Weights once sent blood pressure past 400, but done right, lifting lowers it

Key takeaways

• In a 1985 study, five bodybuilders doing heavy leg presses to failure reached an average peak blood pressure of 320/250, and one man topped 480/350, partly because of straining with held breath¹.
• The American Heart Association’s 2023 update calls resistance training safe and effective for adults with and without heart disease, and after a heart attack, loads as light as 20% of a person’s maximum can safely build strength³.
• In a 2023 analysis of 270 trials, regular strength training lowered resting blood pressure by about 4.6/3.0 points, and pairing it with aerobic exercise lowered the top number by about 6, a less certain result⁶⁷.
• In a 2022 review of 20 trials in type 2 diabetes, resistance training lowered A1C by 0.39 percentage points, and people who gained the most strength saw the biggest drops⁸.
• Stop and get checked if lifting brings on dizziness, chest pain or pressure, unusual breathlessness or palpitations, and call 911 for heart attack signs such as chest pain lasting more than a few minutes³¹⁴.

In 1985, a team led by J.D. MacDougall at McMaster University in Canada placed a thin tube in the arm artery of five experienced bodybuilders¹. Then the men lifted weights to failure at 80% to 100% of their maximum while the researchers recorded the pressure continuously¹.

During double-leg presses, the group’s average peak reached 320/250 mmHg¹. One man went past 480/350¹. Even single-arm curls drove the average to 255/190¹.

Spikes like these have raised safety concerns about lifting, as researchers noted in a 2020 study⁵.

Yet in its 2023 scientific statement update, the American Heart Association (AHA) concluded that resistance training is safe and effective for improving heart health in adults with and without heart disease³⁴. Resistance training, also called strength training, means working your muscles against a force: weights, bands, machines or your own body.

Both findings are true. The difference lies in how you lift. Below, we cover what strength work does for blood pressure, blood sugar and the heart, and a plan built for people who have high blood pressure, diabetes or heart disease.

The famous spike came from maximal lifts and held breath

The 1985 team named three causes for the extreme peaks: working muscles squeezing the blood vessels inside them, a strong reflex that raises pressure during effort, and the Valsalva maneuver¹.

The Valsalva maneuver means bearing down against a closed throat, the way people strain to lift something heavy. It raises pressure inside the chest, and blood pressure climbs almost point for point with it for the first few seconds². Mouth-pressure readings taken during maximal lifts showed the bodybuilders were doing it¹.

In 1992, MacDougall’s group tested 31 healthy men to learn what drives the spike². Their key finding: the rise tracked how hard a person was trying, not how much weight moved or how big the muscles were². A brief Valsalva became unavoidable once the effort topped about 80% of maximum, and it grew stronger as people neared failure². When breath-holding was added to a lift, the rise was exaggerated².

That points to three practical rules: use moderate loads, stop a few reps short of failure, and keep breathing. The American Diabetes Association (ADA) tells people with high blood pressure to avoid the Valsalva maneuver during resistance training⁹.

How you group your reps may matter, too. In a 2020 study, 12 adults taking blood pressure medicine did leg extensions at 50% of their maximum⁵. Doing 45 reps as 9 short sets of 5 raised systolic pressure, the top number, by about 67 points at its peak. Doing them as 3 sets of 15 raised it by about 84⁵.

The total work and rest were the same⁵. The study was small and used a finger cuff rather than an artery line, but it suggests shorter sets keep peaks lower⁵.

Heart groups now treat lifting as part of care

The AHA’s 2023 update, published in Circulation, reviewed the research on lifting and the heart³. Its conclusion was plain: resistance training is a safe, effective and essential part of physical activity for lowering heart disease risk³.

Some of its most striking findings involve people already living with heart disease³:

• Heart failure. Strength training improved strength, endurance and quality of life. Peak aerobic capacity rose by 2.6 mL/kg/min, and the distance people could walk in six minutes grew by about 50 meters.
• A first step for the deconditioned. For heart failure patients too weak to start aerobic training, strength work can come first, and combining the two appears safe in stable patients.
• After a heart attack or similar coronary event. Training at loads as light as 20% of a person’s one-rep maximum, the most weight they can lift once, can safely build strength.

