Start Here TDG Five-Test Programme Resilient Gut System Stress Programme Initial Consultation — £145 Movement & Training AIdan Concierge Products Blog Learn Clinical Diagrams Resources Beyond the Mainstream Book a Call
Appliance of Science · Part 6 of 8

Isometric Exercise: Holding Still to Lower Blood Pressure

A 2023 analysis of 270 exercise trials found that isometric training, holding a position such as a wall sit, lowered resting blood pressure more on average than other types of exercise. The effect is real and worth knowing about. It’s also smaller and less certain than the headlines suggested.

STEPHEN DUNCAN FDN-P BSC HONS MSC · DETECTIVE HEALTH · JULY 2026 · UPDATED 14 OCTOBER 2026 · 4 MIN READ

Evidence: Mixed consistent direction across meta-analyses; small trials; estimates vary

Isometric exercise means a muscle working without the joint moving: a wall sit, a plank, squeezing a handgrip. It has been used in rehabilitation for decades. Over the last few years it has also built up a respectable body of blood pressure trials.

The grades in this post: Strong means good randomised trials agree. Mixed means the trials are few, small, short or unblinded, or disagree. Observational means studies show a link, not proof of cause. Mechanistic means the biology or animal work makes sense but it hasn’t been shown to change outcomes in people. None means there’s no usable evidence in people.

What the Trials Show

In 2023, Edwards and colleagues pooled 270 randomised trials of exercise and blood pressure, with 15,827 participants in total. Compared with not exercising, isometric training lowered resting blood pressure by about 8/4 mmHg. That compares with about 4.5/2.5 for aerobic exercise, 4.6/3.0 for dynamic resistance training, 6.0/2.5 for combined training and 4.1/2.5 for HIIT. In their ranking, isometric training came top and wall squats were the most effective single type (Edwards 2023). Most of those comparisons are indirect: few trials put the exercise types head to head.

Other analyses give different numbers. Across 40 trials of isometric training, systolic pressure fell by about 7 mmHg (Yan 2026). For handgrip training alone it was about 4–5 mmHg (Liu 2026; Lin 2026). A small review of five longer-term trials found about 2 mmHg, which wasn’t statistically significant (Yuan 2026). One review found no clear effect on 24-hour blood pressure measured with a wearable cuff, apart from a small fall in daytime diastolic pressure (Oliveira 2024). In a one-year trial in 24 men with high-normal blood pressure, wall squats lowered it by about 8.5/7.3 mmHg compared with no training (O’Driscoll 2022). Mixed

A UK feasibility trial in the NHS found a wall-squat programme easy to deliver, but a third of people dropped out by six months. A proper trial would need over 500 people (Wiles 2025).

For scale, a single blood pressure drug at standard dose lowers systolic pressure by about 9 mmHg on average (Law 2003). Isometric training is a useful addition, not a swap for medication. Never stop a blood pressure tablet without talking to your GP.

The Wall Sit

Most trials used short, repeated holds. The NHS feasibility trial, for example, tested four two-minute wall squats three times a week (Wiles 2025). Wall squats came out best in the big analysis. Breathe throughout. Holding your breath while straining raises blood pressure sharply. If you have high blood pressure or a heart condition, talk to your GP before starting.

Stephen in a forearm plank, side view
Forearm plank. Keep breathing throughout the hold; don’t hold your breath.
The Mechanism

How it works isn’t settled. A pooled analysis of the mechanism studies found the main change was lower resistance in the blood vessels, possibly through better nervous control of vessel tone (Edwards 2022). Nitric oxide is often suggested but hasn’t been shown to be the main driver.

Grip Strength: a Marker, Not (Yet) a Target

In the PURE study of nearly 140,000 adults in 17 countries, every 5 kg lower grip strength was linked with a 16% higher risk of death from any cause, 17% higher cardiovascular death and 9% higher stroke risk over about four years. Grip predicted death better than systolic blood pressure did (Leong 2015). Observational That’s a link, not proof of cause, and the authors themselves say we don’t yet know whether getting stronger lowers that risk. I think it’s a good reason to stay strong. It’s not proof that a grip trainer will add years.

One small trial in 22 older adults found eight weeks of handgrip training improved a test of thinking speed (Okamoto 2022). A review found only a handful of small studies on handgrip exercise and thinking (Yamada 2022). That’s far too little to call it a dementia intervention.

What You Could Track

Home blood pressure, measured properly over several days, is the outcome the trials used. Grip strength on a dynamometer is easy to measure and to track. Nobody has tested isometric training against blood inflammation markers or hormone tests, so I don’t use those to judge it.

