News · Heart & Metabolic
Brisk walking lowered blood pressure, but the benefit peaked near 460 MET-minutes a week
17 trials and 1,493 people with high blood pressure. Brisk walking lowered both numbers, and the systolic dose-response curve turned back on itself: around 460 MET-minutes a week was the peak, and more did less.
- 17 randomized trials, 1,493 people already diagnosed with high blood pressure.
- Brisk walking lowered systolic and diastolic pressure, both moderate effects.
- The systolic curve was U-shaped: about 460 MET-minutes a week was the peak.
- The authors recommend four sessions a week, up to 40 minutes, for at least 12 weeks.
- Results come as effect sizes rather than millimeters of mercury, so they are hard to picture.
Almost every piece of exercise advice implies a straight line. More is better, and the only question is how much you can manage.
Pool 17 trials of brisk walking in 1,493 people with high blood pressure and the line bends. A U-shaped dose-response relationship was observed for systolic blood pressure, with the optimal dose at approximately 460 MET min/week, and past that peak the benefit fell away again.
Four half-hour walks a week beat six.
What a MET-minute of walking is
Blood pressure is the force of your blood pushing against the walls of your arteries, reported as two numbers: 120/80 means a systolic of 120 and a diastolic of 80. The first is the pressure when the heart beats, the second when it rests between beats.
Exercise dose in this paper is counted in metabolic equivalent minutes, or MET-minutes, which multiplies how hard an activity is by how long you do it. Sitting still is one MET. Brisk walking is around four. So a 30-minute brisk walk earns roughly 120 MET-minutes, and the 460 that came out as optimal is in the region of four such walks across a week.
The authors put their own recommendation in plainer terms: four sessions per week, up to 40 minutes per session, lasting at least 12 weeks, with a total weekly dose of 460-620 MET min/week.
That is a strikingly specific prescription for a literature that usually manages “get more exercise”.
Both blood pressure numbers moved
Before the dose curve, the simple result. Brisk walking significantly reduced systolic blood pressure and diastolic blood pressure, with standardized effects of about 0.48 and 0.51, which the authors describe as moderate.
Moderate is a real effect in this context. Blood pressure is stubborn, most single interventions shift it a little, and the two numbers moving together is what you would expect from something genuinely acting on the cardiovascular system rather than on measurement noise.
The ranges around both estimates are unusually tight, which reflects the Bayesian pooling method and a fairly consistent set of trials.
Why the walking dose curve turns over
The optimal dose sat at approximately 460 MET min/week, indicating a large effect size, around 1.00 standardized units for systolic pressure. Walk more than that and the benefit shrank back toward the average.
Nobody in this analysis can say why, and the honest answer is that a dose-response curve fitted across trials is not a controlled comparison. The 17 trials differed in duration, supervision, participant age and starting blood pressure, and the high-dose end of the curve is built from fewer studies than the middle. A U shape can emerge because the trials that happened to prescribe a lot of walking also happened to differ in some other way.
There are plausible physiological readings too. Very high volumes in an older hypertensive population may bring fatigue, poorer adherence, or a shift from brisk walking into something the trial still counted but the participant experienced as a slog.
Diastolic pressure did not share the shape. It exhibited a negative dose-response relationship, with the most significant improvement observed at approximately 620 MET min/week, continuing to improve where systolic had already turned.
Two numbers, two curves, two optima, which is why the recommended band is a range rather than a point.
The blood pressure number that is missing
The paper reports everything in Hedges’ g, a standardized effect size, and never in millimeters of mercury.
That matters because millimeters are what a person and their doctor actually work with. A reader who wants to know whether four walks a week might take 145 down to 138 cannot get that from this analysis, and converting a standardized effect back into blood pressure points requires the spread of the underlying measurements, which is not in the abstract.
So the shape of the finding travels and the magnitude does not.
The evidence base is also worth knowing about. The searches ran across four Chinese-language databases alongside PubMed, Embase, the Cochrane Library and Web of Science, so a substantial part of the pooled literature comes from Chinese-language trial registries. That widens the evidence base, and it means the pooled result reflects trial conduct standards that vary across regions.
What to do with a bent walking curve
What follows is more reassuring than most exercise research manages.
If you have high blood pressure and you are walking briskly four times a week for half an hour or so, this analysis says you are already at or near the dose where the benefit peaks. You are not falling short of some larger target, and pushing to double it is unlikely to double anything.
If you are doing nothing, the gap between nothing and four walks is where nearly all the value sits. Physical activity contributes to the prevention and management of noncommunicable diseases such as cardiovascular diseases, cancer and diabetes, and blood pressure is among the more responsive of those.
Walking is not the only non-drug option with guideline backing. Isometric handgrip training, twelve minutes of squeezing a grip device, lowered both resting and under-strain pressure in medicated hypertensive women.
One caution the paper cannot give you: a dose that suits a trial population is not a dose that suits a specific person with a specific heart. Poorly controlled hypertension deserves a conversation before a new exercise routine, not after it.
People also ask
What did the analysis find?
Brisk walking significantly reduced systolic blood pressure (Hedges' g = -0.48, 95% CrI -0.54 to -0.43) and diastolic blood pressure (Hedges' g = -0.51, 95% CrI -0.58 to -0.44), both representing moderate effect sizes.
What is the U-shaped part?
A U-shaped dose-response relationship was observed for systolic blood pressure, with the optimal dose at approximately 460 MET min/week (Hedges' g = -1.00, 95% CrI -1.54 to -0.46), indicating a large effect size. Past that point the benefit for systolic pressure fell away rather than continuing to climb.
What is a MET-minute?
A way of counting exercise that multiplies intensity by time. One MET is your body at rest; brisk walking is roughly four. Walking briskly for 30 minutes therefore earns about 120 MET-minutes, so 460 a week is somewhere near four half-hour walks.
What do the authors recommend?
A brisk walking regimen of four sessions per week, up to 40 minutes per session, lasting at least 12 weeks, with a total weekly dose of 460-620 MET min/week, is recommended to achieve the most pronounced blood pressure-lowering effects.
Why is diastolic different?
Diastolic blood pressure exhibited a negative dose-response relationship, with the most significant improvement observed at approximately 620 MET min/week (Hedges' g = -0.55, 95% CrI -1.06 to -0.03). So the two numbers peaked at different doses, and the recommended range spans both.
How much blood pressure is that in real terms?
The paper does not say, and that is its most frustrating limitation. Results are reported as Hedges' g, a standardized effect size, rather than in millimeters of mercury. A moderate standardized effect in hypertension trials often corresponds to a few points of systolic pressure, but converting one to the other requires the underlying spread, which the abstract does not give.
Should someone with high blood pressure start walking?
Almost certainly, and this is about how much rather than whether. Blood pressure is the force of your blood pushing against the walls of your arteries, and lowering it is one of the better-established things exercise does. Anyone with diagnosed hypertension should agree an exercise plan with their doctor, particularly if it is poorly controlled. This is general information rather than medical advice.
References
- The optimal dose of brisk walking for improving blood pressure in hypertensive patients: a systematic review and bayesian meta-analysis of randomized controlled trials. PeerJ, 2026.
- MedlinePlus. High Blood Pressure. US National Library of Medicine.
- World Health Organization. Physical activity fact sheet.