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Low-intensity walking as mild medication for pressure control in prehypertensive and hypertensive subjects: how far shall we wander?

Qin Lu1, Sheng-ming Wang1, Yi-xiao Liu1, Hong Chen1, Rui Zhang1, Wen-hui Zhang1, Yuan-yuan Zou1, Jia-wei Zhou1, Xin-yi Guo1, Ying Zhang1, Teng-Li Huang1, Yu-hang Liu1, Si-qi Zhang1, Kyosuke Yamanishi2, Hiromichi Yamanishi2, Hideaki Higashino2, Haruki Okamura2
1 Department of Pharmacology and Chemical Biology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
2 Hirakata Ryoikuen, Osaka 573-0122, Japan
Correspondence to: Hong Chen:,
DOI: 10.1038/s41401-018-0202-8
Received: 16 September 2018
Accepted: 12 January 2018
Advance online: 13 February 2019


Successful prevention and treatment of hypertension depend on the appropriate combination of antihypertensive drug therapy and nondrug lifestyle modification. While most hypertension guidelines recommend moderate- to high-intensity exercise, we decided to explore a mild yet effective type of exercise to add to hypertension management, especially in populations with complications or frailty. After comparing the short-term cardiovascular effects of low-speed walking versus high-speed walking for 3 kilometers (km) (3 km/h versus 6 km/h) in young, healthy volunteers, we delivered low-speed walking (low-intensity walking, 2.5 metabolic equivalents of task, METs) as exercise therapy in 42 prehypertensive and 43 hypertensive subjects. We found that one session of 3 km low-intensity walking exerted a transient pressure-lowering effect as well as a mild negative chronotropic effect on heart rate in both the prehypertensive and hypertensive subjects; these short-term benefits on blood pressure and heart rate were accompanied by a brief increase in urine β-endorphin output. Then we prescribed regular low-intensity walking with a target exercise dose (exercise volume) of 500–1000 METs·min/week (50–60 min/day and 5–7 times/week) in hypertensive subjects in addition to their daily activities. Regular low-intensity walking also showed mild but significant blood pressure-lowering and heart rate-reducing effects in 7 hypertensive subjects within two months. It is hypothesized that regular low-intensity exercise of the necessary dose could be taken as a pragmatic and supplementary medication for hypertension management.
Keywords: hypertension; prehypertension; exercise medication; low-intensity walking; metabolic equivalent of task; blood pressure; heart rate; urine β-endorphin

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