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.
- 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)
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.