Helping the Population Find Cardiovascular Health Through Chiropractors - PART 2
Dr. Jeffrey Tucker- Apr 21
- 8 min read
I run into a lot of chiropractors exploring a shift from a musculoskeletal treatment model to a longevity health enhancement model. This paradigm shift could potentially include more focus on cardiovascular health as part of overall patient care. Whatever condition you want to throw at me, I’ll recommend eating more plant-based proportions, eating less processed foods, more whole foods, dialing in your protein, choose healthy oily foods, and start walking. If you already walk, then I want you to increase your speed and number of steps, so you get at least 6500 steps per day. I’ll recommend things to improve your sleep if that is an issue. Then I get you to do some flexibility and strength training. Do these things and it’s impossible not to transform someone. I’ve helped hundreds and hundreds of people go through physical transformations, and I’ve learned a thing or two.
Just for hypertension, improving the lifestyle factors - sleep, exercise, and diet can influence everything related to hypertension and stress management.
Sleep, exercise, and diet are the foundation that help everything else improve.
Cardiovascular System and Chiropractic Care
Your chiropractic adjustments and care matters. Several studies and observations suggest a connection between chiropractic treatments and various aspects of cardiovascular function.
Focusing on vertebral subluxation correction, is thought to promote overall health by enhancing neurological integrity (1). This approach may have implications for cardiovascular health:
1. Autonomic Nervous System: Reducing vertebral subluxation could potentially reduce neurological interference, which may influence cardiovascular regulation (2).
2. Pulse Pressure: An observational study found that patients with high pulse pressure (>49 mmHg) showed a statistically significant reduction of 8.9 mmHg following a six-week course of upper cervical chiropractic care (3).
3. Cardiovascular Tone: Understanding the neurologic influence over cardiovascular tone is considered important for chiropractors interested in the role of subluxation correction in overall health and wellness (3).
A study of chiropractic teaching clinics found that health promotion advice was noted in 53.7% of patient charts [2]. However, only 17 out of 97 patients with risk of cardiovascular disease received advice on the topic (4).
Exercise for Blood Pressure Reduction
The two big buckets of exercise are cardiovascular and resistance training. For cardio I see my patients mostly choosing walking, running, elliptical, spinning, road cycling, swimming, mountain biking, tennis, pickleball, Pilates, and hiking. I’m impressed by the way people are aging who have continued skateboarding, surfing, and dance classes into their 50s and more. These days I’m big on encouraging jump rope within workouts for cardio and ping pong for brain health.
For resistance it doesn't necessarily have to be in the gym. I’m still a big fan of starting out with body weight exercise, then resistance bands, even putting items in a luggage bag (or using kettlebells) and carrying it around. Your body doesn't know what it's lifting; all it knows is resistance against gravity.
Cardio and resistance will make your heart more efficient by being able to move the blood to help regulate your blood pressure and make your heart stronger.
My list for weight management and blood pressure
Being overweight is one of the higher risk factors for hypertension. If you're carrying excess body fat, we all know that losing fat is going to help with blood pressure. I have a full-time fat loss coach in my office.
Exercise and diet contribute to weight loss. Getting patients to walk about 6500 steps a day is my first goal. Chiropractic care is the gateway to be able to accomplish proper gait if they are unable to walk from some physical impairment. I need people to walk so we can improve metabolism, burn calories, lose fat, strengthen bones, and do all these transformational things.
The American Heart Association and the Mayo Clinic suggest you can expect to lower blood pressure by about 1 point for each 2.2 pounds (1 kilogram) of weight you lose. I think they have simplified this number for public understanding.
The National Heart, Lung, and Blood Institute’s guidelines, which summarize findings from trials like the Framingham Study or the DASH (Dietary Approaches to Stop Hypertension) trials collectively show that losing about 20 pounds can lower systolic blood pressure by 5-20 mmHg, depending on individual factors like baseline weight, age, and hypertension status. (5)
Paul K. Whelton’s study reported that a weight loss of 17.6 pounds (approximately 8 kg) was associated with reductions of approximately 8.5 mmHg in Systolic BP and 6.5 mmHg in Diastolic BP. (6)
Losing as little as 5-10% of your body weight can make a significant difference in your blood pressure and overall health. (7)
Isometric Exercises and BP Reduction
Isometric resistance training (IRT) is the most effective mode of exercise for reducing both systolic (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) compared to other forms of exercise like aerobic, dynamic resistance, and high-intensity interval training. Isometric training is especially good when you're new to fitness. (8)
The mechanism is that the heart rate decreases a little bit but your cardio output is a stroke volume increase, meaning how much your body's cardio output is going. The change is to total peripheral resistance. Vessels are a tight tube, and you're pushing blood into them. There's a tightness or stiffness in the arteries from high blood pressure. Something about isometric exercise is that it relaxes that. It can go into a more pliable tube. The magnitude of blood pressure reduction is larger than that observed with dynamic aerobic or resistance training.
The physiological mechanisms of isometric exercise to lower blood pressure:
1. Muscle contraction compresses blood vessels, reducing blood flow temporarily raising blood pressure
2. Upon relaxation, blood surges back, delivering oxygen and nitric oxide
3. Nitric oxide causes blood vessels to widen (enhances vascular dilation), reducing blood pressure
4. Over time, this process decreases arterial stiffness
5. Isometric training also reduces sympathetic nervous system activity, further lowering blood pressure
The benefits can be a significant reduction in systolic and diastolic blood pressure; improvements in arterial stiffness; enhanced endothelial function; decreased peripheral vascular resistance.
