BENEFITS OF RESISTANCE TRAINING IN HYPERTENSION

WHAT IS HYPERTENSION?

Hypertension is the increase in blood pressure levels. This pathology, most common from the age of 40 onwards, is a cardiovascular risk due to different factors such as left ventricular hypertrophy, left atrial hypertrophy (Rossi et al., 2013) and even in the right ventricle (Cuspidi et al., 2009), arteriosclerosis, etc. In addition, it can affect the brain and kidneys, among other organs. Up to values of 120/80 mmHg are considered normal values. From 120/80 to 140/90 mmHg is considered prehypertension. Finally, from 140/90 mmHg onwards, we come to classify it as hypertension. 

KRT LIFE HEALTH-BLOOD-PRESSURE PG by Fort Meade. CC BY 2.0

The most evident methods of treatment of this pathology are diverse, but among them we find, to avoid the alcohol, the tobacco and the overweight, a heart-healthy diet (avoiding the salt and increasing the ingestion of fruits, vegetables, legumes, nuts and seeds, to avoid the red meat in favour of the fish or white meats...), and of course the physical activity. In fact, sedentary lifestyles, according to WHO data, cause 1.9 million deaths worldwide each year. And if we add to this the fact that hypertension is the main risk factor for mortality and morbidity globally, causing some 9.4 million deaths in 2010 (Kintscher, 2013), we observe the number of deaths that could be avoided with the implementation of physical activity and avoiding sedentary lifestyle.

SEDENTARISM: A GREAT ENEMY

In a longitudinal study of 454 people of different ages (18-45 years) with diagnosed phase 1 hypertension, it was concluded that people who did regular physical exercise had less risk of left ventricular hypertrophy, while sedentary people had greater volume and thickness of left ventricular walls (Palatini et al., 2008). Also in older people, another study with 958 subjects aged 60 to 80 with hypertension found similar results, in addition to a correlation between lower left ventricular volume and better cardiovascular health. Thus, we say that aerobic exercise prolonged over time can have favourable effects on the structure and mass of the left ventricle, thus lowering blood pressure in hypertensive people (Dimeo et al., 2012). It is so important to decrease these blood pressure values that a decrease of only 2 mmHg in diastolic pressure could prevent 67000 premature deaths from cardiovascular accidents and 34000 deaths from heart attacks (Cook, Cohen, Hebert, Taylor, & Hennekens, 1995). In fact, the effectiveness of physical exercise is very high, since it is estimated that 75% of hypertensives can decrease their blood pressure by 11 and 8 mmHg, respectively. The training recommendations in this population focus on two jobs together. On the one hand, resistance training and, on the other hand, aerobic training. Both exercises are beneficial in this type of population, although with certain considerations that we will describe specifically in the next post, which will deal with more specific recommendations and a practical proposal.

Obesity by State by Ed Kohler. CC BY 2.0

BENEFITS OF RESISTANCE TRAINING ON BLOOD PRESSURE

There are many studies that conclude that aerobic exercise has a positive effect on blood pressure, and that this should be the majority type of exercise in this type of population (Pescatello et al., 2004; Vincent, Vincent, Braith, Bhatnagar, & Lowenthal, 2003; Whaley, Brubaker, Otto, & Armstrong, 2006). However, we have to be aware that these works are too classical, and the research is moving too fast. Even at that time, a meta-analysis was published showing evidence that resistance training, in conjunction with low or moderate intensity aerobic training, was beneficial in lowering blood pressure (Fields et al., 2004). If we look at the most up-to-date evidence, not only is moderate or high intensity aerobic work recommended over low intensity (Boutcher & Boutcher, 2017); but there is also ample evidence of the benefits of resistance training, not only in hypertension (Artero et al., 2012; Johannsen et al., 2016). Briefly, we cite some of these benefits below:

• Reducing blood pressure levels.
• Reduction of LDL values.
• Reduction of total cholesterol levels.
• Increased muscle mass.
• Improved waist/hip index.
• Reduction of the risk of cardiovascular accident.
• Decrease in insulin resistance.
• Improved body composition.
• Reduction of the risk of appearance of metabolic syndrome.

