In this blog for people with normal or high blood pressure (hypertension), Dr Rebecca Gould, Cochrane UK Fellow and Sport and Exercise Medicine Registrar, looks at the latest Cochrane evidence on walking for lowering blood pressure and explores the role of walking in the prevention and treatment of high blood pressure. (Featured image: World Obesity Federation).
When I worked as a GP, I met many people with, or at risk of developing, high blood pressure. It is common, affecting over 50% of people aged over 60 years, and important to treat, as it is a risk factor for a number of other conditions including heart failure, coronary artery disease, stroke, chronic kidney disease and vascular dementia. Reducing high blood pressure helps reduce these health risks.
For those with high blood pressure, starting blood pressure lowering medication should be a shared decision between them and their healthcare professional and take into account factors such as how much blood pressure is raised, the presence of other medical conditions, and long-term risk of cardiovascular disease.
Lifestyle advice is recommended for everyone with high blood pressure, and this was something I found people were often keen to discuss. Helpful changes that can be made include reducing alcohol intake (if excessive), reducing salt intake, avoiding excessive consumption of caffeine-rich products and increasing physical activity. I would often spend a bit more time discussing physical activity as it has many other health benefits (reduces the risk of developing type 2 diabetes, heart disease, joint pain and certain types of cancer and improves quality of life, sleep and stress levels).
Walking was commonly chosen as a way of increasing physical activity as most people are able to do it, it is relatively easy to fit around daily life, and does not cost much (if anything). When I was having these conversations, there was no clear evidence on the ideal amount of walking for people with high blood pressure, so my advice would be to aim for 150 minutes of moderate-intensity physical activity per week (in keeping with UK physical activity guidelines). For people who are unable to do that much, it is important to remember that some physical activity is better than none, and every minute counts. The definition of ‘moderate-intensity’ can vary, but the UK physical guidelines use the ‘talk test’ for moderate intensity physical activity – your breathing is increased but you can still talk.
Cochrane evidence on walking to reduce blood pressure
A new Cochrane Review, published in 2021, has looked at the effect of walking on blood pressure. The authors looked at studies in adults who had normal, or high, blood pressure where walking programmes were compared to no intervention. They found 73 studies with 5763 participants that met their inclusion criteria. The walking programmes used in the studies varied, but they mainly took place at people’s home or in the community, for example walking on a treadmill or walking outside. The walking programmes on average took place over 3 months and, in most studies, people walked for 20 to 40 minutes, at a moderate intensity, three to five times a week (average walking time 153 minutes per week). The walking programmes were usually supervised.
The authors found that walking for approximately 150 minutes per week for 3 months probably reduces systolic blood pressure by around 4mmHg. This reduction is smaller than the reduction seen with medication but is still important, especially when you consider that physical activity has lots of other health benefits. For comparison, a Cochrane Review looking at the effects of medication in people with high blood pressure found that ACE inhibitors and calcium channel blockers (two commonly prescribed types of blood pressure medication) reduced systolic blood pressure by approximately 16mmHg and 9mmHg respectively.
When looking at people by age, a similar reduction in systolic blood pressure was found across all age ranges (there was moderate-certainty evidence for those under 40 years old, and low-certainty evidence in those aged over 41 years). This reduction was seen both in people who had normal blood pressure, and those with high blood pressure. The authors also found walking may reduce diastolic blood pressure and heart rate.
Walking also seems to be relatively safe, only 21 of the 73 included studies recorded adverse events, but in these 21 studies only eight adverse events were reported, 5 of which were knee injuries. Unfortunately, few studies followed participants after the walking programme ended, so the longer term effects of walking on blood pressure are uncertain.
Resources for people wanting to walk more
If you are interested in walking a bit more to help lower your blood pressure, some helpful resources can be found below:
- One You Active 10 Walk Tracker app – this free app from Public Health England tracks your walking, helps you set goals and monitor your progress over time.
- walkingforhealth.org.uk – run by The Ramblers charity, Walking for Health is a network of health walks – group walks open to everyone and led by specially-trained volunteers.
Please note, we cannot give medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.