The AHA also found that participation is low and uneven. Older adults, women, people who aren’t white and people of lower socioeconomic status lift less often than others⁴.

Muscle is where much of your blood sugar goes

Muscle takes up a large share of the sugar cleared from your blood, which is why building it matters for diabetes. Our companion article on insulin sensitivity explains how much muscle handles and how a single workout changes it.

Resistance training may improve insulin sensitivity and help move sugar transporters to the surface of muscle cells, the AHA says³. Trials show the payoff in blood sugar.

In a 2022 review, researchers pooled 20 randomized trials with 1,172 adults who had type 2 diabetes⁸. Strength training lowered A1C, a measure of average blood sugar over the past few months, by 0.39 percentage points compared with control groups⁸. For someone at 8.0%, that would mean about 7.6%, by our math.

Two details stand out⁸:

• Strength gains predicted sugar gains. Programs that made people stronger by larger amounts lowered A1C more.
• Lifting held its own against cardio. In trials that compared the two head to head, A1C results didn’t differ significantly.

The AHA adds that drops tend to be larger in people who’ve had diabetes for less than 6 years and whose A1C started at 7.5% or higher³.

The ADA’s 2026 Standards of Care, its yearly clinical guidance, advise adults with diabetes to do 2 to 3 sessions of resistance exercise a week on nonconsecutive days, alongside at least 150 minutes of aerobic activity¹⁰. Combining the two may bring greater blood sugar benefits than either alone¹⁰.

Lifting lowers resting blood pressure about as much as cardio

A large summary of exercise and blood pressure came from researchers at Canterbury Christ Church University in England⁶. In 2023, they pooled 270 randomized trials with 15,827 people in the British Journal of Sports Medicine⁶⁷.

Dynamic resistance training, a category that covers lifting weights as well as moves such as squats and push-ups, lowered resting pressure by about 4.6 points systolic and 3.0 diastolic⁶⁷. Aerobic exercise did about the same⁷. Combining aerobic and resistance training lowered systolic pressure by about 6.0 points and diastolic by 2.5⁶.

For someone starting at 140 systolic, a 4.6-point drop would mean about 135, by our math.

The effects were larger in people who already had high blood pressure⁶. The authors flagged limits, too: many trials didn’t blind participants, the programs varied widely, and the edge for combined training looked fragile when they rechecked it⁶.

Isometric holds, such as wall sits, ranked highest in the same analysis⁷. Our bodyweight exercise article covers those trials and who should ask a clinician before trying long holds.

Cholesterol and body fat shift a little

Strength training’s effects on blood fats are real but small, the AHA’s 2023 review found³:

• HDL, the “good” cholesterol: up 2 to 12 mg/dL.
• LDL, the “bad” cholesterol: down about 10 mg/dL in a review of 46 studies, with a larger drop of about 13 mg/dL in older adults at higher heart risk.
• Triglycerides: down 7 to 13 mg/dL.
• Adults under 40: only HDL improved, by about 2 mg/dL.

Body shape shifts a little, too. Pooled trials in adults carrying extra weight found that lifters shed roughly 1 kilogram of fat and put on a bit under 2 pounds (0.8 kilograms) of lean tissue, so their body fat percentage fell by about 1.6 points relative to people who didn’t train³. Combined aerobic and strength training cut fat under the skin of the belly more than either did alone³.

Lifting won’t replace a cholesterol medicine for someone who needs one. It’s one more input that nudges several numbers in the right direction at once.

Women and older adults stand to gain, yet lift the least

Long-term studies of women link strength work to lower diabetes risk. These were observational studies, which follow people over time rather than assigning them to exercise, so they show links, not proof.

