PURPOSE: The purpose of this paper was to assess the value of physical exercise in the prevention and treatment of hypertension with particular attention to possible interactions with relative weight. METHODS: We describe epidemiological studies and report meta-analyses of randomized intervention trials, ie, randomized controlled trials on dynamic physical training and randomized comparative trials of exercise and diet. RESULTS: Epidemiological studies show an inverse relationship between physical activity or fitness and the incidence of hypertension, which was either independent of body size or more pronounced in the overweight. The weighted net reduction of blood pressure in response to dynamic physical training averages 3.4/2.4 mmHg (p < 0.001), which appears to be unrelated to the initial body mass index (BMI) and to its training-induced changes. Exercise is less effective than diet in lowering blood pressure (p < 0.02), and adding exercise to diet does not appear to further reduce blood pressure. Future studies should observe scientific criteria more strictly, address the truly obese (BMI >= 30 kg/m2) and attempt to resolve the blood pressure lowering mechanisms. CONCLUSION: Physical activity contributes to the control of blood pressure in overweight as well as in lean subjects.

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