Great point. Comorbidities always require a very nuanced and often a team-based approach. For example, weight loss shouldn't be a strategy for someone who is underweight, rigorous exercise shouldn't be started for someone with angina until cleared by their doctor, and even meditation practices can set off major panic attacks for those predisposed to it.
Gradually working yourself up to a high exercise capacity is one of the most important results of any cardiac rehab program. Some will make it as far as being able to run a marathon after bypass or heart failure. Others may get as far as walking to their mailbox without feeling winded. All of these are wins and what matters is what works the best for the individual.
Stairs for me have always felt moderate but it's always dependent on the individual. The 'perceived' level is what counts. If climbing feels tough for you it's probably high-intensity and not moderate-intensity. Swimming for me is high-intensity even if I'm going 2.5 mph. Rock climbing is almost always moderate.
Really strong, practical list! What I appreciate most is that it treats blood pressure as a system (vascular tone + volume + sympathetic drive), not just a number to “hack”. Two upgrades that make these strategies work in real life:
1. Measure like you mean it. Home BP done correctly (seated, back supported, feet flat, arm at heart level, 2 readings AM/PM for ~7 days) is often more actionable than a single office value. The “diagnosis” and the “response to change” both get clearer when the measurement is clean.
2. Stack the small levers. Most people look for the one magic intervention, but BP usually falls when you layer modest wins: sodium down + potassium/whole foods up (DASH-ish), regular zone 2 + 2–3 days resistance training, weight/waist reduction if relevant, better sleep (especially screening for OSA), and alcohol honestly addressed. Each may be single-digit mmHg, but together they’re often medication-level.
Also love when authors explicitly mention the “why isn’t it budging?” differential; NSAIDs/decongestants, excess alcohol, untreated sleep apnea, kidney disease, primary aldosteronism, thyroid issues, etc. That’s where “lifestyle” meets real medicine!
I'm sceptical that the results are cumulative... Someone doing all these things could easily lower their blood pressure from hypertensive to hypotensive based on these stats, and I don't think it works like that! My gut is that as you layer more and more strategies, they become less and less effective, especially as you become closer to hypotension... I think the evidence is based on the effect of each strategy by itself, not on the effect of them used cumulatively. Happy to be wrong.
Thank you for your thoughts. Just as antihypertensive drugs don't have a linear cumulative effect, I suspect neither do lifestyle interventions. However, I can't imagine that exercising and cutting out salt wouldn't have a lower BP effect than cutting out salt alone. Controlling sleep apnea and managing stress likely would lower BP more than just controlling stress alone.
The best place I can point you is the AFib Cure book which is far more in depth than any article I've ever tried to write on AFib. You can find it under my Book Club list in this link:
The potassium substitute is always interesting to me. Seems like something that could make big differences if implemented in restaurants or if it is more encouraged at the grocery store. I take it the taste is identical. Have you tried it?
I think that's the issue with it - it's not quite the same flavor as regular salt. The good news is that you don't need 100% KCl, even 25% KCl is quite good and you'll hardly notice the difference in taste.
Until it comes in a grinder like my Himalayan pink salt... (Which it doesn't)... I can imagine using it in homemade tomato sauces, but I have a hard time believing it tastes the same... Every other substitute I've tried tastes noticeably different
Thank you for sharing. I am not known for having the most distinguished tastebuds. My wife would probably pick up even one granule of KCl. If the salt substitute doesn't resonate with you, you could try just adding more potassium rich foods. And if that's not as effective, the other 10 items on the list hopefully will move the needle a little.
Also would not be safe or desirable for some folks -eg those with renal impairment
Great point. Comorbidities always require a very nuanced and often a team-based approach. For example, weight loss shouldn't be a strategy for someone who is underweight, rigorous exercise shouldn't be started for someone with angina until cleared by their doctor, and even meditation practices can set off major panic attacks for those predisposed to it.
The exercise prescription for heart failure always puzzled me... We seriously want these folks running marathons???
Gradually working yourself up to a high exercise capacity is one of the most important results of any cardiac rehab program. Some will make it as far as being able to run a marathon after bypass or heart failure. Others may get as far as walking to their mailbox without feeling winded. All of these are wins and what matters is what works the best for the individual.
Would you recommend climbing one flight of stairs up and down for 6 to 8 times as Moderate-intensity cardio exercise. Kindly opine
Stairs for me have always felt moderate but it's always dependent on the individual. The 'perceived' level is what counts. If climbing feels tough for you it's probably high-intensity and not moderate-intensity. Swimming for me is high-intensity even if I'm going 2.5 mph. Rock climbing is almost always moderate.
Really strong, practical list! What I appreciate most is that it treats blood pressure as a system (vascular tone + volume + sympathetic drive), not just a number to “hack”. Two upgrades that make these strategies work in real life:
1. Measure like you mean it. Home BP done correctly (seated, back supported, feet flat, arm at heart level, 2 readings AM/PM for ~7 days) is often more actionable than a single office value. The “diagnosis” and the “response to change” both get clearer when the measurement is clean.
2. Stack the small levers. Most people look for the one magic intervention, but BP usually falls when you layer modest wins: sodium down + potassium/whole foods up (DASH-ish), regular zone 2 + 2–3 days resistance training, weight/waist reduction if relevant, better sleep (especially screening for OSA), and alcohol honestly addressed. Each may be single-digit mmHg, but together they’re often medication-level.
Also love when authors explicitly mention the “why isn’t it budging?” differential; NSAIDs/decongestants, excess alcohol, untreated sleep apnea, kidney disease, primary aldosteronism, thyroid issues, etc. That’s where “lifestyle” meets real medicine!
I'm sceptical that the results are cumulative... Someone doing all these things could easily lower their blood pressure from hypertensive to hypotensive based on these stats, and I don't think it works like that! My gut is that as you layer more and more strategies, they become less and less effective, especially as you become closer to hypotension... I think the evidence is based on the effect of each strategy by itself, not on the effect of them used cumulatively. Happy to be wrong.
Thank you for your thoughts. Just as antihypertensive drugs don't have a linear cumulative effect, I suspect neither do lifestyle interventions. However, I can't imagine that exercising and cutting out salt wouldn't have a lower BP effect than cutting out salt alone. Controlling sleep apnea and managing stress likely would lower BP more than just controlling stress alone.
Could you possibly point out to any non medication forms to control afib attacks? Thanks,
The best place I can point you is the AFib Cure book which is far more in depth than any article I've ever tried to write on AFib. You can find it under my Book Club list in this link:
https://newsletter.drashori.com/p/dr-ashori-book-club?utm_source=publication-search
Any suggestions/source for 8-10 resistance exercises using bands? Ty!
I'm glad you asked. Exercise bands are my favorite.
https://youtube.com/shorts/97i-sDxYGWg?feature=share
The potassium substitute is always interesting to me. Seems like something that could make big differences if implemented in restaurants or if it is more encouraged at the grocery store. I take it the taste is identical. Have you tried it?
I think that's the issue with it - it's not quite the same flavor as regular salt. The good news is that you don't need 100% KCl, even 25% KCl is quite good and you'll hardly notice the difference in taste.
Until it comes in a grinder like my Himalayan pink salt... (Which it doesn't)... I can imagine using it in homemade tomato sauces, but I have a hard time believing it tastes the same... Every other substitute I've tried tastes noticeably different
Thank you for sharing. I am not known for having the most distinguished tastebuds. My wife would probably pick up even one granule of KCl. If the salt substitute doesn't resonate with you, you could try just adding more potassium rich foods. And if that's not as effective, the other 10 items on the list hopefully will move the needle a little.