European Journal of Cardiovascular Medicine

Physical activity (PA) is very important for heart health, especially during adolescence, when the body and mind are going through a lot of changes.  Research with groups of teenagers has shown that regular physical activity has a big preventive effect against long-term diseases like “high blood pressure, coronary artery disease, and type 2 diabetes”.  These benefits are especially important for young people since risk factors for heart disease that show up at this age can last into adulthood and lead to disease [1, 2].  More and more health specialists are realizing that developing physical activity habits as a teenager not only helps with immediate physical growth but also lays the groundwork for a lifetime of good health.  Recent studies show that there is a link between “physical activity (PA) and blood pressure (BP)” changes in teens. Moderate to vigorous physical exercise is consistently linked to decreased systolic and diastolic BP levels [3, 4].  For example, research of populations and treatments show that routinely doing moderate to vigorous physical activity decreases blood pressure and lowers the chance of developing high blood pressure in teens and adults.  On the other hand, some studies show that too much or very intense activity can temporarily raise blood pressure because of changes in the body, like increased sympathetic activity or stiffer arteries. However, it is still unclear whether these changes are harmful or just a normal adaptation [5, 6].  Most people still agree that being physically active is good for the health of young people's blood vessels.  There are many ways that PA can help regulate BP, such as by improving endothelial function, lowering peripheral vascular resistance, and making the heart work better.  Aerobic exercise, in particular, has been found to have a positive effect on these physiological parameters, causing both short-term and long-term drops in blood pressure in both hypertensive and normotensive teens [6].  PA also helps control other cardiovascular risk factors that are linked to each other, like obesity, lipid dysregulation, and insulin resistance. This makes its preventive benefits even stronger.  To get an accurate picture of how physical exercise affects health, it is important to measure it.  Standardized measures like metabolic equivalents (METs) give researchers a strong way to measure energy use across different levels of activity. This lets them look at dose-response correlations with BP and other health outcomes [7].  Self-report questionnaires and accelerometry are two common ways to collect data, but researchers are still working to improve these tools so that they are more accurate and can be used with a wider range of adolescents [8].  Diet, screen time, study habits, and sleep duration are some of the contextual and behavioral factors that also affect the connotation between PA and BP in young people. This shows how important it is to take a whole-person approach to assessing cardiovascular risk and promoting health [9].  There are also variances between men and women that make things even more complicated. Men tend to do more intense physical activity and have different cardiovascular risk profiles than women [10].  These small differences show how important it is to have personalized interventions that take into account not just activity level but also lifestyle habits and sociodemographic factors.

Study Design and Participants

This study looked at the relationship between blood pressure and how often youth move around. The study was conducted at Abeer Medical Center, Sharafiya branch in Jeddah, Saudi Arabia. We got 480 youths to fill out the "International Physical Activity Questionnaire (IPAQ)" and then classified them into three groups based on how much physical activity they did: “low physical activity (low PA), moderate physical activity (moderate PA), and high physical activity (high PA)”.

Physical Activity Assessment

The IPAQ long-form questionnaire was used to quantify physical activity. It asks about different levels and types of activity, like walking, moderate and intense exercise, and sitting about doing nothing.  We used the IPAQ answers to figure up metabolic equivalents (METs), which measure how much energy you use.  Then, depending on the scoring levels set by IPAQ guidelines, the participants were put into groups of low, moderate, or high PA.

Data Collection

We employed standard ways to get anthropometric data, like height, weight, and the sizes of the waist and hips.   We found the body mass index (BMI) by taking the weight in kilograms and dividing it by the height in meters squared (kg/m²).   An automatic sphygmomanometer was used to test the participants' blood pressure after they had been sitting still for at least five minutes.   We conducted three measurements and noted down the “average systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (the difference between SBP and DBP)”.   At the same time, the heart rate was checked.

Lifestyle and Behavioral Measures

Participants reported their daily time spent on various activities, including studying hours, television viewing, sports participation, hobbies, and overall leisure time. These self-reported measures were aimed at contextualizing physical activity levels with other lifestyle behaviors.

