Slow Breathing Regulates High Blood Pressure

Several years ago I wrote a few articles showing that exercise, yoga and other strategies were helpful at regulating high blood pressure (BP). Even small reductions in blood pressure can significantly reduce the risk of heart disease, stroke and kidney failure. The risks associated with hypertension are continuous – this means that with each 2mm Hg rise in systolic BP there is an associated 7% increase in mortality from heart disease and 10% increase in mortality from stroke.

I recently came across a few studies that have shown that paced, slow breathing can significantly decrease blood pressure in patients with hypertension. Joseph et al. (2005) demonstrated that paced breathing at 6 breaths/min for only a couple of minutes was able to decrease systolic BP by more than 8mm Hg and diastolic BP by about 5mm Hg. Similarly, Li et al. (2018) found that paced breathing at 8 breaths/min for 5min lowered systolic BP by about 4mm Hg and diastolic BP by over 8mm Hg. Because the slow breathing was only tested for a few minutes…the long-term effects of daily practice remain to be determined.

For those that are interested in giving it a go, I would recommend wearing loose-fitting clothing and either lying down or sitting back into a chair in a warm environment. Aim to progressively slow your breathing down to 5-7 breaths/min (there are several apps that can help pace your breathing). Breathe with an equal inhalation and exhalation. It may take several sessions to comfortably slow your breath to 5-7 breaths/min…take your time. Enjoy for 15-20min a day!

The 5 Habits of Highly Healthy People


Since 1979 Professor Peter Elwood and his team of researchers from Cardiff University School of Medicine have tracked the lifestyle habits of 2500 men aged 45-59 (at the start of the study). They found that men that followed 5 habits had 70% less chance of developing diabetes, 60% reduced incidents of heart attacks and strokes, 40% fewer cancers, and a reduction of 60% in cases of dementia. Incidentally, less than 1% of the study group followed all 5 habits! These 5 habits have the potential to reduce illness and chronic disease and so promote longevity…what are they?

The 5 habits of highly healthy people are:

  • regular exercise
  • no smoking
  • a healthy bodyweight
  • a healthy diet
  • a low alcohol intake

Not rocket science by any means…and definitely within everyone’s grasp!

Relaxation Response


As mentioned in an earlier post, relaxation has many, many benefits. Through his extensive study of relaxation, Herbert Benson from the Harvard Medical School has put together an 8-step sequence that consistently elicits the relaxation response. The sequence has been proven scientifically and has been used for decades.

Step 1: Pick a focus word, phrase, image or short prayer or focus on your breathing. Choose a word or phrase that is meaningful and emotionally soothing for you. Repeat the word or phrase during your entire exhalation.

Step 2: Find a quiet place away from distractions and sit or lie down comfortably.

Step 3: Close your eyes.

Step 4: Progressively relax all your muscles, moving up from the tip of your toes to the top of your head or vice versa if you prefer.

Step 5: Breath slowly and naturally, silently repeating your chosen word or phrase as you slowly exhale. Alternatively, you can focus on a picture or object or simply pay attention to your breath.

Step 6: Assume a passive attitude. Reserve any judgement regarding how well you are doing or whether it is working. If and when your mind strays to unrelated thoughts, simply think “oh well” and kindly and gently bring your attention back to your word, phrase, object or breath.

Step 7: Continue with this exercise for 12 to 15 minutes.

Step 8: Practice this technique at least once a day, either in the morning to set yourself for the day ahead or at a time that is more convenient or beneficial to you.

Relaxation For Health And Well-Being


The word ‘stress’ has become ubiquitous, but what exactly does it mean? It’s probably in the 1920s that it was first used in its present context. Walter Cannon used it to describe the process where external factors disturbed the body’s natural equilibrium. Around the same time, Hans Selye described stress as the non-specific response of the body to any demand placed upon it. Still confused?

