Nearly 130 crore adults aged 30–79 years worldwide is suffering from hypertension or high blood pressure, and most of them (two-thirds) living in low or middle-income countries. An estimated 46% of adults with hypertension are unaware about their condition and only 1 in 5 adults have it under control.

Unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco, alcohol and being overweight / obese are major modifiable factors behind it though family history also plays a role. Interesting fact is that most people with hypertension don’t suffer any symptom, only very high blood pressures can cause headache, blurred vision, chest pain etc. Hence regular monitoring is the best way to identify if someone has high blood pressure.

Medical therapy is proven to be an effective mean of reducing blood pressure, however, poor adherence, side effects and economic expenditure remain its important limitations. Here comes the role of exercise intervention. Exercise elicits conclusive cardio vascular health benefits and improves long term survival, with a longitudinal association between physical activity and reduced mortality well documented. Latest large scale analyses have reported significant systolic and diastolic blood pressure (SBP and DBP) reductions from varying exercise modes.

Traditional aerobic exercise training (AET) remains the primary recommended approach for the management and control of blood pressure. However, recent investigations have shown promising results with more novel exercise modes, such as high intensity interval training (HIIT), isometric exercise training (IET), as well as independent dynamic resistance training (RT) and combined RT and AET. Physical activity induces a decrease in post exercise blood pressure. This effect typically lasts for 4–10 h, but observed even upto 22 h later. So the people with hypertension can achieve reduced values many hours of the day, which should be seen as having considerable clinical significance.

Even though physical activity is considered safest intervention, people with blood pressure > 160/100 mmHg irrespective of additional risk factors should not begin regular exercise until after pharmacological treatment has been initiated. Also some anti hypertension medications impair body temperature regulation during exercise especially in hot and humid condition, hence people consuming these need to be educated regarding exertional heat illness. Hypotensive episodes are also being reported in other medication group after abrupt cessation of activity, for which extending the cool-down period is generally recommended.

Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of hypertension. However the optimal dosage in terms of training frequency, intensity, time, and type (FITT) need to be better prescribed by a specialist sports and exercise medicine physician to attain effective BP lowering capacities of exercise, particularly for children, women and older adults.