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Case Report | DOI: https://doi.org/10.31579/2641-0419/335
*Corresponding Author: M. Abdelbaki, Laghouat mixed hospital
Citation: M. Abdelbaki, A.Boureghda (2023), Physical Activity for Hypertensives. J. Clinical Cardiology and Cardiovascular Interventions, 6(7); DOI:10.31579/2641-0419/335
Copyright: © 2023, M. Abdelbaki. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 23 October 2023 | Accepted: 31 October 2023 | Published: 17 November 2023
Keywords: hypertension; hypertensives; left ventricular hypertrophy
Hypertension and sport, far from being mutually exclusive, are complementary.
However, the right type of sport (preferably those involving endurance exercise) should be judiciously recommended for the right hypertensive (rather mild hypertensives without left ventricular hypertrophy).
As far as possible, the hypertensive subject should be discouraged from taking part in competitive and/or high-level sports.
Physical activity needs to be an integral part of prescribers' therapeutic decisions, and in particular of the dietary hygiene rules (weight loss, elimination of tobacco, reduction in fat intake) that need to be indicated to all hypertensives, whether or not they are sportsmen or women at the time of diagnosis of hypertension.
Treatment of hypertension is the most common reason for office visits and for the use of chronic prescription medications [6-8]. In addition, roughly one-half of hypertensive individuals do not have adequate blood pressure control [9].
The health benefits of regular exercise are well established [9].
Because physical inactivity is a modifiable risk factor, clinicians should routinely assess and prescribe structured exercise and increased lifestyle activity to all patients [10].
Regular exercise is recommended for many purposes, including blood pressure lowering [1-5] and is considered as an integral part of life style and dietary rules for the treatment of hypertension.
The main aim of physical exercise is to reduce cardiovascular risk at a lower cost.
An “active subject” can be quantified in terms of intensity and duration, but defining an "active" subject remains difficult.
At present, the accepted consensus for considering a person to be "physically active" at the minimum level is a brisk walk of at least 30 minutes a day, which is sufficient for cardiovascular protection.
The effects of physical activity are numerous. Several systems are involved: circulatory, respiratory, osteoarticular, endocrine, etc...
Physical activity is any sustained body movement that increases energy expenditure, such as walking, jogging, dancing, gardening, swimming, heavy physical labor, etc [11].
Exercise is a subcategory of physical activity that is planned, purposeful, and repeated on a regular basis in order to improve or maintain health and fitness [11,12].
Exercise may be divided into three major types, although these may overlap for a given activity, which entail different circulatory adaptations, they include:
Resistance exercises are Characterized by little increase in VO2 and cardiac output, and a significant raise in systolic and diastolic arterial pressures, without any change in peripheral arterial resistance.
Which physical activity for hypertensive patients:
Before making this choice, the physician must be aware of the constraints of each sport. He must take into account the static and dynamic aspects of each sport.
This is the only way to be able to advise patients for a specific activity.
The available evidence supports dynamic aerobic exercise as a means to lower blood pressure and prevent and control hypertension. The evidence supporting resistance exercise is less compelling [13].
Numerous studies, including clinical trials, have examined the effects of exercise
Aerobic, dynamic resistance and isometric resistance exercise can decrease systolic and diastolic pressure by, on average, 4 to 6 mmHg and 3 mmHg, respectively, independent of weight loss [9]
The American Heart Association affirmed these benefits in a 2021 scientific statement on the BP-lowering effects of aerobic and resistance training [13,14].
The mechanisms by which exercise lowers blood pressure and prevents hypertension are uncertain, in part because the etiology of elevated blood pressure is multifactorial. Findings from animal studies suggest aerobic exercise may prevent increases in blood pressure through beneficial changes in insulin sensitivity and autonomic nervous system function [15] while resistance training may prevent increases in blood pressure through reduced vasoconstriction [16]. Other potential mechanisms include reduced inflammation, oxidative damage, sodium sensitivity, and arterial stiffness [2], [13].
Dose and frequency of physical activity:
There is no one exercise prescription that is appropriate for all adults. The prescription should be individualized to the patient's capabilities and to prevent injuries and maximize incentives for maintaining a consistent regimen [13].
The main recommendations are to choose an activity where the intensity of effort does not exceed 70% of VO2 max, and to be aerobic: brisk walking, running, treadmill, cycling, swimming.
For hypertension, lower levels of exercise may be beneficial, such as normal walking, but this does not offer cardiovascular protection.
The goal of physical exercise for hypertensive patients is to expend 2,000 Kcal, which corresponds to 60 minutes of light activity or 20 to 30 minutes of intense activity.
Most studies demonstrating a reduction in blood pressure have employed at least three to four sessions per week of moderate-intensity aerobic exercise lasting approximately 40 minutes for a period of 12 weeks [9]. (Table 1)
Static exercise is not forbidden, but should be moderated, as it improves physical strength (preserves and maintains muscles) and aids dynamic exercise. We recommend weight training with a series of 5 to 10 repetitions of 8 to 10 different exercises, not exceeding an intensity of 50% of maximum strength, 2 times a week.
Table 2: Exercise recommendation to prevent and control blood pressure by professional societies [1,3,17-22].
Conditions for implementing physical activity: (figure 1)
Exercise testing is recommended in some, but not most, patients who start an exercise program [25].
Risks associated with physical activity that is more intense than the daily routine call for precautions.
The patient's level of risk must be assessed. This takes into account the patient's blood pressure level, age, risk factors, family history of cardiovascular disease, target organ damage and the existence of cardiovascular disease.
Low-to-moderate-risk patients with mild-to-moderate hypertension do not require further investigation for moderate aerobic physical activity (<70>
For high-risk patients, it is essential to carry out a stress test before any physical activity.
In the case of symptomatic patients (coronary artery disease, heart failure, stroke), a stress test is indicated, and physical activity should ideally be resumed in a physical rehabilitation center.
Intense physical activity is not recommended if hypertension is severe or poorly controlled.
Physical activity is an integral part of the hypertensive patient's therapeutic arsenal, and has become indispensable for permanently lowering blood pressure levels. It reduces overall risk by acting on other cardiovascular risk factors. It does, however, require knowledge of exercise physiology and, above all, motivation on the part of the physician to prescribe the right physical exercise for the patient.
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