Exercise Prescription

The exact type and amount of training required to optimally lower blood pressure (BP) is unclear, however the summary table at the bottom has been recommeneded to promote and mainain adult health and lower BP in patients with hypertension.

Aerobic Exercise

Frequency
Exercise Sports Science Australia (ESSA) recommend that a mix of moderate to vigorous aerobic activity by undertaken up to 5 days/week in addition to resistance training on 2 more non-consecutive days/week [1] . In addition, to all research analysed producing significant improvements in BP from aerobic exercise[2] [3] [4] [5] [6] [7] (Tsai, et al., 2004), it is recommended that if only aerobic exercise is undertaken, then it should be undertaken a minimum of three days a week. However, due to the majority of exercise being conducted at an average VO2 or HR reserve of 70% for 40-50 minutes, if the intensity is unable to be held (such as walking) than exercise should be conducted more than three times a week.

Duration
Majority of studies examined conducting aerobic exercise, completed exercise for at least 40 minutes at each session [8] [9] [10] [11] [12] . It would therefore be fair to recommend that exercise be conducted for at least 40minutes, or 60 minutes including a 10 minute warm-up and warm-down.

Mode & Intensity
Research conducted by Jones and colleagues discovered that interval training (three 10 minute bouts) reduced BP by a greater amount then continuous exercise (30minutes of continuous cycling)[13] . However, research conducted by Guimaraes and colleague indicated that both types of exercise produced similar considerable reductions in BP, although only interval training (40 minutes on a treadmill with intensity alternating between 50% (2min) and 80% (1min) of reserve HR) significantly decreased arterial stiffness[14] . While both interval and continuous exercising are beneficial in reducing BP considerably, as research indicates that only interval training considerably reduces BP and arterial stiffness, interval training should be conducted more often.
* Heart rate reserve can be calculated by subtracting the resting HR from the maximum HR.

Time of Day
Both interval and continuous training was found to have the greatest decrease in BP in the afternoon[15] , indicating that exercise should be attempted to be conducted in the afternoon. external image insert_table.gif








YouTube Video: High Blood Pressure Tips & Treatments: Exercising to Achieve Target Heart Rate


Resistance Exercise

Frequency
Vaious studies have found significant cardiovascular benefits when implementing a resistance exercise trining program 2 or more days per week[16] [17] [18] [19] .
Aerobic-And-Resistance-Training-Combo-Helpful-For-Diabetics@@fitness.jpg

Duration
Current research[20] [21] [22] [23] has obtained positive results from the implementation of resistance exercise training over a four or more week period. Thus, as little as four weeks of resistance exercise training can have significant BP lowering effects however, longer durations have been associated with further imporvements[24] .

Mode
All current research has implemented resistance training exercise programs with 8-10 exercises that target all the bodies major muscle groups.

Intensity
Each exercise should consite of 3 sets of 10-15 repetitions at 60-65% of their predicted 1 Repetition Maximum (RM).

These common program design features have demonstrated success in improving cardiovascular function. However, this format is not inclusive but further research is necessary to validate other modalities.



Aerobic & Resistance Exercise

As indicated in The Role of Exercise, both aerobic and resistance training has been shown to be simiarly beneficial and so it is recommended that if possible both forms of training be undertaken, to achieve variation and reduce the risk of monotony.






YouTube Video: Exercise & Health: How to Exercie to Lower Hypertension

Summary

Type
Frequency
Intensity
Duration
Further
Information
Aerobic Interval Training
2-3 days/week
Av. 40-70% HRR
30-60min
Exercise in the afternoon if possible
Aerobic Continuous Training
1-2 days/week
40-70% HRR
30-60min
Exercise in the afternoon if possible
Resistance Training
2-3 days/week
60-65% 1RM
10-15 reps
3 Sets; 8-10 Whole body exercises


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  1. ^














    Sharman, J. & Stowasser, M. (2009). Australian Association for Exercise and Sports Science position statement on exercise and hypertension. Journal of Science and Medicine in Sport; 12, 252-257.
  2. ^ Ades, P., Gunther, P., Meacham, C., Handy, M. (1988). Hypertension, exercise, and beta-adrenergic blockade. Annals of Internal Medicine; 109:629-634.
  3. ^ Appel, L., Champagne, C., Harsha, D., Cooper, L. (2003). Effects of comprehensive lifestyle modification on blood pressure control. Journal of the American Medical Association; 290(16): 2083-2093.
  4. ^ Aizawa, K. & Petrella, R. (2008). Acute and chronic impact of dynamic exercise on arterial stiffness in older hypertensives. The Open Cardiovascular Medicine Journal; 2: 3-8. Doi: 10.2174/1874192400802010003.
  5. ^ Blumenthal, J., Siegel, W., Appelbaum, M. (1991). Failure of exercise to reduce blood pressure in patients with mild hypertension. JAMA; 266(15): 2098-2104. Doi: 10.1001/jama.1991.03470150070033.
  6. ^ Guimaraes, G., Ciolac, E., Carvalho, V., D’Avila, V., Bortolotto, L., Bocchi, E. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. The Japanese Society of Hypertension. 210; 33: 627-632. Doi:10.1038/hr.2010.42.
  7. ^ Tsai,J., Yang, H., Wang, W., Hsieh, M., Chen, P., Kao, C., Kao, P., Wang, C., Chan, P. (2004). The beneficial effect of regular endurance exercise training on blood pressure and quality of life in patients with hypertension. Clinical and Experimental Hypertension; 26(3): 255-265.
  8. ^



