Exercise for hypertension

We all know about the benefits of exercise for our health. But, when we get a diagnosis of any health issue like a heart problem or high blood pressure, the first thing that we start doing is- ‘stop moving’. Did you know that stopping physical activity completely can actually worsen your existing health issue? Science has unearthed innumerable benefits of exercise which help you to prevent and lower the progression of high blood pressure(hypertension).

What evidence tells us about exercise benefits for patients with high blood pressure?

Here is what the evidence tells us about the benefits of exercise:

1. Being physically active and having a good baseline physical fitness are associated with a decreased risk of high blood pressure.
2. Regular exercise has been found to reduce resting blood pressure by 7/6mmHg.
3. Reductions in BP due to exercise are more pronounced in people with high BP than those with normal blood pressure
4. Aerobic exercise also reduces ambulatory BP i.e. blood pressure at any point of the day.
5. Resistance exercises (exercise which involves the use of external weights or bodyweight) and static exercise (exercises which involve muscle contractions but no joint movement) have also been found to lower blood pressure.

What is the exercise prescription for high blood pressure patients?

As one is given a prescription for drugs for hypertension, similarly one should also follow a prescription of exercise. The exercise for hypertension has been explained in terms of the FITT principle (frequency, intensity, time, type)

How often? (Frequency)

Aerobic exercises should be done for 5-7 d/week. In addition, resistance exercise should be done 2-3 d/week and flexibility exercise for more than 3 d/week. Hypertensive patients should exercise more frequently than people with normal blood pressure as even a single exercise session has been shown to bring about a blood pressure reduction by 5-7 mmHg. This BP effect persists for around 24 hours.

How hard? (Intensity)

Patients with high blood pressure are recommended moderate-intensity exercise (11- 14 on a scale of 6(no exertion) to 20 (maximal exertion) or exercises which bring about evident changes in heart rate and blood pressure). If a person can do more vigorous-intensity exercise, it can be done (under supervision), as evidence states that the more vigorous the intensity, the greater is the resultant BP reduction.

How long? (duration)

In the case of moderate-intensity aerobic exercise, a continuous bout of 30-60 minutes/ day is recommended. You could also do intermitted bouts of 10 minutes each interspersed throughout the day. Recent research suggests that continuous bout or intermittent bouts have a similar blood pressure lowering effects.

Which exercises? (type)

• For aerobic exercise, performing rhythmic exercises that involve the use of large muscle groups like walking, swimming, cycling, etc.
• Resistance training should include resistance exercise of large muscle groups (2-4 sets; each with 8-12 repetitions). These include- bench press, shoulder press, stair climbing, theraband exercises, etc
• Flexibility exercises, stretch each large muscle group for 10-30 seconds, and perform 2-4 repetitions for each.

Some pointers before starting an exercise regime

Though exercising is safe for most patients with hypertension but before starting an exercise program, one should undergo a pre-participation screening to see if they are fit to take up this exercise regime.

Once medical clearance is obtained, the patients are recommended to pace exercises gradually, especially if they have been previously sedentary.

Certain antihypertensive medications (diuretics and beta-blockers) may impair body temperature control and cause hypoglycemia during exercise. The doctors should teach about the signs of hypoglycemia, the importance of hydration, proper clothing

Sudden stopping of exercise is not recommended as it may precipitate abrupt lowering of blood pressure which may cause syncope. Certain medications like alpha-blockers and calcium channel blockers may aggravate this effect. Excess drop in BP is more common in the elderly.