Strength Training and Blood Pressure | Mass General Brigham

Strength Training and Blood Pressure
Regular exercise is an important piece of a heart-healthy lifestyle. But how does strength training fit into the puzzle? Does lifting weights make blood pressure spike—or help lower it?
The answer is a little bit of both, according to J. Sawalla Guseh, MD, a sports cardiologist at Mass General Brigham and director of the Cardiovascular Performance Program at Massachusetts General Hospital. While a single strength training session can make blood pressure rise temporarily, regular exercise helps lower blood pressure over time.
And that’s a good thing, Dr. Guseh says. “There are many reasons you should try to lower high blood pressure,” he adds—and exercise can help you reach that goal. He explains the relationship between strength training and blood pressure, and how to safely add it into your routine.
Exercise and blood pressure
Blood pressure is the force of the blood moving through your blood vessels. High blood pressure, also known as hypertension, happens when that force is greater than it should be.
During exercise, your heart beats faster to circulate blood throughout your body and supply more oxygen to working muscles. That increase in heart rate doesn't always result in a rise in blood pressure, Dr. Guseh explains. But it is common for blood pressure to increase with the increasing intensity of physical activity. This applies to both aerobic exercises (like jogging or swimming) and higher repetition strength training (muscle-building activities such as weightlifting or push-ups).
"As your heart rate increases, it pumps more blood, leading to a rise in blood pressure due to the increased blood flow," he says.
That temporary rise isn’t usually harmful. In fact, it can lead to a positive outcome: In many people, blood pressure drops after exercise, dipping below their usual resting blood pressure. That dip is known as post-exercise hypotension, and it can last for several hours after a single bout of exercise.
It’s not clear whether a single short-term dip in blood pressure is good for heart health, Dr. Guseh says. “But when you’re a regular exerciser, that time adds up.” High blood pressure causes problems for heart health when it stays high over the course of days, weeks, and years. If you exercise often—and experience a post-exercise dip multiple days a week—that time adds up and brings your average blood pressure down to healthier levels.
Exercise can be one tool in our efforts to decrease blood pressure, and I prescribe it for all of the other benefits that go along with it.
J. Sawalla Guseh, MD
Cardiologist
Mass General Brigham
Effects of weightlifting on blood pressure
Post-exercise hypotension isn’t the only benefit you get from being active. Regular exercise also helps strengthen the heart muscle. A strong heart pumps blood more effectively. That can help lower blood pressure over time.
Blood pressure readings are made up of two numbers, measured in milligrams of mercury (mm Hg):
The systolic, or top, number measures pressure when your heart beats
The diastolic, or bottom, number measures pressure when your heart rests between beats
Blood pressure is considered in the normal range if it’s less than 120/80 mm Hg. And regular exercise can have an impact on that number.
If you start a new exercise program and stick with it for a few months, you might bring your blood pressure down by about 5 points. If your blood pressure is high, you’ll probably need to include other strategies to bring it down to a healthy level, Dr. Guseh says. “But exercise can be one tool in our efforts to decrease blood pressure, and I prescribe it for all of the other benefits that go along with it.”
What are the benefits of strength training?
When people think about exercising for heart health, they usually focus on aerobic exercise, also known as endurance exercise. Aerobic activities are things that get your heart rate up, like running or biking. Those activities help make the heart stronger and can aid in reaching or maintaining a healthy weight.
But don’t ignore the benefits of strength training, Dr. Guseh says. Weightlifting and resistance training build muscle mass, strengthen bones, and can improve balance as you get older. Both aerobic exercise and strength training also improve the function of blood vessels—which may, in turn, help lower high blood pressure.
Both types of exercise can aid in weight loss, too. And losing weight is a great way to lower high blood pressure. If you’re overweight, losing just 5 to 10 pounds can lead to a drop in blood pressure, according to the American Heart Association.
How to safely engage in strength training exercises for blood pressure
Dr. Guseh offers these pointers:
Get the OK from your doctor: Most people with high blood pressure can exercise safely, but it’s always smart to check in with your doctor before starting a new exercise regimen. “Talk to your doctor to make sure you don’t have any risk factors for heart disease that warrant a closer look before you start something new,” Dr. Guseh says. People with very high blood pressure (systolic blood pressure 180 mm Hg or higher), or who have had a previous heart attack, shouldn’t engage in high-intensity exercise without a doctor’s guidance, he adds.
Don’t start or end abruptly: Warm up gradually as you start a strength training session. Afterwards, cool down with light exercise like walking or stretching for 5 or 10 minutes.
Skip when you’re sick: Steer clear of strenuous exercise when you have a respiratory infection (like a cold or the flu).
Go for reps: When doing strength training exercises that use weights or resistance bands, choose a weight light enough that you can do multiple repetitions before you’re too fatigued to continue. A single rep with maximum effort—such as powerlifting a barbell loaded with the maximum amount of weight you could handle—can lead to a more dangerous surge in blood pressure. If you have heart disease (or risk factors for heart disease), talk to your doctor before tackling single-rep, maximal-effort strength activities, Dr. Guseh says. “Weightlifting in sets of 8 to 12 are generally safe and effective.”
Build toward lifting more weight: According to a review of the research on strength training, regularly lifting moderate or heavy weights is more effective for lowering blood pressure than lifting light weights. But don’t try to do too much too soon. As you build strength, you can gradually increase the weight over time.
Mix it up: Dr. Guseh recommends getting a combination of aerobic exercise and strength training. “Each offers some distinct benefits for the heart,” he says. The American Heart Association recommends you get at least 150 minutes per week of moderate-intensity aerobic activity, or 75 minutes per week of vigorous activity. You should also aim for at least two strength training sessions each week.
Bottom line, weightlifting alone probably won’t be enough to bring high blood pressure down to a healthy zone. But together with other factors—such as eating well, quitting smoking, and taking medications as needed—it can be an important part of the package.
“We know that reducing high blood pressure lowers the risk of heart disease, heart attack and stroke, as well as vascular dementia,” Dr. Guseh says. “These are life-altering diseases that are all made worse when you have high blood pressure.”
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