In the 1990s the University of Tennessee conducted research on 57 subjects, finding that persistent cardio-focused training keeps systolic blood pressure above 200 mmHg in the untrained populace while over 220 in the trained populace: https://academic.oup.com/ajh/article/9/11/1099/124285. Their findings, including 30 citations, were published in the Journal of Hypertension. In the almost 30 years since, exercise scientists have corroborated these findings many times over.

Contrast that solid University of Tennessee research against this opinion piece by the American College of Cardiology: https://www.acc.org/latest-in-cardiology/articles/2020/08/07/08/07/exercise-in-aortopathy. The ACC opinion piece, which presents no study results itself, and includes a paltry 11 footnotes, is somewhere between shoddily-crafted and purposely misleading. It's not clear whether the authors have any experience with exercise-related blood pressure testing at all; it's very clear that they have no reading of the literature; and it's even more clear that they ignored basic academic rigor in their use of citations. Curiously, the authors of the opinion piece omitted the thousands of pertinent blood pressure studies conducted by exercise physiologists for decades. Yet, the authors decided to begin the section on recommendations for non-competitive athletes with “there is little data to guide safe levels of exercise”. Then, IN THE SAME SECTION they included an alleged peak systolic pressure from advanced athletes (paragraph 3, footnote 10). More curiously, when you follow that footnote to the paper it references, you find the paper does not even use the peak systolic figure cited in the ACC piece. That alone makes the American College of Cardiology suspect for complicity in academic fraud. At the least, they abused and misrepresented the cited paper. Moreover, that same cited paper actually recommended weight lifting (the exact opposite of the implication of the opinion piece). The nice thing about the cited paper is it at least included an attempt at quantifying intensity, specifically outlining a bench press of up to no more than 50% of the person’s bodyweight: https://pubmed.ncbi.nlm.nih.gov/20924328/.

Only two authors are listed for penning the opinion piece. No disclosure information whatsoever appears for either author on the ACC website, except that both men are fellows for the organization. Outside of the site, search results appears to show the first has a background in mechanical engineering with no obvious pedigree working with exercise-related blood pressure testing himself. The second has been involved with collegiate and professional sports teams, and should know better. Both ignored the KNOWN fact that endurance athletes have a defined aortic diameter increase: https://pubmed.ncbi.nlm.nih.gov/32101252/. Strength athletes do not. How did this opinion piece pass review for publishing on the ACC site?

There is "little data"? Do me a favor. Go on PubMed and punch in search string "exercise blood pressure." It returns 40,106 results. FORTY-THOUSAND. There is "little data" to form exercise recommendations regarding blood pressure? No. There is little rigor in authors for the American College of Cardiology. There is a ton of data to form opinions about blood pressures in exercise. In a review of THIRTY STUDIES on the blood pressure effect of resistance training, WE KNOW FOR A FACT THAT A SINGLE BOUT OF LIFTING WEIGHTS WILL REDUCE BLOOD PRESSURE FOR TWENTY-FOUR HOURS: https://pubmed.ncbi.nlm.nih.gov/27512052/. A SINGLE BOUT. One strength training workout reduces blood pressure for twenty-four hours. No amount of cardio training can boast this. And by the time cardio training could show these types of beneficial adaptations, aortic diameter is increased, raising rupture risk for certain populations.

Anyone who reads scientific literature on physiology knows these things. The absence of the FORTY-THOUSAND papers from the ACC opinion piece is concerning. Even inside the conventional medical world, there are strongly worded summaries stating that “concerns about the risks of exercise, particularly that of moderate intensity, appear un-founded” (bottom right paragraph of page 1: https://www.archives-pmr.org/.../S0003-9993(12)00551-5/pdf). The reader may not readily understand this. But for those of us who have actually conducted blood pressure experiments and studied the applicable research, we know that a lot of this discussion is contrived. How the individual encounters tension in the body will dictate pressure and therefore danger. To be clear, if you cram down on yourself to open a pickle jar, you might spike above 300 mmHg. If you properly breathe through 500lb squats for 12-15 reps, you won’t achieve any mean arterial pressure increase. If you get into the enthusiast world of endurance training, you may be keeping your blood pressure above 200 mmHg for 4-20 hours per week. This is risky. Even if you get into elite competitive strength athletics, you won’t encounter elevations in blood pressure for more than an aggregate of a few minutes per week. This is not risky.

So what the heck exactly is going on?

