercise on most, preferably
all, days of the week to reduce BP levels, whereas
individuals could benefit from breaking up sedentary
behavior by short periods of moderate-to-vigorous
physical activity.
 Results from randomized controlled trials suggest that
performing resistance exercise could lower BP and
possibly prevent hypertension; however, additional
studies are needed to confirm these results.
 Most dose–response studies are based on self-reported
physical activity data; therefore, randomized controlled
trials with longer intervention periods and observational
studies with objectively measured physical activity are
needed to define the exact dose–response relationship
of physical activity and hypertension.
PHYSICAL ACTIVITY
Sedentary behavior
The lack of physical activity is a major risk factor for
morbidity and mortality. Nowadays, the majority of
a person’s waking day involves sedentary behavior,
which encompasses waking activities that are per-
formed while sitting or lying down with an energy
expenditure 1.5 or less metabolic equivalents
(METs). Cross-sectional studies have shown that
objectively measured sedentary time was not asso-
ciated with SBP and DBP [9,10]. Larsen et al. [11]
found in a randomized cross-over trial that 2-min
breaks of light-intensity or moderate-intensity activ-
ities every 20-min lowered SBP (2–3 mmHg) and
DBP (2 mmHg) compared with prolonged sitting
without breaks in 19 overweight or obese adults.
These results were confirmed by Dempsey et al. [12]
who found substantial reductions in SBP (14–
16 mmHg) and DBP (8–10 mmHg) by interrupting
30 min of prolonged sitting with brief 3-min bouts
of light-intensity walking or simple resistance activ-
ities in 24 inactive adults with type 2 diabetes. Such
reductions in SBP and DBP could have a major
impact on the incidence of hypertension [13]. How-
ever, not all studies demonstrated positive effects on
BP by breaking up sitting time. Bailey and Locke [14]
revealed that the area under the SBP curve in their
one-way analysis of variance did not significantly
differ between three conditions of uninterrupted
sitting, sitting with 2-min standing breaks, or sitting
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with light-intensity activity breaks. Bhammar et al.
&
[15 ] found no reduction in SBP after 2-min breaks of
moderate or vigorous-intensity activities every 20 or
30 min, respectively. However, in the same study,
they reported a reduction in SBP (4 mmHg) after one
break of 30 min performing moderate-intensity
activities within 9 h of sitting. The cumulative
amount of break time of all previously mentioned
studies ranged between 16 and 42 min. Based on
these results, the effects of reducing sedentary
behavior on BP look favorable, but the results are
inconsistent. Most trials have recruited small sam-
ples sizes (N ¼ 10–30), which precludes subgroup
analyses among individuals with normal, elevated,
or hypertensive BP levels due to the low statistical
power. In addition, there are no longitudinal studies
available examining the association of sedentary
time and the prevention of hypertension. Therefore,
it is difficult to extrapolate these results to healthy
individuals or to individuals with risk factors, such
as increased BMI or smoking. Future studies are
needed to determine whether reducing sedentary
time or replacing sedentary time with physical activ-
ity could lower BP and prevent hypertension. In
addition, the intensity of the physical activity and
the frequency or duration of the physical activity
breaks might influence the BP-lowering effects.
Aerobic exercise
Aerobic exercise is characterized by activities such as
running that use large muscle groups continuously
and rhythmically. Aerobic exercise also constitutes
most physical activity in the general population.
Previous studies have already shown the benefits
&&
of aerobic activities on BP [2,3 ]. A recent cohort
study including 20 000 Swedish men and women
showed that bicycling to work reduces the risk of
developing hypertension [odds ratio 0.87; 95% con-
fidence interval (CI) 0.79–0.95] compared with pas-
sive travel by car or bus [16]. Meta-analysis of 29
observational cohort studies found a risk reduction
of 6% [relative risk (RR) 0.94; 95% CI 0.92–0.96] of
hypertension with each increment of 10 MET-hours
&&
per week of leisure-time physical activity [17 ].
Most studies are performed in white populations;
yet, the prevalence of hypertension is greater in
other racial and ethnic groups such as African-Amer-
&&
icans [18]. Diaz et al. [19 ] found in a population-
based cohort study that African-Americans with the
highest level of moderate-to-vigorous physical activ-
ity (MVPA) had a lower risk of incident hypertension
(hazard ratio 0.76; 95% CI 0.58–0.99) after full
adjustment for potential confounders. This suggests
that the benefits of performing MVPA are spread
throughout different racial and ethnic groups.
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Physical activity and fitness for the prevention of hypertension Bakker et al.
