Hackensack University Medical Center, Hackensack, New Jersey
Paul Sorace is a clinical exercise physiologist at Hackensack University Medical Center and an instructor for the American Academy of Personal Training (AAPT).
Thomas P. Mahady is the senior exercise physiologist for The Cardiac Prevention & Rehabilitation Program at Hackensack University Medical Center and an adjunct professor at William Paterson University in Wayne, New Jersey.
Nicole Brignola is a recent graduate from William Paterson University. She received her bachelor's degree in exercise science and is currently continuing her education.
RESISTANCE TRAINING HAS BENEFICIAL EFFECTS ON BLOOD PRESSURE AND SHOULD BE PART OF LIFESTYLE INTERVENTION TO HELP PREVENT AND CONTROL HYPERTENSION. THIS COLUMN DISCUSSES RESISTANCE TRAINING PROGRAMMING GUIDELINES AND SAFETY PRECAUTIONS FOR INDIVIDUALS WITH HYPERTENSION.
Paul Sorace, MS, ACSM RCEP, CSCS*D
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RESISTANCE TRAINING PROGRAMMING FOR HYPERTENSION
The Special Populations Column in this issue reviews hypertension (HTN), prehypertension, its risks, medications, and the benefits of resistance training (RT) on blood pressure and HTN. A review of the data available suggests moderate-intensity RT (see Table 1) is indicated and should be a part of the lifestyle strategy to prevent and control HTN (1,2,6). The American Heart Association and American College of Sports Medicine recommend RT programs that include lower resistance with higher repetitions for individuals with HTN (see Table 1) (6,7). Many persons with HTN are older adults (>50 years of age), and the RT guidelines for this population should be considered.
Dynamic forms of RT, such as circuit RT, which incorporate moderate resistance (e.g., 40-60% 1-repetition maximum [1RM]) and high repetitions (e.g., 12-15) with brief rest intervals (e.g., 30 seconds) are associated with decreases in resting blood pressure and considered by many to be the optimal form of RT for individuals with HTN. Circuit RT introduces a moderate aerobic component because of the sustained increase in heart rate. However, research has found no difference with changes in resting blood pressure when conventional RT was compared with circuit RT (2,3).
Periodized, multi-set RT programs as well as circuit RT programs can be performed by individuals with HTN. High-intensity RT programs, which would likely induce the greatest increases in blood pressure, should be discouraged. As a result, 1-RM testing may pose unnecessary risks for individuals with HTN. See Table 1 for recommendations on setting initial loads for RT exercises.
Static RT exercise has been shown to have a favorable effect on blood pressure. Isometric handgrip training at a moderate intensity (30% of the maximum voluntary contraction force) has been shown to produce a hypotensive response after exercise in both normotensive and hypertensive persons (4,5). Although this form of RT has limitations (e.g., need to train at several angles in the range of motion, time-consuming), it may be beneficial and an option for persons with HTN and arthritic joints.
It is prudent that the fitness professional obtain medical clearance from the individual's physician prior to initiating a RT program. The physician may prescribe a blood pressure or rate-pressure product (heart rate × systolic blood pressure) limit. A pre- and postexercise blood pressure reading should always be performed. Regular blood pressure monitoring will help detect any changes in resting or exercise blood pressure, possibly facilitating medical evaluation. Assessing exercise blood pressure during a seated lower body RT exercise, such as a leg press, will be most practical. If exercise blood pressure readings are within reference ranges, it may not be necessary to monitor exercise blood pressure every session.
A postexercise hypotensive response (reduced blood pressure) often occurs after a circuit RT or conventional RT session. This obviously is beneficial for those who have HTN or prehypertension. Lightheadedness, dizziness, and possible fainting (syncope) can occur with large reductions in blood pressure, adding to the importance of measuring blood pressure after exercise or anytime these symptoms are present. The specific effects exercise has on lowering blood pressure remain speculative but are likely multifactorial (1,7).
A type of circuit RT, known as cardioresistance training, will work well for many persons with HTN. Cardioresistance combines circuit RT and cardiopulmonary exercise in an interval format. An example of a cardioresistance training program is described in the side bar below.
* Perform a 5- to 10-minute cardiopulmonary warm-up
* Perform 4-5 RT exercises for the lower body
* Perform 5 minutes of cardiopulmonary exercise
* Perform 5-6 RT exercises for the upper body
* Perform 5 minutes of cardiopulmonary exercise
* Perform 3-4 RT exercises for the core muscles
* Perform a 5- to 10-minute cardiopulmonary cool down
Resistance exercises are performed with a moderate resistance (e.g., 40-60% 1-RM), 12-15 repetitions, one set per exercise, and short rest intervals (e.g., 30 seconds), while keeping cardiopulmonary intensity at 40-<60% of O2R (oxygen uptake reserve). Resistance exercise intensity should be maintained at a rating of perceived exertion of 11-14 on the Borg category scale. Muscular and cardiopulmonary endurance are emphasized with this style of RT.
Resistance training has been proven safe and effective for persons with HTN. Resistance training should be included in a complete exercise program designed to prevent or lower HTN. Following the guidelines presented in this column will ensure safe and effective RT for individuals with HTN, resulting in improved health, fitness, and quality of life.
1. American College of Sports Medicine. Position Stand: Exercise and Hypertension. Med Sci Sports Exerc 36: 533-553, 2004.
2. Cornelissen VA and Fagard RH. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens bibitem-259, 2005.
3. Kelley GA and Kelley KS. Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Hypertension 35: 838-843, 2000.
4. Ray CA and Carrasco DI. Isometric handgrip training reduces arterial pressure at rest without changes in sympathetic nerve activity. Am J Physiol Heart Circ Physiol 279: H245-H249, 2000.
5. Taylor AC, McCartney N, Kamath MV, and Wiley RL. Isometric training lowers resting blood pressure and modulates autonomic control. Med Sci Sports Exerc 35: 251-256, 2003.
6. Whaley, MH, Brubaker PH, and Otto RM, eds. ACSM's Guidelines for Exercise Testing and Prescription (7th ed). Baltimore, MD: Lippincott Williams, & Wilkins, 2005. pp. 215.
7. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, Gulanick M, Laing ST, and Stewart KJ; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: A scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 116: 572-584, 2007.
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