Features April 2014 Issue

Exercise Caution When Exercising With High Blood Pressure

Physical activity is crucial to managing high blood pressure, but it must be done wisely.

You’ve been told repeatedly that regular exercise can help prevent high blood pressure. But it’s also a key part of the equation to lower blood pressure if you’re already dealing with hypertension.

Lifting light weights that take your muscles through a range of motion can be an ideal part of a workout routine if you have hypertension.

“Regular aerobic exercise can lower your resting blood pressure by 10 to 15 mm Hg for the systolic (top number) and by 5 to 10 mm Hg for the diastolic (bottom number),” says Michael Crawford, manager of the Cleveland Clinic Cardiac Rehabilitation Program.

“Exercise is an additional tool along with diet, weight control, stress/emotional management and medications to help keep blood pressure in a range to reduce health-related problems from high blood pressure, such as heart disease, stroke, vascular disease, kidney and eye damage.”

But Crawford adds that there are some important precautions you should take to exercise safely with hypertension.

Be smart when you sweat
If you haven’t participated in a cardiac rehabilitation program, talk with your doctor about possibly prescribing the program for you. Even if you don’t participate in a formal cardiac rehab program, you should still consider a supervised exercise program to make sure you’re doing the proper exercises for your condition, and that you’re doing them correctly and safely.

“Some types of exercise, such as very heaving lifting, can increase blood pressure,” Crawford says. “When a person is performing an isometric exercise, which is holding a weight or resistance in one position without moving through a range of motion, the blood pressure will rise.”

He recommends performing strength/resistance exercise using a weight that can be lifted 10 to 15 times without breaking the form or holding your breath. “The exercise should be dynamic, meaning one that has a range of motion,” Crawford adds. “Breathing throughout the exercise helps to control the blood pressure. Try breathing in when you are doing the easier motion of the exercise and breathing out when doing the harder motion.”

Exercise and medication use
“It’s best to take your blood pressure medications on a regular basis without regard to the timing of your exercise,” Crawford recommends. “Some blood pressure medications can lower your heart rate response to exercise. Keeping a regular schedule with your exercise will provide you more consistent feedback with your exercise progress.”

He adds that if you’re able to lower your blood pressure through exercise, diet and other lifestyle changes, you may be able to lower the dosage of your anti-hypertensive medications or even reduce the number of medications you take. “You should always talk to your doctor prior to reducing or stopping any medication,” Crawford says.

Timing your workouts
In general, exercising earlier in the day is better than at night. Exercising shortly before bedtime may interfere with sleep, and poor sleep is a risk factor for high blood pressure. Research has also shown that morning workouts can help lower blood pressure immediately, and carry those benefits throughout the day.

But if exercising in the morning doesn’t fit your schedule, it’s better to work out later in the day than not at all.

As for meals, Crawford suggests waiting about 90 minutes after eating before exercising. “Your body has a limited blood supply; after eating your body will divert most of the blood to the gut region to help with digestion,” he says. “When you exercise, the blood is diverted to the working muscles and may leave you with an uncomfortable stomach if you have just eaten. Some people can also experience increased symptoms of chest discomfort if they try to exercise right after eating, due to the demand for blood from both the muscles and the gut. That discomfort may also reflect increased GERD symptoms.”

And if you’re exercising outdoors, Crawford strongly recommends avoiding cold weather and very hot and humid conditions. Extreme temperatures can contribute to high blood pressure. Crawford also emphasizes the importance of staying hydrated before, during and after you exercise.

What exercises are best
It’s always best to find an activity you enjoy, so you’ll want to exercise. A 30-minute brisk walk through your neighborhood may not be much fun alone, but with a friend, it could be something you’ll look forward to each day.

“If you are trying to lower your blood pressure, then try to find an aerobic or cardio exercise such as walking, cycling, swimming, rowing or any other type that uses the large muscle groups in a repetitive fashion, keeping the heart rate elevated for 30 to 40 minutes,” Crawford explains. “If you are just starting out, try to keep to a limited amount of time and gradually increase to 30 to 45 minutes a day over a few weeks to meet the recommended amount of 200 minutes per week.”

He adds that for optimal results on blood pressure management, a moderate amount of exercise should be done daily. “Starting off, it is recommend to begin with three to four days per week, with rest days in between to allow for the muscles, joints and your schedule to get accustomed to the exercise,” Crawford advises.

Exercise classes are strongly recommended, especially because you can learn proper form before trying various exercises on your own. Local senior centers and other facilities often have low-impact aerobics classes and other programs designed for older adults. Your doctor’s office may be able to recommend an appropriate program in your community.

Keeping a record of your workouts can also be helpful as you start to increase the intensity or duration of your exercises.

Final thoughts
When you exercise, your systolic blood pressure will increase above the resting rate to make sure your working muscles get the blood and oxygen they need. Your diastolic reading may stay the same or go lower than its normal, resting rate.

“Your body’s blood vessels dilate during exercise,” Crawford says. “When the exercise is done, the blood vessels tend to stay more relaxed or dilated after, thus creating less resistance for the blood flow and reducing how hard the heart has to pump the blood throughout the body.”

But understand that if your blood pressure climbs to dangerous levels during exercise, you may not notice any symptoms. The same is true about high blood pressure when you’re at rest. But Crawford warns that if a hypertensive crisis occurs, you may experience symptoms such as a severe headache, shortness of breath, severe anxiety or nose bleeds.

Muscle and joint pain or increased fatigue may be signs you’re doing too much during your workout. Muscle pain from overuse will gradually go away. A sharp and sudden pain is often a sign of injury and a signal that you should stop exercising immediately.
That’s why starting gradually and exercising with some supervision may be the best approach to exercising with hypertension. And if you can keep moving every day, you may make great strides in lowering your blood pressure.

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