Moderate hypertension: Exercise should be first line of treatment
- The American Heart Association (AHA) and the American College of Cardiology (ACC) offer a new “prescription” for people with moderately high blood pressure and cholesterol: exercise more.
- Their new statement suggests that exercise should be the first line of defense against moderate cases of hypertension and cholesterol issues.
- Physically active people are less likely to develop and die from cardiovascular disease.
- Regular exercise can lower blood pressure, low-density lipoprotein (LDL) cholesterol, and triglyceride levels.
The advice from the AHA for otherwise healthy adults with moderately elevated blood pressure and blood cholesterol is to “sit less and move more.” Together with the ACC, the AHA has released a new scientific statement that stresses the value of recommending physical exercise as the first line of treatment for such individuals.
The paper defines moderate hypertension as a systolic blood pressure level of 120–139 millimeters of mercury (mm Hg) or a diastolic reading of 80–89 mm Hg. It says that about 53 million adults in the United States, equating to about 21% of these individuals, fall into this category.
The authors also note that moderate LDL levels, which are those exceeding 70 milligrams per deciliter (mg/dl), affect 78% of U.S. adults, or 71 million people.
Bethany Barone Gibbs, Ph.D., of the University of Pittsburgh, PA, was chair of the group responsible for writing the paper. Dr. Gibbs says:
“The current American Heart Association guidelines for diagnosing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks.”
People who meet these criteria are candidates for the lifestyle-only treatment of their condition, according to the new guidance.
“The first treatment strategy for many of these patients should be healthy lifestyle changes, beginning with increasing physical activity,” says Dr. Gibbs.
The AHA has published the new scientific statement in its journal Hypertension.
How much moving should you be doing?
“In our world, where physical activity is increasingly engineered out of our lives, and the overwhelming default is to sit — and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus — the message that we must be relentless in our pursuit to ‘sit less and move more’ throughout the day is more important than ever,” says Dr. Gibbs.
The amount of exercise that the statement recommends is based on the
To address moderate hypertension and cholesterol issues, the statement recommends a minimum of 150 minutes each week of moderate intensity aerobic exercise — such as brisk walking, running, bicycling, jumping rope, and swimming — or 75 minutes each week of vigorous intensity aerobic activity. It also recommends performing strength-training activities on at least 2 days of the week.
Such exercise can reduce systolic blood pressure by 4 mm Hg, diastolic blood pressure by 3 mm HG, LDL cholesterol by 3–4 mg/dl, and triglycerides by 4–12 mg/dl.
Although this may not seem like a significant improvement, cardiologist Dr. Jennifer Wong, M.D., told Medical News Today, “I think more than the absolute drop that somebody might see from the exercise, it’s just the drop in your cardiovascular risk.”
If a person can invest even more time in exercise, notes the AHA statement, “Even greater health benefits are realized by exceeding these recommendations.”
The doctor’s role
The authors of the statement hope that doctors will do all they can to encourage their patients to live more physically active lives.
They suggest that doctors prescribe exercise in the same way that they prescribe medications.
The statement advises doctors to help by:
- checking in with patients about their physical activity at every appointment, either by asking questions or by tracking their activity using a wearable device
- offering suggestions for ways a patient can increase and sustain their physical activity levels
- encouraging patients to spend more time engaging in physical activities that they enjoy
- encouraging and verbally rewarding any, even small, increase that the patient undertakes, such as doing more walking or taking the stairs instead of the elevator
Dr. Wong said that doctors should mention being physically active “at every single appointment.”
The AHA’s statement makes it clear that even minimal increases in physical activity can lead to health benefits. “Every little bit of activity is better than none. Even small initial increases of 5–10 minutes a day can yield health benefits,” says Dr. Gibbs.
“We encourage [people],” said Dr. Wong, “to make small changes — small increases in physical activity like walking down that hallway instead of calling up your colleague.”
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