Exercise in hypertension

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Exercise is the cornerstone of prevention, treatment and control of blood pressure. People with hypertension should follow therapeutic exercise programs. The programme must be prescribed by specialists and individualised according to the patient.

The exercise in hypertensive patients presents particularities firstly due to diastolic dysfunction, which is frequent because of the usually concurrent cardiac hypertrophy, ischemia, and old age that affect cardiac function and cause disturbances in hemodynamic parameters and secondly due to neuro-hormonal and vascular factors that reduce the endurance of hypertensive in the fatigue of the exercise. At the program planning we should additionally take into account the functional capabilities and the accompanying diseases (ie musculoskeletal problems) of the patients.

The key recommendations in patients with hypertension regard the establishment of regular physical activity in the lifestyle and the control of their body weight.

In respect of the actual exercises, loading exercises, ie weight bearing aerobic exercises (walking, brisk walking, dancing, cycling, swimming) that train major muscle groups are the most important. Exercise at an intensity of 40-70% of the maximum heart rate appears to reduce blood pressure equally or even more than a more intensive training. The duration of an exercise program should range from 30 to 60 minutes and the frequency from 3 to 7 times per week. A daily aerobic exercise is ideal, because by this way hypertensive patients take advantage of the decrease of blood pressure that follows the exercise and that lasts for hours. Strengthening exercises (with resistance) complement the programs and are of secondary importance. The latter exercises consist of strengthening exercises with low resistance of about 40% of the weight of the maximum force, i.e. the weight that the patient could hypothetically raise at one repetition. A set of 15 repetitions is necessary for large muscle groups.

Brisk walking is an excellent exercise for Hypertension

It should be noted that during the execution of the programs, the following key points require special attention:

The athletic activities should not be initiated if either the resting systolic blood pressure is greater than 200 mmHg or the diastolic one is greater than 110 mmHg.

Regarding the interaction of exercise with medications taken by hypertensive patients, it is well known that diuretics may potentially cause arrhythmia during exercise, while also disturbing the thermo-regulation in a warm environment that is also caused by the beta-blockers, which additionally reduce the functional capabilities during exercise. Moreover, both alpha-blockers and calcium channel blockers could cause hypotension after exercising so a period of relaxation is necessary at the end of the exercise programme.

There are different <risks> personalized according to the rates of the systolic and diastolic pressure of the exerciser. The above suggests that the hypertensive patients benefit from exercising, although its performance should be properly planned and based on scientific criteria, so that patients can benefit without additional risks for their health.

Yannis Dionyssiotis, MD, PhD, e-mail:yannis_dionyssiotis@hotmail.com
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