[Guided training as a therapeutic measure in the treatment of hyper- and hypotension]

The high prevalence of hypertension and orthostatic hypotension is a challenge for both preventive and curative medicine. Physical exercise can be of great therapeutic value in these disturbances of blood pressure regulation. Endurance training has been shown to normalize resting and exercise blood pressure in young borderline hypertensives. Other beneficial effects include a decrease in myocardial oxygen consumption (tension-time index) and plasma adrenaline levels at rest and during exercise and an improvement in left ventricular compliance. This can bei achieved without the risks and expense of long-term drug therapy. When medication is needed for the therapy of hypertension, drug-induced changes in blood pressure reaction and circulatory responses to physical training have to be considered. We found that orthostatic hypotension in otherwise healthy people is often associated with poor general physical condition. In such cases endurance training combined with isometric exercise aimed at increasing leg muscle tone is advisable. However, exercise training as a therapeutic measure has to be prescribed in terms of dose (frequency and duration), intensity and type of exercise. This requires an understanding of exercise physiology, as well as the ability to make a rational selection and evaluation of patients using a graded exercise test.