Exercise against hypertension

When a visit to the doctor's office reveals that you have hypertension, it's likely that your doctor will tell you to 'start exercising'. But what kind of exercise hasn't always been clear.

The American College of Sports Medicine (ACSM) recently released a position statement that provides more details on how physical activity can be used to help control hypertension. The statement appears in this month's Medicine & Science in Sports & Exercise. A team of ACSM experts reviewed best-available evidence to update the previous position stand of 11 years ago.

Their general exercise recommendations for people with high blood pressure:

  • Frequency: Exercise most, if not all, days of the week.
  • Intensity: Moderate. It shouldn't be too easy, but it shouldn't be too difficult.
  • Time: At least 30 minutes of continuous or accumulated physical activity a day.
  • Type: Primarily cardio activity, supplemented with resistance or strength-training exercise. It's OK to increase frequency and duration of exercise, but keep the intensity moderate to get the optimum benefit for your blood pressure, said Linda Piscatello, ACSM vice president.

The exercise scientists arrived at their recommendations based on these and other findings: Long-term studies showed that higher levels of physical activity and fitness were associated with a lower risk of developing hypertension. Cardio exercise combined with resistance training not only lowers blood pressure but also prevents hypertension. The effects of these types of exercise are pronounced in people who participate in one bout of an endurance activity or regular exercise. Blood pressure can be lowered for about 22 hours after endurance exercise.

Yoga and other types of stretching exercises were not included because the scientists decided to focus only on cardiovascular and resistance exercise for the guidelines, Piscatello said.

More detailed advice from the ACSM report:

You need a doctor's thorough evaluation and clearance if you have severe or uncontrolled hypertension before you begin any exercise program. If you have heart disease, you should lessen the intensity of training.

If you are taking medications to lower blood pressure, ACE inhibitors, angiotension II receptor blockers and calcium channel blockers are the drugs of choice for recreational exercisers and athletes with hypertension. But make sure to extend your cool-down period because the medications may cause your blood pressure to drop too much if you abruptly end your workout.

If you are using beta-blockers, be especially careful about heat illness. These medications impair the ability to regulate body temperature.

It's important to remember that these are guidelines, not rigid recommendations. Your exercise prescription needs to be tailored to you. Your doctor will monitor and evaluate your progress.

If you have been sedentary, your physician may recommend that you begin walking, which is a simple exercise that most people can do. If 30 minutes at first feels too overwhelming, it's OK to walk 10 to 15 minutes today. Tomorrow, add another five minutes. Keep adding five minutes as you improve your exercise capacity.