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Exercise and Blood Whatadvice should we be giving? Pressure Blood pressure and exercise • Increasing blood pressure is normal and healthy with exercise • Increased CO > vasodilation = increased BP • Pattern of increases and magnitude can highlight issues with arterial stiffness (10 mmHg per MET) Hypertension and exercise • Excessive rises in BP increase risk of adverse events • >250 mmHg SBP • >115 mmHg DBP • >150 mmHg @ 5 METs • Abnormal post exercise decline in BP • Ratio >0.90 (3 minutes post vs. peak exercise BP) • Some individuals with normal resting BP show hypertensive response • Abnormal NO relationship • Arterial stiffness • Increased SNS vasoconstriction • All linked to increased CVD risk, early predictor of HTN? Acute response POST EXERCISE-HYPOTENSION • 3-12 mmHg reduction in SBP, with effects lasting up to 10 hours! • Effective for both HTN and normotensive patients • 40-75% VO2max intensity Chronic response • Chronic training adaptations can reduce SBP by 8-12 mmHg and ambulatory BP by 3.3-3.5 mmHg • Changes brought about through a lower SNS and therefore lower peripheral vascular resistance Resistance training • Evidence suggests SBP is reduced by 3.2-3.5 mmHg from chronic RT • BUT…. More evidence is needed! What do the guidelines say? • NICE Guidelines 136 • Ask about and give advice on exercise and diet • BUT there are no specific guidelines on what exercise should constitute • ACSM • Recommends individuals with Hypertension engage in moderate intensity, aerobic exercise 5-7 days/wk, supplemented by resistance exercise 2-3 d/wk and flexibility >2-3 d/wk. • BUT same recommendations for general population also • BP UK • Follow government guidelines for activity and exercise • BIHS • Explains NICE guidelines as aboveWhat does the evidence say? Practical advice 1. Use exercise as a tool to reduce acute bouts of high BP 2. It seemsthat most exercise above lactate threshold (approx >40%Hrmax) will have a significant impact 3. Use multi modalities to combine potency for other health effects (resistance and aerobic) 4. Aim for a minimum of 3 sessions per week 5. Aim for a minimum session length of 30 minutes 6. Reassure those with HTN that an elevated BP in short term (well controlled) exercise is ok Exercise and anti-hypertensives Considerations to be made when exercising with meds: • Medications that interact with SNS (BBs etc) will reduce exercising HR by 20-30 bpm depending on dosage and can reduce exercise performance • Diuretics could accelerate dehydration in exercise • Different medications will have differing effects on BP rises within the exercise session • Use aerobic exercise only is SBP >160 mmHg or DBP >100 mmHg due to local vascular resistance* Key takeaways • Exerciseis an essentialcomponent of management and reductionof BP • Exerciseis safe and effectivein HTN • Give precise exercise adviceto increase uptake and confidencein prescription • Use a measurementof BP pre and post to show effectiveness • Don’t forgetto warm up and cool down!!