    Fleischmann, E., Friedrich, A., Danzer, E., Gallert, K., Walter, H., Schmieder, R. (2004). Intensive training of patients with hypertension is effective in modifying lifestyle risk factors. Journal of Human Hypertension. 18: 127-131. doi:10.1038/sj.jhh.1001648.
  9. ^ Ades, P., Gunther, P., Meacham, C., Handy, M. (1988). Hypertension, exercise, and beta-adrenergic blockade. Annals of Internal Medicine; 109:629-634.
  10. ^ Appel, L., Champagne, C., Harsha, D., Cooper, L. (2003). Effects of comprehensive lifestyle modification on blood pressure control. Journal of the American Medical Association; 290(16): 2083-2093.
  11. ^ Blumenthal, J., Siegel, W., Appelbaum, M. (1991). Failure of exercise to reduce blood pressure in patients with mild hypertension. JAMA; 266(15): 2098-2104. Doi: 10.1001/jama.1991.03470150070033.
  12. ^ Guimaraes, G., Ciolac, E., Carvalho, V., D’Avila, V., Bortolotto, L., Bocchi, E. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. The Japanese Society of Hypertension. 210; 33: 627-632. Doi:10.1038/hr.2010.42
  13. ^



    Jones, H., Taylor, C., Lewis, N., George, K., Atkinson, G. (2009). Post-exercise blood pressure reduction is greater following intermittent than continuous exercise and is influenced less by diurnal variation. Chronobiological International; 26(2): 293-306.
  14. ^ Guimaraes, G., Ciolac, E., Carvalho, V., D’Avila, V., Bortolotto, L., Bocchi, E. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. The Japanese Society of Hypertension. 210; 33: 627-632. Doi:10.1038/hr.2010.42.
  15. ^



    Jones, H., Taylor, C., Lewis, N., George, K., Atkinson, G. (2009). Post-exercise blood pressure reduction is greater following intermittent than continuous exercise and is influenced less by diurnal variation. Chronobiological International; 26(2): 293-306.
  16. ^







    Fagard, R. (2006). Exercise is good for your blood pressure: effects of endurance training and resistance training. Clinical and Experimental Pharmacology and Physiology, 33: 853–856.
  17. ^ Collier, S.R., Kanaley, J.A., Carhart, R Jr., Frechette, V., Tobin, M.M., Luckenbaugh, A.N., & Fernhall, B. (2008). Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives. Journal of Human Hypertension, 22: 678-686.
  18. ^ Shaw, B.S. (2010). Resting cardiovascular function improvements in adult men following resistance training. African Journal for Physical, Health Education, Recreation and Dance, 16(3): 402-410.
  19. ^ Collier, S.R., Kanaley, J.A., Carhart, R Jr., Frechette, V., Tobin, M.M., Bennett, N., Luckenbaugh, A.N., & Fernhall, B. (2009). Cardiac autonomic function and baroreflex changes following 4 weeks of resistance versus aerobic training in individuals with pre-hypertension. Acta Physiologica, 195: 339-348.
  20. ^



    Fagard, R. (2006). Exercise is good for your blood pressure: effects of endurance training and resistance training. Clinical and Experimental Pharmacology and Physiology, 33: 853–856.
  21. ^ Collier, S.R., Kanaley, J.A., Carhart, R Jr., Frechette, V., Tobin, M.M., Bennett, N., Luckenbaugh, A.N., & Fernhall, B. (2009). Cardiac autonomic function and baroreflex changes following 4 weeks of resistance versus aerobic training in individuals with pre-hypertension. Acta Physiologica, 195: 339-348.
  22. ^ Shaw, B.S. (2010). Resting cardiovascular function improvements in adult men following resistance training. African Journal for Physical, Health Education, Recreation and Dance, 16(3): 402-410.
  23. ^ Collier, S.R., Kanaley, J.A., Carhart, R Jr., Frechette, V., Tobin, M.M., Luckenbaugh, A.N., & Fernhall, B. (2008). Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives. Journal of Human Hypertension, 22: 678-686.
  24. ^ Fagard, R. (2006). Exercise is good for your blood pressure: effects of endurance training and resistance training. Clinical and Experimental Pharmacology and Physiology, 33: 853–856.