However, a limitation of most current studies is that
almost all of the physical activity is measured by self-
reported questionnaires, which are subjective and
can lead to measurement error. One exception is the
study by White et al. [20], who examined the effects
of short spurts (10 continuous minutes) of MVPA
on the development of hypertension using acceler-
ometry in 2076 adults (mean age of 45.2 years).
Their findings suggest that increasing time spent
in short spurts of MVPA protects against the devel-
opment of hypertension (RR 0.69; 95% CI 0.49–
0.96), which was independent of bouted (>10 con-
tinuous minutes) MVPA. Apart from observational
studies, two large meta-analyses of RCTs by Whelton
et al. [21] and Cornelissen and Smart [22] showed
that aerobic exercise training reduces SBP by 3.8 and
3.5 mmHg, respectively, and DBP by 2.6 and
2.5 mmHg, respectively. In addition, the effects of
aerobic exercise training were larger in hypertensive
individuals (reduction of SBP/DBP 5–8/4–5 mmHg)
compared with participants with normal BP (reduc-
tion of SBP/DBP 1–4/1–2 mmHg). Even though this
decrease in BP is small on an individual level, it
could result in a substantial reduction in total mor-
tality and cardiovascular mortality due to stroke and
coronary heart disease [13]. Therefore, the American
College of Cardiology and American Heart Associa-
tion recommend to increase physical activity with a
structured exercise program in adults with elevated
&&
BP or hypertension [3 ]. These findings emphasize
the beneficial effects of aerobic exercise in the pre-
vention of hypertension. However, exercise pre-
scriptions providing the minimal and optimal
amount of aerobic exercise to prevent hypertension
are still limited. In addition, the WHO and US
government physical activity guidelines recom-
mend to perform aerobic activities in bouts of at
least 10 min duration, but the study by White et al.
[20] suggests that short spurts may also be beneficial
in preventing hypertension. With only half of the
US population meeting the physical activity guide-
lines for self-reported aerobic activities [23], aerobic
physical activity including personalized exercise
prescription in inactive individuals should continue
to be promoted to prevent hypertension.
Resistance exercise
Resistance exercise such as weight lifting is based on
repeated bouts of isolated muscle groups to stimu-
late muscle strength and growth. Observational
studies examining the association of resistance
exercise and the development of hypertension are
scarce. A cross-sectional study of Drenowatz
et al. [24] found no association between mean
arterial pressure and resistance exercise. Another
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observational study found no difference in SBP
and DBP between participants performing different
levels (minutes/week) of resistance exercise at base-
line [25]. However, pooled analyses of RCTs suggest
that one single bout of resistance exercise could
lower BP (SBP 2.9 mmHg, 95% CI 3.5 to 2.3;
and DBP 2.5, 95% CI 3.0 to 2.0) for up to 24 h
[26]. Other meta-analyses have also shown that
resistance exercise training could decrease BP
[22,27,28] and that both dynamic and isometric
resistance exercise training could lower SBP
(1.8 mmHg, 95% CI 3.7 to 0.011; and
10.9 mmHg, 95% CI 14.5 to 7.4, respectively)
and DBP (3.2 mmHg, 95% CI 4.5 to 2.0; and
6.2 mmHg, 95% CI 10.3 to 2.0, respectively)
[22]. The meta-analysis on isometric exercise train-
ing was expanded 1 year later and resulted in a
smaller overall effect size than the original meta-
analysis for SBP (6.8 mmHg, 95% CI 7.9 to 5.6)
and DBP (4.0 mmHg, 95% CI 4.8 to 3.1 mmHg)
[29]. Still, the effect size suggests that isometric
resistance exercise might be comparable or even
superior to dynamic exercise training (aerobic or
resistance). However, the number of RCTs and sam-
ple sizes are very small, ranging from 15 to 50
participants. In addition, it is unclear whether the
results are different in normotensive or hypertensive
individuals and for exercise sessions involving larger
muscle groups. Another limitation of the current
RCTs is that most exercise training studies only
report their planned exercise program but not the
actual completed amount of exercise. A small inter-
vention study (n ¼ 31) found that the weekly
amount of weight lifted during the intervention
period was correlated with more favorable changes
in peripheral and central SBP and DBP [30].
Based on the results from RCTs, we suggest that
resistance exercise could lower BP and possibly pre-
vent hypertension. However, additional RCTs and
long-term prospective studies are needed to confirm
these results in larger populations. In addition, only
22% of the US population meet both aerobic and
muscle-strengthening guidelines [23]. This might
be explained by the challenge of performing resis-
tance exercise without access to a health club,
where weight training equipment is typically avail-
able. A cross-sectional study showed that the odds
of meeting both aerobic and resistance physical
activity guidelines were 10 and 14 times higher,
respectively, in health club members compared
with nonmembers, and the odds of meeting the
guidelines increased with longer membership dura-
&
tions [31 ]. This study suggests that promoting
aerobic and resistance exercise at a health club could
be an effective public health strategy to prevent
hypertension.
