Hello, welcome back to the "Hypertension Medicine Course." I am Jessica.
In the previous lecture, we discussed how to lower blood pressure
through dietary adjustments. In this lecture, we begin the second
prescription for lifestyle therapy—exercise prescription.
Many people commonly believe that exercise raises blood pressure. When
you go for a run or climb stairs, your blood pressure goes up. Doctors
often advise hypertensive patients not to engage in vigorous exercise
to avoid excessively high blood pressure or even stroke. This is indeed
true. During exercise, your limbs require more blood flow, so your
heart beats faster and stronger, and blood pressure naturally rises.
So, the question arises: if that's the case, how can exercise lower
blood pressure? Should hypertensive patients avoid exercise and rest
instead? Actually, no. The blood pressure-lowering effect of exercise
does not rely on immediate results, but rather on the long-term effects
during and after exercise.
Mechanisms of Blood Pressure Reduction Through Exercise
In the second lecture on blood pressure regulation mechanisms, we
discussed the neural and vascular mechanisms related to blood pressure.
Exercise has a positive impact on both.
First, improvement of the nervous system.
During exercise, the sympathetic nervous system is excited, causing the
heart to beat faster and stronger, and blood pressure to rise. At the
same time, the parasympathetic nervous system is also activated. It
acts in opposition to the sympathetic system, slowing the heart rate
and lowering blood pressure.
During and after exercise, the parasympathetic nervous system remains
activated. Therefore, after long-term exercise, not only do blood
pressure and heart rate not rise excessively, but the coordination
between the sympathetic and parasympathetic systems also improves. This
means the blood pressure regulation system becomes more sensitive and
coordinated, which is beneficial for blood pressure stability.
Second, improvement of blood vessels.
During exercise, the endothelium of blood vessels releases a substance
called nitric oxide (NO). This is a naturally produced vasodilator in
the human body, which can effectively relax blood vessels and lower
blood pressure. Moreover, long-term exercise increases the number of
capillaries in muscles and thickens blood vessels, which also helps
lower blood pressure.
Numerous studies have shown:
After more than four weeks of exercise training, people with
prehypertension experience an average reduction in systolic blood
pressure by 4.3 mmHg and diastolic blood pressure by 1.7 mmHg. For
hypertensive patients, the effect is even better, with systolic blood
pressure dropping by an average of 8.3 mmHg and diastolic by 5.2 mmHg.
Even for those with resistant hypertension who do not reach target
blood pressure despite maximum doses of three medications, exercise
still has an effect.
Moderate-Intensity Aerobic Exercise
Since the blood pressure-lowering effect of exercise is so significant,
should we just happily get a gym membership and start exercising?
Not quite. Because lowering blood pressure through exercise is already
a treatment method for hypertension, and there are risks of blood
pressure spikes during exercise. At this point, exercise is more like a
medication. When taking medicine, there are prescriptions for dosage,
frequency, and timing; exercise also requires a prescription.
Currently, the most evidence-based exercise for lowering blood
pressure is still continuous aerobic exercise. As an exercise
prescription for hypertension, it includes four components, abbreviated
as FITT. Let's go through them one by one.
First, F stands for Frequency.
Ensure at least five exercise sessions per week, ideally seven, meaning
daily exercise, to achieve a clear blood pressure-lowering effect. The
effect of each exercise session lasts about 24 hours, so daily exercise
is like taking a 24-hour antihypertensive pill, maintaining the effect.
Conversely, if the interval between sessions is too long, even
prolonged exercise in one session cannot stabilize the effect.
You might ask: does this mean you can never stop exercising? Must you
exercise every day?
Actually, after three months of regular exercise, blood pressure
stabilizes. At this point, the effect is no longer a short-term
response but the body's feedback to long-term regular exercise.
Afterward, you can reduce to three to five times per week. However,
stopping completely is not advisable, as blood pressure will rebound
after stopping, just like stopping medication.
Second, I stands for Intensity. This is the core of the exercise
prescription. Currently, moderate intensity is widely recognized.
What is moderate intensity?
If you have confirmed hypertension, it is recommended to determine this
at a specialized hospital. Through cardiopulmonary exercise testing,
your maximum oxygen uptake can be measured, and 40-60% of this value
corresponds to your moderate-intensity heart rate range.
If it is inconvenient to go to the hospital, or if you are only in the
prehypertensive stage, you can refer to the calculation formula
provided in the text to determine your moderate-intensity heart rate
range:
> Optimal heart rate for aerobic exercise = (220 - age - resting heart
rate) × |40%-60%| + resting heart rate
However, if your blood pressure exceeds grade 1 hypertension (over
160/100 mmHg), or if you have cardiovascular disease, diabetes, or
other issues, please consult a professional doctor.
Third, T stands for Type of exercise.
This naturally refers to aerobic exercise, such as running, swimming,
rowing, etc.
Finally, T stands for Time, or how long each session should last.
Currently, almost all guidelines recommend at least 30 minutes of
moderate-intensity aerobic exercise per session. Note that this time
excludes the 5-minute warm-up and 5-minute cool-down; only the 30
minutes at effective intensity count. Thus, five to seven times per
week totals 150 to 210 minutes.
A comprehensive study by the American Heart Association found that
exceeding 210 minutes per week may not be as effective as 150-210
minutes. The specific reason is unclear, but 210 minutes per week is
sufficient.
Other Types of Exercise
Moderate-intensity aerobic exercise is the classic prescription, with
the most research and evidence. However, in the past five years, more
and more studies suggest that there may be exercise types with even
more pronounced blood pressure-lowering effects than continuous aerobic
exercise. Here is a ranking:
First place: Isometric strength training.
