By Jamie Toll PEP 4370 Dr. Molly Smith

Transcription

1 By Jamie Toll PEP 4370 Dr. Molly Smith

2 What is Hypertension? Can Hypertension be treated? The DASH diet Effects of exercise on blood pressure What factors are involved in writing an exercise prescription Effects of hypertensive medications on heart rate & blood pressure

3 A cardiovascular problem in which the blood exerts a greater than normal force against the inner walls of the blood vessels. Also known as high blood pressure (HBP) The Silent Killer

4 UNDERSTANDING HIGH BLOOD PRESSURE

5 1 in 4 adults in the U.S has HBP Leading cause of Cardiovascular Disease #1 reason why people visit physicians Account for the most drug prescriptions Major risk factor for heart disease and stroke #1 attributable risk for death worldwide

6 Greater for males than females More for blacks than other races Increases decade by decade until age 65 At age 65: 50% whites and 60% of blacks have high BP

7 High BP typically does not cause pain or discomfort Severe stage of hypertension Headache Visual disturbances Vomiting Convulsions Can continue to be asymptomatic

8 PRIMARY/ESSENTIAL About 90% of all hypertension (primary) SECONDARY Cause may be linked with specific disorders Renal Hypertension Endocrine Hypertension Obesity Pregnancy

9 Obesity Sedentary lifestyle Smoking Excessive amounts of Salt Alcohol

10 Blood Pressure Category Systolic mmhg (upper #) Diastolic mmhg (lower #) Normal less than 120 and less than 80 Prehypertension or High Blood Pressure (Hypertension) Stage 1 High Blood Pressure (Hypertension) Stage 2 Hypertension Crisis (Emergency care needed) or or higher or 100 or higher higher than 180 or higher than 110 *This chart reflects blood pressure categories defined by the American Heart Association (AHA)

11 SYSTOLIC Contraction phase (most pressure) AV valves closed 3 V s Visualize Valentines Heart Ventricles: squeezing all of the blood up into the arteries DIASTOLIC Relaxation phase (pressure at lowest point) AV valves open Relaxed oval

12 Medical History Physical examination Electrocardiography (ECG) Blood tests Hematocrit Potassium levels Sodium levels Creatinine Lipid Profile Urine tests

13 Arteriosclerosis Aortic Aneurysm Left Ventricular Hypertrophy Congestive Heart Failure Kidney Complications Retinopathy Cognitive Abilities and Memory (Stroke) *Left Ventricular Hypertrophy

14 EFFECTS OF HIGH BLOOD PRESSURE ON YOUR BODY

15 Healthy diet loose excess weight DASH eating plan reduce sodium intake Exercise aerobic exercise reduces BP (can combine with resistance training) Environmental Factors avoid things that cause emotional stress

16 DASH, or Dietary Approaches to Stop Hypertension, has been shown to decrease blood pressure, helping prevent and control high blood pressure. The DASH diet is rich in fruits, vegetables and lowfat dairy foods, and low in sodium, and saturated and total fat. It also is low in cholesterol and high in fiber, potassium, calcium and magnesium.

17 Increase intake of calcium, magnesium, potassium and fiber (Beans and nuts supply magnesium) Keep sodium low to moderate ( mg/day) Keep fat, especially saturated fat, low (7-8% of total calories)

18 7-8 servings of whole grains per day 4-5 servings of fresh vegetables daily 4-5 servings of fresh fruits daily 2-3 servings of lowfat/nonfat dairy products daily 2 or less servings of meats, poultry or fish daily Salt intake no more than 1150 mg daily 2-3 servings of fats and oils daily 4-5 servings of legumes, nuts and seeds weekly 5 servings of snacks or sweets weekly

19 BREAKFAST 4 oz. Orange Juice 1 medium banana 1 Fruit 1 Fruit 8 oz. skim milk 1 Dairy 1 ½ cups Corn Flakes 1 piece whole wheat toast 1 tsp. soft margarine 2 Grains 1 Grain 1 Fat LUNCH OR DINNER 2 oz. Turkey 1 Meat 2 slices whole wheat bread 6-8 sticks carrots and celery 2 Grains 1 vegetable 1 slice low fat cheese 1 Dairy 8 oz. skim milk 1 Dairy 1 med. apple 1 Dairy