Let’s put things a little more clearly. To ensure our survival we must either be in ‘protection mode’ or in ‘growth mode’. Protection mode ensures our short-term survival i.e. running away from or slaying a sabre-toothed tiger, moving out of the way of an oncoming car, etc. Growth mode ensures our long-term survival i.e. taking in nutrients by eating and digesting a meal, recharging our batteries by sleeping, wound-healing, having sex and reproducing, etc. Protection mode is more commonly known as ‘fight-or-flight’ and growth mode as ‘rest-and-digest’. They are like two sides of the same coin…it’s either one or the other…we’re either in ‘fight-or-flight’ or we’re in ‘rest-and-digest’. You may be more familiar with ‘fight-or-flight’ or the stress response as it’s also known.

The stress response kicks in as soon as we sense a threat. Things start off in the amygdala deep inside our brains. Other areas of the brain (hypothalamus, pituitary gland) also become involved as does the sympathetic nervous system. The adrenal glands then release adrenaline and cortisol. The aim is to quickly prepare the body for vigorous muscle activity by releasing fats and glucose into the blood stream, increasing the heart rate and breathing rate, dilating blood vessels in muscles, increasing blood pressure and increasing muscle tension. All this helps get us immediately primed for action without having to go through any mental preparation or physical warm-up! It sounds too good to be true and it’s helped us survive and thrive through time. Fortunately nowadays, we don’t often face the type of physical emergency the fight-or-flight system was designed for…but our brains still perceive lots of threats out there…traffic jams, time pressures, bad bosses, financial worries, difficult partners, noisy kids, not to mention 24/7 connectivity, contactability and accountability with the advent of new technology! All this ends up firing off our stress response in a completely different context than that for which it was designed. Rather than a sporadic short blast, it’s now more of a constant slow simmer…without the physical activity required to reset the system. Almost like preparing for a battle that never arrives…revving a car that never goes anywhere.

This ongoing low-level stress response has negative consequences. According to the Mayo Clinic, if left unchecked, “stress can contribute to health problems such as high blood pressure, heart disease, obesity and diabetes”. They cite the following common effects of stress:


What’s the solution? The key is to find a way of getting ourselves back into ‘rest-and-digest’ mode. In 1968 Herbert Benson, a cardiologist from Harvard Medical School, fortuitously stumbled across something whilst studying blood pressure. He had been approached by a group of transcendental meditators claiming they could lower their blood pressures through the use of their minds! Initially sceptical and reluctant to study them, he eventually succumbed and discovered what he called the ‘relaxation response’. Benson described the relaxation response as the opposite of the ‘fight-or-flight’ or stress response, it’s essentially the ‘rest-and-digest’ mode mentioned earlier. He characterised it by:

  • Decreased metabolism, heart rate, blood pressure and rate of breathing
  • A decrease or calming in brain activity
  • An increase in attention and decision-making functions of the brain
  • Changes in gene activity that are the opposite of those associated with stress


Research has found that the relaxation response can be effective in treating the following complaints:


Additionally, research shows that mind-body techniques can also be effective in treating the following:


In summary, any symptom or disease caused or exacerbated by stress can be helped by relaxation. Happily, there are lots of ways to evoke the relaxation response such as relaxation techniques (progressive relaxation, passive muscular relaxation, Mitchell method, breathing exercises, etc.), meditation, prayer, yoga, tai chi, exercise, cognitive behavioural therapy and hypnosis.

Hypnosis is a personal favourite of mine. It can combine the immediate relaxing effects of relaxation techniques with a change in thinking, mood and behaviour such as can be obtained using CBT. Better still, because it uses the power of the unconscious mind, these changes take place effortlessly…as if by magic!

Give it a go (click on the icon to go directly to the shop)!


Relax and enjoy better physical health and mental well-being.



Should We Stretch To Warm-Up?

Icone04Should passive (static) stretching form part of our pre-activity warm-up or not? Ever since I can remember I’ve had this discussion with colleagues, clients and training partners. People usually have a firm view on the subject and stick to it doggedly.

Over the last few years the evidence base has mounted; static stretching before exercise or sport decreases performance! It decreases strength, speed and power. In addition to that, its effect on injury prevention is still controversial. Does this mean that static stretching has no place in training, not at all, it can be performed at the end of the work-out as part of a cool-down or as a stand-alone session. Static stretching increases flexibility which can improve technique and performance and may decrease injury risk.

