Lowering blood pressure by adding stair climbing to brisk walking

HYPERtension Reduction Through WALKing Stairs Versus Brisk Walking in Individuals With Increased Cardiometabolic Risk - The HYPERWALK Randomized Controlled Trial

We will test whether adding short daily stair climbing to a brisk-walking program lowers systolic blood pressure in adults 35 and older who have high blood pressure, are overweight, and are not regularly active.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 450 (estimated)
• Ages: 35 Years and up
• Sex: All
• Sponsor: Karolinska Institutet (other)
• Locations: 4 sites (Stockholm and 3 other locations)
• Trial ID: NCT06952348 on ClinicalTrials.gov

What this trial studies

This randomized trial assigns adults with hypertension and BMI 27–40 to one of three groups: stair climbing plus brisk walking, brisk walking alone, or standard lifestyle advice, with randomization stratified by age (<65 vs ≥65) and site. The stair-climbing group is asked to climb ≥250 steps per day (or equivalent elevation) plus complete ≥75 minutes of brisk walking per week, the brisk-walking group targets ≥75 minutes per week, and the control group receives usual lifestyle advice without specific exercise targets. The primary outcome is change in systolic blood pressure, and secondary outcomes include other cardiometabolic risk factors. The trial is conducted at Karolinska University Hospital and affiliated primary care and outpatient cardiology clinics in Stockholm.

Who should consider this trial

Good fit: Adults aged 35 years or older with clinically confirmed hypertension, a BMI of 27–40, and a physically inactive lifestyle are the intended candidates for this protocol.

Not a fit: Individuals with medical contraindications to physical activity (for example severe aortic stenosis, recent myocarditis, suspected aortic dissection, or very high uncontrolled blood pressure), those already regularly active, or those outside the study's age or BMI ranges are unlikely to receive benefit from joining.

Why it matters

Potential benefit: If successful, adding brief daily stair climbing could provide a simple, low-cost way to achieve larger reductions in systolic blood pressure and improve cardiometabolic risk compared with brisk walking alone.

How similar studies have performed: Brisk walking is well-established to lower blood pressure, and smaller studies suggest stair climbing can improve fitness and metabolic markers, but large randomized evidence specifically comparing stair-plus-walking to walking alone is limited.

Eligibility criteria

Inclusion Criteria

Men and women aged 35 years or older with increased cardiometabolic risk, defined by all of the following:

1. Clinically confirmed hypertension, with or without antihypertensive treatment, as documented in the Electronic Health Record (EHR).
2. Overweight or obesity, defined as BMI between 27 and 40.
3. Physically inactive lifestyle, defined as either:

   * Light intensity or inactive category on the Stanford Brief Activity Survey (SBAS), or
   * Light intensity or inactive category in the physical activity section of the Swedish National Board of Health and Welfare Lifestyle Questionnaire.

Exclusion Criteria

Medical contraindications to physical activity (based on FYSS 2021, p. 182):

* Severe, symptomatic aortic stenosis
* Acute pulmonary embolism, myocarditis, pericarditis, or systemic infection (e.g., fever, muscle pain, lymphadenopathy)
* Suspected or known aortic dissection
* Severe hypertension (Grade 3: SBP \>180 mmHg or DBP \>110 mmHg), regardless of symptoms
* Unstable coronary artery disease (including unstable angina, suboptimally treated stable angina, or recent myocardial infarction \<8 weeks)
* Symptomatic, uncontrolled arrhythmia
* Symptomatic, uncontrolled heart failure

Other exclusion criteria:

* Implanted pacemaker or ICD
* Pregnancy
* Smartphone incompatibility with Fitrockr© app (iOS \<16 or Android OS \<10)
* Inability to understand Swedish or English
* Any condition that may interfere with protocol compliance (e.g., severe mental illness or cognitive impairment)
* Inability to walk stairs

Where this trial is running

Stockholm and 3 other locations

• Karolinska Universitetssjukhuset Huddinge — Stockholm, Sweden (NOT_YET_RECRUITING)
• Liljeholmen Primary Care Center — Stockholm, Sweden (RECRUITING)
• Södersjukhuset — Stockholm, Sweden (NOT_YET_RECRUITING)
• Södertälje sjukhus — Stockholm, Sweden (NOT_YET_RECRUITING)

Study contacts

• Study coordinator: Carl Johan Sundberg

Conditions: Metabolic Disease, Cardiovascular Diseases, Hypertension, Obesity and Overweight, Cardiovascular prevention, Physical activity, Smart medicine, Obesity