Chris Smyth

Health Editor

The Times

Gerry Gajadharsingh writes:

 “At an estimated cost of £163M per annum to the UK taxpayer for blood pressure medication, having an alternative to a pill, that is equally effective at reducing blood pressure and without the potential side effects that comes with many medications, and helping patients to take responsibility for their health, what is there not to like?

 I am not surprised that the new health secretary Matt Hancock has already endorsed the recommendation of this study, encouraging people to exercise more to control their blood pressure. The Academy of Medical Royal Colleges has previously described physical activity as a “miracle cure”.

 As with many studies, it does not suggest a mechanism as to why the recommendation works, perhaps because there are several mechanisms and therefore more difficult to prove cause and effect. It’s worth looking at the science that we already know to help people extrapolate.

 One of the common benefits of exercise is that it makes people breathe differently, by default. People who exercise also tend to retain better levels of CO2 for metabolic reasons, therefore increasing oxygenation on a cellular level, oxygen drives all cellular reactions. The paradox of good breathing behaviour is that adequate levels of CO2 in the body are required to increase cellular oxygenation. CO2 is not all bad!

 Exercise and better breathing also tend to improve Heart Rate Variability, a measurement of autonomic nervous system balance (the part of our nervous system that controls most systems in the body, helping to balance our stress nervous system response with our relaxation nervous system response. This also tends to cause vasodilation, a good thing which lowers blood pressure. Interestingly our reserves of NO (Nitric Oxide, not the bad NO2, Nitrogen Dioxide from vehicle emissions) tend to be in our nose and para nasal sinuses, it’s also a potent vasodilator, therefore lowering blood pressure, so nose breathing is preferable to mouth breathing!

Obviously, exercise can improve our cardiovascular fitness and therefore help our bodies cope with the load on our bodies also reducing blood pressure. A stronger pumping heart helps deliver blood to our muscles and organs, therefore reducing the need for increased blood pressure.

 The list goes on!

 The challenge is to exercise appropriately, I believe medicine should be individualised as much as possible. Exercise is no exception. Talking to your healthcare clinician who knows you as an individual and your health history is a great starting point.”

Exercise is as good as medicine for lowering high blood pressure, the first overview of research has concluded.

Doctors should encourage their patients to get off the sofa instead of simply taking a pill, scientists have said. Their work adds to mounting evidence that walking, cycling and even gardening protects against fatal illness.

Matt Hancock, the health secretary, has urged GPs to tell patients to exercise as often as they prescribe pills, and the Academy of Medical Royal Colleges has previously described physical activity as a “miracle cure”.

For those with the highest blood pressure, exercise might even be more effective than drugs, the analysis of 391 trials involving 40,000 people suggested.

High blood pressure increases the danger of heart attacks and strokes and affects more than a quarter of British adults, making it one of the country’s biggest health risks.

Drugs to lower blood pressure are some of the most commonly used medications. Prescriptions are up 50 per cent in a decade, with 72 million dispensed last year at a cost to the NHS of £163 million.

Few trials have directly compared drugs with exercise, but researchers have now combined the results of trials of each to make detailed comparisons. Generally, exercise trials showed a smaller effect, but researchers argue that this is because they looked mainly at healthier people.

When comparing only people who had high blood pressure, defined as pumping pressure higher than 140mmHg, exercise and drugs were equally effective. Both lowered pressure by about 9mmHg, according to results in the British Journal of Sports Medicine.The higher people’s blood pressure, the more exercise lowered it, with a fall of 11mmHg for those starting with blood pressure above 150mmHg.

The biggest effects seemed to come from combining endurance exercise such as running, walking or swimming with resistance exercise such as weight training. This brought a drop of 14mmHg.

David Nunan, of the University of Oxford, one of the study authors, said that the “million-dollar question” was how much exercise to recommend. “What we don’t know is if it’s 20 minutes, 15 minutes, 40 minutes, if it’s three times a week, five times a week. We don’t have the granularity yet. And it’s not like a pill — you can’t prescribe 50mg of exercise.”

NHS guidelines advise people to do the equivalent of a 20-minute walk a day but a third of people fail to achieve this. Dr Nunan said that the key was helping people to find activities they could stick at rather than hectoring them to join a gym.

“The GP’s skill is going to come in knowing their patients and knowing what conversations they can have about incorporating exercise into their daily routines,” he said. “This is really about setting up a habit that works for you, finding an activity that suits your lifestyle.”

He added that people could choose both to exercise and take a pill, perhaps coming off the medication if exercise worked. However, he said that overworked GPs would need more time with patients when, at present, “a pill is often the easier option”.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “GPs are already encouraging large numbers of their patients to make lifestyle changes, such as increasing the amount and type of exercise or changing their dietary habits, where appropriate, for a wide range of conditions. Lifestyle changes should always be considered before prescribing medication to lower blood pressure, as well as in addition to it. But no two patients are the same and blood pressure-lowering drugs save lives so, as the author of the study highlights, it is vitally important that patients do not give up their medication without the advice of their GP.”

Scarlett McNally, lead author of that report, said: “This paper is a fantastic ‘missing link’ that should change how we do things.” She added that the benefit of exercise “only happens if people can get started. My elderly mother started going for a walk every day and using the stairs and her blood pressure has reduced into the normal range.”

Julie Ward, of the British Heart Foundation, said: “This study shines a light on the importance of physical activity in lowering blood pressure, and in doing so reducing your risk of a heart attack or stroke. However, blood-pressure medications are proven to save lives.”