Dynamic stretching on the other hand, can be performed as part of the warm-up as it fulfills a lot of a warm-up’s requirements. The active movements help raise the heart rate, increase blood flow to the muscles, increase muscle temperature and pliability, improve coordination and stretch muscles and tendons.

In summary, perform dynamic stretches to warm-up and static stretches to cool-down. Simple!

Best Sources Of Omega-3 Fatty Acids

What are the best sources of omega-3 fatty acids? Before we delve into that, it’s important to distinguish between 3 types of omega-3 fatty acids:

  • alpha-linolenic acid (ALA)
  • docosahexaenoic acid (DHA)
  • eicosapentaenoic acid (EPA)

Our bodies don’t produce ALA, so it’s essential to our diet. We can convert ALA into DHA and EPA but this is limited, so they’re required as well. In brief, we need all three. ALA is found in flaxseed oil (1:3) , canola oil (2:1), soybean oil (7:1), olive oil (3-13:1), butternuts, walnuts, edamame and chia seeds. EPA/DHA are found in oily fish (herring, sardines, mackerel, salmon, anchovies, trout and halibut). Surprisingly, EPA and DHA can also be found in meat and eggs but mainly when the animals were fed on grass rather than grain.

Although the previous post focussed on the anti-inflammatory effects of omega-3s, there are other benefits. They have been found to improve appetite, weight and quality of life in cancer patients. They stimulate blood circulation and decrease systolic blood pressure, reduce the risk of heart attack and help with varicose veins. Lastly, they improve brain function and help with depression and Attention Deficit Hyperactivity Disorder (ADHD). However, like most things in life, omega-3s should be taken in moderation…an excess of 3g of DHA/EPA per day could lead to an increased risk of bleeding, stroke, decreased blood sugar tolerance in diabetics and an increase in low density lipoproteins (LDL). Another concern is the presence of heavy metals and other fat soluble pollutants in fish…healthy eating is good but not simple! Fortunately the benefits outweigh the disadvantages.

The suggested intake of ALA is 1.1g/day (women) – 1.6g/day (men) and for EPA/DHA it’s 2 servings of fish per week (more for those with risk of heart disease).

Omega-3 Fatty Acids Decrease Inflammation

Our diets have changed considerably over time. Today, diets in industrialised countries have a higher composition of saturated fat, trans fatty acids, omega-6 polyunsaturated fatty acids (PUFA) and a lower composition of omega-3 PUFA than ancestral diets. The ratio of omega-6 to omega-3 is around 15:1 and it’s thought that an optimum ratio should be about 1-4:1.

What’s the significance of this? Well, omega-6 PUFA and omega-3 PUFA have opposing effects on our bodies. Put simply, omega-6 PUFA are pro-inflammatory whereas omega-3 PUFA are anti-inflammatory.  Omega-3 PUFA inhibit the metabolism of omega-6 PUFA into inflammatory cells. Inflammation is characterised by the cardinal signs: pain, redness, swelling, heat and loss of function. Although it’s a normal response to infection and injury…inappropriate inflammation can cause problems! Scientists have noticed that the change in our diets has coincided with an increase in inflammatory disease such as nonalcoholic fatty liver disease, cardiovascular disease, inflammatory bowel disease, rheumatoid arthritis, Alzheimer’s disease, etc.

Clinical studies have reported beneficial effects of increased omega-3 PUFA consumption in people with rheumatoid arthritis, inflammatory bowel disease and asthma. Less pain, fewer tender joints, a shorter duration of morning stiffness, a decreased use of non-steroidal anti-inflammatory drugs and an improved physical performance has been observed in people with rheumatoid arthritis. It has also been suggested that omega-3 supplements may be beneficial to patients in intensive care or post surgery. The grandmother’s remedy of taking cod-liver oil for arthritis now seems to make sense!