A wall sit is cheap, quick and has better evidence for blood pressure than most people expect. It’s not magic and it’s not a drug. Treat it as one more tool.

How strong is the evidence?

ClaimGradeMain source
Isometric training lowers resting clinic blood pressureMixed consistent direction; size varies, about 2–9 mmHgEdwards 2023; Yan 2026; Yuan 2026
Isometric beats other exercise typesMixed mostly indirect comparisonsEdwards 2023
Isometric training matches or beats drugsNone never compared head to headLaw 2003 for scale
Handgrip training lowers 24-hour blood pressureMixed mostly nullOliveira 2024
Grip strength predicts deathObservational Leong 2015
Training grip lowers the risk of deathNone untestedLeong 2015
Handgrip training improves thinkingMixed one tiny trialOkamoto 2022; Yamada 2022
Handgrip training prevents dementiaNone untested—
Works mainly through nitric oxideMechanistic not supported as the main driverEdwards 2022

Sources

  1. Edwards JJ et al. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. Br J Sports Med 2023;57:1317–26. PMID 37491419. doi:10.1136/bjsports-2022-106503
  2. Edwards JJ, Wiles J, O’Driscoll J Mechanisms for blood pressure reduction following isometric exercise training: a systematic review and meta-analysis. J Hypertens 2022;40:2299–306. PMID 35950976. doi:10.1097/HJH.0000000000003261
  3. Law MR et al. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003;326:1427. PMID 12829555. doi:10.1136/bmj.326.7404.1427
  4. Leong DP et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015;386:266–73. PMID 25982160. doi:10.1016/S0140-6736(14)62000-6
  5. Lin CW et al. The optimal dosage of isometric handgrip exercise for blood pressure reduction: systematic review and meta-analysis. J Clin Hypertens 2026;28:e70246. PMID 41922197. doi:10.1111/jch.70246
  6. Liu R et al. Isometric hand grip training on populations with different baseline resting blood pressure: a systematic review and meta-analysis. BMC Public Health 2026;26. PMID 42289678. doi:10.1186/s12889-026-27002-2
  7. O’Driscoll JM et al. One year of isometric exercise training for blood pressure management in men: a prospective randomized controlled study. J Hypertens 2022;40:2406–12. PMID 35969194. doi:10.1097/HJH.0000000000003269
  8. Okamoto T, Hashimoto Y Decreases in arterial stiffness and wave reflection after isometric handgrip training are associated with improvements in cognitive function in older adults. Int J Environ Res Public Health 2022;19:9585. PMID 35954942. doi:10.3390/ijerph19159585
  9. Oliveira MS et al. Effects of isometric handgrip training on ambulatory blood pressure in individuals over 18 years old: a systematic review and meta-analysis. J Cardiopulm Rehabil Prev 2024;44:303–10. PMID 39185910. doi:10.1097/HCR.0000000000000880
  10. Wiles JD et al. Feasibility randomised controlled trial to assess the delivery of a novel isometric exercise intervention for people diagnosed with uncomplicated stage 1 hypertension in the National Health Service: key quantitative findings. BMJ Open 2025;15:e091219. PMID 40467325. doi:10.1136/bmjopen-2024-091219
  11. Yamada Y et al. The impact of isometric handgrip exercise and training on health-related factors: a review. Clin Physiol Funct Imaging 2022;42:57–87. PMID 35072335. doi:10.1111/cpf.12741
  12. Yan Y et al. Effects of isometric training based on the entire population on blood pressure regulation: systematic review and meta-analysis of randomized controlled trials. Front Public Health 2026;14:1774541. PMID 41846839. doi:10.3389/fpubh.2026.1774541
  13. Yuan H et al. The effect of long-term isometric contraction training intervention on blood pressure normalization in prehypertensive individuals: a systematic review and meta-analysis. BMC Cardiovasc Disord 2026;26. PMID 41820846. doi:10.1186/s12872-025-05124-6

I sell testing, consultations and personal training, so I declare an interest: the article’s grades apply to them too.

The Appliance of Science — All Eight Parts

Introduction — The Series, Graded Part 1 — Cold Plunges: Who They Help, Who They Harm Part 2 — Heat, Cold and Infrared: What the Evidence Shows Part 3 — Light Therapy & Chronobiology Part 4 — Breathwork Part 5 — The Soleus Muscle Part 6 — Isometric Exercise and Blood Pressure Part 7 — The Gravitostat Part 8 — Fasting: Who It Helps, Who It Harms

Which of these interventions matters most for your biology?

Ask the DH Clinical Concierge — built on nearly forty years of working with people. Free, open, no account required.

Ask the Concierge → Book a call with Stephen