Assessing the Existing Professional Exercise Recommendations for Hypertension: A Review and Recommendations for Future Research Priorities

Abstract

The Eighth Joint National Committee guideline on the management of adult hypertension was recently released. Rather than recommending specific lifestyle modifications as in the Seventh Joint National Committee guideline, the Eighth Joint National Committee endorsed the recommendations of the American Heart Association/American College of Cardiology 2013 Lifestyle Work Group. The Lifestyle Work Group report included systematic reviews and meta-analyses of randomized controlled trials or controlled clinical trials from 2001 through 2011 of "fair to good" quality. In total, 11 reviews qualified for inclusion in the report, 6 of which included blood pressure (BP) as the primary outcome. Three reviews did not find significant reductions in BP, and BP status was not reported in 5. When BP was reported, only 22% of the patients had hypertension. Yet, the group concluded with a strength of evidence categorized as "high" that aerobic exercise training reduces BP by 1 to 5 mm Hg in individuals with hypertension and that the most effective exercise interventions on average included aerobic physical activity of moderate to vigorous intensity for at least 12 weeks, 3 to 4 sessions per week lasting 40 minutes per session. The exercise prescription recommendations of the Lifestyle Work Group deviate from those of other professional organizations and committees including the Seventh Joint National Committee, another American Heart Association scientific statement, the American College of Sports Medicine, the European Society of Hypertension/European Society of Cardiology, and the Canadian Health Education Program. The purposes of this review are to present the existing exercise recommendations for hypertension, discuss reasons for differences in these recommendations, discuss gaps in the literature, and address critical future research needs regarding exercise prescription for hypertension.

Coming of Age: Considerations in the Prescription of Exercise for Older Adults

“…This recommendation is made due to the immediate and sustained BP-lowering effects of acute aerobic exercise (i.e., postexercise hypotension; PEH). 18,19 In other words, BP is lower on days when individuals with hypertension exercise than when they do not exercise.…”

A Prescription for Health and Fitness Based on Your Genes

“…Waist circumference was taken with a nondistensible Guilick tape measure at the narrowest part of the torso (Pescatello et al 2013). …”

Effects of Different Aerobic Exercise Programs with Nutritional Intervention in Primary Hypertensive and Overweight/Obese Adults: EXERDIET-HTA Controlled Trial

“…However, there is a substantial lack of evidence on many issues surrounding BP treatment and management in adults with HTN, including exercise prescription and its design. The components of the FITT principle (i.e., frequency, intensity, time or volume, and type or modality) constitute the exercise dose needed to improve health, in a way similar to a pharmacologic intervention, making it mandatory for it to be designed in a systematic and individualized manner by an exercise specialist [15]. The intensity and modality of aerobic exercise has also been presented in different guidelines and associations [7,15].…”

“…The components of the FITT principle (i.e., frequency, intensity, time or volume, and type or modality) constitute the exercise dose needed to improve health, in a way similar to a pharmacologic intervention, making it mandatory for it to be designed in a systematic and individualized manner by an exercise specialist [15]. The intensity and modality of aerobic exercise has also been presented in different guidelines and associations [7,15]. There appears to be a general consensus for recommending moderateto high intensity continuous exercise training (CT) as antihypertensive therapy.…”

“…Nonetheless, the American Heart Association, ESH and ESC also endorse high-to severe intensity exercise through interval training (IT). In contrast with the CT protocol, IT alternates short bouts of high-to severe intensity exercise with a few minutes of light-to moderate exercise in the intervening periods [6,7,15,16]. Based on the results of previous studies, both CT and IT programs are effective adjunct, non-pharmacological management of chronic essential HTN [10,17,18].…”