April 19, 2019
Exercise for Blood Pressure, Cognition, and Fall Prevention

Exercise for Blood Pressure, Cognition, and Fall Prevention

by Wellness Letter  

Need more reasons to exercise? Just about every month, research is published showing a wide array of benefits from exercise. Several clinical trials and analyses have confirmed some important effects.

Blood pressure control

Exercise programs—whether aerobic (cardio) workouts, strength training, or a combination—may reduce blood pressure in people with hypertension as much as first-line medication does, according to a meta-analysis in the British Journal of Sports Medicine in December 2018. It looked at 391 clinical trials, half focusing on exercise, including mostly people with normal or only modestly elevated blood pressure. The other half focused on medication, involving only people with hypertension, defined here as systolic blood pressure of 140 mmHg and above.

Overall, drugs lowered systolic pressure nearly twice as much as exercise (8.8 vs. 4.8 points, on average). But when the findings from the exercise trials were limited to results for participants with baseline hypertension, the reduction in blood pressure was 9 points, about the same as seen in the drug trials.

Since none of the studies involved head-to-head comparisons of exercise and medication, and since there were far fewer people with hypertension in the exercise studies than in the drug studies, the results have to be interpreted with caution. Still, medical guidelines recommend that people with hypertension try lifestyle changes, including increased exercise, before starting drugs—and that they should continue afterwards.

Improved cognition

Aerobic exercise may improve thinking ability in older people with cognitive impairment, according to a Duke University study in the journal Neurology in January 2019. The study involved 160 sedentary people, average age 65, who reported cognitive problems and did poorly on a cognitive screening test but did not have dementia; cardiovascular risk factors were also evaluated. They were divided into four groups: aerobic exercise (brisk walking or stationary cycling for 35 minutes three times a week); the anti-hypertension DASH diet; both the exercise and the diet; or just health education.

After six months, cognitive testing found that the exercise-plus-diet group had marked improvements in executive function (the ability to solve problems, set and meet goals, and exert self-control), followed by the exercise-alone group; the diet-only and health-education groups did not benefit. No group had improvements in memory or verbal fluency. People who followed the DASH diet had the biggest improvements in cardiovascular risk factors such as blood cholesterol and body weight, which might have led to cognitive benefits had the study been longer, other research suggests.

Fall prevention

Long-term exercise programs modestly reduce the risk of falls, according to a systematic review and meta-analysis, published in JAMA Internal Medicine in January 2019. It included more than 40 clinical trials involving people ages 60 and older (average age 73) who undertook exercise programs for at least a year.

Compared to people who didn’t become more physically active, the exercise groups had a 12 percent reduced risk of any type of fall, on average, and a 26 percent reduction in “injurious” falls. In most studies, exercise training was multi-component—that is, aerobic (such as brisk walking), strength (focusing on lower body), plus balance training—done two or three times a week (about 50 minutes per session) at moderate intensity.

This article first appeared in the UC Berkeley Wellness Letter.

Also see Exercise: The Key to Active Aging.