Americans with slightly higher blood pressure or cholesterol levels than optimal have lots of company.
Millions of U.S. adults share a similar mild-to-moderate heart disease risk, but they can improve those readings just with lifestyle changes as the first line of treatment, especially exercise, a recent scientific statement from the American Heart Association noted.
The paper offered guidance for doctors on how to “prescribe” more physical activity for those patients. That’s often not a comfort zone for physicians, who know how to prescribe medication but not necessarily lifestyle changes, said Bethany Barone Gibbs, a vascular researcher and chair of the group that wrote the report.
Patients, in turn, may feel intimidated when asked to exercise more, but the “prescription” shouldn’t be daunting.
“We really wanted to make sure that all clinicians feel empowered and take the scariness out of physical activity because it doesn't have to be going to the gym every day or running 5 miles every day,” Gibbs, an associate professor in the department of health and human development at the University of Pittsburgh, told TODAY.
“For people who do nothing, even increasing by 30 minutes a week can yield health benefits… we just wanted to help physicians know that physical activity is a great option. It treats both cholesterol and elevated blood pressure.”
About 21% of U.S. adults, or 53 million, have slightly elevated blood pressure according to guidelines released in 2017. That usually means the top number of the reading falling between 120-139 mmHg, and the lower number registering between 80-89 mmHg.
The authors estimated at least 28% of Americans, or 71 million, have cholesterol levels that are a little too high, with their LDL, or “bad cholesterol,” higher than 70 mg/dL.
Elevated cholesterol and blood pressure often happen together and they both increase the risk of heart disease.
That’s where exercise can come in. It addresses both problems and may be easier to implement for people than losing weight or changing diet — some of the other lifestyle treatments that can help — and it comes with many other health benefits.
“A lot of people don't want to start medication, so this is really a critical moment of motivation,” Gibbs said.
“A physician giving a (physical activity) prescription really motivates patients… they're going to take that more seriously.”
How much exercise is needed to have an impact?
The statement recommends the federal Physical Activity Guidelines, which call for 150–300 minutes of moderate-intensity physical activity per week, or 75–150 minutes of vigorous-intensity exercise or an equivalent combination of both.
That's the best case scenario, but every minute counts: “Actually, the steepest improvements happen from starting with nothing and getting a little bit,” Gibbs said.
Even short spurts of exercise are beneficial, researchers have found.
What kind of exercise is best?
Any kind of exercise that you want to do and that you'll keep doing, she noted. Aerobic exercise and resistance exercise can both provide the cholesterol- and blood pressure-lowering benefits.
For someone who doesn't exercise at all, brisk walking is the best recommendation, because people know how to do it, it’s easy to incorporate into a daily routine and doesn’t require any equipment, Gibbs noted.
Many people already have an activity tracker on their phone or smartwatch, so it could be just a matter of looking at how many steps they take now and boosting that number a bit. “It doesn't have to be so hard,” she said.
A recent study found light physical activity — like walking, gardening or house work — spread throughout the day is key to get the benefits of exercise.
How long will it take to have an impact?
Exercise can lower a person’s blood pressure the next day, but of course, the goal is to achieve a sustained change, which would take about three months of regular exercise, Gibbs said.
When it comes to improving a person’s cholesterol profile, studies have found it may take several months to make a difference.
“We're just really advocating that doctors, clinicians, nurse practitioners and anyone who is in contact with patients really, really prescribes exercise because it honestly, it has so many health benefits. It can treat almost anything,” Gibbs said.
Physical activity not only helps control high blood pressure (HBP or hypertension), it also helps you manage your weight, strengthen your heart and lower your stress level. A healthy weight, a strong heart and general emotional health are all good for your blood pressure.
Take charge of your activity level
Exercise in our culture may not “just happen.” But taking charge of your fitness may be one of the best decisions you’ll ever make. The choice is yours. Even moderately intense physical activity, such as brisk walking, is beneficial when done regularly.
Being inactive is bad for your health
People who aren't physically active are much more likely to have health problems, like heart attack and stroke. On the other hand, regular physical activity helps to lower blood pressure, control weight and reduce stress.
For overall health benefits to the heart, lungs and circulation, get regular aerobic activity using the following guidelines:
- For most healthy people, get the equivalent of at least 150 minutes (two hours and 30 minutes) per week of moderate-intensity physical activity, such as brisk walking.
- You can break up your weekly physical activity goal however you like. An easy plan to remember is 30 minutes a day on at least five days a week. But shorter sessions count, too.
- Physical activity should be spread throughout the week.
- Include flexibility and stretching exercises.
- Include muscle-strengthening activity at least two days each week.
Finding the time and energy to be more active
When it comes to physical activity, just get moving. Find ways to enjoy and savor the benefits as you gradually increase your activity level.
Don’t be afraid to get active
If you have not been active for quite some time or if you are beginning a new activity or exercise program, take it gradually. Consult your healthcare professional if you have cardiovascular disease or any other preexisting condition. It's best to start slowly with something you enjoy, like taking walks or riding a bicycle. Scientific evidence strongly shows that physical activity is safe for almost everyone. Moreover, the health benefits of physical activity far outweigh the risks.
Find something you like
If you love the outdoors, combine it with exercise and enjoy the scenery while you walk or jog. If you love to listen to audiobooks, enjoy them while you use an elliptical machine.
