Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research

Linda S Pescatello, Hayley V MacDonald, Lauren Lamberti, Blair T Johnson, Linda S Pescatello, Hayley V MacDonald, Lauren Lamberti, Blair T Johnson

Abstract

Hypertension is the most common, costly, and preventable cardiovascular disease risk factor. Numerous professional organizations and committees recommend exercise as initial lifestyle therapy to prevent, treat, and control hypertension. Yet, these recommendations differ in the components of the Frequency, Intensity, Time, and Type (FITT) principle of exercise prescription (Ex Rx); the evidence upon which they are based is only of fair methodological quality; and the individual studies upon which they are based generally do not include people with hypertension, which are some of the limitations in this literature. The purposes of this review are to (1) overview the professional exercise recommendations for hypertension in terms of the FITT principle of Ex Rx; (2) discuss new and emerging research related to Ex Rx for hypertension; and (3) present an updated FITT Ex Rx for adults with hypertension that integrates the existing recommendations with this new and emerging research.

Keywords: Aerobic exercise; Blood pressure; Concurrent exercise; Postexercise hypotension; Prehypertension; Resistance exercise.

Figures

Fig. 1
Fig. 1
Flow diagram detailing the systematic search for potentially relevant reports (k) and the selection process of included meta-analyses (l) and exercise trials (n). CINAHL cumulative index to nursing and allied health literature. EMBASE–Excerpta Medica dataBASE. PEDro physiotherapy evidence database. RCTs—Randomized controlled trials. RE—Resistance exercise. a Indicates the databases that were searched in our previous systematic review to locate relevant meta-analyses; the complete search strategy is available from reference [••]. b Indicates the databases that were searched to locate potentially relevant exercise studies published since the ACSM position stand [6]; PubMed also includes the electronic database MEDLINE. Adapted from references [••, ••, ••]
Fig. 2
Fig. 2
Linear regression of the average blood pressure change from baseline following low, moderate, and vigorous intensity exercise. SBP systolic blood pressure. DBP diastolic blood pressure. VO2max maximum oxygen consumption. Black diamond suit indicates SBP, y = -14.9x + 14.0, R2 = 0.998. Black square indicates DBP, y = -5.9x–0.3, R2 = 0.969 (ps < 0.01). Adapted from reference [42]

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