In the Women’s Health Study, 35,754 healthy women around age 63 reported their activity in 2000 and were followed for about 11 years¹¹. Over that time, 2,120 developed type 2 diabetes, about 6% of the group, by our math¹¹. Women who did any strength training had a 30% lower rate of diabetes, even after accounting for their other activity, and a 17% lower rate of cardiovascular disease¹¹.

In two Nurses’ Health Study groups totaling 99,316 women, 3,491 developed type 2 diabetes over 8 years, about 3.5%, by our math¹². Women who did more than 150 minutes a week of muscle-strengthening and conditioning work had a 40% lower risk than those who did none. Women who met both the aerobic and the strength guidelines had about a third of the risk of inactive women¹².

Both studies relied on self-reported activity, and the nurses were mostly of European ancestry¹¹¹². Our strength training article covers a 2024 study that found women gained more than men from strength work.

For older adults, our article on preserving muscle with age covers training into your 90s. It also explains why people on GLP-1 weight-loss drugs need a strength plan to protect muscle.

The strength plan for blood pressure and blood sugar

This plan is our own tool, built from the sources in this article. It starts lighter and builds more slowly than plans for healthy adults, because the goal is steady benefit without big pressure spikes. Use 8 to 10 exercises that together cover your legs, hips, back, chest, shoulders and arms⁴.

Weeks	Sessions	Sets and reps	How hard	Notes for blood pressure and blood sugar
1 and 2	2 a week, not back to back10	1 set of 10 to 15	Very light; learn the movement and the breathing	If you take insulin or a sulfonylurea, check blood sugar before and after313
3 and 4	2 a week10	1 set of 8 to 124	About 40% to 60% of your one-rep max, ending with several reps left23	Split a long set into short ones with a brief pause to keep peaks lower5
5 to 8	2 or 3 a week10	1 to 2 sets of 8 to 124	Still moderate; never grind out the last rep2	Note how you feel when you stand up after a set
9 on	2 or 3 a week10	2 to 3 sets4	Add weight slowly as sets get easy	Keep home blood pressure and glucose logs to share with your clinician

The breathing rule. Breathe out as you lift or push, breathe in as you lower, and never hold your breath²⁹. One easy check: count your reps out loud.

The effort rule. Stop each set while you could still do a few more good reps. The pressure surge climbs with effort and peaks near failure².

The medicine rule. Don’t change any medicine on your own. In people who take insulin or sulfonylureas, exercise can lower blood sugar during activity and for up to 24 hours afterward¹⁵. Ask your health care professional whether to adjust food or insulin around workouts¹³.

What the evidence shows

Claim	Evidence rating	What it rests on
Strength training lowers resting blood pressure a few points	Strong evidence	270 trials; about 4.6/3.0 points6
It lowers A1C in type 2 diabetes	Strong evidence	20 trials; 0.39 points8
It helps people with stable heart failure function better	Strong evidence	Trials summarized by the AHA3
It modestly improves cholesterol and body fat	Promising but early	Small, varied effects in pooled trials3
Women who lift have less diabetes	Promising but early	Two large observational studies with self-reported activity1112
Shorter sets lower blood pressure peaks during lifting	Promising but early	One 12-person study5
People with heart disease should avoid strength training	Evidence says no	AHA: safe and effective with and without heart disease, with clearance for some3

Strength is a tool you carry with you

Natural health puts a high value on self-reliance, and few tools are as self-reliant as your own muscle. The AHA says bodyweight exercise works about as well as weights or machines⁴. You don’t need a gym contract or a branded device.

Lifting also respects how the body adapts. You ask a little more of it, it answers, and the benefits reach your blood pressure, blood sugar and blood fats at once³. That’s prevention you can feel in a stronger grip and easier stairs.

It isn’t a replacement for medicine when you need it. Habits and treatment work best together, and your clinician can adjust treatment as your numbers improve.

Questions readers ask

The bottom line

The 1985 artery readings were real, but they came from maximal lifts to failure with held breath. Moderate loads, sets that stop short of failure and steady breathing change the picture, and regular strength training lowers resting blood pressure, A1C, triglycerides and LDL by modest amounts.

