Just five minutes of daily activity could lower blood pressure, with 20-27 minutes of exercise like uphill walking, stair-climbing, or cycling offering even greater reductions, researchers estimate.

*Study: Device-Measured 24-Hour Movement Behaviors and Blood Pressure: A 6-Part Compositional Individual Participant Data Analysis in the ProPASS Consortium. Image Credit: siam.pukkato/Shutterstock.com*

In a cross-sectional study published in the Circulation, researchers analyzed data from thigh-worn accelerometers and blood pressure (BP) measurements to investigate the potential associations between different 24-hour movement behaviors and BP.

They found that greater time spent exercising or sleeping was associated with lower BP, with small increments of exercise linked to modest BP reductions. In comparison, greater sedentary time was associated with higher BP.

Background

Hypertension affects over a billion people globally and remains a major cause of death despite medical advances. While exercise is known to lower BP, less is understood about how daily patterns of sleep, sedentary time, and light and moderate-to-vigorous activity impact BP outside of structured exercise.

Advances in tracking technology allow detailed study of movement patterns, revealing unique health benefits from specific behaviors like vigorous bursts of activity or different types of light movement and standing. Compositional data analysis, which examines the 24-hour movement composition, enables a better understanding of how shifting one behavior (e.g., replacing sitting with activity) can reduce BP. This allows for more personalized movement guidelines that specify optimal and minimal activity levels needed for meaningful BP improvement.

In the present study, researchers analyzed how a 24-hour movement composition of six behaviors—sleep, sedentary behavior, standing, slow walking, fast walking, and exercise-like activity—relates to systolic BP and diastolic BP (SBP and DBP). Additionally, they modeled how shifting time between any two behaviors could potentially affect SBP and DBP.

About the study

Cross-sectional data were pooled from six cohort studies and 14,761 participants within the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS). The mean age of the participants was 54.2 years. Participants wore thigh-worn accelerometers for seven days to measure six movement behaviors— sleep, sedentary behavior, standing, slow walking, fast walking, and exercise-like activities.

The accelerometer data were processed centrally to harmonize movement classifications across different devices used in the studies. BP was measured using automated monitors, and multiple readings were averaged per participant. Adjustments to BP values were made for participants taking antihypertensive medications.

Covariates, such as age, sex, smoking status, and alcohol consumption, were harmonized and included in the analysis to control for potential confounding factors. Additional covariates, such as mobility limitations, education, and occupational class, were gathered from a subset of cohorts.

At the same time, body mass index (BMI) was considered only in sensitivity analyses due to its potential role as a mediator. Statistical analysis involved the use of isometric log-ratio transformation, linear regression analysis, isotemporal substitution modeling, sex interaction testing, sensitivity analysis, subgroup analysis, and two-stage random-effects meta-regression.

Results and discussion

Participants spent an average of 10.7 hours being sedentary, 3.2 hours standing, 1.6 hours slow walking, 1.1 hours fast walking, and only 16 minutes in exercise-like activity (e.g., running or cycling). Higher SBP was found to be associated with more sedentary time, while more time spent in exercise-like activities or sleep was linked to lower SBP. Replacing any behavior with exercise-like activity showed the most significant SBP reduction, with the largest improvement achieved by substituting 5 minutes of sedentary time with exercise. A clinically significant reduction of 2 mm Hg in SBP required substituting 20–27 minutes of other activities with exercise-like activity or nearly three hours of sedentary time with sleep.

More exercise-like activity and sleep were also found to be associated with lower DBP, while sedentary time showed the opposite effect. A significant reduction of 1 mm Hg in DBP could be achieved by reallocating 10–15 minutes to exercise-like activity or by substantial reductions in sedentary time with standing, slow walking, or sleeping.

Sensitivity analyses confirmed these findings across different antihypertensive adjustments and participant subgroups, though there was minimal sex difference in associations. Subgroup analyses showed that the benefits of exercise-like activity and sleep on BP were more pronounced among participants with lower sedentary time or those who slept less than 7.2 hours daily.

The findings highlight the BP-lowering potential of exercise-like activities and provide evidence for movement-based strategies to manage BP effectively. The study is strengthened by its large scale, standardized measurements, and robustness of the findings. However, the study is limited by its cross-sectional design, which hinders causal inference, lack of ethnic diversity, and lack of consideration of the intensity or quality of exercise and sleep.

Conclusion

In conclusion, the study suggests that adding even five minutes of exercise-like activity daily could be a feasible strategy to help reduce BP, with up to 10–30 minutes potentially needed for clinically meaningful reductions. Even modest reductions in BP can significantly lower the risk of cardiovascular events.

While sleep also benefited BP, reallocating enough time from other activities may not be feasible for everyone. In the future, personalized approaches to activity and movement patterns may enhance BP management and reduce hypertension risk.