Role of Exercise in Hypertension

This World Hypertension Day, Cardiac Wellness Institute aims to improve awareness about hypertension and it’s causes and provide some practical tips to keep blood pressure under control.

World Hypertension Day: 17 May

The term blood pressure or BP refers to the force of blood flow in our arteries, produced by the pumping action of the heart, and should be lower than 120 / 80 mmHg in healthy adults. As a fitness expert, the most important parameter that I rely on to assess a person’s heart health is their BP.

High BP or hypertension is a silent killer as most people do not know their BP is high and may end up with a heart attack, heart failure, stroke, or renal failure without any warning. The only way to diagnose hypertension in an individual is by checking the BP using a BP monitor (at a doctor’s office or at home).

The factors known to cause hypertension are lack of physical activity, unhealthy diet along with excess salt intake, being overweight or obese, psychological stress, tobacco use, alcohol consumption, and a family history of hypertension.

There are 4 stages of hypertension as shown below.

Prehypertension:  120-139 / 80-89: At this stage we can control the BP by lifestyle modifications such as eating healthy fibre-rich foods, exercising regularly, reducing weight, and managing stress adequately.

Hypertension Stage I (140-159 / 90-99) and Stage II (160/100 and above): The plan here is to bring the BP under control at the earliest with medications and lifestyle modifications.

Hypertensive crisis (above 180/110): This is a medical emergency and will need urgent intervention to avoid multi organ damage and sudden death.

How regular exercise affects BP:

Regular exercise makes the heart healthier. A strong heart can pump more blood with less effort. As a result, the force on the arteries decreases, lowering the BP.

Regular exercise also helps to maintain a healthy weight which is another important way to control BP. Even losing small amounts of weight can lower the BP. In fact, adequate BP control in heart patients paves the way for reducing medications and reversal of the heart disease.

To keep the BP under control, one has to exercise regularly. It takes about one to three months for regular exercise to have an impact on the BP. It is important to note that the benefits last only as long as you continue to exercise. A combination of aerobic and strength training exercises has been shown to provide the most heart health benefits.

As you see in the American Heart Association’s guidelines below, we have to engage in at least 30 minutes of aerobic activity such as brisk walking, cycling, swimming etc. on 5 days of the week and also do muscle strengthening exercises on 2-3 days per week. Examples of resistance exercises that will improve our muscle strength are exercises using our own body weight like pushups, planks, squats etc. or using equipment like weight cuffs, resistance bands, dumbbells etc.

American Heart Association Recommendations for Physical Activity -  Infographic

Practical tips to keep BP under control:

  • Taking medications as advised
  • Being physically active regularly
  • Reducing salt intake (to less than 5 grams daily)
  • Eating more fruit and vegetables
  • Limiting the intake of foods rich in unhealthy fats and trans fats (eg. fried / baked / packaged foods)
  • Staying hydrated
  • Getting at least 6-8 hours of sleep per day
  • Avoiding the use of tobacco in any form
  • Reducing alcohol consumption
  • Splitting your exercise session into short bouts of 10-15 minutes 2 or 3 times a day if you are hard pressed for time

Patient stories:

Let me share a couple of real-life examples of how a lifestyle approach has helped in controlling BP in our clients.

A 54-year-old Civil Engineer, treated for hypertension and cholesterol issues for about 20 years, suffered a heart attack and underwent a bypass surgery. He enrolled in a 3-month cardiac rehabilitation program with us during which time we focused on supervised exercise training along with dietary modification and stress management counselling. He showed a lot of dedication and commitment to improve his health and we were glad to see his BP, cholesterol and other parameters coming under control beautifully.

A middle-aged working mother enrolled in our lifestyle program with a desire to reverse her hypertension and come off her BP medications which she had been taking for about 8 years. She had a young child and a demanding job, both of which had slowed down her self care attempts. We guided her on strategies to reduce her BP through exercise (effective walking and strengthening exercises for the limbs and core), following a balanced healthy diet rich in fibre and whole grains and focusing on breathing exercises to manage her stress better. Her overall wellbeing and lifestyle choices have improving significantly within a few weeks of joining our program and she is well on her way to achieving her health goal.

