(2002) showed statistically significant improvements in blood pressure for interventions involving at least 120 minutes/week of aerobic exercise; magnitude of effect was clinically meaningful for SBP and DBP.[121] Kelley et al. (2001) also showed statistically significant improvements in blood pressure; furthermore, a meta-regression showed that increased minutes of exercise per session were associated with greater reductions in blood pressure.[120] Based on the assessment of the quality of the evidence put forth in the 2014 VA/DoD HTN CPG,[120,121] the Work Group determined the confidence in the quality of evidence is moderate for SBP and low for DBP. Benefits clearly outweigh the harms, although some patients may dislike, or have limited ability to, exercise. c. Dietary Modifications Recommendation 20. We recommend a dietitian-led Dietary Approaches to Stop Hypertension Diet for the treatment or prevention of hypertension for patients with hypertension or interested patients with other cardiovascular risk factors. (Strong for | Not Reviewed, Amended) Discussion Clinical trials on supplements frequently produce different or even opposite results than those expected based on epidemiologic data showing associations between food constituents and health outcomes. As individuals consume whole foods rather than isolated nutrients, it is more useful to confirm that a pattern of whole foods confers benefit, rather than that a micro/macronutrient is beneficial dependent on context. Fiber and various micronutrients such as potassium, magnesium, and calcium are thought to improve blood pressure based on epidemiologic data. The DASH trial represents the first major clinical trial to test a dietary pattern for the prevention and/or management of HTN. The DASH trial emphasized inclusion of these nutrients via commonly consumed foods rather than supplements.[122] This approach allows for the detection of potential additive and/or synergistic effects of these nutrients which might individually be too small to detect. 