Article | Published:

Low-intensity walking as mild medication for pressure control in prehypertensive and hypertensive subjects: how far shall we wander?

Abstract

Successful prevention and treatment of hypertension depend on the appropriate combination of antihypertensive drug therapy and nondrug lifestyle modification. While most hypertension guidelines recommend moderate- to high-intensity exercise, we decided to explore a mild yet effective type of exercise to add to hypertension management, especially in populations with complications or frailty. After comparing the short-term cardiovascular effects of low-speed walking versus high-speed walking for 3 kilometers (km) (3 km/h versus 6 km/h) in young, healthy volunteers, we delivered low-speed walking (low-intensity walking, 2.5 metabolic equivalents of task, METs) as exercise therapy in 42 prehypertensive and 43 hypertensive subjects. We found that one session of 3 km low-intensity walking exerted a transient pressure-lowering effect as well as a mild negative chronotropic effect on heart rate in both the prehypertensive and hypertensive subjects; these short-term benefits on blood pressure and heart rate were accompanied by a brief increase in urine β-endorphin output. Then we prescribed regular low-intensity walking with a target exercise dose (exercise volume) of 500–1000 METs·min/week (50–60 min/day and 5–7 times/week) in hypertensive subjects in addition to their daily activities. Regular low-intensity walking also showed mild but significant blood pressure-lowering and heart rate-reducing effects in 7 hypertensive subjects within two months. It is hypothesized that regular low-intensity exercise of the necessary dose could be taken as a pragmatic and supplementary medication for hypertension management.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    World Health Organization. Global recommendations on physical activity for health. http://www.who.int/dietphysicalactivity/publications/9789241599979/en/. Published 2010. Accessed September 12, 2018.

  2. 2.

    Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;71:e127–e248.

  3. 3.

    Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, et al. Hypertension Canada’s 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Can J Cardiol. 2017;33:557–76.

  4. 4.

    Chinese Committee of Hypertension Management Guideline Revision. Chinese Guidelines for Hypertension Management (2014 revised). Chin J Hypertens. 2015;23:24–43.

  5. 5.

    Schultz MG, Otahal P, Cleland VJ, Blizzard L, Marwick TH, Sharman JE. Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis. Am J Hypertens. 2013;26:357–66.

  6. 6.

    Wang SM, Chen YC, Lu Q, Wang J, Zhong MF, Chen H, et al. Low-speed walking for three kilometers was effective to lower short-term blood pressure and heart rate with increased β-endorphin release in normotensive and hypertensive subjects. Chin J Hypertens. 2018;26:953–61.

  7. 7.

    Sun MW, Qian FL, Wang J, Tao T, Guo J, Wang L, et al. Low-intensity voluntary running lowers blood pressure with simultaneous improvement in endothelium-dependent vasodilatation and insulin sensitivity in aged spontaneously hypertensive rats. Hypertens Res. 2008;31:543–52.

  8. 8.

    Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 suppl):S498–516.

  9. 9.

    Pal S, Chaki B, Chattopadhyay S, Bandyopadhyay A. High-intensity exercise induced oxidative stress and skeletal muscle damage in postpubertal boys and girls; A comparative study. J Strength Cond Res. 2018;32:1045–52.

  10. 10.

    Coates A, Incognito AV, Seed JD, Doherty CJ, Millar FJ, Burr JF. Three weeks of overload training increases resting muscle sympathetic activity. Med Sci Sport Exerc. 2018;50:928–37.

  11. 11.

    Meeusen R, Duclos M, Foster C, Fry A, Gleeson M, Nieman D, et al. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med Sci Sports Exerc. 2013;45:186–205.

  12. 12.

    Bender T, Nagy G, Barna I, Tefner I, Kádas E, Géher P. The effect of physical therapy on beta-endorphin levels. Eur J Appl Physiol. 2007;100:371–82.

  13. 13.

    Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, American College of Sports Medicine. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–53.

  14. 14.

    Dang N, Huang XZ, Lin X, Pan YX. Exercise training improves the baroreflex function in hypertensive rats. Chin J Hypertens. 2015;23:47–51.

  15. 15.

    Dampney RA, Michelini LC, Li DP, Pan HL. Regulation of sympathetic vasomotor activity by the hypothalamic paraventricular nucleus in normotensive and hypertensive states. Am J Physiol Heart Circ Physiol. 2018. https://doi.org/10.1152/ajpheart.00216.2018.

  16. 16.

    Pepe S, Olivier WV, van den Brink, Lakatta EG, Xiao RP. Cross talk of opioid peptide receptor and adrenergic receptor signaling in the heart. Cardiovasc Res. 2004;63:414–22.

  17. 17.

    Greco A, Paroni G, Seripa D, Addante F, Dagostino MP, Aucella F. Frailty, disability and physical exercise in the aging process and in chronic kidney disease. Kidney Blood Press Res. 2014;39:164–68.

  18. 18.

    Hayashi T, Tsumura K, Suematsu C, Okada K, Fujii S, Endo G. Walking to work and the risk for hypertension in men: the Osaka Health Survey. Ann Intern Med. 1999;131:21–6.

  19. 19.

    O’Donovan G, Lee IM, Hamer M, Stamatakis E. Association of “weekend warrior” and other leisure time physical activity patterns with risks for all-cause, cardiovascular disease, and cancer mortality. JAMA Intern Med. 2017;177:335–42.

  20. 20.

    Sun MW, Zhong MF, Qian FL, Gu J, Gu JZ, Chen H. Effects of different levels of exercise volume on endothelium-dependent vasodilatation. Role of nitric oxide synthase and heme oxygenases. Hypertens Res. 2008;31:805–16.

  21. 21.

    Lamb SE, Sheehan B, Atherton N, Nichols V, Collins H, Mistry D, et al. Dementia and physical activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial. BMJ. 2018;361:k1675.

Download references

Acknowledgements

The study was supported by grants from the National Natural Science Foundation of China (No. 30971154, 31171099). We sincerely appreciate Ms. Min-shu Wu for her creative discussion and suggestions. The authors are very grateful to all the volunteers who joined our study without any material incentives, and also to Mr. Haiyang Zhang for his assistance in the picture drawing.

Author information

Correspondence to Hong Chen.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Keywords

  • hypertension
  • prehypertension
  • exercise medication
  • low-intensity walking
  • metabolic equivalent of task
  • blood pressure
  • heart rate
  • urine β-endorphin

Further reading

  • Sunny walking counts more

    • Rui Zhang
    • , Hong Chen
    • , Yi-xiao Liu
    • , Wen-hui Zhang
    • , Qin Lu
    • , Hiromichi Yamanishi
    • , Chiaki Yamanishi
    • , Kyosuke Yamanishi
    • , Yu-lan Qiu
    • , Xiao-fei Ye
    • , Zi-rui Huang
    • , Bo-yuan Zhang
    • , Yi-fei Chen
    • , Yan-qian Zheng
    • , Yong-fang Zhang
    • , Zi-zhen Guo
    • , Dong Dong
    • , Tie-xin Liu
    • , Yi-qing Dai
    • , Mei-han Xu
    • , Yu Hao
    • , Sheng-zhou Li
    • , Fei-yang Cai
    • , Rui-qi Wang
    • , Xin-yi Guo
    • , De-hao Zhu
    • , Hai-yang Zhang
    • , Zhi-tong Zeng
    •  & Hideaki Higashino

    Acta Pharmacologica Sinica (2019)

Fig. 1
Fig. 2