Exercise therapy for hypertensive patients

Hypertension is the most common chronic disease in adults with diabetes, hypercholesterolemia, and obesity. Hypertension is a major risk factor for cardiovascular and cardiovascular diseases such as stroke and coronary artery disease. The higher the blood pressure, the greater the risk of death. It is well documented that lowering blood pressure in people with high blood pressure reduces cardiovascular complications and deaths caused by high blood pressure.

Many lifestyle factors are involved in the development of hypertension, including obesity and lack of exercise. People who lack exercise are twice as likely to develop high blood pressure as those who are physically active. Regular exercise is very effective in the prevention and treatment of high blood pressure, improves conditions such as obesity, hyperlipidemia, and elevated blood sugar that are common in people with high blood pressure, and can reduce cardiovascular complications and death. Therefore, lifestyle control, including diet, exercise and weight control, is the first step to lowering blood pressure and is highly recommended and is the basis for treating hypertension.

Table of Contents

Effect of Exercise Training

Exercise as a treatment for hypertension

Exercise lowers blood pressure, improves cardiopulmonary function, and helps you lose weight. It is also very useful for hypertensive patients by improving blood cholesterol levels and relieving stress. Studies have shown that steady aerobic exercise lowers blood pressure and reduces the risk of developing hypertension by 50% or more than those who do not exercise.

Exercise slows the development of high blood pressure and can be a useful treatment for people with blood pressure. When hypertension patients exercise together, they not only reduce blood pressure, but also reduce the amount of antihypertensive drugs they take by losing weight, controlling the autonomic nervous system, and improving their biological conditions. Therefore, regular aerobic exercise is recommended for hypertensive patients for treatment. Regular exercise is carried out three to five times a week. When you start exercising for the first time, 10 to 20 minutes, then slowly increase the exercise time is 30 to 50 minutes is appropriate. Patients with heart disease or significant health problems should be tested after an exercise load test or a thorough evaluation by a specialist.

Lowering blood pressure through exercise is known to be more pronounced in people with mild (stage 1) hypertension. Therefore, in patients with mild (stage 1) and moderate (stage 2) hypertension, regular exercise should be highly recommended because it improves motor performance and lowers blood pressure. Although there is still a lack of research on the effects of exercise in people with severe hypertension, it is advisable to exercise to maintain their ability.

This continuous exercise reduces blood pressure, but its blood pressure reduction effect is not proportional to the intensity of the exercise. Even low-intensity exercise (40-70% of your maximum oxygen intake) can lower your blood pressure to a significant level, and you can increase your blood pressure reduction by longer exercise time. Therefore, low-intensity exercise prescription is important for people with hypertension who have many diseases, including the elderly and complications. It is known that there is no difference in exercise effects by gender.

It is not clear when exercise should reduce blood pressure. The longer you exercise, the greater your blood pressure reduction, but after three to six months of exercise, your blood pressure will decrease.

Right after exercise, your blood pressure and heart rate rise normally. Depending on the type of exercise, this effect may vary slightly, but aerobic exercise (endurance exercise), such as walking, jogging, biking, swimming, or aerobic gymnastics increases systolic blood pressure but maintains or decreases diastolic blood pressure. However, static strength exercises, such as lifting heavy weights or lifting dumbbells, temporarily raise both systolic and diastolic blood pressure. But if you continue to exercise, your average blood pressure decreases. Studies have shown that after three to four months of regular aerobic exercise, systolic blood pressure drops to 8-10 mmHg and diastolic blood pressure drops to 5-10 mmHg.

Immediately after aerobic exercise by hypertensive patients, systolic and diastolic blood pressure decreases more than usual. Systolic blood pressure can remain low for 60 to 90 minutes, but diastolic blood pressure rises to its previous level within an hour.

Studies have shown that aerobic exercise can reduce the risk of developing high blood pressure in people at high risk of developing it. Endurance exercise has been shown to reduce systolic and diastolic blood pressure by an average of 10 mmHg in patients with mild to moderate hypertension. Even if you have high blood pressure, people who continue to exercise and have a high cardiopulmonary rate have a lower mortality rate than those who do not exercise or have low exercise ability. Even during exercise, strength training is known to lower blood pressure lower than aerobic exercise even for a long time.

In some patients with hypertension, systolic blood pressure may be very high during aerobic exercise, in which case the arteriovascular elasticity is reduced or the sympathetic nervous response is abnormally increased among the autonomic nerves involved in controlling the function of the body. Adjustment is necessary.