I would recommend eating foods rich in omega-3 PUFA or taking supplements for any musculoskeletal condition with inflammation and pain. What foods are rich in omega-3? Make sure to check in next week for the answer…

Have Some More Chocolate!

Easter is upon us and as usual, we’re about to indulge in fistfuls of chocolate….so I thought I’d remove the guilt by telling you about some of the potential benefits! Extensive research has shown that the cocoa in chocolate can help: improve arterial blood flow and decrease blood pressure, improve glucose and fat metabolism, and improve vascular and platelet function. A 50% decrease in mortality, mostly due to decreased myocardial infarction, has been seen. The mechanisms underlying the effects are thought to be due to the activation of nitric oxide as well as antioxidant and anti-inflammatory effects.

What type of chocolate is best and how much should we have? It’s been recommended that we eat up to 25g/day of flavanol rich dark chocolate (85% cocoa content) for cardiovascular prevention. The belief is that, at this dose, the effects on weight gain and Cadium intake are minimal.


Enjoy…Happy Easter!

What Else Can Help Lower Blood Pressure?

Last week we discovered that exercise is very effective at decreasing high blood pressure but what else can help? For those with hypertension, you’ll be relieved to hear that there are several things you can do to decrease your blood pressure and cut down the risks of heart disease and stroke.

  • Weight loss. Losing 8kg can decrease your systolic blood pressure (SBP) by 8.5mm Hg and decrease your diastolic blood pressure (DBP) by 6.5mm Hg. A man’s waist circumference should be less than 102cm (90cm for asian men) and a women’s should be less than 88cm (80cm for asian women).
  • Diet. A small reduction in sodium intake can lower blood pressure by 8-10mm Hg. Sodium intake should be restricted to 1500-2300mg in those with hypertension. According to the Mayo Clinic, the DASH (Dietary Approaches to Stop Hypertension) diet can reduce blood pressure by up to 14mm Hg. The DASH diet is rich in whole grains, fruits, vegetables and low-fat dairy products and low in saturated fat and cholesterol.
  • Alcohol. In small amounts alcohol can actually be beneficial for the cardiovascular system but the protective effect is lost if you drink too much. The NHS recommends that “men should not regularly drink more than three to four units a day and women should not regularly drink more than two to three units a day”. Check out this unit calculator if you’re wondering exactly how much a unit is.
  • Smoking and second-hand smoke. Smoking can elevate your blood pressure by about 10mm Hg for up to an hour after smoking.
  • Caffeine. Caffeine has been found to increase blood pressure temporarily but the long-term effects are still unknown. The Mayo Clinic recommend that you drink no more than 2 cups of coffee a day whereas the NHS recommend drinking no more than 4 cups a day. I guess it depends on the type of coffee you’re drinking!
  • Stress. Stress and anxiety can temporarily increase blood pressure so relaaaaax! Yeah, I know, easier said than done…It helps if you can identify the cause and then take some steps to curtail or eliminate it. Breathing exercises, meditation, yoga, exercise, CBT, counselling, etc may help as well.

Remember to check your blood pressure regularly to see how well you’re doing and why not enrol family and friends to offer support and make sure that you stick to the programme!

BBC Horizon’s Truth About Exercise

Last month BBC Horizon ran a programme entitled “The Truth About Exercise”. In it Dr Michael Mosley travelled the country speaking to an assortment of Exercise Scientists. One of the first points made was that it takes a lot of exercise to burn calories. In fact, the example provided was that to burn off a cappuccino, a blueberry muffin and a banana, one would have to jog around a track for about 55 mins! Therefore, to stand any chance of losing weight, we must control what we eat.

Fortunately, exercise can have benefits even when no weight is lost. One of the benefits mentioned was the production of an enzyme that helps redistribute fat in the body and sends it to the muscles where it’s burned. This helps reduce the chance of getting atherosclerosis and possibly death from cardiovascular disease. Other health factors that can be improved are insulin sensitivity and the body’s maximum oxygen consumption (VO2 max). Insulin sensitivity is important because it means that blood glucose levels can decrease more rapidly thereby requiring less secretion of insulin by the pancreas. This reduces the likelihood of developing Type 2 diabetes. As for VO2 max, it’s been found to be a good marker of health and longevity.