Start light, two days a week, and build slowly. Get cleared first if you have heart disease, uncontrolled blood pressure or advanced diabetic eye disease, plan with your clinician if you take insulin or a sulfonylurea, and stop for warning signs.

Related reading

• One workout raises insulin sensitivity for about a day, and habits make it last
• Most adults skip strength training, though under an hour a week goes a long way
• Bodyweight moves build real strength, and a wall sit may even lower blood pressure
• Frail 90-year-olds nearly tripled their strength, proof that muscle responds at any age
• Habits can lower blood pressure like a pill, and a home cuff keeps score

Sources

1. MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR. “Arterial blood pressure response to heavy resistance exercise.” Journal of Applied Physiology, 1985;58(3):785–790 (McMaster Experts record). experts.mcmaster.ca
2. MacDougall JD, McKelvie RS, Moroz DE, Sale DG, McCartney N, Buick F. “Factors affecting blood pressure during heavy weight lifting and static contractions.” Journal of Applied Physiology, 1992;73(4):1590–1597 (copy hosted by paulogentil.com). paulogentil.com
3. Paluch AE, Boyer WR, Franklin BA, et al. “Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association.” Circulation, 2024;149(3):e217–e231, doi:10.1161/CIR.0000000000001189 (copy hosted by fisiologiadelejercicio.com). fisiologiadelejercicio.com
4. American Heart Association. “Top Things to Know: Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update.” Professional Heart Daily. u1-cd-professional.sc.heart.org
5. Paulo AC, Forjaz CLM, Mion D Jr, Silva GV, Barros S, Tricoli V. “Blood Pressure Increase in Hypertensive Individuals During Resistance Training Protocols With Equated Work to Rest Ratio.” Frontiers in Physiology, 2020;11:481. frontiersin.org
6. Edwards JJ, Deenmamode AHP, Griffiths M, et al. “Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials.” British Journal of Sports Medicine, 2023;57:1317–1326. pubmed.ncbi.nlm.nih.gov
7. BMJ Group. “Static isometric exercise, such as wall sits, best for lowering blood pressure.” Press release, July 25, 2023. bmjgroup.com
8. Jansson AK, Chan LX, Lubans DR, Duncan MJ, Plotnikoff RC. “Effect of resistance training on HbA1c in adults with type 2 diabetes mellitus and the moderating effect of changes in muscular strength: a systematic review and meta-analysis.” BMJ Open Diabetes Research & Care, 2022;10(2):e002595 (PEDro record). search.pedro.org.au
9. Colberg SR, Sigal RJ, Yardley JE, et al. “Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association.” Diabetes Care, 2016;39(11):2065–2079 (PubMed Central copy). pmc.ncbi.nlm.nih.gov
10. American Diabetes Association Professional Practice Committee. “5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026.” Diabetes Care, 2026;49(Suppl 1):S89–S131 (course copy hosted by the Weitzman Institute). education.weitzmaninstitute.org
11. Shiroma EJ, Cook NR, Manson JE, et al. “Strength training and the risk of type 2 diabetes and cardiovascular disease.” Medicine & Science in Sports & Exercise, 2017;49(1):40–46 (Harvard DASH record). pubmed.ncbi.nlm.nih.gov
12. Grøntved A, Pan A, Mekary RA, et al. “Muscle-Strengthening and Conditioning Activities and Risk of Type 2 Diabetes: A Prospective Study in Two Cohorts of US Women.” PLoS Medicine, 2014;11(1):e1001587. journals.plos.org
13. National Institute of Diabetes and Digestive and Kidney Diseases. “Healthy Living with Diabetes.” NIDDK, last reviewed October 2023. niddk.nih.gov
14. National Institute of Diabetes and Digestive and Kidney Diseases. “Diabetes, Heart Disease, & Stroke.” NIDDK, last reviewed April 2021. niddk.nih.gov
15. National Institute of Diabetes and Digestive and Kidney Diseases. “Low Blood Glucose (Hypoglycemia).” NIDDK, last reviewed July 2021. niddk.nih.gov