This refers to exercises where the muscle length does not change while
resisting force, usually by holding a posture, such as planks, wall
sits, or traditional Chinese horse stance. Even simply standing on
tiptoes or holding a basin of water counts.
Research shows that this type of exercise rapidly increases deep muscle
blood flow, stimulates vascular regeneration, and improves endothelial
function. Long-term training enhances neural regulation and reduces
vascular resistance.
Although evidence is limited, results are consistent: within a month,
it can lower systolic blood pressure by 10.9 mmHg and diastolic by 6.2
mmHg—a dark horse in hypertension management.
These exercises are mostly static, require no equipment or venue, and
can start with one minute per session every other day, gradually
increasing duration.
However, this method carries some risk, often causing breath-holding
and potentially excessive blood pressure spikes if intensity is too
high. It is recommended to try this under medical supervision
initially.
Second place: High-intensity interval training (HIIT).
This is simple: alternate between high and low intensity. For example,
run at 85-95% of your maximum oxygen uptake for 3 minutes, then at 50%
for 3 minutes, repeating four cycles. This is a typical HIIT session.
It not only lowers blood pressure significantly but also improves
vascular elasticity and is more efficient, achieving the same effect in
half the time.
However, this requires a certain level of physical fitness. If you have
joint, muscle, or other health issues, consult a doctor before trying.
Third place: General strength training.
Such as dumbbell curls, presses, pull-ups, push-ups—three times a week,
with rest days in between. Muscle repair after strength training takes
about 24 hours.
The blood pressure-lowering effect, especially on systolic pressure, is
not very significant—about 3 mmHg. Regardless of intensity (low,
medium, or high), the effect is similar. Thus, it is generally
considered an adjunct in hypertension management.
Practical Exercise Plan
That concludes the exercise prescription. Based on this, you can set
your own plan. If you want something simpler, here is a complete plan
you can follow:
First, warm up for 5 minutes to stretch your body;
Then, run at moderate intensity for 30 minutes daily, five days a week.
After running, do eight strength training exercises, ten reps each. The
specific exercises are listed at the end of the text. Do strength
training three times a week.
Then, after general strength training, add a 2-minute plank, also three
times a week.
Finally, do simple stretching for 5 minutes.
Preview of Next Lecture
Next, we will discuss the third aspect of lifestyle therapy—stress
reduction.
I am Jessica. See you in the next lecture.
Appendix: General Strength Training Exercises
1. Arm Curl
Stand naturally, tighten your core, shoulders back and down;
Hold dumbbells with palms facing forward, upper arms close to your body
and fixed;
Bend your arms at the elbows to lift the dumbbells to chest level,
pause briefly;
Slowly lower back to the starting position, do not fully relax at the
lowest point, and do not fully extend your arms;
Exhale when curling, inhale when lowering.
2. Shoulder Press
Stand naturally, tighten your core, shoulders back and down;
Hold dumbbells near your neck, hands shoulder-width apart;
Push the dumbbells up, keeping forearms vertical, do not lock elbows;
Lower slowly to ear level, forearms always vertical;
Exhale when pressing up, inhale when lowering.
3. Overhead Triceps Extension
Stand naturally, tighten your core;
Hold a dumbbell behind your neck with both hands crossed, extend
upward;
Bend elbows to lower the dumbbell, pause at the lowest point, then
return, keeping shoulders and upper arms stable;
Exhale when lifting, inhale when lowering.
4. Bent-Over Row
Stand with feet apart, bend forward about 50 degrees; hold dumbbells
with palms facing each other; elbows slightly bent, arms vertical;
Pull dumbbells to your sides, pause at the top, lower slowly to the
starting position;
Keep elbows close throughout;
Exhale when pulling up, inhale when lowering.
5. Squat
Stand naturally, feet slightly wider than shoulders, toes slightly
outward, knees and toes aligned, core tight, shoulders down, hold
dumbbells;
Move hips back and squat until thighs are parallel to the ground,
pause, then stand up;
Keep your back straight, core tight, look forward, keep knees and toes
aligned;
Inhale when squatting, exhale when standing up.
6. Glute Bridge
Lie on a yoga mat, knees bent, feet slightly wider than shoulders;
Lift hips until thighs and body form a straight line, upper back
supports the ground;
Exhale when lifting hips, inhale when lowering;
Advanced: use a resistance band around the pelvis, pull tight with
hands, arms close to the ground, lift hips.
7. Crunch
Lie on a yoga mat, knees bent, feet shoulder-width apart, feet flat;
Place hands on knees, use abdominal muscles to lift shoulders and upper
back off the ground, pause at the top, then return slowly;
Exhale when crunching, inhale when lowering.
8. Kettlebell Swing
Stand naturally, feet slightly wider than shoulders, toes slightly
outward, knees and toes aligned, core tight, shoulders down, hold
kettlebell with both hands, arms relaxed;
Move hips back and squat until thighs are parallel to the ground,
pause;
Stand up while swinging arms forward to shoulder height;
Move hips back and squat, lowering the kettlebell naturally;
Keep your back straight, core tight, look forward, keep knees and toes
aligned;
Inhale when squatting, exhale when standing up.
Key Points
1. The blood pressure-lowering effect of exercise relies on long-term
effects during and after exercise, not immediate results.
2. Currently, continuous moderate-intensity aerobic training is the top
recommendation in hypertension guidelines.
3. In recent years, some "dark horse" exercises for lowering blood
pressure have emerged, ranked by effectiveness: isometric strength
training, high-intensity interval training, and general strength
training.
Comments
Post a Comment