Exercise as it relates to Disease/Hypertensive Medication and Implications for exercise

Hypertension is a disease known to affect the blood pressure within the body and is associated with all cause mortality, strokes, coronary artery disease, heart failure, peripheral arterial disease and renal insufficiency. Hypertension is a term used to describe high blood pressure within the body. Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body. The universal diagnosis for hypertension is a systolic blood pressure of 140mmHg and a diastolic blood pressure of 90mmHg. It is known to have a high prevalence in those aged 50 years and older although there is an increasing presence within younger years. Treatment for hypertension is often anti-hypertensive drugs along with lifestyle changes like increasing daily exercise. Many of the common anti-hypertensive drugs have adverse effects on the body, which are important to consider when exercising, as this is another major form of treatment.

Causes of Hypertension

There are no underlying causes for hypertension, however the following factors are believed to be involved:

• Obesity
• Frequent stress or anxiety
• Excess alcohol (more than one drink per day for women and more than two drinks per day for men)
• Increased salt in diet
• Family history of high blood pressure
• Diabetes
• Smoking

Treatment for Hypertension

Exercise prescription for improving VO₂ max is also found to be effective in lowering blood pressure in hypertensive individuals. In addition is it also recommended that individuals:

• Modify diet (i.e. decreasing sodium intake)
• Reduce weight by increasing daily exercise
• Limit alcohol consumption
• Pharmacotherapy

Drug	Side Effects	Implications for Exercise
Diuretics	Increase thirst Increase urination Fluid loss in the body (reduced plasma volume)	Impairs exercise capacity in the first few weeks of treatment. Need to ensure appropriate hydration during the initial phase of treatment due to increased fluid loss in body.
ACE & Angiotensis II receptor blockers	Dry cough Rash or itchy skin Allergy like symptoms	ACE inhibitors & Angiotensis II Receptor blockers are commonly used by patients with high cardiovascular risk. Reduction in strength training should be applied with a focus on increasing moderate cardiovascular endurance exercise.
Beta Blockers	Slows heart rate Limits the endurance of a person who exercises Not recommended for asthmatics or diabetics	As heart rate will not increase despite increase in work load it is recommended that a target heart rate is not used during exercise rather a rate of perceived exertion. These individuals are also at risk of developing post exercise hypotension and have a decline in thermoregulation. Therefore it is recommended to monitor heart post exercise and appropriately prepare for weather conditions.
Calcium Channel Blockers	Dizziness, headache, redness in the face Fluid build-up in the legs Rapid heart rate	Calcium channel blockers decrease an individuals tolerance to exercise by blocking the amount of calcium entering the heart muscle. Exercise for patients on this drug should perform at low-moderate intensities, as they are incapable of performing high intensity exercise due to lack of calcium. These individuals are also at risk of developing post exercise hypotension.

Recommendations

For athletes who are participating in recreational sports it is recommended that they treat their hypertension with ACE inhibitors or calcium channel blockers. These anti-hypertensive drugs prove to have the least adverse effects during exercise. The Heart Foundation suggests 30 minutes of moderate-intensity physical activity on most, if not all, days of the week.

Further reading

• Heart Foundation
• Hypertensive Medications