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Hypertension
FITNESS
Cardiorespiratory fitness
Cardiorespiratory fitness (CRF) is considered as an
objective marker of recent aerobic physical activity
that could prevent the measurement error issue of
self-reported aerobic physical activity. Research has
shown an inverse dose–response association
between CRF and the incidence of hypertension
[32,33]. A population-based cohort study by Liu
et al. [34] demonstrated that BP was inversely asso-
ciated with CRF levels, and more importantly, they
showed that CRF is an effect modifier for the associ-
ation between SBP and age. SBP linearly increases
with age; however, the slope of low fit individuals is
higher compared with the slope of high fit individ-
uals suggesting that high levels of CRF could atten-
uate the increase of SBP with age. Most studies treat
CRF as a fixed value or parameter, but individual
levels of CRF change over time. These time-depen-
dent changes in CRF might influence the risk of
developing hypertension. An earlier study by Lee
et al. [32] showed that participants who maintained
or improved CRF had 24 and 23% lower risk of
incident hypertension, compared with those who
lost CRF after adjusting for potential confounders
including baseline percentage body fat and CRF
levels. As shown in Fig. 1, this result was consistent
regardless of changes in percentage body fat indi-
cating that individuals who maintained or
improved CRF had lower risk of developing hyper-
tension even though they gained percentage body
fat. A recently published study by Sui et al. [35 ]
&&
examining more complex trends of CRF found that
an increasing pattern of CRF was associated with the
lowest risk of hypertension. This association
remained consistent across different strata of base-
line CRF and BMI. Taken together, the results of
observational studies suggest that increasing CRF
could prevent hypertension independent of base-
line CRF and body fatness. RCTs regarding CRF
improvements and BP are not available. Still, large
observational studies could give insight into the
effects of increasing CRF and the prevention of
hypertension, especially if changes in CRF through-
out life are taken into account.
Muscle strength
Handgrip strength is often used as an indicator of
muscle strength, because it is simple, quick, and
inexpensive. Lawman et al. [36] showed in a cross-
sectional study that increased handgrip strength
was associated with lower SBP independent of phys-
ical activity among US adults. In partial support of
these findings, Lee et al. [37] found a borderline
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FIGURE 1. Hazard ratios (95% confidence intervals) of
incident hypertension by combined categories of changes in
cardiorespiratory fitness and percentage body fat. Adjusted
for age, sex, examination year, maximal metabolic
equivalents, % body fat, SBP at baseline, and lifestyle
changes (smoking status, alcohol intake, and physical
activity) between the baseline and second examinations.
Follow-up for incident hypertension was calculated from the
second examination to the first event of hypertension or the
last examination through 2006 in 3,148 men and women
without hypertension at baseline in this study (previously
published in Lee et al. [32]). CI, confidence interval; HR,
hazard ratio.
significant association (P ¼ 0.051) between relative
handgrip strength and SBP in men, but not in
women. On the other hand, Kawamoto et al. [38]
did not find any association between high BP and
handgrip strength in community-dwelling Japanese
individuals. A major limitation of the previously
mentioned studies is that they all examined cross-
sectional associations, which makes it more difficult
to infer causation without a temporal design. One
longitudinal study found that whole body muscle
strength at baseline was inversely associated with
incident hypertension over 19 years in men with
increased BP (SBP 120–139 mmHg or DBP 80–
89 mmHg) [39]. This association disappeared after
adjusting for CRF and was not present in normoten-
sive men. In the study, CRF and muscle strength
were modestly correlated, which may explain the
disappearance of the effect. In addition, the associ-
ation was only present in men with increased BP,
which suggests effect modification by baseline BP
status. Another limitation of the study was that they
did not include women, and there may be sex differ-
ences regarding the association of muscle strength
and BP. Therefore, little evidence suggests that high
muscle strength may prevent hypertension, but
future longitudinal studies are essential, particularly
those that focus on sex differences and the role of
baseline CRF and BP status.
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Physical activity and fitness for the prevention of hypertension Bakker et al.
FIGURE 2. Potential mechanistic pathway between exercise and blood pressure. " Indicates an increase; # indicates a
decrease. BP, blood pressure; NO, nitric oxide; RAS, renin–angiotensin system.
