5 things you didn’t know about exercise and high blood pressure.

Since I am on a cardiovascular roll, I thought I’d keep going.

One of the most frustrating things I experience as a scientist of human mechanics is the constant mis-prescription of exercise that is happening everywhere.

You know how, when someone points something out, like an annoying trait someone has, or like when you learn a new word, or like when you get a new car, you hear/see it everywhere? It’s like that. (It's like, annoying, right?)

I cannot escape poor movement science information. It punches me in the face when reading any “health” magazine, stabs me in the ears when I listen to any radio or television segment on exercise, and, unfortunately, I often out of the mouths of professionals.

A few posts back I mentioned a bit about the intensity of exercise (over 60% of peak) increasing turbulent flow (read here), a precursor for arterial plaque accumulation. Big deal. Huge deal. Especially for those of you out there who think that the more you work your heart, the healthier your heart will be.

Nope. This is not correct, and it is really frustrating when I see people at the prescription counter for their blood pressure meds who are regularly doing intense to very intense exercise. Most of you out there may be aware that high blood pressure (HBP) is a major public health issue (and you who are on the meds are not “cured” of your HBP - you still have it.) In fact, the American College of Sports Medicine states:

"Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality."

Because many of you are using exercise to deal with or prevent HBP, I thought I’d clarify a few things for ya’all.

1. The correct exercise intensity for those with medicated or unmedicated HBP is moderate, or 40-60%, NOT 70-85%.

You’ve heard that walking is super-hyper-awesomely beneficial to your health, right? One of the reasons it is so beneficial is you get all the benefits of movement (a symmetrical, whole-body pattern of muscle contraction, fully weight bearing on the skeleton, increased circulation and oxygen distribution) without the plaque increasing turbulent flow that comes with greater intensities.

According to the American College of Sports Medicine (ACSM) “The intensity of the exercise is directly related to the hemodynamic response and myocardial VO2[oxygenation]." What’s this about turbulent flow from exercise and increased CV risk factors? Read here.

2. Resistance exercise lowers blood pressure and has additional benefits to “cardio.”

Strengthening your body is not just about being a beefcake.* Nor does resistance exercise need to look like lifting weights. In fact, using your body weight as resistance gets you much more of the BP-lowering effect as well as uses way more energy (aka "burns more calories"). Pilates, yoga, calisthenics, martial arts, cross-fit, etc. are all good options, but you need to keep the intensity 40-60% to get the healthy-heart benefit.

(BUT, even if you do a lot of BP-lowering whole-body resistance training, you still have to walk. EVERY HUMAN needs to be walking at least 3 miles a day.)

Why does it work? The more muscle you innervate, the more the blood leaves the big tubes (the arteries) and flows into the capillaries of the working muscle. When you take a tube (artery) and remove some of the fluid (blood), it drops the pressure.

Simple. Easy. Inexpensive. Like me.

Just kidding,

I’m not that simple.

3. More exercise (above the daily 40-60% walk and whole-body resistance training) is not better.

Medical literature has demonstrated that excessive training, or “chronic exercise” (think marathon running) can actually precipitate a heart attack in certain individuals. What causes it? Researchers aren’t sure. It may be the abrupt change in heart rate, or the temporary oxygen deficiency at the heart-cell level. Or a billion other things. What increases the risk?

Age.

Already having coronary disease.

The intensity of exercise. (See #1)

4. If you ARE taking a medication for HBP, using a heart rate monitor to gauge intensity doesn’t work very well.

Blood pressure meds can often alter the natural hemodynamics of exercise, so you can be working at a high intensity but you won’t actually create a measurable increase on your measuring tool. It is much better to go with a self-gauge or perceived rate of exertion (PRE). If you feel like you are struggling but your tool shows that you are “flying safe,” trust your gut and bring down the intensity until you can talk comfortably to the person next to you, but not down so low that you find yourself on the couch eating potato chips.

It’s all about balance.

5. “The risk of cardiovascular complications and orthopedic injuries is higher and adherence to an exercise program is lower with higher-intensity exercise programs.”

Or said another way -- If you taking exercise for heart and joint health (as opposed to competition), lower intensity is more better.

I just typed “more better.”  For reals.

And, P.S. I chose for #5 a quote from the ACSM’s Guidelines for Exercise Testing and Prescription because some of the greatest offenders of bad exercise prescription are professional exercise prescribers.

MOVEMENT or HEALTH PROFESSIONALS, please read the abundant scientific information on exercise. Exercise is actually a very intense science. If you are training others in exercise, read the text books, find the literature for yourself, and be smart. Don’t make reading CARDIO magazine or BodyBuilders.com (sorry if that’s a real website -- I was just making one up) your continuing education.

Now go and take a walk, ok.

*Now that I’ve typed it, beefcake is a pretty creepy word.

And don’t just take my word for it...

American College of Sports Medicine Position Paper, Exercise and Hypertension

FRANKLIN, B. A., M. H. WHALEY, and E. T. HOWLEY (Eds.).

ACSM’s Guidelines for Exercise Testing and Prescription,6thEd. Baltimore: Lippincott Williams & Wilkins, 2000.

KELLEY, G. A., and K. S. KELLEY. Progressive resistance exercise

and resting blood pressure: a meta-analysis of randomized con-

trolled trials. Hypertens. 35:838 – 843, 2000.

KELLEY, G. A., K. S. KELLEY, and Z. V. TRAN. Aerobic exercise

and resting blood pressure: a meta-analytic review of random-

ized, controlled trials. Prev. Cardiol. 4:73– 80, 2001.

KELLEY, G. A., K. S. KELLEY, and Z. V. TRAN. Walking and

resting blood pressure in adults: a meta-analysis. Prev. Med.

33:120 –127, 2001.

KELLEY, G. A., and K. K. SHARPE. Aerobic exercise and resting

blood pressure in older adults: a meta-analytic review of ran-

domized controlled trials. J. Gerontol. A Biol. Sci. Med. Sci.

56:M298 –M303, 2001.

MACDONALD, J. R., J. M. ROSENFELD, M. A. TARNOPOLSKY, C. D.

HOGBEN, C. S. BALLANTYNE, and J. D. MACDOUGALL. Post exercise

hypotension is sustained during subsequent bouts of mild exer-

cise and simulated activities of daily living. J. Hum. Hypertens.

KIVELOFF B., and O. HUBER. Brief maximal isometric exercise in

hypertension. J. Am. Geriatr. Soc. 19:1006 –1012, 1971. in humans. Hypertens. 18:575–582, 1991.