These activities are especially beneficial when done regularly:
- Brisk walking, hiking or stair-climbing
- Jogging, running, bicycling, rowing or swimming
- Fitness classes at your appropriate level
- Activities such team sports, a dance class or fitness games
Mix it up! Adding variety to your workout is good for you
A variety of activity helps you stay interested and motivated. When you include strength and flexibility goals (using weights, resistance bands, yoga and stretching exercises), you also help reduce your chances of injury so you can maintain a good level of heart-healthy fitness for many years.
Know what moderate means for you
If you injure yourself right at the start, you are less likely to keep going. Focus on doing something that gets your heart rate up to a moderate level. If you're physically active regularly for longer periods or at greater intensity, you're likely to benefit more. But don't overdo it. Too much exercise can give you sore muscles and increase the risk of injury.
Make it social
Consider walking with a neighbor, friend or spouse. Take an exercise challenge. Connecting with others can keep you focused and motivated to walk more.
Reward yourself with something that supports your goals:
- Pay yourself. Set aside a small amount of money for every workout. After one month, invest your payoff in something that motivates you to keep up the good work, like new music to enjoy while you walk or a new workout shirt.
- Celebrate your milestones. Fitness needs to a regular part of your life, so finding ways to savor your success is important. Log your walk time or distance and write yourself a congratulatory note when you achieve a milestone, or indulge in a massage after every 100 miles — whatever incentive works to keep you moving!
Warm up and cool down
Warming up before exercising and cooling down afterwards helps your heart move gradually from rest to activity and back again. You also decrease your risk of injury or soreness.
- Your warm-up should last at least 10 minutes — longer if you are older or have been inactive for a long time.
- Making time for a cool-down is also especially important. If you stop exercising too quickly, your blood pressure can drop sharply, which can be dangerous and can cause muscle cramping.
- Adding some relaxing yoga poses to your routine will also increase your flexibility.
Practice breath control
Make sure that you breathe regularly throughout your warm-up, exercise routine and cool-down. Holding your breath can raise blood pressure and cause muscle cramping. Regular, deep breathing can also help relax you.
Do I need to consult my doctor before increasing my activity level?
Healthy adults generally do not need to consult a healthcare provider before becoming physically active. Adults with chronic conditions should talk with their healthcare provider to determine whether their conditions limit their ability to do regular physical activity.
Is there a simple test for moderately intense physical activity?
Use this “conversational pace” test to determine if you’re working hard enough.
- If you can easily carry on a full conversation and perform the activity at the same time, you probably aren't working hard enough.
- If you can sing and maintain your level of effort, you're probably not working hard enough.
- If you can exchange brief sentences easily while performing the activity, but not a comfortable or lengthy conversation, your intensity level is likely on target.
- If you get out of breath quickly, or if short sentences feel like a strain, you're probably working too hard, especially if you have to stop and catch your breath.
If you like to get really technical, see the information below and learn how to identify and monitor your target heart rate to measure the intensity of your activity.
How do I calculate my heart rate?
To calculate your target training heart rate, you need to know your resting heart rate. Resting heart rate is the number of times your heart beats per minute when it's at rest. The best time to find your resting heart rate is in the morning after a good night's sleep and before you get out of bed. Typically, an adult’s resting heart rate is 60-100 beats per minute. However, for people who are physically fit, it's generally lower. Also, resting heart rate usually rises with age.
- The best places to find your pulse are the wrists, inside of your elbow, side of your neck or top of your foot.
- To get the most accurate reading, put your finger over your pulse and count the number of beats in 60 seconds.
How much do I need to exert myself?
Once you know your resting heart rate, you can then determine your target training heart rate. Target heart rates let you measure your initial fitness level and monitor your progress in a fitness program. You do this by measuring your pulse periodically as you exercise and staying within 50 to 85 percent of your maximum heart rate. This range is called your target heart rate.
Remember, pacing is important
It’s important to pace yourself properly when exercising. If you’re just starting a program, aim at the lowest part of your target zone (50 percent) during the first few weeks. Gradually build up to the higher part of your target zone (85 percent). After six months or more of regular exercise, you may be able to exercise comfortably at up to 85 percent of your maximum heart rate. However, you don’t have to exercise that hard to stay in shape.
Using fitness trackers and health apps for heart health
Health apps and wearable fitness trackers (or a combination of both) can help you set specific goals and objectives. It’s also pretty motivating to see your progress.
A note about hot tubs and saunas
People with high blood pressure should be able to tolerate saunas well as long as their blood pressure is under control. If you have high blood pressure and have any concerns about hot tubs and saunas, consult your healthcare professional for advice.
Heat from hot tubs and saunas cause blood vessels to open up (called vasodilation). Vasodilation also happens during normal activities like a brisk walk.
- If your doctor has told you to avoid moderate exercise, you should also be careful when considering hot tubs and saunas.
- People with high blood pressure should not move back and forth between cold water and hot tubs or saunas as this could cause an increase in blood pressure.
- Drinking alcohol and using a sauna isn't a good combination either, so don't mix the two.
Learn more
- Get fact sheets on:
- Being Physically Active (PDF)
- Making Physical Activity a Way of Life (PDF) | Spanish (PDF)
- Download a log to track your physical activity (PDF).
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.