To summarise, hypertension is a silent killer but we can prevent, control and reverse high BP by being aware and acting in a timely manner. The mantra to follow is know your BP, consult your doctor, modify your health behaviour and keep your heart healthy.


Blood pressure and your heart

High blood pressure (BP) or ‘hypertension’ means that the pressure exerted by your blood on the inner walls of your blood vessels is higher than normal. It depends on several factors like pumping capacity of your heart, volume and viscosity of your blood, and state of your vessel wall.

You would have noticed an inflatable cuff from the BP apparatus fixed to your upper arm when someone wants to measure your BP. The electronic device measures your BP by a method called “oscillatory method” whereby inflation of the cuff to a high pressure followed by deflation allows blood flow in the artery in a cyclical pattern that is captured as BP by the device.

You must have heard the term “120 over 80”; this is nothing but the upper limit of normal BP in adults. The upper number denotes systolic BP (SBP) or the peak pressure in the arteries during contraction of the heart and the lower number is the diastolic BP (DBP) or the least pressure in the arteries when the heart is actually filling with blood from the veins. Apart from BP, your heart rate (number of times the heart beats in 1 minute) is also shown on the BP monitor. The normal heart rate in a healthy adult ranges from 60-80 beats per minute in a resting condition.

The most recent international guidelines for hypertension classify BP as Normal, Elevated and High as shown in this table:

If you have never had your BP measured earlier, now is the time! You should not wait for warning signs of hypertension because quite often there are none. That is exactly why hypertension is termed a “SILENT KILLER”. Diabetes (high blood sugar) and dyslipidemia (abnormal cholesterol level) are the other two Silent Killers. All 3 should be measured at least once every year to catch abnormalities early.

Prevalence and Types of hypertension

An article published in the Journal of Hypertension in 2014 estimated that 1 in 3 persons living in cities and towns and 1 in 4 individuals living in rural areas in India are hypertensive.

  • Primary hypertension is the most common type where there is no specific cause for the high BP. General preventive measures like reduced salt intake, high fiber diet, regular exercise and stress reduction techniques should be the first line of management in this case. Medications are often prescribed to control your BP, it is best to take them as advised by your doctor and not stop them on your own.
  • Secondary hypertension is less common and denotes that there is an underlying medical problem for the high BP like kidney disease, hormonal disorder, structural problem in the major artery leaving the heart or other cardiac diseases. Very high BP at the time of diagnosis, blood pressure not responding to medical management and presence of other health issues are clues to this type of hypertension. Appropriate treatment of the underlying cause will help to manage hypertension in this case.

Impact of hypertension on your heart and other systems

Your heart is constantly pumping blood and supplying oxygen and energy to each and every cell in your body through your arteries. The health of your arteries is a very important factor that determines the health of your heart.

  • Constant increased pressure of the blood flowing through your arteries can damage the inner wall and lead to hardening or stiffening – Atherosclerosis. This in turn can lead to heart attack, stroke and other serious problems. Another life-threatening effect of untreated high BP is Aneurysm or weakening and bulging of important blood vessels like those supplying the brain and the major blood vessel leaving the heart. Rupture of these bulging arteries can lead to instant death.
  • Heart failure is one of the common complications of high BP wherein the pumping capacity of the heart drops below normal. This is measured by an echo test and the symptoms are weakness, breathlessness and swelling of feet.
  • Chronic kidney disease is again very common in hypertensive individuals and is due to damage to the blood vessels supplying the kidneys. The kidney function gradually drops which is seen as rising urea and creatinine levels in blood and reduced urine formation.
  • If you have high BP, regular eye checks are a must because an increased pressure in all the arteries including the arteries of the eye is possible. This can lead to damage to the back of the eye called Hypertensive Retinopathy, which can impair vision.
  • Memory loss, dementia and cognitive impairment are neurological complications of hypertension.

With World Heart Day fast approaching (29 September), let us all take a pledge to know our blood pressure and keep it under control!