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[EXERCISE ADVISER]

Taking the Pressure Off: How Exercise Can Lower High Blood Pressure

Barry A. Franklin, PhD with James R. Wappes

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 6 - JUNE 96


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Your doctor has told you that you have high blood pressure, or hypertension. If you have this condition for a prolonged period, you may be more likely to have a heart attack or stroke. That's why treating high blood pressure is so important. And part of your pressure-lowering treatment plan may involve exercise.

Many recent studies have shown that regular aerobic exercise (workouts like brisk walking that use large muscles for an extended period) over several months may modestly lower blood pressure. According to a recent National Institutes of Health conference, aerobic exercise reduces resting (nonexercise) blood pressure in people who have hypertension by an average of 11 points off the top number and 9 points off the bottom number. That could be enough to lower high blood pressure to normal (see "Blood Pressure Basics").

Before you dive into an exercise program, though, you need to talk to your doctor about your specific needs. Depending on how high your blood pressure is, he or she may want to supplement your exercise program with dietary changes, like less salt, or with drugs.

Because your body diverts blood to working muscles, exercise typically raises blood pressure. Although this effect is only temporary, if you have very high blood pressure, your doctor may want to lower it with drugs before you increase your physical activity. Exercise for people who have mild or moderate hypertension, however, is generally safe.

Which Exercises Are Best?

Your doctor can help you decide what type of exercise might be best for you. But whatever your blood pressure, it's hard to go wrong with walking. Studies have shown that moderate aerobic exercise like walking may be even more effective in the long-term lowering of resting blood pressure than more intense aerobic exercise like running.

Start walking at whatever pace feels comfortable. As you slowly build fitness, gradually increase your pace and distance. Aim for at least 30 minutes per session 3 days a week—daily if possible—even if you have to work up to that level.

Depending on your fitness level and interests, you may want to try jogging, stationary or outdoor bicycling, swimming, rowing, using a stair-stepper, or low-impact aerobics. Or you can add some of these activities to your walking program for variety.

Conditioning your upper body can be a nice complement to aerobic exercise and may also help lower blood pressure. But the type of upper-body workout you do is crucial. It's generally safe to lift light weights for many repetitions (often called circuit training), but don't use heavy weights. Pumping heavy iron can raise blood pressure to dangerous levels. For the same reason, avoid pure isometric exercises, in which you push against a fixed object like a wall.

As long as you choose appropriate, moderate exercise like the types listed above, you and your doctor can tailor a safe, effective exercise program to your tastes and needs. The important thing is that you pick activities that you enjoy and that you stick with the program: It may take months for your blood pressure to decrease appreciably. In the meantime, though, you'll benefit from feeling more in shape and healthier.

Finally, ask your doctor how often you should schedule a check-up. Regular visits can help your doctor assess your health, and he or she may even decide to reduce or eliminate your blood-pressure medication.

Out of the Pressure Cooker

Most people would prefer to control their hypertension without drugs—or minimize their need for medication—if possible. Though it's no cure-all, exercise can help you feel fit, healthy, and better about yourself while offering a good possibility of moderately lowering your blood pressure. And after all, who needs more pressure in life?


Blood Pressure Basics


(Back up to article)

Often when you visit the doctor's office you have your blood pressure checked. You will be told that your blood pressure is, say, "120 over 80." What do those numbers mean?

Every beat of your heart pushes a wave of blood through your blood vessels, which raises the pressure in the arteries. This is called systolic blood pressure and is represented by the first number. The blood pressure between heartbeats (called diastolic pressure) is lower and is represented by the second number.

A reading of 120/80 mm Hg (or "120 over 80") is normal for a healthy adult. The abbreviation "mm Hg" is a unit of measure for pressure and is short for "millimeters of mercury." (Meteorologists use this same unit for measuring barometric [air] pressure.)

Keep in mind, though, that several factors can affect blood pressure, like how nervous you are. Your blood pressure can rise just from being in the doctor's office, so don't get too excited over one high reading. But if your blood pressure reading is consistently 140/90 or higher, you have high blood pressure—also called hypertension—a condition that afflicts nearly 62 million Americans. The higher the numbers are above 140/90, the more serious the hypertension (table A).

___________________________________________________________
Table A. Classifying Blood Pressure
___________________________________________________________
If Your Blood Pressure                You Have:*
Values Are:
Systolic**           Diastolic**
___________________________________________________________
Less than 130  and   Less than 85     Normal blood pressure
130-139        or    85-89            High-normal blood pressure
140-159        or    90-99            Stage 1 (mild) hypertension
160-179        or    100-109          Stage 2 (moderate)
                                        hypertension
180-209        or    110-119          Stage 3 (severe) hypertension
210 or higher  or    120 or higher    Stage 4 (very severe)
                                        hypertension
___________________________________________________________
Source: Report of the Joint National Committee on Detection, 
Evaluation, and Treatment of High Blood Pressure, Bethesda, 
MD, National Heart, Lung, and Blood Institute, National High 
Blood Pressure Program, 1993
* If your systolic and diastolic blood pressures are at 
different levels, the higher level is your blood pressure class.
** Systolic blood pressure is the top, or first, number; 
diastolic is the bottom, or second, number.
___________________________________________________________

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Franklin is the director of the Cardiac Rehabilitation Program and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Michigan. He is also a professor of physiology at Wayne State University School of Medicine in Detroit and an editorial board member of The Physician and Sportsmedicine. James Wappes is an associate editor of The Physician and Sportsmedicine.


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