HYPERTENSION

to make follow-up appointments to encourage adherence and assess the need for any modifications to a given programme.

Medication Anti-hypertensive medications are likely to be prescribed which may have side affects that will need to be considered when rec- ommending physical activity (1,5,8). There is a significant amount of evidence showing that beta blockers impair endurance exercise performance by between 20-40% depending on the type of beta blocker and are therefore often contraindicated in the case of physically active patients. Other antihypertensives such as calci- um antagonists, ACE inhibitors and alpha blockers usually have little effect on performance however there is little data on the effects of diuretics. Table 2 outlines the common medication types, effects and indications.

Risks of exercise Although blood pressure levels will be elevated during exercise, reviews have consistently shown that hypertensive individuals can safely enjoy exercise (2,6,7). However hypertensive individuals should take care to avoid intense vigorous or isometric exercise that may cause a sharp or excessive increase in blood pressure or heart rate (eg. sprinting, lifting of heavy weights, squash).

When advising exercise any prescribed medication and predispos- ing health condition must be considered. For example, high impact activities are not advisable for individuals suffering from arthritis or lower back pain. Lower impact (eg. walking) or non- weight bearing (eg. cycling or swimming) activities are ideal alternatives.

week are a good practical guide and starting point (9). Lifestyle activities such as walking or cycling which may be fitted into daily routines more easily than formal types of exercise may be ideal.

For overweight or obese individuals the importance of increasing total energy expenditure during the day should also be consid- ered. Incorporating short bouts of lower intensity activities such as stair climbing, and short walks and generally reducing sitting time will be beneficial.

Circuit training which involves performing resistance-exercises utilising low weights and high repetitions may have a beneficial affect upon blood pressure if incorporated into a well balanced activity programme. Activities promoting relaxation and stress relief (eg. Yoga or Tai Chi) may also be recommended as part of an overall programme, particularly for those susceptible to, or suf- fering from, stress.

Although transient decreases in blood pressure are associated with single bouts of exercise it is important to emphasise that regular routine physical activity is essential to ensure that poten- tial reductions in blood pressure or body weight occur. Any phys- ical activity programme recommended should be practical and reflect the individual’s lifestyle, personal preferences and goals. Health care professionals should discuss realistic targets to ensure progression to a desirable level of activity. It is also a good idea

14 SportEX

Severe hypertension For individuals with blood pressure readings of 180/110 or above it is recommended that the commencement of a physical activity programme should occur only after the administration of pharma- cological treatments to lower blood pressure (1,2,8).

References 1. American College of Sports Medicine.

Guidelines for Exercise Testing and Prescription. 5th Edition. London: Williams & Wilkins 1995 2. American College of Sports Medicine. Position Stand: Physical activity, physical fitness and hypertension. Medicine & Science in Sports and Exercise 1993;25(10) 3. Guidelines Subcommittee of the World Health Organisation: International Society of Hypertension (WHO-ISH) Mild Hypertension Committee. Guidelines for the Management of Hypertension. Journal of Hypertension 1999;17:151-183 4. Prescott-Clarke P, Pidmesta P. Health Survey for England 1997. HMSO 1999 5. Heart Disease and Rehabilitation 3rd Edition. Pollock, ML and Schrriidt DH. (Eds). Europe: Human Kinetics, 1995 6. Hagberg, JM. 1990.\Exercise fitness and hypertension. In Exercise, Fitness and Health, ed. C. Bouchard et al, 455-466. Champaign, IL: Human Kinetics 7. Fagard RH. Physical activity in the prevention and treatment of hyper- tension in the obese. Medicine and Science in Sport and Exercise 1999;31(11),Suppl.,S624-S630 8. American College of Sports Medicine. Exercise Management for persons with chronic diseases and disabilities. Europe: Human Kinetics, 1997 9. Health Education Authority. Active For Life Campaign. London, 1999 10. Clinical Exercise Specialist Manual ACE’s Source for Training Special Populations R.T. Cotton and R.E. Andersen (Eds). San Diego: American Council on Exercise.