Getting Started With Exercise When You Have Hypertension
If you have hypertension (what most people call "high blood pressure"), it's important to know how to use exercise to manage blood pressure and improve health. But you want to make sure you get the most benefit out of exercise while minimizing the risks that are involved.
What is Hypertension?
Hypertension is a blood pressure measurement of 140/90 mm Hg and above. Normal pressure is a measure of 120/80 mm Hg. High blood pressure is one of the risk factors for cardiovascular disease. It's also associated with a higher risk of heart attacks and strokes.
There are two types of hypertension:
- Primary Hypertension
- Secondary Hypertension
Primary hypertension is also referred to as "essential hypertension". This is when high blood pressure has no known cause—no identified illness or medication causing the condition.
Secondary hypertension is the result of some illness or medication a person might be taking. So there _is_ an identified cause, making the high blood pressure secondary to a known factor.
The majority of people with hypertension (about 95%) have primary hypertension. They don't know what's causing it, and the hypertension is usually a result of multiple factors.
This highlights the importance of using exercise and other lifestyle modifications to help you manage high blood pressure when you don't know what's causing it.
Common Treatments for Hypertension
Medical professionals typically treat hypertension with some combination of lifestyle factors and medication. Lifestyle factors include:
- Exercise
- Nutrition
- Stress management
- Quitting smoking
A single medication may be used or in some combination with others. This depends how a person responds to medications prescribed by their doctor.
Beta blockers are one type of hypertension medication that works by lowering a person's heart rate. That's why if you're exercising while using beta blockers, you can't rely on heart rate as an accurate measure of the intensity of your exercise.
Instead, medical exercise professionals use the rate of perceived exertion, a subjective measurement based on a scale of 0 to 10 that lets you assess the intensity of your exercise program.
When working with a client, I might ask them, "How does this exercise feel on a scale of 0 to 10?" This makes it possible for me to monitor the intensity level and determine if we need to reduce it by decreasing the duration, increasing rest periods, or making other modifications.
How Exercise Affects Blood Pressure
Under normal conditions, blood pressure rises during exercise. This makes sense. After all, you're working harder, so your heart has to pump more blood to the working muscles.
That's a normal response.
But the hypertensive client can have a normal, exaggerated, or diminished response. Their response depends on factors that include baseline blood pressure and any medications they're using. Everyone's going to be different.
Exercise can reduce resting blood pressure for people with hypertension. Other benefits include an increase in the maximum amount of oxygen used when exercising.
Exercise also increase the amount of calories you burn, which can help with weight management. This is especially important given that obesity is a common condition among people with hypertension.
How to Get Started With Exercise When You Have Hypertension
Get a Medical Clearance From Your Doctor
Always consult with your doctor before beginning a new exercise program.
If you have hypertension, your doctor will help you determine appropriate blood pressure levels for you. That way, when you're monitoring your blood pressure before, during, and after your exercise, you can make sure that you're staying within those appropriate ranges.
If you're working with a medical exercise specialist, personal trainer, or another exercise professional, there should be some assessment and screening process in place. They should identify red flags you need to be aware of before you begin an exercise program.
The assessments allow us to determine where you are now, what your baseline is with blood pressure and how you're going to respond to different exercises. This will be important as you progress and modify your exercise program appropriately to help you gain more of the benefits and reduce the risks.
Aerobic vs. Resistance Exercise for Hypertension
Aerobic exercise is what most people call "cardio" or cardiovascular training. This consists of walking, jogging, cycling, swimming, and other activities that involve continuous movement of larger muscle groups.
With aerobic exercise, the hypertensive client can aim to do 4-5 days a week of exercise lasting 30 to 60 minutes. This can be continuous (e.g., 30 minutes of exercise at one time) or accumulated (e.g., 15 minutes in the morning and then 15 minutes in the evening, totaling 30 minutes of exercise).
Individuals with hypertension can perform aerobic exercise at a moderate level of intensity.
With the resistance exercise (strength training, weight lifting), the goal for the hypertensive exerciser is to work at a low intensity and perform no more than 10 to 15 repetitions per set.
Each set shouldn't last longer than 30 to 45 seconds, followed by a rest period lasting approximately 60 seconds.
A blood pressure measurement of 180/105 mm Hg or higher is an indication that you should not take part in a strength training program. Consult with your doctor to find out when you can start resistance training.
Breathing is critical when performing resistance exercises.
People have a tendency of holding their breath when working against resistance. But this can significantly raise your blood pressure, which is a concern for anyone who already has high blood pressure.
If you're working with a medical exercise specialist or a personal trainer, they should teach you how to do proper breathing when performing resistance exercises.
If you have uncontrolled arrhythmia or unstable chest pains, these are also signs that you should avoid doing resistance training. Focus on aerobic exercise first, and begin strength training when appropriate and approved by your physician.
Here's a quick recap:
- Aerobic Exercise
- Moderate intensity
- 4-5 times per week
- 30-60 minutes per session (continuous or accumulated)
- Resistance Training
- Low intensity
- 10-15 repetitions per set
- No longer than 30-45 seconds duration per set
- 60 seconds of rest between sets
- No more than 10-12 exercises per workout
These general guidelines that can help you determine what exercise program might be best for you. Always get a medical clearance from your doctor and establish appropriate blood pressure levels for your unique needs and health history.
If you're working with a medical exercise specialist or personal trainer, they should perform an assessment and screening prior to beginning an exercise program with you.
Exercise can be a powerful tool to help you manage hypertension and its related health risks.
With the help of your physician and the guidance of a qualified Medical Exercise professional, you can use exercise and other strategies achieve your health and functional outcome goals.
Darwin Ruiz helps individuals use exercise and lifestyle changes to manage chronic medical conditions like hypertension, disc herniations, and total joint replacements. If you'd like to learn more about Medical Exercise and Holistic Lifestyle Coaching, click here to schedule a complimentary phone/video consultation today.
References:
- Jones, PhD., Michael. Medical Exercise Management of Hypertension: Lesson #38 Guide. Medical Exercise Specialist Training Series. www.postrehab.com
Image Credits:
- rawpixel.com, CC0, via Wikimedia Commons
- Photo by ryan park on Unsplash
- Photo by Gursimrat Ganda on Unsplash