J.D. Inder’s study found average reductions of 6.77 mm Hg in SBP and 3.96 mm Hg in DBP after isometric training. (8) Another analysis by Edwards, et. al. showed even greater reductions of 8.24 mm Hg in SBP and 4 mm Hg in DBP. (9)
Isometric exercise may improve basal dilation of blood vessels. It can lead to resetting of baroreceptors, potentially contributing to long-term blood pressure lowering effects.
The additional benefits of isometric training can increase muscle bulk and strength; It may improve bone density and reduce the risk of bone fractures; These exercises can be particularly beneficial for older adults, enhancing mobility and quality of life. (10-16)
Isometric Exercises Recommended Protocol
- Hold isometric contractions for 20 seconds to 2 minutes at 30-50% of maximum effort
- Perform 4 times per day, 3-5 times per week
- Focus on the same exercise building up to 2 minutes initially, then vary exercises as you progress
- Breathe steadily—avoid holding your breath to prevent blood pressure spikes.
- Improvements in blood pressure typically manifest after 4-10 weeks of consistent training
Effective Isometric Exercises
If we as a profession taught every patient to do wall sits, planks, and static squats which by the way is obviously helpful for people’s leg strength and healthy aging, pelvic floor strength (such a buzz word), and core strength for healthy backs and spines, these isometric exercises could do all that and help reduce blood pressure.
Tucker’s Top Isometrics
Wall sits with a Swiss ball between the legs. Squeeze the ball and put stress on the muscles without having to go through the full range of motion. You can go fully up and down. A good wall squat is when you sit about 90 degrees and hold the position there. If you're holding 45 degrees, that's still putting stress on the muscles in your legs. Edwards et al. identified wall sits as the most effective individual exercise for reducing systolic blood pressure (-8.24 mm Hg), likely due to large muscle group engagement (quadriceps, glutes) and increased vascular response.
Static Squat Hold (without a wall) are a good movement assessment. Someone with immobility issues who can’t do a squat without tweaking a knee or low back, or who can’t do the movement efficiently, isometrics are a great place to start. Then you can move into basically doing the full range of motion. There is always an easier variation. Think of 90 degrees as being the hardest one. Like wall sits, this targets quads and glutes, offering a portable alternative with comparable effects.
Isometric Push-Up Hold can start with hands on the wall. Just start from there, and eventually go to the counter or chair, then go to your knees on the ground, and then do a foot push-up. There's always an easier variation of one of those exercises. The best way is to lower yourself halfway in a push-up position and hold with arms bent. This engages chest, shoulders, and core, providing a full-body isometric challenge linked to blood pressure reduction.
Planks can be done holding a push-up position with forearms on the ground, keeping your body straight from head to heels. While not specifically isolated in Edwards et al., planks are a staple isometric exercise engaging the core, shoulders, and legs, contributing to overall blood pressure benefits (-8.24/-4 mm Hg from isometric training).
Side Plank propped up on one forearm, lift your hips to form a straight line, and hold. This targets obliques and core, contributing to the systemic effects seen in isometric training.
Isometric Handgrip. Squeeze a handgrip dynamometer or tennis ball at 30% of your maximum voluntary contraction for 2 minutes per hand. Inder et al. noted significant reductions (-6.77/-3.96 mm Hg), with handgrip exercises widely studied for their accessibility and vascular dilation effects. You can stack hand squeezes with almost all the other exercises.
Leg Extension Holds can be performed sitting on a chair or machine. Extend your legs fully and hold the position with quadriceps engaged. Edwards et al. included leg extensions in their isometric protocols, showing strong blood pressure-lowering effects due to sustained quadriceps contraction.
Glute Bridge Holds where the patient lies on their back, knees bent, lift hips to align with shoulders and knees, and hold. This engages glutes and core, offering a low-impact option with potential blood pressure benefits similar to other isometric holds.
Calf Raise Hold is performed standing only. I like the challenge of rising onto your toes and trying to get all 10 toes to participate and hold the elevated position without holding on to anything for balance. This activates calf muscles, which support circulation in the lower body.
Chair Pose Hold (Yoga-inspired) is performed standing with the feet together, bend knees, raise arms overhead, and hold as if sitting in an invisible chair. This combines lower body tension (quads, glutes) with balance, reflecting isometric principles effective for blood pressure.
One of the challenges I like to give to patients is the bench press machine. Instruct the patient to go about halfway to three-quarters press and hold it (goal is up to 2 minutes); you're going to be able to hold a lot heavier weight than if you were trying to go through the full motions. For example, the patient is used to performing 100 pounds for ten reps. I can probably load 120-130 pounds and hold the tension there. It's going to put a different amount of stress on the bones and the muscles. We can teach similar moves for quads, glutes, and hamstrings.
References:
(2)
(5) https://www.webmd.com/hypertension-high-blood-pressure/features/take-charge-of-your-blood-pressure
(8) [1] Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Inder JD, Carlson DJ, Dieberg G, McFarlane JR, Hess NC, Smart NA.Hypertens Res. 2016 Feb;39(2):88-94.
(9) Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. Edwards JJ, Deenmamode AHP, Griffiths M, Arnold O, Cooper NJ, Wiles JD, O'Driscoll JM.Br J Sports Med. 2023 Oct;57(20):1317-1326.
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