Can I Lift Weights with High Blood Pressure?

My 16-year-old son has high blood pressure and loves weight training. His doctor recently told him he shouldn't lift weights. Are there other exercises he could do to add definition to his biceps and triceps without elevating his blood pressure?

Your doctor may be overly conservative in prohibiting weight lifting if your son is medicated and his blood pressure is within normal limits. I call your attention to a position statement published in 1997 by the American Academy of Pediatrics (AAP) titled, "Athletic Participation by Children and Adolescents Who Have Systemic Hypertension." The serious risks of uncontrolled high blood pressure are described in the paper and should not be ignored (no one wants to put kids at risk), but it is also stated in one of four recommendations in the paper that, "Youth who have severe hypertension need to be restricted from competitive sports and highly static (isometric) activities until their hypertension is under adequate control and they have no evidence of target organ damage." My interpretation of this statement is that exercise is safe when blood pressure is controlled and there is no damage to organs like the kidneys or heart. In addition, it is also stated in the paper that there is limited evidence to show greater risk with highly static exercises (like weight lifting) compared with dynamic exercise like running. Furthermore, the AAP considers weight lifting a low dynamic exercise compared with a sport like bodybuilding (where athletes lift very heavy), or boxing, where the risks are more obvious and serious. You can read the full report here: http://pediatrics.aappublications.org/cgi/reprint/99/4/637.pdf.

You may also be interested in the June 2001 position statement titled, "Strength Training by Children and Adolescents," also published by the American Academy of Pediatrics. The benefits of weight lifting for kids are described in the paper and precautions are listed. You can find the paper here: http://pediatrics.aappublications.org/cgi/reprint/107/6/1470.pdf.

I am not aware of studies involving the effects of resistance exercise on blood pressure in children or teens, but in adults, the effects can be positive. For example, in a recent analysis of multiple studies (called a meta-analysis) involving 320 male and female adults, resistance-training programs produced significant decreases in resting systolic (the top number) and diastolic (the bottom number) blood pressure. The decreases were equivalent to reductions of approximately 2% and 4%, respectively. It's not clear if these results translate to children, and so we will have to wait for the studies to be done.

I suggest that you discuss these issues with his doctor. Here are some tips for keeping your son's blood pressure down during lifting if he gets the okay to do so from the doctor.

1. Keep the weight light enough so that he can perform 12-15 repetitions.
2. He should not hold his breath and strain (his face should not turn red). Instead, he should exhale with effort; that is, exhale during the hardest part of the lift (the lifting portion of the repetition) and inhale during the lowering portion.
3. Avoid isometric contractions (where muscle tension increases without any movement).
4. Start the exercise program by avoiding small group exercises like biceps and triceps work. Instead, use large muscle, dynamic exercises like bench press and rows that work major muscles as well as biceps and triceps. Large muscle groups tend to raise blood pressure less than smaller ones.

I suggest an activity like swimming if he does not get the okay from his doctor. The rhythmic and large muscle movements will keep his blood pressure down while his arms gain strength and tone. Other aerobic activities like biking, skiing, skating, hiking, jogging, and walking will condition him as well. Of course, the irony of preventing him from lifting and getting stronger is that the stronger he is the less likely it is that he will strain and raise his blood pressure during exercise or any other exertion, but that's something you'll need to discuss with his doctor.