Taken together, these previous studies present a mixed picture. One study20 showed comparable BP reductions in exercisers and controls; 2 studies found BP reductions in both groups, but one40 found larger SBP, but not DBP, changes in the exercise group, whereas the other43 found larger DBP, but not SBP, changes in the exercise group; and 2 other studies41,42 found larger BP reductions in the exercise group relative to controls. The final study44 lacked a control group, and did not have sufficient statistical power to detect group differences. In addition, all of the studies were limited because of high dropout rates, unplanned crossover, imprecise measurement of BP or aerobic fitness, or failure to precisely measure other potential confounders. Moreover, only 2 studies20,44 included women. The present study suggests that exercise is associated with modest BP reductions, independent of weight loss, and, in the absence of sex-by-treatment interactions, that women and men achieve significant exercise-related BP reductions. Furthermore, findings indicate that moderate exercise by itself is generally not associated with significant weight loss, and that adding a behavioral weight loss program to an exercise intervention results in even greater BP reductions than the reductions observed with exercise alone. Indeed, while changes in aerobic fitness were correlated with changes in SBP (r=−0.21, P=.04) and DBP (r=−0.27, P=.007), weight loss was even more highly correlated with SBP and DBP changes (r=0.38 and 0.44, respectively; P<.001 for both). These BP reductions are not only statistically significant but are clinically meaningful: 22 (67%) of the 33 participants engaging in exercise and weight loss who met criteria5 for stage 1 hypertension (SBP, 140-159 mm Hg, or DBP, 90-99 mm Hg) at baseline were no longer hypertensive (SBP, <140 mm Hg, and DBP, <90 mm Hg) after treatment compared with 13 (43%) of the 30 who only exercised and 2 (12%) of the 17 controls. When participants with stage 2 hypertension were included (SBP, 160-179 mm Hg, or DBP, 100-109 mm Hg), 23 (55%) of 42 participants in the weight management group, 13 (37%) of 35 participants in the exercise only group, and 2 (11%) of 19 participants in the control group were no longer hypertensive.