There is always a lot of health information circulating in the public sphere. Occasionally we will take a deeper dive into a recent publication if it seems interesting or generally useful. A recent publication making some waves in the press caught my eye, particularly when considered in the context of exercise as medicine. The article explores the efficacy of two interventions in lowering blood pressure — aerobic exercise versus Tai Chi. The article came out in JAMA, the Journal of the American Medical Association, in its online version.
Of most interest, Li and colleagues assess if either or both of these commonly recommended interventions lower blood pressure and if so, which one had a larger effect. The group under study were adults who had been diagnosed with pre-hypertension. This designation is used to describe people with blood pressures that are consistently elevated from ideal but not high enough to be officially diagnosed as hypertensive. Because not officially hypertensive, the participants in the study were not taking blood pressure lowering medications. Lifestyle interventions, it was hoped would lower blood pressure sufficiently to prevent the need for medication and/or improve health outcomes. If one were to draw up an ideal study design as far as usefulness is concerned, this one is quite good. The main limit of the participant pool is that individuals with diabetes, either Type 1 or 2, were excluded.
The biggest piece of information to take from this study, at least in our view here at Digman Health and Performance HQ, is that both aerobic exercise and Tai Chi are effective interventions in helping to lower blood pressure when used as a consistent intervention over an extended period of time. The study lasted 1 year. The aerobic exercise group saw systolic blood pressure drops in the range of 4 points at six months and 5 points total drop at one year. This group also showed drops in diastolic blood pressure of approximately 2.5 points at 6 months and 1 year. Those are solid improvements. That noted, the Tai Chi intervention group showed even more robust improvements. Systolic blood pressure improved by over 6 points on average after 6 moths and 7 points total after 12 months. Diastolic improvements were present and larger than the aerobic exercise group as well, in the range of 3.5 points decrease at 6 and 12 months.
The implication of this study highlights a point I hope is getting more fully appreciated — aerobic exercise is great but it is not the only, nor always the best, intervention to improve health. We clearly need to do things to maintain and/or improve cardiovascular fitness but we can’t assume this type of activity is a cure all. In this study, mindfully done movement produced more reduction in blood pressure than did aerobic exercise. That point is a major challenge to how many in the American exercise community value particular forms of physical activity.
One notable limitation to this study is that omits diabetics. Because of the ways diabetes can influence the functioning of blood vessels, for the worse, the omission of diabetics likely exaggerated the effects of these exercise focused interventions when compared to the whole of the population. This is not to say that Tai Chi and/or aerobic exercise would not work at lowering blood pressure for diabetics, the issue is the extent of the reduction in blood pressure.
We should also make clear that the study participants were naive to interventions focused on lowering their blood pressure. Like with the omission of diabetics, it is possible the influence of these interventions could be lower if they were a second or third line treatment versus the primary one. These complexities make the take home recommendations from this article a bit more complicated than simply to do Tai Chi. At Digman Health and Performance, we took home a few different points:
1. There a number of different ways in which people can move their bodies that have notable effects of their health.
2. Exercise as a concept needs to be seen in a broad way, not as a simple dichotomy of aerobic versus strength
3. There is good evidence for the use of mindfulness focused interventions for blood pressure control but how effective it will be for individuals needs verification, just like we should do for the introduction of a medication.
Exercise, in a broad sense, has great potential as a medical intervention. The implementation of that intervention is not always simple and it’s our mission here at Digman Health and Performance to help people to find ways to live happier and healthier lives with interventions that are effective for them and something they can and will include in their lives going forward.