Hypertension effect of exercise

1. Epidemiological Basis

A cross-sectional study of adults and children found that people with high performance had low blood pressure. In the Loma Linda Adolescent Blood Pressure Study, the systolic and diastolic blood pressures were lower in the above-average groups, even though the height, weight, and age were corrected. In addition to low blood pressure in people who are engaged in dynamic exercise, a 8.5-year follow-up has shown a 52% lower risk of developing hypertension than the non-exercise group.

2. Prospective Movement Research

Continuous exercise reduces blood pressure, but its effect on blood pressure is not proportional to the intensity of the exercise. In animal testing, blood pressure decreased even though exercise intensity was as low as 40-60% VO2max. Regular exercise below the lactate threshold has also shown a significant decrease in blood pressure. Similarly, circuit training showed a slight increase in VO2max but decreased blood pressure in diastolic hypertension. In other words, low-intensity exercise training (40-70% of the maximum oxygen intake) can lower blood pressure sufficiently.

Lowering blood pressure through exercise is known to be more pronounced in mild (stage 1) hypertension. Exercise has been shown to be more effective in people with mild (1st stage) hypertension, especially when they have increased heart rate and cardiac output, compared with those with moderate (2nd stage) hypertension. The effect appeared in both men and women, with no gender differences. Therefore, in patients with mild to moderate hypertension, regular exercise not only improves athletic performance, but also has a blood pressure-lowering effect. Data on how exercise affects blood pressure in patients with severe (third) hypertension have yet to be investigated and are believed to have no effect on blood pressure reduction. Nevertheless, it is advisable to maintain motor skills even in people with severe hypertension.

It is not known how long exercise should reduce blood pressure. The longer the exercise program lasted, the greater the reduction in blood pressure. However, exercise for three to six months seems to reduce blood pressure.

3. Resistant exercise and blood pressure

In patients with hypertension, it is not advisable to perform resistance exercise alone. The reason for this is that you cannot lower your blood pressure regularly except for circuit training. In people with normal blood pressure, diastolic blood pressure decreased after 9-10 weeks of circuit training. Eight weeks of Olympic-style barbell lifting significantly reduced resting blood pressure.

Circulation training combined with aerobic exercise reduced blood pressure in hypertensive patients. Adolescents with high blood pressure stopped aerobic exercise and continued lifting weights after aerobic exercise normalized their blood pressure.

Therefore, resistance exercise should be part of a well-designed exercise program and should be combined with aerobic exercise.

4. Combination of Medication and Exercise

Because exercise reduces blood pressure, exercise in hypertensive patients can reduce the dose of antihypertensives. Blood pressure decreased from 145 / 97mmHg to 131 / 84mmHg after 10 weeks of circuit training and aerobic exercise in hypertensive patients who did not exercise. In another study, after 10 weeks of aerobic exercise, blood pressure was normal, and blood pressure remained normal even after stopping the medication.

The mechanism by which exercise lowers blood pressure

1. Obesity

Lowering body fat through exercise improves insulin sensitivity, reduces blood insulin levels, and lowers catecholamine levels, which leads to a decrease in blood pressure.

2. Catecholamines

In the early stages of hypertension, catecholamines are hyperfunctional, which decreases with exercise. Therefore, one of the main mechanisms of long-term blood pressure reduction through regular exercise is the reduction of no epinephrine with steady exercise.

3. Insulin

Reducing plasma insulin levels through exercise is also an important mechanism for reducing blood pressure. When insulin levels decrease, sodium is more excreted in the urine by reducing sodium reabsorption in the kidneys and lowers catecholamine levels, which can lower blood pressure.

4. Blood volume change

Reducing plasma levels with exercise is another mechanism of blood pressure control. Exercise raises the atrial natriuretic factor (ANF). The result is a decrease in blood levels of blood, which leads to a decrease in blood plasma levels of renin and aldosterone. In addition, a decrease in plasma insulin levels reduces sodium retention, resulting in a decrease in blood volume.

Exercise and high blood pressure medication

Beta-blockers reduce heart rate response at submaximal and maximal exercise, while calcium antagonists diltiazem and verapamil slightly reduce heart rate, but dihydropyridine, such as nifedipine Derivative calcium antagonists and vasodilators may increase or decrease the heart rate response during submaximal exercise.

Most antihypertensive drugs, with the exception of beta-blockers, do not significantly change the systolic blood pressure response from a single dynamic exercise. Beta-blockers not only reduce the amount of systolic blood pressure rise at baseline, but also reduce blood pressure at rest, reduce pulse and cardiac output, and reduce the amount of blood going to muscle during exercise. Unfortunately, beta-blockers, especially non-selective agents, are often less effective because they reduce exercise endurance in people without myocardial ischemia, reduce blood pressure lowering, triglyceride-lowering and HDL-cholesterol effects from exercise training. .