Well, it appears a lot of armchair philosophers have waded into the arena of official recommendations without their own data, without test results, without a familiarity with the literature, and without even properly citing supporting materials. It wouldn't even matter, except that they are speaking for the entirety of American cardiology. And, as usual, with simpletons, they present very little specificity with regard to load, intensity, breathing, and sustained effort. A fraudulent, errant, uniformed, and wholly inadequate opinion piece is standing where a well-crafted academic work could be summarizing known science. That's incredibly problematic.

It strikes me as one part odd and three parts insane, because I have been taking blood pressure readings with myself and clients for almost 20 years and KNOW the opposite of the two authors' implied message to be true. I can assure you that an advanced athlete DURING a maximal lift will raise systolic pressures very high (this is a good thing) for a moment. Yes. That is true. But as the review of 30 studies on resistance training and blood pressure shows us, inherently weight lifting only confers improved blood vessel health in-between and after training. Meanwhile, cardio training raises blood pressure and keeps it there. Even a damaged circulatory system is built to withstand momentary spikes without risk. Even a perfect circulatory system is not built to endure sustained pressure increases without risk. This isn't that hard of a concept to understand, frankly.

Thus, I decided to renew my testing experience this past week. I have medical grade arm cuffs which I've used in comparable experiments before. This go round, I obtained a pricey wrist cuff which I could more readily use in different stances and activities. I first took 40 readings in different positions and activity to ensure the baseline is accurate to other medical grade readings and that we will have reliable comparisons. In the past few days, I’ve continued to do countless more tests to confirm or deny initial results. Putting aside my career intake of some 2,000 tests, just this past week I’ve taken at least another 100 readings. Videos of some of the tests are here (https://www.instagram.com/p/CMmRvNIHWX6/) with more to come.

Summary:

- seated baselines, ave 126/83
- standing baselines, ave 138/87

- deep squat with 160lbs, no change
- deep squat with 250lbs, no change
- deep squat with 340lbs, pressure down
- partial squat with 430lbs, pressure down
- stand with 700lbs, no change

- incline fast walk, errored out cuff (210+?)
- incline med walk, error (210+?)
- flat slow walk, error (210+?)
- elliptical all, error (210+?)
- recumbent intense, error (210+?)
- recumbent med, pressure up (175-180)
- recumbent slow, pressure up (174-177)

Conclusion:

There is an effort in the cardiology medical community against performing actual scientific inquiry, utilizing appropriate tests, honest citation, and trustworthy interpretation of the known findings. The exercise science and exercise physiology communities appear to be more in-line with the known biology and physiology, understanding the breadth of intensity-vs-pressure relationships, and honestly communicating that knowledge to an audience.

Moderate-to-high intensity cardio will raise pressures persistently. Low intensity cardio is suspect. Endurance exercise is unavoidably risky at all intensities, even in healthy individuals. Chronic moderate-to-high intensity has defined correlations with negative morphological remodeling such as aortic diameter increases and ventricular hypertrophy.

High intensity lifting with high-pressure breath work will raise pressures momentarily. Risk is unclear. Moderate intensity lifting with continuous breath work will lower or maintain pressures. Risk is low-to-none, even in compromised populations. Low intensity lifting has no risk with regard to known and testable blood pressure metrics. There are no correlations or even proposed plausible causal relationships between strengthening and negative cardiac adaptation.

In 1973, the University Department of Medicine at Dundee, Scotland, published findings on a patient who completed a 382 day fast: https://www.ncbi.nlm.nih.gov/.../pdf/postmedj00315-0056.pdf

You didn’t misread. THREE-HUNDRED EIGHTY-TWO days. Blood markers improved. Unsurprisingly, the man went from 456lbs to 180lbs. Shockingly, he was doing a pretty good job keeping off the weight at year 5 thereafter, only scooting up to 196lbs.

Gluttony is the sin Americans just don’t touch. Guaranteed, if you’ve ever heard sermons condemning any behavior, it wasn’t gluttony. If you've heard any activist get up on a pedestal and rail on about the failings of mankind, I know it wasn't about gluttony. We will happily entertain any other subject, except mismanaged eating. You’ll find plenty of books trying to square the hoarding of wealth with Christian theology. You’ll find endless posts on gun rights versus gun control. You’ll encounter a nonstop barrage of proper pronoun etiquette shares. But gluttony? ... uhhhhh... no thanks.

The leading causes of death and skyrocketing medical costs are all tied into gluttony. But we won’t touch the subject. It kills more people than every other hot topic combined. The thing is, it’s not only unpopular to discuss. It’s anathema. Even bringing it up is essentially a call to action for the thought police to shut down the idea before more than a couple people entertain it. And that’s just with SELF-imposed restriction as the talking point.

