Whether you consider it fair or not, if you are a commercial driver, being fit is part of your job. In my office, I am interested in total body health and wellness. For this reason, I am one of those chiropractors who actually take blood pressure readings as a normal course of business whenever an exam is being performed. Blood pressure is also a required element of the Federal Motor Carrier Safety Administration physical certification exam that is required to maintain a license to drive a commercial vehicle. Suffice it to say that I see a LOT of elevated blood pressure readings (called “hypertension”) because, well… because I look for them. In a country where 70% of the population is overweight or obese and where heart disease is the #1 leading cause of premature death, it should not be surprising that you will find hypertension if only you would bother to look for it. It is certainly no coincidence that 65% of the U.S. Population over 60 years of age has high blood pressure.
A blood pressure measurement includes an upper number (the systolic pressure which corresponds to the maximum artery pressure that occurs when the ventricles of the heart are contracting) and a lower number (the diastolic pressure which corresponds to the resting period between contractions). Any blood pressure measuring higher than 115 mm Hg systolic or 80 mm Hg diastolic is considered “above normal” in the general healthcare disciplines. When you look at the effect of an average 20 point rise in systolic pressure and/or a 10 point rise in diastolic pressure, studies show that the corresponding risk of a life threatening cardiac event doubles. DOUBLES! 100% increase!. That is huge. In addition, hypertension, while hard on the kidneys and other organ systems, is typically not a primary condition but is instead a result of other disease processes that are already damaging your health elsewhere in your body. So, yeah, blood pressure is a big deal. Especially since 50% of those with hypertension are not aware of it and go untreated in the U.S.
What can you do about it? Lose weight, right? Well, sure. But if it were that easy, heart disease and hypertension and a host of other diseases wouldn’t such a problem as they are in the U.S. The challenge is that if you are overweight, losing weight requires effort. And people often do not make the sustained lifestyle changes that would be needed to improve their health. I often counsel commercial drivers that if they have any concerns about their blood pressure, then they should plan ahead for their certification exams by walking 30 to 45 minutes per day, switching to decaffeinated coffee, drinking lots of water, decreasing the consumption of high fat and high sugar meals, avoiding alcohol and avoiding smoking for at least 3 weeks prior to their exam. This will allow them the best chance to demonstrate a blood pressure that will allow for driver certification (which is actually higher than normal, as the FMCSA only requires them to demonstrate a blood pressure below 140/90 mm Hg).
I’m writing this today to share some research that has caused me to update my recommendations. As it turns out, diaphragmatic exercises, isometric exercises and stretches have been shown in research studies to reduce blood pressure significantly. I will provide references below, but if you want to lower your blood pressure for a commercial driver certification exam, you may want to include the following exercises along with the recommendations I have previously suggested during those 3 weeks prior to your exam:
1. Train the diaphragm – Use a breathing trainer (available on Amazon for as little as $30) to exercise your diaphragm with inspiratory exercises, 30 inhales at a time, twice a day. The diaphragm’s whole job is the manage the pressure in your chest (thoracic pressure) to facilitate breathing. The heart and lungs are both integrally affected by thoracic pressure changes that diaphragmatic function produces. In a small 2019 study, those doing these breathing exercises enjoyed a 10 mm Hg drop in systolic blood pressure while those that did not had no change at all.
2. Isometric exercise – Do isometric exercise (meaning contracting muscles without movement), such as something so simple as the daily squeezing of both fists for two minutes followed by a 3 minute rest and repeated 3 more times . You don’t even need to squeeze hard as the 1992 study that used this approach demonstrated a reduction in blood pressure with the participants only contracting 30% of their capacity. Several studies since the 1992 have demonstrated improvements of 12 to 15 mm Hg in blood pressure resulting from isometric exercise.
3. Stretches – Perform stretches of the calves, quads and hamstring muscles. A 2020 study concluded that this causes a stretch of the arteries triggering remodeling of the inner lining of those arteries and improvement in their production of nitric oxide and better allowing them to normally relax, and significantly improving the participants’ blood pressure readings.
OK, so if you are a driver, you might be thinking, “Aha! That is how I can pass my physical without having to go on blood pressure medicine!”. Well, yes, this may be true. In fact, these studies all showed improvements similar to those resulting from pharmaceutical treatments. But consider what I have recommended in the past…
1. Exercise (walking)
2. Diet (reduce caffeine, reduce intake of dietary fats and sugars)
3. Eliminate toxins such as alcohol and cigarette smoke (both are known carcinogens)
Now, add these items: isometric contractions, breathing exercises, and stretches. These may be just enough to help you pass your certification exam. And if you figure out which has the biggest effect for you, you might gain invaluable insight into what minor lifestyle changes you could make that might help you avoid a future of avoidable diseases and medications.
References to studies regarding isometric exercise, stretches and breathing exercises on blood pressure:
- Wiley RL, Dunn CL, Cox NH, et al. Isometric exercise training lowers resting blood pressure. Med Sci Sports Exerc 1992 Jul;24(7):749-54.
- Bisconti AV, Cè E, Longo S, Venturelli M, Coratella G, Limonta E, Doria C, Rampichini S, Esposito F. Evidence for improved systemic and local vascular function after long-term passive static stretching training of the musculoskeletal system. J Physiol. 2020 Sep;598(17):3645-3666.
- Craighead DH, Heinbockel TC, Freeberg KA, Rossman MJ, Jackman RA, Jankowski LR, Hamilton MN, Ziemba BP, Reisz JA, D’Alessandro A, Brewster LM, DeSouza CA, You Z, Chonchol M, Bailey EF, Seals DR. Time-Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above-Normal Blood Pressure. J Am Heart Assoc. 2021 Jul 6;10(13):e020980
Note: Content of this article was based on reporting by columnist Thomas Michaud, DC in October 2021 Dynamic Chiropractic