Hypertension

Exercising With Hypertension

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What is hypertension?

Hypertension, or high blood pressure (BP), is when the force of your blood pushing against the walls of your blood vessels is consistently too high, putting a strain on the vessels and heart1. Over time, damage occurs and fatty plaque builds up on the inner lining of the arteries, causing them to become stiff and narrow. The heart has to work harder to pump blood around the body and less blood reaches the tissues and organs. Hypertension is a risk factor for more serious health conditions, such as cardiovascular disease, heart failure, stroke, and dementia1,2.There are a number of modifiable risk factors for hypertension, including obesity, physical inactivity, poor diet, high blood lipids, diabetes, smoking and excess alcohol consumption.

In Australia, one third of adults aged over 18 years have hypertension, and in 68% of these, it is uncontrolled3. Hypertension is diagnosed by a medical professional, such as a general practitioner, by measuring blood pressure. The Heart Foundation use the follow criteria:2

Diagnostic CategorySystolic Blood Pressure (mmHg)Diastolic Blood Pressure (mmHg)
Optimal<120and/or<80
Normal120-129and/or80-84
High-Normal130-139and/or85-89
Grade 1 (mild) hypertension140-159and/or90-99
Grade 2 (moderate hypertension)160-179and/or100-109
Grade 3 (severe hypertension)≥180and/or≥110

What are the benefits of exercising with hypertension?

According to Exercise and Sports Science Australia (ESSA) and the American College of Sports Medicine (ACSM), regular exercise has a number of benefits for managing hypertension:

  • Lower blood pressure: Regular exercise can help lower blood pressure, especially in individuals with established hypertension4. Dynamic endurance exercise training of moderate-to-vigorous intensity may reduce systolic blood pressure by up to 8 mmHg1,3,5.
  • Improved cardiovascular health: Regular physical activity is associated with lower incidence of cardiovascular disease, coronary artery disease, and stroke4.
  • Weight management: Physical activity can help manage weight, which is beneficial for blood pressure control4.
  • Enhanced well-being: Exercise can lower stress levels, reduce depression and anxiety, and improve well-being4, which can also contribute to better blood pressure management.

How much should I be exercising with hypertension?

Both ESSA and ACSM recommend exercising on most days of the week, preferably every day, to benefit from the favourable blood pressure-lowering effects of regular exercise1,3. Specifically, the ACSM guidelines recommend 30 minutes of moderate intensity, or 20 minutes of vigorous-intensity aerobic exercise 5 to 7 days per week, and resistance training 2 to 3 days per week to achieve maximal benefits1.

exercising with hypertension table

What intensity should my exercise be?

Even light to moderate regular exercise can improve blood pressure1. Exercise intensity can be measured using a Rating of Perceived Exertion (RPE) scale (see above), which is a subjective score given by an individual to represent how hard they feel they are working while exercising. An RPE between 4-6 is the desired range to maintain moderate-intensity exercise and should feel somewhat hard, while vigorous activity on the scale is between 7-8 and should feel hard1.

What type of exercise should I be doing?

Exercise, regardless of the type, is beneficial for health. Both resistance and aerobic training result in decreases in BP1,3. The greatest reductions have been associated with aerobic training, such as jogging, cycling, and swimming, which has been found to reduce resting BP, light-intensity exercising BP, and BP in the 24 hours after exercise, in both normotensive and hypertensive individuals, irrespective of sex3. Even relatively small increases in physical activity above sedentary levels correspond with BP reductions in a dose-dependent fashion3.

Tips for exercising with hypertension:

  • Find something you like: the best kind of activity is the one you will do, so find something you enjoy and do it regularly.
  • Warm up and cool down: this allows your heart rate and breathing to gradually increase before more intense activity, and then decrease to resting levels after exercise.
  • Breathe: breathe regularly during exercise and try not to hold your breath as this can increase your BP.
  • Know what different exercise intensities mean for you: use the RPE scale above to help you determine what intensity you are working at and use it to help you keep track of your daily and weekly targets.
  • Seek advice from a qualified health professional: it’s important to consult with a healthcare professional, such as an exercise physiologist, before starting any new exercise program, especially if you have high blood pressure.

SportsPlus offers Exercise Physiology services. If you are interested in better managing your hypertension, or reducing your risk of developing it, get in touch! During your assessment we can monitor your blood pressure as a response to exercise to help you more accurately grade your intensity.

The information in this article is general in nature and should not replace the advice of a qualified health professional. Please consult an appropriate health professional prior to commencing exercise to ensure you receive information tailored to your individual needs

References

(1) ACSM. (2021). Exercising Your Way to Lowering Your Blood Pressure. https://www.acsm.org/docs/default-source/files-for-resource-library/exercising-your-way-to-lowering-your-blood-pressure.pdf?sfvrsn=1aa17ebd_2

(2) Heart Foundation. (2016). Guidelines for the diagnosis and management of hypertension in adults. https://www.heartfoundation.org.au/getmedia/c83511ab-835a-4fcf-96f5-88d770582ddc/PRO-167_Hypertension-guideline-2016_WEB.pdf

(3) Sharman, J.E., Smart, N.A., Coombes, J.S., & Stowasser, M. (2019). Exercise and sport science australia position stand update on exercise and hypertension. Journal of Human Hypertension, 33, pp. 837–843. doi: 10.1038/s41371-019-0266-z

(4)American College of Sports Medicine. (2022). ACSM’s Guidelines for Exercise Testing and Prescription (11th Ed.). Wolters Kluwer.

(5) Schultz, M.G., Currie, K.D., Hedman, K., Climie, R.E., Maiorana, A., Coombes, J.S., & Sharman, J.E. (2022). The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance. International Journal of Environmental Research and Public Health, 19(5) doi: 10.3390/ijerph19052819. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910717/

(6) American Heart Association. (2023). Getting Active to Control High Blood Pressure. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/getting-active-to-control-high-blood-pressure

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