It is one of the most important preventable causes of early deaths worldwide and its incidence is increasing. According to future estimates of hypertension, it is predicted that approximately half of the world population will enter the limits of hypertension in 2025. Studies show that one out of every three adults in Turkey hypertensive. A significant number of patients are in the middle age group considered economically productive. Therefore, early diagnosis and treatment are important because of both the risk to human health and the cost to the national economy.
Lifestyle factors, including physical inactivity, are important modifiable risk factors in the development of hypertension. Epidemiological studies have demonstrated the benefits of regular physical activity on hypertension and cardiovascular diseases in addition to standard anti-hypertensive therapy. Regular physical activity decreases the risk of disease, accelerates healing after the emergence of the disease, slows the progression of the disease and increases the quality of life. Cardiac rehabilitation exercises reduce total mortality and cardiac mortality. Accordingly, physical activity and other lifestyle modifications (weight loss, alcohol consumption limitation, diet, and sodium intake regulation, stress management) are an important component of American, European, and World Health Organization guidelines for anti-hypertensive therapy. The role of physical activity and exercise is increasingly important to maintain health and to ensure an active lifestyle.
Why is exercise important?
Regular exercise is one of the first steps in the prevention and treatment of hypertension.
The strongest support for exercise effect comes from randomized controlled trials. Numerous studies have shown that regular exercise reduces blood pressure by 10 mmHg on average in mild and moderate hypertension. This effect is similar to the effect achieved with hypertensive drugs. However, the long-term benefits are much higher. A 2 mmHg reduction in mean diastolic blood pressure in the population has been reported to cause a 17% reduction in the prevalence of hypertension. Therefore, even a modest decrease in blood pressure can have significant consequences for public health. With regular exercise;
- Blood pressure is reduced,
- The drug dose used can be reduced or the need for the drug can be eliminated,
- Reduces the risk of cardiovascular disease and other chronic diseases,
- It's easier to lose weight,
- Stress management becomes easier,
- Muscles get stronger,
- Bones get stronger,
- Quality of life increases.
How Exercise Affects Blood Pressure?
Exercise has effects on blood pressure in both acute and chronic periods. Dynamic exercise causes increase in systolic blood pressure in normal individuals. In individuals with hypertension, this increase is more than normal. Diastolic blood pressure remains the same or increases slightly.
Acute effect: After exercise, blood pressure values are reduced to 10-20 mmHg below resting blood pressure. This decrease depends on the intensity, duration and type of exercise and ends in approximately 24h. Chronic effect: As exercise continues on a regular basis, blood-pressure-lowering effects persist. In addition to resting blood pressure reduction, blood pressure responses to physical exertion and mental stress are reduced.
Exercise training causes structural and functional changes in coronary arteries and vessels feeding skeletal muscle. It increases the dilatation capacity of arterioles and lumen diameter of the great arteries. Reduces the vasoconstrictor status of peripheral vascularization with decreased sympathetic neural effect or increased local vasodilator effect. These mechanisms contribute to decreased parasympathetic activity, decreased adrenaline and noradrenaline release, and reduced resting blood pressure.
What type and amount of exercise is best?
Aerobic exercise (walking, running, cycling, swimming) is generally recommended for individuals with hypertension after the comorbid conditions such as diabetes, ischemic heart disease and heart failure have been adequately controlled and the necessary safety measures are taken. Aerobic exercise can reduce systolic blood pressure by 5-8 mmHg and diastolic blood pressure by 6-8 mmHg. The recommended frequency for exercise is 3 to 7 days per week. Moderate intensity exercise (50-65% of the maximum heart rate) is more effective in lowering blood pressure than high-intensity exercises. The duration of physical activity should be 30-60 minutes per day for a significant change. It can be divided into minimum 10 minutes interval sessions.
In addition to aerobic exercise training, the program of hypertensive individuals should include low-to-moderate intensity muscle strength training, which includes large muscle groups. The intensity of the exercise for upper extremities should be 30-60% of one repetition maximum and 50-60% of one repetition maximum for the lower extremities. It can be applied in 1-3 sets of 10-15 repetitions and each program should include 8-10 exercises.
What are the precautions for exercise?
- During exercise, the systolic blood pressure should not exceed 200 mmHg, and the diastolic blood pressure should not exceed 115 mmHg.
- Antihypertensive drugs may impair body temperature regulation throughout the exercise and cause hypoglycemia. When exercising, make sure that the environment is not too hot or cold.
- Warming up and cooling down are good for your exercise performance. Warm up for 5 to 10 minutes. The more intense the activity, the longer the warm-up. It’s good to stretch when you’re cooling down because your limbs, muscles and joints are still warm. Stretching can help reduce the buildup of lactic acid, which can lead to muscles cramping and stiffness.The cooling down period can be extended. Hold each stretch 10 to 30 seconds. If you feel you need more, stretch the other side and return for another set of stretching. The stretch should be strong, but not painful.
- Do not hold your breath during exercise and avoid the valsalva maneuver.
Heart rate should be monitored during exercise. It can be monitored by counting the heart rate or by using the device that shows the heart rate.
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