# NIH grant: MOVE-BP: A MOST Framework Trial Evaluating the MOst effectiVe Exercise types for Blood Pressure control (1R61HL189298-01) — retained record

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NIH grant 1R61HL189298-01: MOVE-BP: A MOST Framework Trial Evaluating the MOst effectiVe Exercise types for Blood Pressure control
Institute: {'code': 'HL', 'abbreviation': 'NHLBI', 'name': 'National Heart Lung and Blood Institute', 'admin_org_id': '12500068', 'admin_funding_url': ''}. PI: Deepika  Laddu. Award: $1076003.
Start: 2026-09-05T00:00:00.
PROJECT SUMMARY/ABSTRACT
Nearly one-third of hypertension cases are preventable through exercise alone. Yet among the more than 30
million U.S young adults with stage I hypertension, fewer than 10% achieve BP control, and up to half progress
to stage II within five years. While moderate-to-vigorous intensity aerobic training (AT) is first-line therapy, up to
40% of individuals, especially those with stage I hypertension, show little or no benefit. Current guidelines
continue to emphasize generic AT prescriptions, overlooking physiological variability that may influence exercise
effectiveness. Resistance training (RT), including dynamic (DRT) and isometric (IRT) types, is also guideline-
recommended for managing hypertension, and can lower systolic BP as much as—or even more than AT. DRT
and IRT engage different physiological pathways—systemic vs. localized vascular adaptations—suggesting their
BP effects may differ. However, most RT trials only assess BP as a secondary or tertiary outcome and focus on
older populations, limiting generalizability given known differences in vascular biology, and risk factor profiles in
young adult hypertension. Indeed, lifestyle trials most often test exercise types (components) in isolation or as
bundles (e.g., AT + RT) without systematically evaluating which components drive BP reduction. This leaves
critical gaps in understanding which exercise components or combinations thereof are most effective, and by
what mechanisms. A component-specific approach is necessary to move toward a more tailored, effective
exercise treatment strategy for stage I hypertension. To address these gaps, we will apply the Multiphase
Optimization Strategy (MOST), an efficient factorial framework adapted from engineering, to identify and optimize
intervention components—AT, DRT, and IRT—alone and in combination, for maximal systolic BP reduction in
young adults with stage I hypertension. In the R61 phase (year 1), we will finalize protocols, establish trial
infrastructure, and enroll the first 25 participants to facilitate R33 transition. In the R33 phase (year 2-5), 264
adults aged 18-44 years eligible for lifestyle therapy only, will receive a core intervention (Fitbit + standard BP
health education) and be randomized into one of eight remotely delivered conditions, with each testing AT, DRT,
and IRT alone or across all possible combinations. Aim 1 will identify which exercise components or combinations
most effectively reduce systolic BP at 6 months, with follow-up at 12 months to evaluate maintenance of BP
effects and exercise adherence. Aim 2 will examine whether improvement in arterial stiffness, endothelial
function, and carotid artery distensibility mediate BP change, and whether individual-characteristics (age, sex,
race, body weight, diet quality) moderate exercise component effects. By moving beyond “whether exercise
works” to identifying “which exercise components are most effective, and by what mechanism,” this study will
generate critical evidence to inform the development of optimized, scalable exercise treatment packages for
hypertension control and long-term cardiovascular disease prevention in young adults.
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