In the previous post we captured the theoretical foundations of
hypertension, which are very important to understand the current entry. In
addition, we present the broad benefits of strength training in this type of
population. Therefore, and without pretending to extend ourselves too much, in
this post we will pose what are the basic guidelines at the time of programming
a training for the hypertensive population.
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| hypertension-867855_1920 by stevepb. Pixabay license |
GENERAL RECOMMENDATIONS
Aerobic training
Before we talk about strength training recommendations, let's
briefly talk about aerobic exercise guidelines. Low-intensity endurance
exercise appears to provide less benefit than moderate or high intensities
(Cornelissen & Smart, 2013), so the general guideline would be aerobic
exercise above 50% of the Reserve Heart Rate or 65% of the Maximum Heart Rate.
Both intervalic and continuous exercise have been shown to be beneficial,
although there is now a trend towards intervalic. Three or four days a week would
be a recommended frequency, with a duration of between 30 and 60 minutes per
session. We should bear in mind that the total volume of the week should not
exceed 210 minutes. Of course, in a situation where the subject has a systolic
blood pressure of 160 mmHg and/or a diastolic of 100 mmHg, we should not engage
in physical activity without medical supervision. In the case of 180/110 mmHg,
we are faced with a hypertensive crisis, it is urgent to cease activity and go
to the nearest hospital, since the subject is in serious danger. As a general
precaution in the control and assessment of this type of training in which we
use heart rate, we must be aware that beta-blockers reduce the activation of
the sympathetic system, so that heart rate should not be the monitoring
parameter used. In addition, they cause premature muscular fatigue, and in
prolonged efforts they can generate hypoglycemic pictures due to the lack of
metabolic substrates. Therefore, one of the best and simplest methods of
control of training could be the scales of perceived effort (RPE).
Strength training
As for strength training, it has traditionally been strongly
discouraged, since it "seemed" to radically increase blood pressure,
reaching peaks of 480/350 mmHg (MacDougall, Tuxen, Sale, Moroz, & Sutton,
1985). However, if we are critical and read the article we observe that, in the
methodology of this one, the analyzed practitioners were bodybuilders, they
applied the Valsalva Maneuver, they trained at intensities between 85-100% 1RM,
and in addition the arterial pressure was measured by means of a catheter in
the brachial artery. It is obvious that, in these absolutely special
conditions, the blood pressure peaks are so high, mainly associated with the
mechanical compression of the blood vessels.
Therefore, and after seeing the aspects for which that study
yielded those results, we are going to provide some general recommendations on
strength training in hypertensive population:
- The initial intensities will be around 30-40% 1RM for the upper limb and 50-60% 1RM for the lower limb. The progression could reach, at most, 70-75% 1RM, being this in fractions of 5% approximately.
- Initially 1 series of 8-10 repetitions, progressing up to 3 series.
- Breaks of not less than 1 minute between series, being 90 seconds or more a more recommendable figure.
- The frequency will be 2 or 3 days per week at the most.
- With 20 or 30 minutes per session can be enough, and try not to exceed 60 minutes.
As considerations regarding strength training, as in aerobic
exercise, avoid physical exercise without medical supervision from a tension of
160/100 (Braith & Stewart, 2006); and of course, with values of 180/110, go
urgently to a hospital. Avoid at all costs the Valsalva maneuver and muscle
failure (MacDougall et al., 1985). In addition, the greater the volume of
mobilized muscle mass, the greater the increase in blood pressure, so
unilateral work on large muscle groups could be an excellent option. Likewise,
the more series and repetitions, the greater the increase in blood pressure.
Similarly, contraction time, speed of movement, and rest between repetitions
and series also affect blood pressure. More sustained contractions, too slow or
too fast speeds, and insufficient rest (less than 60 seconds) are harmful in
any case.
Isometric training
For many years, as with strength training, isometric training has
been banned in people with hypertension, and in fact continues to be banned on
many occasions, although as we will see, the scientific evidence proposes its
use in a somewhat different way than we know it. There is plenty of evidence to
support this type of blood pressure training (Carlson, Dieberg, Hess, Millar,
& Smart, 2014; Lawrence, Cooley, Huet, Arthur, & Howden, 2015; Millar,
McGowan, Cornelissen, Araujo, & Swaine, 2014; Wiles, Coleman, & Swaine,
2010). We could summarize that the literature has studied both manual grip and
knee extension isometry, unilaterally and bilaterally, with similar results
(decreases of 10-22 mmHg immediately after the protocol, and sustainable over
time). The basic guidelines are:
- Intensity between 20 and 50% of maximum voluntary contraction (MCV). This maximum voluntary contraction must be measured before the protocol is carried out with a dynamometer, in order to estimate the percentage of work.
- 4x2 minutes with 1-5 minutes rest (there are different combinations in the literature with beneficial results). A unilateral work is carried out, and the hands of work are alternated.
- Between 3 and 5 days per week seems to be enough, although it depends on the intensity and the protocol used, since the rest varies between series.
- Sessions of 12-15 minutes, during 4 weeks have given satisfactory results, although prolonging it to 8-10 weeks seems to be much more effective (Wiles et al., 2010).
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| Hand_dynamometer by Ashashyou. CC0 1.0 |
PRACTICAL PROPOSAL (PDF)
Finally, here is a practical training proposal for the hypertensive population. I hope you like it!
See you in the next post.
May the force be with you!
References
References
Braith, R. W., & Stewart, K. J.
(2006). Resistance Exercise Training. Circulation, 113(22),
2642–2650. https://doi.org/10.1161/CIRCULATIONAHA.105.584060
Carlson, D. J., Dieberg, G., Hess,
N. C., Millar, P. J., & Smart, N. A. (2014). Isometric Exercise Training
for Blood Pressure Management: A Systematic Review and Meta-analysis. Mayo
Clinic Proceedings, 89(3), 327–334.
https://doi.org/10.1016/j.mayocp.2013.10.030
Cornelissen, V. A., & Smart, N.
A. (2013). Exercise Training for Blood Pressure: A Systematic Review and Meta‐analysis. Journal of
the American Heart Association, 2(1), e004473. https://doi.org/10.1161/JAHA.112.004473
Lawrence, M. M., Cooley, I. D.,
Huet, Y. M., Arthur, S. T., & Howden, R. (2015). Factors influencing
isometric exercise training-induced reductions in resting blood pressure. Scandinavian
Journal of Medicine & Science in Sports, 25(2), 131–142.
https://doi.org/10.1111/sms.12225
MacDougall, J. D., Tuxen, D., Sale,
D. G., Moroz, J. R., & Sutton, J. R. (1985). Arterial blood pressure
response to heavy resistance exercise. Journal of Applied Physiology, 58(3),
785–790. https://doi.org/10.1152/jappl.1985.58.3.785
Millar, P. J., McGowan, C. L.,
Cornelissen, V. A., Araujo, C. G., & Swaine, I. L. (2014). Evidence for the
Role of Isometric Exercise Training in Reducing Blood Pressure: Potential
Mechanisms and Future Directions. Sports Medicine, 44(3),
345–356. https://doi.org/10.1007/s40279-013-0118-x
Wiles, J. D., Coleman, D. A., & Swaine, I. L.
(2010). The effects of performing isometric training at two exercise
intensities in healthy young males. European Journal of Applied Physiology,
108(3), 419–428. https://doi.org/10.1007/s00421-009-1025-6
MagnÃfico!!!
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