Current issues of ACP Journal Club are published in Annals of Internal Medicine


Review: Aerobic exercise reduces systolic and diastolic blood pressure in adults


ACP J Club. 2002 Nov-Dec;137:109. doi:10.7326/ACPJC-2002-137-3-109

Source Citation

Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002 Apr 2;136:493-503. [PubMed ID: 11926784] (All 2002 articles were reviewed for relevancy, and abstracts were last revised in 2008.)



In persons ≥ 18 years of age, are interventions that include aerobic exercise more effective than interventions without aerobic exercise for reducing blood pressure?

Data sources

Studies were identified by searching MEDLINE (1966 to September 2001) and SPORTDiscus and by reviewing bibliographies of relevant articles.

Study selection

Studies published in English were included if they were randomized controlled trials (RCTs) comparing interventions that included aerobic exercise (treatment group) with interventions without aerobic exercise (control group), lasted ≥ 2 weeks, reported changes in blood pressure (systolic, diastolic, or both) from baseline to follow-up with the corresponding variances or data to estimate them, and participants were ≥ 18 years of age. All frequencies, intensities, and types of aerobic exercise were considered.

Data extraction

3 reviewers independently extracted data on sample size, participant characteristics, study design, details of the intervention, study duration, and outcomes. Outcomes included changes in blood pressure (systolic, diastolic, or both) from baseline to follow-up.

Main results

54 RCTs (2419 participants) met the selection criteria. Data from the RCTs were pooled in a random-effects model, with each study weighted by the reciprocal of the total variance for blood pressure change. Both overall and subgroup analysis showed that reduction in systolic and diastolic blood pressure was greater in the treatment group than in the control group (Table).


In adults, aerobic exercise is effective for lowering systolic and diastolic blood pressure.

Sources of funding: National Heart, Lung, and Blood Institute and National Institutes of Health.

For correspondence: Dr. J. He, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. E-mail

Table. Interventions with aerobic exercise vs interventions without aerobic exercise for reducing blood pressure*

Outcomes Participant group Number of trials Weighted mean difference (95% CI)†
Systolic blood pressure (mm Hg) Overall 53 −3.84 (−4.97 to −2.72)
Hypertensive 15 −4.94 (−7.17 to −2.70)
Normotensive 27 −4.04 (−5.32 to −2.75)
BMI (kg/m2) < 24.5 11 −3.90 (−6.82 to −0.97)
24.5 to 26.4 12 −4.54 (−7.19 to −1.89)
> 26.4 12 −2.17 (−3.30 to −1.03)
Diastolic blood pressure (mm Hg) Overall 50 −2.58 (−3.35 to −1.81)
Hypertensive 13 −3.73 (−5.69 to −1.77)
Normotensive 26 −2.33 (−3.14 to −1.51)
BMI (kg/m2) < 24.5 11 −2.38 (−3.69 to −1.06)
24.5 to 26.4 9 −3.62 (−6.45 to −0.76)
> 26.4 12 −1.75 (−2.31 to −1.18)

*BMI = baseline body mass index. CI defined in Glossary.
†All differences favor aerobic exercise.


The recently published paper by Whelton and colleagues is the largest meta-analysis to measure the effect of aerobic exercise on blood pressure to date. Previous meta-analyses have shown more dramatic effects of exercise on blood pressure, which may be attributed to trials of shorter duration with better patient compliance or exercise supervision. The meta-analysis by Whelton and colleagues shows that similar blood pressure reductions were achieved with low-, moderate-, and high-intensity exercise and that little benefit was gained from exercising for more than 2.5 h/wk. Physicians who recommend even modest increases in physical activity are therefore providing valuable advice.

Both short- and long-term increases in physical activity or physical fitness have been achieved by using physician-based exercise interventions (1, 2). Increasing physical activity is popular with patients and physicians (3) and has an effect on blood pressure similar to that of other nonpharmacologic interventions. Interventions for weight loss (e.g., with a weight loss of about 4.5 kg), reduction of dietary sodium (4), or lowering alcohol intake all have the potential of reducing blood pressure by 1 to 4 mm Hg for at least 6 months.

Aerobic exercise of even modest duration, frequency, and intensity is a useful adjunct to other lifestyle changes and antihypertensive medications in the therapy of essential hypertension. It should be recommended to all patients with hypertension who are willing and able to try it.

C. Raina Elley, MBChB
University of Auckland
Auckland, New Zealand

Bruce Arroll, MBChB, PhD
University of Auckland
Auckland, New Zealand


1. Calfas KJ, Long BJ, Sallis JF, et al. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med. 1996;25:225-33. [PubMed ID: 8780999]

2. The writing group for the Activity Counseling Trial Research Group. Effects of physical activity counseling in primary care: the Activity Counseling Trial: a randomized controlled trial. JAMA. 2001;286:677-87. [PubMed ID: 11495617]

3. Arroll B, Jenkins S, North D. Non-pharmacological management of hypertension: results from interviews with 100 general practitioners. J Hypertens. 1996;14:773-7. [PubMed ID: 8793701]

4. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med. 1997;157:657-67. [PubMed ID: 9080920]