MECHANISMS OF BLOOD PRESSURE
REDUCTION
Multiple mechanisms are involved in the adaption
of BP to physical activity or exercise. The potential
effects of aerobic and resistance exercise are summa-
rized in Fig. 2. Mean arterial pressure is determined
by cardiac output (CO) and total peripheral resis-
tance. Since net CO does not change or slightly
increases with exercise training [40,41], the major
component that could change arterial pressure is
total peripheral resistance. Peripheral resistance
may be affected by exercise-related changes in vas-
cular function and structure. Endothelial dysfunc-
tion is an important determinant of local vascular
function and largely depends on nitric oxide (NO)
bioavailability. Both aerobic and resistance exercise
could upregulate NO bioavailability, which main-
tains and enhances endothelial function [42,43 ].
&&
In addition, patients with hypertension have an
increased vasoconstrictor tone, which could be
influenced by upregulation of the renin–angioten-
sin system and could be altered by aerobic exercise
[44–46]. Vascular structure could be influenced by
both chronic aerobic and resistance exercise, which
could induce increased artery diameter, decreased
intima–media wall thickness, and increased peak
flow-mediated dilatation [47]. Arterial stiffness plays
a major role in the pressure fluctuations of every
heartbeat. Tanaka et al. [48] found that 3 months of
aerobic exercise training reduced arterial stiffness
and increased arterial compliance. Conversely,
high-intensity resistance exercise has been associ-
ated with increased arterial stiffness especially in
young individuals [49]. Finally, BP is controlled by
the autonomic nervous system. Elevated activation
of the sympathetic nervous system and loss of para-
sympathetic control are common in patients with
hypertension [50]. Sympathetic nervous system
overactivity could be normalized and the sensitivity
of the baroreflex could be reset by exercise [41,51].
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Other risk factors such as insulin resistance [52]
and obesity [53] are common in individuals with
hypertension. Literature suggests that there is a rela-
tion between insulin resistance and BP, where BP
could be regulated by insulin concentrations
[54,55]. In addition, weight loss improves insulin
sensitivity and lowers plasma insulin concentrations
[53], which could lower BP. Both insulin metabolism
and weight loss are improved by performing aerobic
&
and resistance exercise [56 ,57]. Another physiologi-
cal response to exercise is postexercise hypotension [58–
60], which is a prolonged reduction in BP for several
hours after acute exercise. This acute postexercise
decrease in BP is correlated with chronic BP reduc-
tions [61], but the mechanism is still unknown. The
previously mentioned mechanisms are likely to cause
changes in BP levels. However, it is still not possible to
make definitive conclusions about the hypotensive
influence of exercise, because hypertension is multi-
factorial disease, and multiple systems contribute to
exercise-related BP reductions.
EXERCISE PRESCRIPTION
Exercise is the planned and structured form of phys-
ical activity. Exercise prescriptions are based on
training frequency, intensity, time, and type. In
general, there is a dearth of evidence regarding
the effects of specific exercise prescriptions on pre-
venting hypertension, but some data are available
and discussed below.
Frequency
Research showed that regularly active (3 days/
week) individuals had a slightly lower risk for mor-
tality than individuals who performed their physical
activity in 1–2 days/week, but since the difference in
hazard ratio was very small, the authors concluded
that a compressed pattern of physical activity may
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Hypertension
&
be sufficient to reduce mortality [62 ]. Similar stud-
ies have not been conducted on hypertension, but
researchers focused on BP recommend exercise on
most, preferably all, days of the week, based on the
post exercise hypotension effect [59,60]. However,
these recommendations were made for adults with
prehypertension to established hypertension, and as
mentioned before, the magnitude of the effects of
exercise on BP might be different for individuals
with normal BP levels.
Intensity
Current physical activity guidelines recommend a
combination of moderate and vigorous-intensity
exercise, where 2-min moderate-intensity exercise
equals 1-min vigorous-intensity exercise [7,8]. Vig-
orous-intensity exercise appears to be even more
beneficial in lowering DBP compared with moder-
ate-intensity exercise with equal energy expenditure
[63]. In addition, an intervention study demon-
strated that postexercise hypotension was dose depen-
dent and that higher exercise intensities resulted in
greater BP reductions [64]. Meta-analysis on high-
intensity interval training (HIIT), a form of vigorous
exercise, reported that short-term HIIT significantly
improved DBP (mean 4.74 mmHg) and long-term
HIIT lowered both SBP (mean 4.57 mmHg) and
DBP (mean 2.94 mmHg) in overweight or obese
populations. However, the effects of HIIT on BP were
&&
inconsistent in normal weight populations [65 ].