CONCLUSIONS

Therefore, after analysing the amount of benefits that physical activity would bring us against sedentariness, we should seriously consider introducing this lifestyle into our routine. Not only in hypertensive population, but in healthy population, since we will help to prevent this and many other pathologies. An active lifestyle and a healthy diet is considered the best medicine for the prevention of any non-communicable disease. Many organisations such as the WHO have established their position on the importance of physical activity in global health.

In the following post we will try, in a more practical and visual way, how to approach the training in the face of this widespread pathology. So, as we always tell you, see you in the next post. 

May the force be with you!

References

Artero, E. G., Lee, D., Lavie, C. J., España-Romero, V., Sui, X., Church, T. S., & Blair, S. N. (2012). Effects of Muscular Strength on Cardiovascular Risk Factors and Prognosis. Journal of Cardiopulmonary Rehabilitation and Prevention, 32(6), 351–358. https://doi.org/10.1097/HCR.0b013e3182642688

Boutcher, Y. N., & Boutcher, S. H. (2017). Exercise intensity and hypertension: what’s new? Journal of Human Hypertension, 31(3), 157–164. https://doi.org/10.1038/jhh.2016.62

Cook, N. R., Cohen, J., Hebert, P. R., Taylor, J. O., & Hennekens, C. H. (1995). Implications of small reductions in diastolic blood pressure for primary prevention. Archives of Internal Medicine, 155(7), 701–709. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7695458

Cuspidi, C., Negri, F., Giudici, V., Valerio, C., Meani, S., Sala, C., … Mancia, G. (2009). Prevalence and clinical correlates of right ventricular hypertrophy in essential hypertension. Journal of Hypertension, 27(4), 854–860. https://doi.org/10.1097/HJH.0b013e328324eda0

Dimeo, F., Pagonas, N., Seibert, F., Arndt, R., Zidek, W., & Westhoff, T. H. (2012). Aerobic Exercise Reduces Blood Pressure in Resistant Hypertension. Hypertension, 60(3), 653–658. https://doi.org/10.1161/HYPERTENSIONAHA.112.197780

Fields, L. E., Burt, V. L., Cutler, J. A., Hughes, J., Roccella, E. J., & Sorlie, P. (2004). The Burden of Adult Hypertension in the United States 1999 to 2000. Hypertension, 44(4), 398–404. https://doi.org/10.1161/01.HYP.0000142248.54761.56

Johannsen, N. M., Swift, D. L., Lavie, C. J., Earnest, C. P., Blair, S. N., & Church, T. S. (2016). Combined Aerobic and Resistance Training Effects on Glucose Homeostasis, Fitness, and Other Major Health Indices: A Review of Current Guidelines. Sports Medicine, 46(12), 1809–1818. https://doi.org/10.1007/s40279-016-0548-3

Kintscher, U. (2013). The burden of hypertension. EuroIntervention, 9(R), R12–R15. https://doi.org/10.4244/EIJV9SRA3

Palatini, P., Visentin, P., Dorigatti, F., Guarnieri, C., Santonastaso, M., Cozzio, S., … HARVEST Study Group. (2008). Regular physical activity prevents development of left ventricular hypertrophy in hypertension. European Heart Journal, 30(2), 225–232. https://doi.org/10.1093/eurheartj/ehn533

Pescatello, L. S., Franklin, B. A., Fagard, R., Farquhar, W. B., Kelley, G. A., Ray, C. A., & American College of Sports Medicine. (2004). American College of Sports Medicine position stand. Exercise and hypertension. Medicine and Science in Sports and Exercise, 36(3), 533–553. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15076798

Rossi, G. P., Cesari, M., Cuspidi, C., Maiolino, G., Cicala, M. V., Bisogni, V., … Pessina, A. C. (2013). Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism. Hypertension, 62(1), 62–69. https://doi.org/10.1161/HYPERTENSIONAHA.113.01316

Vincent, K. R., Vincent, H. K., Braith, R. W., Bhatnagar, V., & Lowenthal, D. T. (2003). Strength training and hemodynamic responses to exercise. The American Journal of Geriatric Cardiology, 12(2), 97–106. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12624579

Whaley, M. H., Brubaker, P. H., Otto, R. M. (Robert M., & Armstrong, L. E. (2006). ACSM’s guidelines for exercise testing and prescription (7th ed.). Philadelphia  Pa.: Lippincott Williams & Wilkins. Retrieved from https://www.worldcat.org/title/acsms-guidelines-for-exercise-testing-and-prescription/oclc/56415071