What if you had to pass a rigorous background check before you could obtain more than 300 calories of food per day for yourself? What if you needed to complete a licensing program before allowed in restaurants or grocery stores? What if online food sales were banned? What if the state levied a 10,000 dollar fine for every pound gained per year? Our intentional early deaths and outrageous medical costs don’t stop at our wallets or in our yards. Shouldn’t the government intervene in the most widespread cause of death in America?
​
If we dare to mention government fines or external impositions to control gluttony, forget about it. People will burn your house down before you see the first pitchfork in the distance. They won’t suffer the discussion on SELF-imposed management. Forget about external imposition.

I just find it very interesting. In any other subject, people are just peachy with affirming the opposite of their alleged belief in some other discussion. Even the most hardcore capitalists are ok with a 100% communist/socialized military in the US. No choice or capitalist price controls. No free market. No private intervention. No problem. Even the staunchest liberals are ok with discussing imposed vaccine measures. No personal freedom. No personal choice. No identity. No inner space allowed. No problem.

And the list goes on. Except with gluttony. Even though gluttony is tied to lack of sustainability, climate impact, toxic consumerism, and leading health risks, nope. Just won’t touch it. Hell, we joke about it. The church bake sale is just fine. The hoarding of Girl Scout cookies is A-ok. The binges and endless food porn are worthy of regular social media posts. Not only aren’t they vilified, demonized, regulated, they are held up as a sort of fun braggadocio, carefree silliness, light-hearted humor.

During no prior time in history was gluttony as widespread or damaging. Sin. Total disrespect for the temple, for ones neighbor, for the Earth, for creation. The cost of our early deaths and skyrocketing medical care don’t stop in our wallets or in our yards. Yet, for some reason, it’s easier to point out the splinter in everyone else’s eye than remove the plank from our own.

​We at least need to talk about it.

When we train long duration efforts, we REDUCE athletic performance (relative to that individual’s potential). Low speed efforts train a person to become less powerful, lower balance, and, as the reader might expect, lower speed. This is why jogging and walking can be suspect for individuals who want to dramatically improve health and fitness. Low resistance with slow reps can be not just a waste of time but an ally in reducing your fitness.

Zoom in on the table to see how even resistance training aimed at size gain/muscular failure is inferior at athletic performance results.

There are three types of skeletal muscle fibers: I, IIA, and IIX. They’re also known as Slow Oxidative, Fast Oxidative, and Fast Glycolytic, respectively. Each serves a different portion of the energy spectrum. You can also see why, when referencing this terminology, people who want to improve health prospects regarding prediabetes ought to spend some time working on type IIX (as the name implies, glucose is disposed). To be clear, once skilled enough to be safe, people should be training speed and training maximal weights WITHOUT going to failure. Training for advancement in one area reduces the relative outcome in the other two. This is a biological law, not something which can be subverted by force of will or hoping it isn’t true.

And it’s imperative that the fitness professionals and laypeople keep this in mind. Most popular programming and pop fitness recommendations aren’t just untrue. They’re counterproductive for most of the populace most of the time. Professional athletes and fanatics who train 15-40+ hours per week are often succeeding IN SPITE of inefficient programs. The average person can’t afford the time to use nonsense recommendations from gifted genetic freaks or uneducated fanatics.

For the absolute beginner, yes, just begin with movement, any movement. After that stage, endeavor for some muscle gain in order to combat lean tissue loss. But for athletic improvements (ie - agility, balance, speed, acceleration, power), low speed exercise, including to muscular failure, doesn’t yield as good of results as high speed ands strength.

​Everyone runs out of time in a given week, which is where periodization enters. That is, to glean benefits for all energy systems, one can emphasize one modality of training for a period of weeks or months before moving to another. Just remember: each one causes a relative reduction in the others.

Read this 2007 paper published in the American Journal of Physiology: https://journals.physiology.org/doi/full/10.1152/ajprenal.00149.2007

It's actually pretty straight-forward: insulin resistance plus insulin causes high blood pressure regardless of restrictions in dietary sodium intake.

And the inverse is pretty straight-forward as well: healthy insulin sensitivity does not yield high blood pressure regardless of spikes in insulin or increases in dietary sodium.

To summarize, insulin is the sodium-retention pump. When it's added to an unhealthy person, the signal for blood pressure increase is overwhelming. When piles of salt and/or insulin are added to a healthy person, there is no strong signal to increase blood pressure.