Two observational studies found similar risk reduc-
tions for the risk of hypertension for participants
performing moderate or vigorous exercise [66,67],
but these studies were limited by self-reported phys-
ical activity and hypertension. Based on the existing
literature, it is difficult to conclude that vigorous-
intensity exercise is more beneficial compared with
moderate-intensity exercise. In addition, sedentary
individuals who are more prone to injuries and falls
are not recommended to start with vigorous exercise
but should gradually increase the frequency and
intensity of their physical activity. Still, vigorous-
intensity exercise may be a good alternative to mod-
erate-intensity exercise since it is less time-consum-
&&
ing and more efficient in improving CRF [65 ].
Future studies should clarify the results for normal
weight populations, and longitudinal studies using
objective measures for physical activity and incident
hypertension in large populations are needed.
Time
Studies focused on cardiovascular disease (CVD) and
mortality demonstrated that even small amounts of
physical activity are associated with health benefits,
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whereas higher levels of physical activity provide
&
even more health benefits [68 ]. Similar findings are
also reported for hypertension. The earlier study
of White et al. [20] confirms that short sessions
(10 continuous minutes) of MVPA may contribute
to a lower incidence of hypertension. Moreover, the
&&
study of Liu et al. [17 ] found a linear dose–response
relationship between physical activity levels and
incident hypertension, which suggests additional
benefits for preventing hypertension with higher
levels of physical activity. Therefore, even small
amount of MVPA reduces the risk of developing
hypertension, and higher levels of physical activity
further reduce the risk of hypertension.
Type
There exists strong evidence that aerobic exercise
lowers BP. The evidence for resistance exercise is
limited, and further evidence is needed to determine
how much resistance exercise is needed to lower BP.
Some studies also examined the effects of combined
exercise training (CET), a combination of aerobic
and resistance exercise. A recent RCT demonstrated
that CET improved CRF to the same extent as aero-
bic training alone and muscle strength to the same
extent as resistance training alone. This suggests
&
that CET provides the greatest benefits [56 ]. How-
ever, findings of studies focused on BP suggest that
CET only reduces DBP [22] and that BP reductions
are modified by BP status at baseline [69]. Long-term
RCTs are needed to determine whether these effects
on DBP and SBP are maintained after increasing the
training frequency or time as well as after longer
durations of the intervention periods.
LIMITATIONS AND FUTURE DIRECTIONS
The current review is based on epidemiological
studies of both observational studies and RCTs that
evaluated the effects of a broad spectrum of physical
activity and exercise on BP and the incidence of
hypertension. Most exercise-dose studies are obser-
vational studies and based on self-reported exercise
data. Subjectively measured physical activity is
often overestimated, which results in an underesti-
mation of the benefits of physical activity on health
and may ignore potential health benefits of lower
levels of physical activity. Another limitation of
most physical activity studies is that individuals
who participate in these studies tend to have a
healthier lifestyle, which may cause selection bias.
Studies focused on the minimal and optimal
amount of physical activity are limited. Therefore,
more RCTs with longer intervention and follow-up
periods are needed to better define the exact dose–
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Physical activity and fitness for the prevention of hypertension Bakker et al.
response relationship of physical activity and hyper-
tension. These studies should investigate the mini-
mal and optimal frequency, intensity, duration, and
the optimal type of exercise. In addition, further
cohort studies should follow individuals over time
to examine which exercise prescription is optimal to
reduce the risk for developing hypertension. Sub-
group analyses should be applied to determine the
effects of baseline BP and weight status on the dose–
response relationship between physical activity and
hypertension. Finally, research should focus on how
we could encourage and motivate sedentary indi-
viduals to start physical activity as well as maintain
it. Initiatives to reduce sedentary behavior by
increasing low-intensity physical activity and
increasing short periods of MVPA may be more
likely to be implemented and sustained. For exam-
ple, the main message of the Japanese physical
activity guidelines is to add 10 min of activity every
day, anywhere, anytime [70], and this approach may
be more attractive for sedentary individuals to
increase their levels of physical activity.
CONCLUSION
Strong evidence supports that performing aerobic
exercise and increasing CRF reduces BP levels and
incident hypertension. Further studies are needed to
determine the associations between resistance exer-
cise and muscle strength with the incidence of
hypertension. In addition, to motivate and encour-
age sedentary individuals to increase levels of physi-
cal activity, research should focus on determining
the minimal and optimal amount of exercise asso-
ciated with lowering BP levels and reducing the risk
of hypertension.
Acknowledgements
None.
Financial support and sponsorship
D.-c.L.’s research activity was supported by the National
Institutes of Health grant (HL133069).
Conflicts of interest
There are no conflicts of interest.
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Volume 33  Number 00  Month 2018