Antihypertensives, which decrease peripheral blood vessel resistance by expanding blood vessels, can lead to hypotension after exercise. These side effects can be prevented by prolonging the exercise without suddenly stopping the exercise. However, alpha blockers, such as prazosin, can reduce blood pressure during rest and exercise and allow you to exercise without compromising your ability to exercise. Diuretics can lead to a decrease in serum potassium and as a result increase the risk of arrhythmia from exercise.

Calcium blockers and ACE inhibitors reduce left ventricular mass but do not reduce left ventricular function during static exercise such as dumbbell exercise. ACE inhibitors are the best recommended for athletes because they lower peripheral blood vessel resistance, which reduces blood pressure, does not change cardiac output or heart rate, and does not change VO2max. Beta-blockers and alpha-beta blockers reduce the blood pressure-boosting effect in isometric exercises such as dumbbell exercises, but ACE inhibitors do not affect blood pressure responses.

Exercise Program Composition in Hypertensive Patients

In general, exercise prescription in people with high blood pressure is: Basically, regular aerobic exercise can be recommended for people with high blood pressure unless they have severe hypertension or have special exercise restrictions.

1. Type of exercise

In general, we recommend aerobic exercise, which involves rhythmic repetition of the joints and muscles throughout our body for a significant amount of time. Walking, jogging, biking, swimming, gymnastics, jumping rope, tennis, volleyball and aerobics are among the aerobic exercises.

However, care should be taken that isometric exercises, such as lifting heavy ones, can temporarily raise blood pressure. Strength training alone, such as lifting dumbbells or weight lifting, can’t lower your blood pressure alone, so it’s recommended to do a few times a week and 10-15 times in parallel with aerobic exercise as part of a well-designed exercise program. In this case, even if it is lighter than heavy weight, it is recommended to repeat the exercise several times.

2. Intensity of movement

When you exercise, your heart rate gets faster. In general, it’s best to target your target heart rate at 50-60% of your maximum heart rate. The maximum heart rate can be calculated simply with the “220-age” equation.

3. Number of exercises

Regularly three to five times a week.

4. Duration

It is recommended that you start your workout for about 10 to 20 minutes and then gradually extend your workout time for 30 to 50 minutes. It’s a good idea to do warm-up and finish exercises for 5 minutes before and after your workout.

You should continue to exercise, and you should consume at least 150 kcal a day as an aerobic exercise. If you do low-intensity exercise, you should spend more time exercising. To consume 150 kcal per day for an adult weighing 70 kg, you need the following amount of exercise:

Glass and Flooring: 45-60 minutes
Outer phase (normal step): 35 minutes
Basketball: 30 minutes
Biking: 30 minutes
Dancing: 30 minutes
Quick Walk: 20 minutes
Swimming: 20 minutes
Jogging: 20 minutes
Run: 15 minutes
Climb the stairs: 15 minutes

Most people with high blood pressure who do not have complications can safely increase their exercise without having to do special tests beforehand. However, if you have heart disease or risk factors, we recommend that you perform a detailed examination by a specialist, such as an exercise load test, on your exercise prescription and thoroughly evaluate it.

Consider the following parts of your exercise program: If you are older or have poor athletic performance, you can start exercising at a lower level of exercise intensity. Low intensity exercise training (40-70% of your maximum oxygen intake) can lower your blood pressure as much as high intensity exercise. If you have severe (third stage) hypertension with blood pressure higher than 180/110 mmHg, we recommend that you start treatment and add resistance exercise after your blood pressure is controlled to some extent.

Resistance exercise is combined with aerobic exercise.
Do not reduce your blood pressure medication dose until your blood pressure is fully controlled.
After 3-4 months of exercise, you can gradually reduce your antihypertensives.
It is recommended to do circuit training together for strength improvement.
700kcal per week is the initial goal and the long term goal is 2000kcal per week.

Frequently Asked Questions

1. What is the exercise load test?

Standard exercise test methods and protocols can also be used for people with high blood pressure. Persons with two or more of the risk factors for coronary artery disease (men, diabetes, hyperlipidemia, family history of coronary artery disease, smoking), men over 40 years old, and women over 50 years of age should monitor the ECG before starting a severe exercise program. Should be enforced.

Regardless of the intensity of your exercise training, people who have symptoms of cardiovascular disease or have cardiovascular disease should perform an exercise load test while monitoring the ECG before starting an exercise program.

Hypertension patients should use their usual antihypertensive medication when an exercise load test is done to prescribe exercise. Resting systolic blood pressure above 200mmHg or diastolic blood pressure above 115mmHg is a relatively contraindicated exercise test.

If your systolic blood pressure exceeds 260 mmHg or your diastolic blood pressure exceeds 115 mmHg, you should stop testing your exercise.

