Q: I’ve heard that exercise can help control hypertension. How much and what type of exercise is recommended for individuals with hypertension?
A: While drug therapy is traditionally considered
to be the most effective form of treating high
blood pressure, exercising on a regular basis has
been found to be a valuable and safe adjunct
therapy for many people with hypertension. In
fact, a sound exercise program may serve as an
effective non-drug alternative for some people.
Research shows that low-intensity (40 percent
to 70 percent of VoO2 max) aerobic exercise can
lower systolic blood pressure by approximately
11 mmHg and diastolic blood pressure by
approximately 9 mmHg in people with mild-to moderate
hypertension. It is theorized that exercise
lowers resting blood pressure by decreasing
sympathetic nervous system activity. A reduction
in sympathetic nerve activity could lower
one or both of the two principal determinants of
blood pressure, since mean arterial blood pressure
equals the product of cardiac output and
total peripheral resistance.
Over the past 15 years, substantial information
has emerged concerning what constitutes an
appropriate exercise prescription for individuals
with hypertension. When choosing an exercise
program, individuals with hypertension should:
- Avoid exercise if resting systolic blood pressure
exceeds 200 mmHg and/or diastolic
blood pressure exceeds 115 mmHg.
- Emphasize non-weightbearing activities (e.g.,
aquatic activities, stationary cycling) or low impact
aerobic activities (walking, elliptical
cross-training, cycling) if you have lower-body
orthopedic problems.
- Keep the intensity level at the low end of the
intensity range (40 percent to 70 percent of
O2 max or 50 percent to 75 percent of maximum
heart rate [MHR]). Evidence suggests
that higher-intensity exercise (greater than
70 percent of VoO2 max or 80 percent of MHR)
produces no greater reductions in blood pressure
- Use the ratings of perceived exertion (RPE)
scale to monitor exercise intensity if taking
antihypertensive medications (e.g., betablockers)
that influence heart-rate response.
The recommended RPE range is
2 to 4 (weak to moderate).
- Exercise for 20 to 30 minutes per session and
progress to 30 to 60 minutes.
- Exercise at least four times per week
(although exercising on a daily basis is
preferable). A single bout of aerobic exercise
may temporarily reduce blood pressure for
several hours.
- Warm up longer than five minutes to ensure
that the cardiovascular system is prepared
for the upcoming physical activity. This will
reduce the chance of experiencing an abrupt,
sudden rise in blood pressure.
- Perform more than five minutes of cooldown
exercises so that a gradual transition
can be made from the conditioning activity
to the resting state. Cooling down helps to
prevent dizziness, lightheadedness or fainting,
which are frequently associated with
an abrupt cessation of exercise, especially
for those who are taking certain medications
such as vasodilating agents.
- Avoid isometric or high-tension, dynamicresistance
strength-training exercises. All
strength-training exercises should be performed
at a low-to-moderate intensity (i.e.,
able to perform 12 to 20 repetitions per set).
- Maintain normal breathing patterns while
exercising (particularly while engaged in
strength training), since holding your breath
can cause an excessive, transient rise in
blood pressure.
- Start with a prolonged warm-up, especially
before high-intensity, start-stop bursts of
activity (e.g., racquetball, tennis, basketball,
handball).
Finally, make a firm commitment to exercise,
because even a small amount of regular activity
(and the subsequent reduction in blood pressure)
can help diminish the long-term consequences of
high blood pressure. For example, lowering systolic
blood pressure by a mere 2 millimeters of
mercury has been shown to reduce deaths from
stroke by 6 percent, heart disease by 4 percent
and all causes by 3 percent.
The widespread tendency to treat hypertension
pharmacologically has markedly reduced stroke
mortality, but has not significantly reduced the
mortality from coronary heart disease (CHD).
Proper use of a non-drug therapy, such as exercise,
in conjunction with drug therapy can offer
hypertensive patients added protection against
CHD. Exercise has also been shown to favorably
modify other CHD risk factors (e.g., obesity, lipidlipoprotein
profiles and glucose tolerance). In
short, a sound exercise program is an excellent
strategy for helping to treat and prevent high
blood pressure.
Source: Dr. Cedric X. Bryant, ACE's Chief Science Officer; ACE FitnessMatters, Jul/Aug 2006.
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