Statistical Analysis

We employed descriptive statistics to describe demographic, anthropometric, cardiovascular, and lifestyle characteristics for the three PA groups.  We used analysis of variance (ANOVA) for continuous data & chi-square tests for categorical variables to look at differences between groups.  We used Pearson correlation coefficients to look at the relationship between METs (both total and vigorous) and clinical or lifestyle factors such blood pressure, heart rate, gender, and time spent on study or leisure activities.  For all analyses, a p-value of less than 0.05 was used to determine statistical significance.

Ethical Considerations

The relevant institutional review board gave its approval for the study protocol.  Before they could join, all participants and their guardians gave their informed consent.  All techniques followed ethical guidelines for research that involves people as subjects.

This study aimed to inspect the relationship between varying levels of physical activity and blood pressure among adolescents. Participants were categorized into three groups according to their physical activity levels assessed via the “International Physical Activity Questionnaire (IPAQ)”: “low physical activity (low PA), “moderate physical activity (moderate PA)”, and “high physical activity (high PA)”. The study assessed not only the cardiovascular parameters across these groups but also examined their daily behaviors such as studying, leisure activities, and sedentary habits. The demographic and anthropometric characteristics of the adolescent groups were largely similar, indicating a comparable baseline in terms of age, height, weight, waist-to-hip ratio, and body mass index. Family history of hypertension was also equally distributed among the groups, ruling out hereditary bias. Despite these similarities, significant differences emerged in key cardiovascular indicators. Notably, adolescents with high levels of physical activity demonstrated significantly higher systolic blood pressure and pulse pressure when compared to their low PA counterparts. While diastolic blood pressure did not show significant variation, heart rate notably decreased as physical activity increased. The prevalence of prehypertension & hypertension was also highest among the high PA group, suggesting a complex interplay between vigorous activity and blood pressure regulation in this population.

Table 1. Demographic, anthropometric, and cardiovascular characteristics according to physical activity group.

Beyond cardiovascular parameters, patterns of daily activity and sedentary behavior varied markedly among the groups. As expected, total metabolic equivalents (METs) increased significantly with higher physical activity levels, indicating greater overall energy expenditure. Adolescents in the high PA group dedicated more hours to sports and hobbies, activities which likely contributed to their elevated PA scores. Conversely, time allocated to studying showed a significant decline with increasing physical activity, suggesting a trade-off between academic activities and active leisure. Television viewing hours, a common sedentary behavior, did not differ significantly across groups, indicating that leisure screen time was independent of overall physical activity levels. Total leisure time, which encompassed all non-study and non-sport recreational periods, was also higher among those with greater PA.

Table 2. Patterns of daily activities and total metabolic equivalents (METs) across physical activity groups.

Gender differences were analyzed to further understand PA patterns. While no statistically significant variations were found between males and females in the low and moderate PA groups, the high PA group demonstrated significant gender disparities in participation in vigorous activities, with males engaging more frequently in high-intensity physical activity. This finding may help to explain some of the physiological differences observed in cardiovascular measurements. Univariate analyses explored correlations between vigorous METs and key health and lifestyle variables. Vigorous METs showed positive correlations with systolic blood pressure & pulse pressure, reinforcing the observed relationship between higher intensity activity and elevated BP parameters. Additionally, vigorous METs were positively correlated with time spent on hobbies and leisure, and negatively correlated with gender (indicating males were more active vigorously), heart rate, and hours dedicated to studying.

Table 3. Univariate correlations between vigorous physical activity and selected clinical and lifestyle parameters

When examining total METs, similar patterns of association were found. Total METs positively correlated with systolic blood pressure, pulse pressure, time spent on hobbies, and leisure time. Conversely, total METs were negatively correlated with gender (reflecting higher METs in males), heart rate, and hours spent studying. These consistent associations support a model in which increased physical activity intensity elevates certain cardiovascular markers while simultaneously correlating with lifestyle behaviors reflecting higher engagement in active leisure and lower sedentary time.