2. How is the exercise program organized?

People with blood pressure higher than 180/110 mmHg are encouraged to start with medication first and then add resistance exercise when the blood pressure is reduced to an appropriate level. Exercise prescription for people with high blood pressure is as follows.

Form: large muscle exercises (including lower extremity exercises including thigh muscles), aerobic exercise
Frequency: 3-7 days a week
Duration: 30-60 minutes
Strength: 50- 85% of maximum oxygen intake
Muscle exercise (lifting or lifting weights) is combined with aerobic exercise but repeated 2-3 times a week, 10-15 times

Interestingly, exercise at low intensity (40-70% of maximum oxygen intake) can lower blood pressure as well as exercise at high intensity. This low-intensity exercise regimen is important in older people or people with chronic hypertension.

Walking is the most common type of exercise, and moderate walking has the effect of lowering blood pressure. Swimming, jogging and biking have been proven to lower blood pressure.

However, when swimming in the elderly, blood pressure rises after soaking in cold water or just starting swimming, so it is recommended to observe it carefully and measure your blood pressure after exercise. But in middle-aged men and women, blood pressure dropped after 10 weeks of training.

Resistance exercise alone should not be prescribed to hypertensive patients because it does not lower blood pressure consistently except for circuit training.

Therefore, resistance exercise should be prescribed as part of a well-formed exercise program and combined with aerobic exercise.

Even if you do resistance exercise, you should try to do resistance exercise many times with small resistance rather than heavy weight.

Aerobic exercise improves the autonomic nervous system, but resistance exercise does not improve autonomic tone.

After the first 12-16 weeks of regulators, you can gradually reduce your antihypertensives, and you should follow your blood pressure every two weeks to prevent your blood pressure from rising.

However, do not reduce your blood pressure medication dose until your blood pressure is fully controlled.

3. What happens when a hypertension patient exercises?

Immediately after exercise, systolic blood pressure rises more than normal blood pressure, and diastolic blood pressure does not change or rises slightly.
Long-term exercise reduces blood pressure by about 10 mmHg for both systolic and diastolic blood pressure.
Regular aerobic exercise is a preventive way to reduce the incidence of hypertension and is a sure or supplementary treatment for high blood pressure.
Exercise reduces plasma noepinephrine, increases vasodilators in blood vessels, improves hyperinsulinemia, and reduces blood pressure.
Even if you have high blood pressure, people who have a high cardiovascular activity by steadily exercising have a lower mortality rate than those who do not exercise or have poor exercise ability.

4. What role does exercise play in the treatment of hypertension?

By maintaining dynamic exercise, your risk of developing high blood pressure is reduced by 50% compared to people who do not exercise.
Aerobic exercise mainly lowers blood pressure, but circuit training also significantly lowers blood pressure.
You should continue to exercise for 3-6 months to see the effect of lowering blood pressure.
In patients with borderline hypertension, blood pressure decreased even with resistance exercise.
The normalized blood pressure will increase again after you stop exercising, but after 2-3 weeks it will rise back to the level before the exercise.

5. What is the mechanism by which exercise lowers blood pressure?

Exercise lowers blood pressure by reducing obesity and reducing body fat.
Regular exercise reduces blood pressure and no epinephrine.
Exercise reduces plasma insulin levels.

6. What are the precautions when doing exercise test?

An exercise load test should be done before starting exercise.
- Men over 40
- Women over 50
- Those who have two or more of the risk factors for coronary artery disease (man, diabetes, hyperlipidemia, family history of coronary artery disease, smoking)
Exercise test should be done under the supervision of a doctor while monitoring the ECG.
At rest, systolic blood pressure of more than 200mmHg or diastolic blood pressure of 115mmHg is relatively contraindicated in the exercise test.
If your systolic blood pressure exceeds 260mmHg or your diastolic blood pressure exceeds 115mmHg during the exercise load test, you should stop the exercise load test.
If you experience chest pain, severe breathing problems, or muscle spasms during an exercise load test, you should stop the test.

7. What are the precautions when prescribing exercise in patients with high blood pressure?

People with blood pressure above 180 / 110mmHg should start medication and add resistance exercise.
Low intensity exercise training (40-70% of the maximum oxygen intake) can lower blood pressure as much as high intensity exercise.
In hypertensive patients with elderly or chronic diseases should exercise low intensity.
Resistance exercise is combined with aerobic exercise.
Do not reduce your blood pressure medication dose until your blood pressure is fully controlled.
After 3-4 months of exercise, you can gradually reduce your antihypertensives.
It is recommended to do circuit training or weight training together to improve your strength.
700kcal per week is the initial goal and the long term goal is 2000kcal per week.

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