Rui Brás1,2, Dulce Esteves1,2, Ricardo Gouveia Rodrigues3,4, Paulo Duarte3,4, Ana Gouveia5,6, Kelly O’Hara1, Paulo Pinheiro3,4

1University of Beira Interior, Sport Sciences Department, Covilhã, Portugal
2Sports Sciences, Health Sciences and Human Development (CIDESD), Covilhã, Portugal
3University of Beira Interior, Business and Economics Department, Covilhã, Portugal
4Research Unit in Business Sciences (NECE - UBI), Covilhã, Portugal
5University of Beira Interior, Faculty of Health Sciences, Covilhã, Portugal
6University of Lisbon, Institute of Biophysics and Biomedical Engineering, Lisbon, Portugal

Evaluation of Risks and Benefits of Physical Activity of Hypertensives and Normotensives: Fighting a Societal Burden

Monten. J. Sports Sci. Med. 2020, 9(1), 11-18 | DOI: 10.26773/mjssm.200302


Physical Activity (PA) is considered a coadjutant factor in the control of hypertension, helping to control this societal burden. This study investigates the factors that may influence the adoption of PA recommendations by hypertensive individuals by comparing physical activity patterns among hypertensives and normotensives and the importance placed on PA by both groups. Data from 966 Portuguese participants aged between 18 to 90 years old, representing hypertensives (n=144) and normotensives (n=822) were collected using a face-to-face questionnaire. The results show significant differences between the two groups in terms of causes of non-participation and dropping out, preferred PA activities, perceived knowledge, and information-seeking behaviour. The main barriers to exercise reported by hypertensives were the perception that PA is not adequate or even dangerous to their health. Doctors must be considered a key factor in promoting exercise. When compared to normotensives, hypertensives feel that PA information available is not appropriate (p=.0006). Hypertensives consider that existing programmes will not meet their needs and do not like traditional fitness classes, such as those in gyms. The fear of risks associated with exercise seems to be a significant barrier that impairs PA participation.


hypertension, exercise, health benefits, behavioural change, barriers, risks

View full article
(PDF – 240KB)



American College of Sports Medicine. (2018). ACSM’s guidelines for exercise testing and prescription. In Lippincott Williams & Wilkins (Tenth edit). Philadelphia: Wolters Kluwer Health.

Bakker, E. A., Sui, X., Brellenthin, A. G., & Lee, D. (2018). Physical activity and fitness for the prevention of hypertension. Current Opinion in Cardiology, 33(4), 394–401.

Booth, M. L., Bauman, A., Owen, N., & Gore, C. J. (1997). Physical Activity Preferences, Preferred Sources of Assistance, and Perceived Barriers to Increased Activity among Physically Inactive Australians. Preventive Medicine, 26(1), 131–137.

Burke, L. E., Ma, J., Azar, K. M. J., Bennett, G. G., Peterson, E. D., Zheng, Y., … Quinn, C. C. (2015). Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention. Circulation, 132(12), 1157–1213.

Cavalcante, P. A., Rica, R., Evangelista, A., Serra, A., Pontes Junior, F., Kilgore, L., … Figueira Junior, A. (2015). Effects of exercise intensity on postexercise hypotension after resistance training session in overweight hypertensive patients. Clinical Interventions in Aging, 10, 1487.

Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., … Roccella, E. J. (2003). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42(6), 1206–1252.

Churilla, J. R., & Ford, E. S. (2010). Comparing Physical Activity Patterns of Hypertensive and Nonhypertensive US Adults. American Journal of Hypertension, 23(9), 987–993.

Cornelissen, V. A., & Fagard, R. H. (2005). Effects of Endurance Training on Blood Pressure, Blood Pressure–Regulating Mechanisms, and Cardiovascular Risk Factors. Hypertension, 46(4), 667–675.

Craig, C. L., Marshall, A. L., Sjöström, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., … Oja, P. (2003). International physical activity questionnaire: 12-Country reliability and validity. Medicine and Science in Sports and Exercise, 35(8), 1381–1395.

Eckel, R. H., Jakicic, J. M., Ard, J. D., De Jesus, J. M., Houston Miller, N., Hubbard, V. S., … Yanovski, S. Z. (2014). 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American college of cardiology/American heart association task force on practice guidelines. Journal of the American College of Cardiology, 63(25 PART B), 2960–2984.

Gallegos-Carrillo, K., García-Peña, C., Salmerón, J., Salgado-de-Snyder, V. N., Vázquez-Cabrer, G., & Lobelo, F. (2014). Exercise-referral scheme to promote physical activity among hypertensive patients: design of a cluster randomized trial in the Primary Health Care Units of Mexico’s Social Security System. BMC Public Health, 14(1), 706.

Gerage, A. M., Benedetti, T. R. B., Farah, B. Q., Santana, F. da S., Ohara, D., Andersen, L. B., & Ritti-Dias, R. M. (2015). Sedentary Behavior and Light Physical Activity Are Associated with Brachial and Central Blood Pressure in Hypertensive Patients. Plos One, 10(12), e0146078.

