HYPERtension Reduction Through WALKing Stairs Versus Brisk Walking

Inclusion criteria

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

• Clinically confirmed hypertension, with or without antihypertensive treatment, as documented in the Electronic Health Record (EHR).
• Overweight or obesity, defined as BMI between 27 and 40.
• 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