Table 4. Correlations of total metabolic equivalents with clinical and lifestyle factors.

The present study enriches the growing body of literature exploring the nuanced “relationship between physical activity (PA) and blood pressure (BP)” regulation among adolescents. Tsioufis et al. observed, “vigorous exercise is associated with higher systolic BP and pulse pressure levels in youth,” showing a clear dose–response relationship between activity intensity and these cardiovascular parameters. Similarly, Mohammed et al. detail that exercise-induced hypertension (EIH) is common among athletes and healthy individuals, describing a rise in BP during exercise that results from increased sympathetic activity, changes in arterial compliance, and the activation of the renin-angiotensin-aldosterone system, which collectively elevate blood pressure and pulse pressure during and possibly after vigorous activity [11]. Further research indicates that as exercise intensity increases, systolic blood pressure rises linearly as a result of elevated cardiac output and stimulation of the sympathetic nervous system, whereas diastolic blood pressure remains stable or may experience a slight decrease due to vasodilation in active muscles.  These physiological responses are typically benign and indicate a "training effect" rather than a pathological condition.  Studies highlight the necessity of monitoring, as elevated blood pressure during or following exercise may indicate potential long-term cardiovascular risk in certain individuals [12]. Our observations are corroborated by longitudinal cohort and intervention studies, which report that both the frequency and intensity of PA contribute meaningfully to healthy BP trajectories during adolescence and into adulthood [13]. Notably, meta-analyses and systematic reviews confirm that PA interventions, particularly when combined with nutritional and behavioral strategies, yield the greatest reductions in both systolic and diastolic BP [3]. This comprehensive approach supports the idea that lifestyle modification, rather than PA alone, constitutes the most effective strategy for BP control and cardiovascular risk reduction in youth. A particularly salient aspect of our findings relates to the detrimental impact of sedentary behavior. In both boys and girls, sedentary activity patterns—including screen time and inactivity—were linked to higher BP, especially when coupled with obesity or unhealthy dietary habits [14]. The fact that these risk behaviors cluster together shows how complicated cardiovascular health is in teens and how important it is to have interventions that target physical activity, sedentary behavior, and eating habits.  Our data also show that males who mostly conduct sedentary activities are more likely to develop high blood pressure. However, the links in girls may be affected by distinct physiological or behavioral changes, which is what recent epidemiological studies have found [15].  There were also major differences between men and women.  Boys reported more robust physical activity and had different blood pressure patterns than females, who generally did less intensive activity and were more likely to be sedentary. This is in line with prior findings.  Also, while PA helped lower BP in both men and women, the strength and kind of the link were different, which could be due to hormones, behavior, and social variables [16].  These differences show how important it is to use gender-sensitive methods in initiatives for promoting teen health and managing blood pressure.  The way measurements are taken is also important.  Using standardized self-report questionnaires and proven measures like metabolic equivalents (METs) makes it easier to compare our results to other studies. However, the choice of instruments can affect how strong the links are between PA and BP [17].  Accelerometry and other objective metrics may help future studies be more accurate.

This study demonstrates that there is a convoluted connection between teens' heart health and how much they exercise.   Higher levels of physical activity, especially hard exercise, were connected to higher systolic blood pressure and pulse pressure.  But they were also connected to a decreased resting heart rate, which implies the heart was operating better.  health.  These results suggest that high blood pressure among active teens may be a normal response of the body rather than a bad thing, but further research is needed to be sure.  People who were more active spend more time on sports and hobbies and less time studying. This is because being more active changes how people live their lives.  Differences between men and women in how much strenuous activity they do also show how important it is to think about demographic considerations when looking at cardiovascular responses.  Overall, the results show how important it is to find the right balance between the intensity of exercise and the specific features of young people to improve their heart health. Longitudinal studies are essential to clarify the long-term impact of different activity levels on adolescent blood pressure and overall cardiovascular risk, ultimately guiding tailored recommendations for healthy development.

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