Hypertension and physical activity
Exercise and high blood pressure head - NHS
Other reviews maintain this idea but also reinforce the recommendation of the combination of diet and exercise as effective means to facilitate weight loss Bacon et al. Therefore, if weight loss is desired in addition with BP pressure reductions, then diet should be modified accordingly. Can Exercise Prevent Hypertension? The encouragement of regular exercise is not only useful as a treatment method for individuals with hypertension, but should also be advocated as a means for prevention. Predictors that may be examined to evaluate the risk of developing hypertension include resting BP, family history, and physical activity levels.
Higher physical activity levels have shown an inverse relationship to the development of hypertension. As well, Barengo and associates presented evidence that European men doing equatl to and greater than 4 hours per week of leisure-time physical activities e. Thus physical activity and regular exercise can protect against hypertension. The responses to acute bouts of exercises are the physiological changes that occur within only a few exercise sessions, whereas the chronic adaptations are derived from the accumulation of several continuous exercise bouts over a period of time.
The underlying mechanisms relating to anti-hypertensive benefits are not completely understood, however several studies have shown connections to specific physiological mechanisms. The mechanisms associated with the chronic adaptations to blood pressure are more complex. A recent meta-analysis supports this chronic role being partially explained by a decreased systemic vascular resistance in which the autonomic nervous system and renin-angiotensin system a hormone system that helps normalize long-term blood pressure and blood volume in the body are most likely the underlying regulatory mechanisms Cornelissen and Fagard, a.
Another factor contributing to this decrease in vascular resistance is the increase of nitric oxide production from different sites in the body causing a vasodilation increase in the internal diameter of a blood vessel that results from relaxation of smooth muscle within the wall of the vessel in response to regular aerobic exercise. Final Thoughts The rise in hypertensive patients causes concern and calls for action in the prevention and treatment for this condition.
As hypertension is associated with an increase in risk for cardiovascular disease, it is vital that effective interventions are advocated to reduce overall morbidity and mortality. Although pharmacological treatments can be costly and necessary for treating some BP conditions, lifestyle modifications should also be implemented whenever possible.
The role of exercise has been shown to be consequential in lowering both systolic and diastolic BP. Both aerobic and resistance training have been shown to facilitate anti-hypertensive responses, although aerobic exercise has been more largely studied. END Side Bar 1. Always know what medications your client is taking and how the drugs may affect the exercise training. Single set of 8 to 10 different exercises e.
Perform days per week c. Progress very gradually and do not perform isometric exercises Side Bar 2. Blood Pressure Measurement Recommendations to Follow Although hypertensive clients should always be in contact with their physician to monitor blood pressure, you as a health professional should also periodically measure their blood pressure throughout the training.
Here are six reminders on how to accurately measure blood pressure. This is especially important for children, small adults and obese clients. It is unclear if one side is better for measurement, but for consistency use the same arm for all repeat measurements. Measuring blood pressure needs to be practiced to do accurately. L, Sherwood, A. Effects of exercise, diet and weight loss on high blood pressure.
Sports Medicine, 35 5 , Barengo, N. Low physical activity as a predictor for antihypertensive drug treatment in year-old populations in Eastern and south-western Finland. Journal of Hypertension, 23, Cheung, B. Randomised controlled trial of qigong in the treatment of mild essential hypertension. Journal of Human Hypertension, 19, Cornelissen, V. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials.
Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension, 46, Dickinson, H. Lifestyle interventions to reduce raised blood pressure: a systematic review or randomized controlled trials. Journal of Hypertension, 24, Fagard, R.
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Exercise characteristics and the blood pressure response to dynamic physical training. Fang, J. American Journal of Hypertension, 18, Hagberg, J. The role of exercise training in the treatment of hypertension. An update. Sports Medicine, 30 3 , Halbert, J. However, not all reports made it clear that the trials involving exercise were smaller, and often included people who did not have high blood pressure.
Both these factors make the results less reliable. This was a network meta-analysis of randomised controlled trials RCTs. A meta-analysis pools results of trials, usually looking at the same intervention and outcome. A network meta-analysis is a way of comparing results of trials of different interventions, in this case exercise and medicines, when they have not been compared directly in trials. Researchers searched for the most up to date meta-analyses of trials of blood pressure medicines, and of exercise programmes that measured effect on systolic blood pressure.
Systolic pressure is the pressure of blood as it is pumped out of the heart and through the blood vessels. They also looked for additional RCTs of exercise programmes, published since the most recent meta-analyses. They didn't look for more recent RCTs of blood pressure medicines, as the meta-analyses were considered up to date and no new drugs had come onto the market since the meta-analyses were carried out, so it was unlikely there would be new evidence.
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The researchers divided the medicines group into 5 types of drug: ACE inhibitors, angiotensin-2 receptor blockers, beta blockers, calcium channel blockers and diuretics, and into high or low doses. They divided exercise into endurance aerobic exercise such as walking, jogging and swimming , resistance strength training such as using weights or a combination of both.
They also categorised exercise as high, moderate or low intensity. For each study, the researchers looked at the difference between systolic blood pressure at the start and at the end of the study, for people who'd had the intervention exercise or medicine compared to the control group no exercise or placebo. They used this figure to calculate the average change in blood pressure that could be attributed to the intervention.
They then compared the average change in blood pressure across the different groups exercise, different types of exercise, medicines, different types of medicines. Many people in the exercise studies did not have high blood pressure, or had only slightly raised blood pressure.
All the people in the medicine studies had high blood pressure. Because of this, the researchers looked separately at the effects of exercise on people with high blood pressure only mmHg or over. The researchers included studies looking at exercise with 10, participants and studies looking at medicines with 29, participants.
Exercise 'as good as medicine' for controlling high blood pressure
None of the studies directly compared exercise with medicines. Only 56 of the exercise studies with 3, participants included people with high blood pressure. All types of exercise and all types of medication worked better than the control groups to lower blood pressure.
Programmes which combined endurance and resistance exercise seemed to have the biggest effect. Studies involving exercise were more likely to be subject to bias, however, because of a lack of blinding people in the groups knew whether they were the exercise or control groups. The researchers said their study showed evidence of "modest but consistent reductions in systolic blood pressure across diverse populations and settings" which "appear similar to that of commonly used antihypertensive medications" among people with high blood pressure.
This summary of research adds to evidence that exercise can be a powerful tool to reduce and control blood pressure. It should encourage everyone to do enough physical activity to keep blood pressure at healthy levels. The results do not mean, however, that people should ditch their blood pressure medication. Lowering blood pressure by exercise takes time and may require more sustained exercise than many people are used to.
Anyone taking blood pressure medicines who wants to try to control blood pressure by exercise should talk to their GP first, so they can plan this properly. The review has a number of limitations.
What kind of research was this?
Most importantly, the included studies don't compare exercise and medicines directly, which makes it hard to rely on the indirect comparison between the 2 interventions. Participants in the exercise and medicine studies were quite different from each other — for example, people in the medicine studies had higher blood pressure and were older — so we don't know how well the results translate from one group to another. As the researchers point out, many people currently taking blood pressure medication are on several medicines and have a number of illnesses.