HYPERTENSION
INTRODUCTION:
Chronic primary hypertension (essential
hypertension is defined as having a resting
systolic blood pressure >140mmHg and/or a
resting diastolic blood pressure >90mmHg.
Thisis confirmed by a minimum of two
measures taken on at least 2 separate days,
or taking antihypertensive medicine for the
purpose of hypertension.
Primary hypertension accounts for 95% of all
cases.
Some antihypertensive medications may
affect the physiological response to exercise
and therefore must be taken into
consideration during exercise testing and
when prescribing exercise.
Alsothere should be emphasize on lifestyle
modifications that include habitual physical
activity as initial therapy to lower BP and to
prevent or attenuate progression to
hypertension in individuals with pre-
hypertension.
EXERCISE TESTING:
IfBP is not controlled, the individual should
consult with their physician prior to initiating
an exercise program to determine if an
exercise test is needed.
Individuals with stage 2 hypertension or with
target organ disease must not engage in any
exercise or exercise testing without medical
testing and adequate medical management.
A medically supervised symptom limited
exercise test is recommended prior to
engaging in an exercise program.
When exercise testing is performed for the
specific purpose of designing the exercise
treatment, it is preferred take their usual
antihypertensive medications.
Individuals with beta-blocker therapy are
likely to have an attenuated HR response to
exercise and reduced maximal exercise
capacity.
Individuals on diuretic therapy also might
experience hypokalemia and other
electrolyte imbalances or potentially a false
positive exercise test.
EXERCISE PRESCRIPTION:
Chronic aerobic exercise of adequate intensity,
duration and volume that promotes an increased
exercise capacity leads to reductions in resting
SBP and DBP.
Also it causes reductions in exercise SBP at
submaximal workloads.
Regression of cardiac wall thickness and left
ventricular mass have been reported in
individuals participating in regular aerobic
exercise training.
Also, a lower left ventricular mass in individuals
with pre-hypertension and a moderate-to-high
physical fitness, have been reported.
Emphasis should be placed on aerobic
activities; however these may be
supplemented with moderate intensity
resistance training.
Flexibilityexercise should be performed after
a thorough warm-up or during the coo-down
period following the guidelines for healthy
adults.
FITT PRINCIPLE:
FITTrecommendations for individuals with
hypertensives as per the ACSM guidelines
includes prescription of:
AEROBIC TRAINING.
RESISTANCE TRAINING.
FLEXIBILITY TRAINING.
AEROBIC TRAINING:
FREQUENCY: 5-7 days/week.
INTENSITY:
Moderate 40-59% of VO2R or
HRR; 12-13 RPE on Borg scale.
TIME:>30 mins/day of cont. or accumulated
exercises. If intermittent exercise performed,
begin with min of 10 min bouts.
TYPE:prolonged rhythmic activities using
large muscle groups such as walking,
cycling, swimming.
RESISTANCE TRAINING:
FREQUENCY: 2-3 days/week
INTENSITY:
60-7-% of 1RM; may progress to
80% of 1RM. For elderly and beginner start
with 40-50% of 1RM
TIME:
2-4 sets of 8-12 repetitions for each of
the major muscle groups.
TYPE:Resistance machines and free weights
and/or body weights.
FLEXIBILITY TRAINING:
FREQUENCY: > 2-3 days/week.
INTENSITY:Stretch to the point of feeling
tightness or slight discomfort.
TIME:Hold static stretch for 10-30 seconds;
2-4 repetitions of each exercise.
TYPE:Static stretching, dynamic stretching
and/or PNF stretches.
EXERCISE TRAINING
CONSIDERATIONS:
Levelof BP control, recent changes in
antihypertensive drug therapy, medication
related adverse effects, the presence of target
organ disease, other co-morbidities and age.
Gradual
progression with each of the FITT
components.
An exaggerated BP response to relatively low
exercise intensities and at HR levels of <85%
of the age related HRmax is likely to occur.
It
is wise to maintain SBP<220mmHg and
DBP<105mmHg when exercising.
Moderateintensity exercise is generally
recommended to optimize the benefit-to-risk
ratio.
Inhaling and breath holding while engaging
in the actual lifting of a weight i.e. valsalva
maneuver can result in extremely high BP
responses, dizziness and even fainting.
Thus such practice should be avoided during
resistance training.
SPECIAL
CONSIDERATIONS:
Exercisetesting and vigorous intensity
exercise training for individuals with
moderate to high risk for cardiac
complications should be medically
supervised.
Beta-blockers and diuretics may adversely
affect thromboregulatory functions.
Beta-blockers may also increase the
predisposition to hypoglycaemia in certain
individuals and also mask some of the
manifestations of hypoglycaemia.
Beta-blockers may reduce submaximal and
maximal exercise capacity primarily in
patients without myocardial ischemia.
The peak HR achieved during a standardized
exercise stress test should then be used to
establish the exercise training intensity.
If the peak HR is not available, RPE should
be used.
Antihypertensive medication may suddenly
lead to sudden excessive reductions in post-
exercise BP.
Therefore termination of the exercise should
be gradual until BP and HR return to near
resting levels.
The exercise related BP reduction is
independent of age.
Therefore older individuals experience
similar exercise induced BP reductions as
younger individuals.
The BP lowering effect of aerobic exercise
are immediate, a physiologic response
referred to as postexercise hypotension.
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