Gliemann, L., Buess, R., Nyberg, M., Hoppeler, H., Odriozola, A., Thaning, P., … Mortensen, S. P. (2015). Capillary growth, ultrastructure remodelling and exercise training in skeletal muscle of essential hypertensive patients. Acta Physiologica, 214(2), 210–220.

Gong, J., Xu, Y., Chen, X., Yang, N., Li, F., & Yan, Y. (2018). Persistent effect at 30-month post intervention of a community-based randomized trial of KM2H2in reducing stroke and heart attack among senior hypertensive patients. International Journal of Behavioral Nutrition and Physical Activity, 15(1), 1–12.

Hagströmer, M., Oja, P., & Sjöström, M. (2006). The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutrition, 9(06), 755–762.

Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., & Ekelund, U. (2012). Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet, 380(9838), 247–257.

Hébert, E. T., Caughy, M. O., & Shuval, K. (2012). Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. British Journal of Sports Medicine, 46(9), 625–631.

Hu, G., Barengo, N. C., Tuomilehto, J., Lakka, T. A., Nissinen, A., & Jousilahti, P. (2004). Relationship of Physical Activity and Body Mass Index to the Risk of Hypertension: A Prospective Study in Finland. Hypertension, 43(1), 25–30.

Jakes, R. W., Day, N. E., Khaw, K.-T., Luben, R., Oakes, S., Welch, A., … Wareham, N. J. (2003). Television viewing and low participation in vigorous recreation are independently associated with obesity and markers of cardiovascular disease risk: EPIC-Norfolk population-based study. European Journal of Clinical Nutrition, 57(9), 1089–1096.

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., … Ortiz, E. (2014). 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA, 311(5), 507.

Kraus, W. E., Bittner, V., Appel, L., Blair, S. N., Church, T., Després, J. P., … Whitsel, L. (2015). The National Physical Activity Plan: A Call to Action from the American Heart Association A Science Advisory from the American Heart Association. Circulation, 131(21), 1932–1940.

Nyberg, M., Gliemann, L., & Hellsten, Y. (2015). Vascular function in health, hypertension, and diabetes: Effect of physical activity on skeletal muscle microcirculation. Scandinavian Journal of Medicine and Science in Sports, Vol. 25, pp. 60–73.

Patnode, C. D., Evans, C. V., Senger, C. A., Redmond, N., & Lin, J. S. (2017). Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors. Jama, 318(2), 175.

Pescatello, L. S., MacDonald, H. V., Lamberti, L., & Johnson, B. T. (2015). Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research. Current Hypertension Reports, 17(11), 87.

Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., … Verschuren, W. M. M. (2016). 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Atherosclerosis, 252, 207–274.

Pinheiro, P., Esteves, D., & Brás, R. (2012). Effect of Internet and social networks on knowledge regarding physical activity. The International Journal of Management Science and Information Technology (IJCSIT), 4(4), 29–41

Plotnikoff, R. C., Johnson, S. T., Karunamuni, N., & Boule, N. G. (2010). Physical activity related information sources predict physical activity behaviors in adults with type 2 diabetes. Journal of Health Communication, 15(8), 846–858.

Romero Blanco, C., Villalvilla Soria, D. J., Cabanillas Cruz, E., Laguna Nieto, M., Aznar Laín, S., Blanco, C. R., … Lain, S. A. (2015). Cumplimiento de las recomendaciones de actividad física para la salud en adultos hipertensos. Nutricion Hospitalaria, 31(1), 415–420.

Thomas, N., Alder, E., & Leese, G. P. (2004). Barriers to physical activity in patients with diabetes. Postgraduate Medical Journal, 80(943), 287–291.

Toro-Ramos, T., Kim, Y., Wood, M., Rajda, J., Niejadlik, K., Honcz, J., … Michaelides, A. (2017). Efficacy of a mobile hypertension prevention delivery platform with human coaching. Journal of Human Hypertension, 31(12), 795–800.

Twinamasiko, B., Lukenge, E., Nabawanga, S., Nansalire, W., Kobusingye, L., Ruzaaza, G., & Bajunirwe, F. (2018). Sedentary Lifestyle and Hypertension in a Periurban Area of Mbarara, South Western Uganda: A Population Based Cross Sectional Survey. International Journal of Hypertension, 2018, 1–8.

Widmer, R. J., Collins, N. M., Collins, C. S., West, C. P., Lerman, L. O., & Lerman, A. (2015). Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis. Mayo Clinic Proceedings, 90(4), 469–480.

Wienert, J., Kuhlmann, T., Fink, S., Hambrecht, R., & Lippke, S. (2017). Motivational and Volitional Correlates of Physical Activity in Participants Reporting No, Past, and Current Hypertension: Findings from a Cross-Sectional Observation Study. International Journal of Behavioral Medicine, 24(6), 908–914.