Is lifting weights safe if I have high blood pressure?

The answer is Yes and No. To answer it simply, It depends on how high your blood pressure is to start with.

What we know from research:

1. Medical research tells us that regular exercise, including sensible weightlifting, provides many health benefits, including helping to lower blood pressure in the long term, especially in those who suffer with hypertension or pre-hypertension.​
   
2. On the other hand, medical research shows that during bouts of acute exercise and especially lifting weights, particularly heavy weights, it can cause a temporary rise in blood pressure.

So why the big fuss on hypertension (high blood pressure)

Hypertension is one of the most important cardiovascular disease risk factors due to its high prevalence and significant medical costs. Approximately, 78 million Americans (33 %) have hypertension [systolic blood pressure (SBP)≥140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg] (Mozaffarian et al 2015).  Similarly, according to the Australian Heart foundation, in Australia these figures are similar with close to 6 million or 33.7% of the population suffering with hypertension.    

​Individuals 50 years of age or younger with pre-hypertension have double the lifetime risk of stroke, heart failure, coronary heart disease, and intermittent claudication compared to individuals of the same age with normal BP. (Mozaffarian et al 2015). Fortunately, exercise has been widely recognised as a method to reduce hypertension. 
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As mentioned already, lifting heavy weights temporarily increases blood pressure. Paradoxically, high levels of chronic physical activity and aerobic exercise training can prevent some of the age-associated rise in blood pressure seen in many normal humans, and exercise training can also lower blood pressure in those with hypertension. 

I want to lift weights – how do I do it safely?

First and foremost, you shouldn’t lift heavy weights or even engage in a vigorous exercise program unless you are cleared by your doctor and had a chance to discuss any precautions or special considerations.

As a general guideline, it is recommended that you shouldn't lift weights if your blood pressure is uncontrolled and higher than 180/110 mm Hg. If your blood pressure is lower at 160/100 mm Hg you shouldn’t lift heavy weights without consulting your doctor (Sorace et al 2014).

Safety Tips

If you have hypertension and have been cleared by your doctor here are some tips for those who want to exercise with a vigorous program or who want to lift heavy weights:

• Have an experienced personal trainer, exercise physiologist or physiotherapist to instruct, educate and teach you to use proper form when lifting weights to reduce the risk of injury.
• Don't hold your breath during a lift. It is important that you are taught by your trainer or therapist the correct breathing technique. Holding your breath during a heavy lift (Valsalva manoeuvre) can cause an excessive and dangerous spike in blood pressure. So if you are already a pre-hypertensive, it will dramatically increase your BP into the danger zone. Instead, it is advisable you breathe continuously during each lift with exhaling on the concentric of lifting phase and inhaling on the eccentric or lowering phase.
• Lift lighter or a moderate weights more times. Heavier weightlifting can cause a spike in BP as already mentioned putting more strain on the heart. You can still get the benefits of weight lifting by picking a lighter weight but increasing the number of repetitions so you are doing 3 to 4 sets of 12 to 15 repetitions. 
• Rest in between sets. Successive sets tends to increase your BP so allow adequate rest of up to 90 seconds minimum particularly for hypertensives. 
• Alternating between upper and lower body exercises to let your major muscle groups rest during exercise. As a rule of thumb, the more muscle groups involved in a weight lifting action the greater the temporary rise in BP.
• Invest in a good BP monitor that can give you an immediate measure of your BP. Knowing what range you are in can help regulate your training and make sure you are training in a safe zone.
• And always remember, to work closely and be guided by your doctor and health care professional.

Disclaimer: This text does not serve as medical advice and if you have any questions, seek advice from your doctor.

Blog post written by Jack Perisa.

Jack Perisa is a specialist sports physiotherapist (FACP) and Practice Principal at Lane Cove Physio, New South Wales, Australia www.lanecovephysio.com.au. He is also director of Cliniknote, an iPad app designed to draw and record your clinical notes  www.cliniknote.com


References
Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: heart disease and stroke statistics-2015 update: a report from the American heart association. Circulation. 2015;131(4): 434–41. 
Sorace, P., Churilla, J.R. & Magyari, P.M. (2012). Resistance Training for Hypertension. ACSM’s Health & Fitness Journal, 16(1), 13-17.