Any management of high blood pressure through medication/mineral imbalance (ie - salt restriction, calcium or potassium manipulation, diuretic, or beta blocker) is a mild symptom reducer AT BEST. Of course, this symptom reduction comes at incredible costs to other organ systems, since its exact method of action is the disruption of various health systems throughout the body. The restoration of health, therefore, is the only cure for hypertension. Specifically, the restoration of insulin-sensitivity is the cure. In the many medical studies on type 2 diabetes reversal, all participants had a dramatic drop in blood pressure that exceeds any drop which could be obtained from salt restriction and hypertensive medications combined: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928595/.

In wider reviews of the literature (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/#B110-nutrients-11-00766), what the reader discovers is that there are many different names for the manifestation of metabolic diseases, but they all intertwine at the development of insulin resistance and persistent rampant inflammatory response. In one person, the primary manifestation may be atherosclerotic plaque buildup. In another, the primary manifestation may be weight gain. In another, the primary manifestation is hypertension; and so on. In all cases, all manifestations are up for grabs. The onlooker may only see one manifestation prominently; and the inclination is to throw one diagnostic name on that person (eg - hypertension, OR hypercholesterolemia, OR type 2 diabetes). But all manifestations are readying themselves underneath the surface, without a care about the diagnostic name chosen. The body doesn't care at all whether it obtained the name "prediabetes" or "type 2 diabetes". In both cases, blood pressure is mismanaged. That could showcase as LOW blood pressure, HIGH blood pressure, or even BOTH. Yes. You read that right. An exhausted person who is incredibly unhealthy may run very high blood pressures most of the time, and therefore be incapable of managing the normal healthy increases required from life when he stands up from tying his shoes.

Statistical analyses have been unhelpful. It's long been known that a diagnosis of high blood pressure doubles that person's risk of prediabetes. What those analyses miss is mechanism and direction of causation. They merely observe correlations and prevalence of correlation. And, of course, this all requires placing people in neat little bins of specific diagnostic names. To be clear, what's easier to catch: a high blood pressure number or chronic unregulated insulin? People with ridiculously unhealthy insulin response can land at "normative" glucose numbers many times before the clinician finally discovers an awful insulin relationship under the surface. Thus, although correlation is cute, it isn't a rigorous science. In the rigors of science, we work to understand mechanisms and really don't care at all what the correlational statistics say. In this particular case, there isn't a great alternative to slicing the data pie anyway. The data pie still says prediabetes has strong correlation to hypertension. If we ignore those stats and simply focus on known biology, unhealthy insulin management is causal for high blood pressure. That is not in dispute.

Regardless of what names we want to slap on someone to label him or her, restoration of health is the cure. In the review of type 2 diabetes reversals, hypertension disappeared in the responding participants. And in the 2007 paper discussing mechanisms, we find that a healthy, insulin-sensitive individual cannot run high blood pressure no matter how much salt and insulin you add to his system. Meanwhile, an unhealthy, insulin-resistant individual runs mismanaged blood pressure while medicated and salt-restricted UNTIL he restores health and insulin-sensitivity.

According to the CDC, in just over 15 years, obesity in America increased by 39%. Severe obesity about doubled.

In that same period, social media became every day, weight loss shows gained popularity, and fitness tracking technology exploded onto the scene. Deterioration of health and fitness ACCELERATED.

I’m not sure what else to say. It's not enough to say that the gimmicks don't work. The gimmicks are WORSENING our outcomes. I have been preaching sustainable lifestyle shift for longer than that 15 year period of time. And I’ve seen sustainability work while every sexy fitness trend has failed. I’ve coached sustainable. I’ve known it. I’ve lived it.

No guilt. Every popular voice is telling us the wrong things and we are listening. Intently. Our compliance is high. We are executing perfectly according to the food pyramids which indoctrinated us. We are living very tightly to our clinicians’ recommendations. We are abiding well by the popular shows, influencers, fitness trackers, exercise equipment, and franchises.

​People aren't failing. People aren't weak. People aren't refusing advice. People aren't struggling with self-control and willpower. People are doing exactly what popular voices tell them to do. And we are getting the precise outcome which the methodology reaps. Severe obesity DOUBLED. DOUBLED! People, wake the f up. More than 2 out of 5 Americans are obese, and that wasn't true 20 years ago. The commonly-accepted beliefs are clearly ineffective. 
...
So maybe...
think differently?