Next, Dr Mosley met Jamie Timmons, professor of ageing biology at Birmingham University, and was told how training for 7 mins 3 times a week could deliver many of the health and fitness benefits of hours of conventional exercise! The training is called High Intensity Training (HIT) and resembles interval training. Interval training has been around for a long time and has been used by athletes to increase cardiovascular efficiency and increase tolerance to the build-up of lactic acid. The HIT protocol used on the programme was done on a static bike and consisted of: 2 mins warm-up, 20 secs full-out, 2 mins gentle, 20 secs full-out, 2 mins gentle and 20 secs full-out. This added up to a whopping 7 mins and was done 3 times a week for 4 weeks. It’s thought that this type of exercise can appeal to those that are time poor and need to get it done quickly or simply don’t enjoy it and so want to get it over and done with swiftly…hmmmmmm? It’s at this point that I became curious about exactly how many people fell into this category…so I did a little survey among some of my clients.

First I asked them whether they did any exercise or took part in any sports. Amazingly 95% of them did!

I then asked them how many times a week they exercised or took part in sports. Again I was surprised…an average of 3.6 times a week. I started wondering whether they were trying to please or impress me? Apparently 80% of the population doesn’t exercise regularly!

Finally, I asked them why they exercised? This was the last curveball…the most popular answer was because they enjoyed it…it made them feel good! Other popular reasons were for fitness, health (hypertension, diabetes, back pain) and weight loss.

So unfortunately there didn’t seem to be any takers for HIT. The claims are that HIT can give around 24% improvement in insulin sensitivity and 10% increase in VO2 max. After 4 weeks Dr Moseley did in fact improve his insulin sensitivity by exactly 24% but had no change in his VO2 max. His inability to improve his VO2 max was put down to genetics. According to Timmons, research has shown that 20% of the population doesn’t respond to endurance training.

What do I think about the HIT programme? Well, it paints exercising as a chore, but as the survey showed, most people get more from exercise or sports than just an improved insulin sensitivity…they enjoy it, it makes them feel good…possibly because of the endorphin release or a sense of achievement or accomplishment, maybe even because of social interactions? The HIT programme didn’t place much emphasis on fitness but other HIT protocols have. Gibala’s studies have shown benefits but his protocol was longer and a lot more gruelling…definetly not for everyone. There are many components to fitness: endurance, strength, flexibility, speed, agility, etc and I suppose people in the survey were happy to focus on particular aspects of this.

My main issue with the HIT protocol is its intensity. Pedalling “hell for leather” without a warm-up (not one that can be recognised as one anyway!) seems like a recipe for disaster. As a physiotherapist, I was a little uneasy watching Dr Moseley bounce around on his bike whilst pedalling as hard as he could for 20 secs…he should have known better after pulling a hamstring earlier in the programme when trying to sprint without any earlier warm-up…who knows, he may have felt comfortable doing it because he was surrounded by scientists? Surely this is not something that should be recommended to the sedentary masses?

The main drive of the HIT protocol seemed to be on health (primarily insulin sensitivity) and I think there are better, safer and more convenient ways of achieving this. New research published in the journal Diabetes Care has concluded that after meals, regular short bouts of light-intensity or moderate-intensity walking lower glucose and insulin levels. The subjects were asked to walk around for 2 mins every 20 mins. The light intensity walking decreased blood glucose and insulin levels by 24% compared to uninterrupted sitting. That figure is exactly the same as the one achieved by Dr Moseley after the HIT protocol.

If you enjoy exercise or sport and are happy with the fitness you’re achieving, keep it up! If you don’t enjoy exercise or sport and are mainly doing it for health or weight loss, you’re unlikely to keep going very long. My advice would be to focus on increasing your movement through activities of daily living…this was also talked about on Horizon but it seemed to get much less attention than HIT…in my opinion it’s where the real revolution lies…check in next week to find out more…