Physical activity and hypertension

Edited by Roberto Eusebio

The force with which the heart manages to circulate the blood inside the blood vessels is called blood pressure. When the heart contracts and pumps blood, we are talking about systolic pressure (commonly defined as maximum); instead, when the heart relaxes we have diastolic pressure (commonly defined as minimum).

People who suffer from "high blood pressure", defined as hypertensive, have an increased pressure exerted on the walls of blood vessels, which can be associated both with an increase in diastolic (low), systolic (high) or both .

Arterial hypertension, in accordance with the WHO-ISH guidelines, is defined based on the finding, in resting individuals, of a systolic (or "maximum") pressure equal to or greater than 140 mmHg (millimeters of mercury), or of a diastolic (or "minimum") pressure equal to or greater than 90 mmHg. This is a very frequent morbid condition, which affects on average 10-15% of the white population and 20-30% of the black population, with an increasing frequency with increasing age: over 50% of subjects in fact, over 65 years of age suffers from hypertension. In the vast majority of cases it is not possible to trace back to a precise cause of the disease and therefore we speak of essential arterial hypertension (90-95% of cases); the remaining forms (5-10% of the cases) are defined as secondary and recognize a precise etiology, such as pathologies of the endocrine system, of the aorta, renals, alcohol, medicinal herbs, etc. The importance of diagnosing these secondary forms lies in the fact that, although on the whole rare, they are often subject to adequate and definitive treatment.

A condition of arterial hypertension damages the blood vessels of the so-called "target organs" over time, especially retinal, cerebral, coronary and renal organs, both directly and indirectly, favoring the onset of atherosclerosis. The result is an increased risk of stroke, retinal hemorrhage and thrombosis, myocardial infarction, arrhythmias, heart failure, renal failure and peripheral arterial disease. The increase in blood pressure also determines an increase in the heart's work, which in the long run, through processes of hypertrophy and dilation of the heart chambers, favors the appearance of heart failure. From the above it emerges the need to establish a correct treatment for hypertension, in order to reduce as much as possible the overall risk of cardiovascular morbidity and mortality, bringing blood pressure back to normal. Leaving aside the subject of drug therapy, the modification of life habits is fundamental, abolishing cigarette smoking, reducing emotional stress (useful relaxation techniques and biofeedback) and controlling body weight, alcohol intake, coffee, fat and salt.

In the absence of signs of damage to target organs, a major role is played by physical activity: in particular that of an aerobic nature should be encouraged (walking, running, swimming, cycling or bicycle ergometer, arm ergometer, water aerobics, aerobics, step), with a frequency of 3-5 times a week, a duration varying from 20 to 60 minutes and a muscular effort equal to 40-70% of the theoretical maximum: so as to obtain an average reduction of the systolic and diastolic pressure values ​​of 4-10 mmHg, substantially similar to the effect of an anti-hypertensive drug monotherapy.

The mechanisms underlying the reduction of arterial pressure induced by aerobic physical activity seem to be linked to a decrease in peripheral vascular resistance, in turn determined by reduced activity of the sympathetic nervous system and endothelin 1 levels (which normally perform vasoconstrictor activity ) and an increase in nitric oxide (NO), with vasodilatory activity. Alongside this neurohormonal mechanism, structural adaptations of the blood vessels themselves occur over time, with an increase in their intraluminal diameter and a consequent reduction in peripheral resistance.

As far as isometric physical activity is concerned, which involves a static muscular effort, it can be practiced in the gym respecting two conditions: a lower frequency (not more than 2-3 times a week) and a mild-moderate intensity (for example free body with small weights on the limbs, exercises on machines with moderate loads). In this case the training program provides an average of 12-15 repetitions for both the upper and lower limbs and a recovery time of at least 1 minute between the series. Strict high intensity gym activities such as weight lifting and body building are not to be prescribed, as they cause a sharp increase in blood pressure, also highlighted by the constriction vessel due to excessive muscle contraction.

In weightlifters and body builders, in fact, one of the contraindications that are highlighted in the long run, is that the heart, being a striated muscle, therefore developable exactly like the other muscles, increases the thickness of its walls, thus decreasing the ability to contain blood and increasing pulse volume and resting heart rate. For this reason, those who practice sport in the gym are always advised to combine isotonic and aerobic training; just to compensate and train the heart by not creating the conditions for a possible cardiac hypertrophy.

Finally, it should not be forgotten that regular physical activity not only performs a beneficial action on blood pressure, but is also able to improve sugar tolerance, reduce circulating levels of inflammatory cytokines, triglycerides, total cholesterol and LDL ( the so-called "bad" cholesterol) and to increase those of HDL cholesterol (the so-called "good" cholesterol).

The increase in weight, sedentariness, combined with an incorrect diet, are certainly the main reasons for the formation of this disease. Therefore physical activity takes priority at first glance.

We must train the body in its entirety, both on a cardiovascular and toning level, to safeguard the joints and the skeletal structure in general with correct posture.

Aerobic activity - that is where there is a consumption of Vo2max between 60 and 75% of the maximum heart rate - is based on a formula that each of us must remember before undertaking an aerobic training. Let's look at an example:

60 year old man or woman.

Fixed parameter 220, minus age, for 70% of its maximum heart rate.

220 - 60 = R. (160 x 70) / 100 = 112 bc (heart beats)

112 heartbeats per minute, is the heart rate, which this person must maintain to stay in the aerobic threshold, and then perform a workout that counteracts hypertension.

Given this, as a purely aerobic activity, the treadmill, the exercise bike, the step, the rotex, outdoor jogging, free swimming, are the most suitable cardiovascular activities.

With regards to muscle toning, the concept of keeping the heart rate up to 70% remains unchanged, and we can perform the exercises monitored by a heart rate monitor.

In this regard, I recommend a complete circuit training of the whole body with 12 exercises, to do in the gym for the completeness of the work.

At the end of the recommended exercises another 10 minutes of exercise bikes, treadmills or other, then repeat the round of these exercises for 2/3 times with a number of repetitions varying between 12 and 20, depending on the heart rate monitor what it indicates, that is if we are maintaining the aerobic threshold.

It is advisable to change the order of such exercises in order to create a district circuit training, drawing blood from one muscle district to another in order to promote micro and macro circulation.

In conclusion, a correct and healthy diet combined with sport is certainly the cure for preventing this pathology.

Sport, training, passion and love for oneself are the initial ingredients for high-level human results. Sport where morality is a distinctive feature of man's approach to himself.

Hypertension and sport


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