Northwestern University
Exercise is known to prevent nearly one in three cases of hypertension and slow its progression in young adults, but we do not know which specific exercise types are most effective. The main objective of this study is to determine which exercise prescription (ExRx) intervention component(s) alone or in combination most effectively lower systolic BP in young adults with stage I hypertension, identify the vascular mechanisms underlying these changes, and guide the development of optimized exercise-based prescription packages for effective hypertension control in this population.
Nearly one-third of hypertension cases are preventable through exercise alone. Yet among the more than 30 million U.S young adults with stage I hypertension, fewer than 10% achieve BP control, and up to half progress to stage II within five years. While moderate-to-vigorous intensity aerobic training (AT) is first-line therapy, up to 40% of individuals, especially those with stage I hypertension, show little or no benefit. Current guidelines continue to emphasize generic AT prescriptions, overlooking physiological variability that may influence exercise effectiveness. Resistance training (RT),…
Inclusion Criteria: Age 18-44 years Northwestern University patient with untreated Stage I hypertension (blood pressure 130-139/80-89 mmHg) documented on at least 2 outpatient encounters in the prior year No current antihypertensive medication use Estimated 10-year cardiovascular disease risk below 7.5% by the PREVENT risk calculator Body mass index 18.5-39.9 kg/m² Average home blood pressure of 130-139/80-89 mmHg during a 7-day home monitoring period Fewer than 150 minutes per week of moderate-to-vigorous physical activity measured by accelerometer Exercise readiness confirmed by the Physica…
All participants receive a wrist-worn Fitbit activity tracker (Charge 3 or similar) to wear daily during waking hours, synced to a secure coaching portal that study staff use to monitor wear adherence. Participants also receive standard blood pressure health education materials (videos and flyers adapted from NHLBI and the American Heart Association) by email or mail twice per month for 6 months. Topics include hypertension and its health risks, BP self-monitoring, healthy eating, and active lifestyle strategies. Materials are non-interactive and standardized across all conditions. Arms: 1, 2, 3, 4, 5, 6, 7, 8
6-month remotely delivered endurance-based exercise program (e.g., walking, stair climbing) performed 4 sessions per week at moderate-to-vigorous intensity. Intensity begins at 40-59% heart rate reserve and progresses to 60-89% heart rate reserve, guided by 6-minute walk tests at baseline, 3 months, and 6 months. One session per week is supervised by a trainer via videoconference; the remaining sessions are completed independently using manualized videos. Intensity is monitored by Fitbit heart rate and rating of perceived exertion. Arms: 1, 2, 3, 4
6-month remotely delivered resistance exercise program performed 3 sessions per week, consisting of 6 multi-joint, single-joint, and trunk exercises (e.g., squat, chest press, lunges, shoulder press), 3 sets each. Intensity begins at 50% of 1-repetition maximum and progresses to 70-80% of 1-repetition maximum by 6 months using overload principles, with 1-repetition maximum retested at 3 and 6 months. Participants receive an adjustable dumbbell set. One session per week is supervised by a trainer via videoconference; the remaining sessions are completed independently using manualized videos. Sets, repetitions, and load are logged in the coaching portal. Arms: 1, 2, 5, 6
6-month remotely delivered isometric exercise program performed 3 sessions per week, consisting of a 3-exercise circuit (e.g., wall sit, plank, glute bridge) completed for 4 sets with 1-2 minutes of rest between sets. Holds begin at 30 seconds and increase by 15 seconds per week to a maximum of 2 minutes. Intensity is 30% of maximum voluntary contraction for upper-body exercises and 95% of peak heart rate for lower-body exercises. One session per week is supervised by a trainer via videoconference; the remaining sessions are completed independently using manualized videos. Arms: 1, 3, 5, 7
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