Exercise as medicine: role in the management of primary hypertension

Primary hypertension affects ∼1 in 5 Canadians and significantly increases the risk of myocardial infarction, stroke, heart failure, and early mortality. Guidelines for the management of hypertension recommend lifestyle modifications (e.g., increased physical activity, smoking cessation, moderate alcohol consumption, improved dietary choices) as the frontline strategy to prevent and manage high blood pressure (BP). In particular, acute and chronic aerobic exercise has consistently been shown to reduce resting and ambulatory BP, with the largest effects in hypertensive patients. Current guidelines recommend 30-60 min of moderate- to vigorous-intensity aerobic exercise 4-7 days per week, in addition to activities of daily living. The role of resistance training in the management of hypertension is less clear, although available data suggests resistance exercise can be performed safely without risk of increasing BP or adverse events. Presently, resistance exercise (8-10 exercises, 1-2 set(s) of 10-15 repetitions, 2-3 days/week) is advocated only as an adjunct exercise modality. Patients desiring to begin an exercise program should complete the Physical Activity Readiness Questionnaire (PAR-Q or PAR-Q+) or as required, the Electronic Physical Activity Readiness Medical Examination (ePARmed-X) or Physician Clearance Form in consultation with their clinician and (or) trained exercise professional. A greater emphasis on utilizing exercise as medicine will produce positive nonpharmacologic benefits for hypertensive patients and improve overall cardiovascular risk profiles.