20 Healthy lifestyle Medication Antihypertensive Diuretics (water pills) Vasodilators Blocking agents *Antihypertension drugs affect the validity of heart rate monitoring during exercise

21 PREHYPERTENSION/STAGE 1 BP > 140/90 Recommended to exercise Aerobic exercise should help reduce BP and help with the hypertension Help rid the body of visceral fat in obese patients HYPERTENSION/STAGE 2 BP > 160/100 Should add endurance exercise only after starting drug therapy

22 Long-term aerobic exercise has been proven to: lower BP improve cholesterol and lipid levels reduce inflammation in the arteries assist in weight loss help keep blood vessels flexible and open Sedentary people have a 35% greater risk of developing hypertension than active people do!

23 Standard exercise testing methods may be used Before graded exercise testing you should: Obtain a detailed health history Get a baseline BP in supine and standing positions. ACSM states that before starting a vigorous exercise test, people with the below risk factors should use an electrocardiogram Hypertensive individuals with CHD risk factor Males >45 yrs Females >55 yrs *Certain medications affect BP & HR response at rest and during exercise

24 The American College of Cardiology, American Heart Association, and ACSM guidelines state: Severe arterial hypertension (BP > 200 systolic or >110 diastolic)at rest cannot be tested.

25 NORMAL HYPERTENSIVE Diastolic BP remains the same during and after exercise Often have increase in diastolic BP during and after exercise

26 Significant decrease in systolic (>10 mmhg) from baseline systolic despite an increase in workload An excessive increase in BP (systolic >250 mmhg or diastolic >115 mmhg)

27 Clinical state of client Find out what medications client is taking & how it will effect their BP Look at frequency, intensity, duration, & mode of exercise How will they manage their hypertension May even want to discuss the program with client s physician *According to the American Council on Exercise

28 Exercise is one of the most important lifestyle modifications for the prevention and management of Hypertension!

29 Emphasize breathing during exercise (avoid valsalva maneuver) If resistance training is included keep weights light and repetitions high Monitoring exercise using RPE scale can be beneficial if hypertension meds effect clients HR Make sure client notifies you of any changes in medication, abnormal symptoms they may have before, during, or after exercise Encourage patient to monitor BP before and after exercise *According to the American Council on Exercise

30 Frequency: 3 to 7 d per week Intensity: 40% to 70% V02 or HRR Time: 30 to 60 min of continuous or intermittent (minimum of 10 min bouts) aerobic activity Type: Primarily aerobic exercise supplemented by resistance exercise Contractor, Gordon, 2009

31 Frequency: 2 to 3 d per week Sets: one Reps: 10 to 15 Stations or devices: 8 to 10 exercises that condition the major muscle groups *endorsed by ACSM Contractor, Gordon, 2009

32 Hypertension is a common, chronic problem Hypertension can be adequately treated The DASH diet is a very useful tool to reduce HBP Based on cross-sectional & experimental findings exercise appears to lower BP Exercise prescription should be based on medical history and risk factor status Exercise program should be adapted to antihypertensive medications that may affect HR and BP

33 American Council on Exercise. Guidelines for training hypertensive individuals adapted from Aerobics instructor manual. American Heart Association. (2010). Understanding Blood Pressure Readings. Retrieved from Readings_UCM_301764_Article.jsp ACSM Position stand. Exercise for patients with coronary artery disease. Med. Sci. Sport Exer. 26(3): i-v American College of Sports Medicine Exercise and Hypertension in ACSM s Resource Manual for Guidelines For Exercise Testing and Prescription, 4 th ed. Baltimore: Lippincott Williams Wilkens, pp Chobanian, A.V Hypertension in Clinical Symposia. Summit, NJ: CIBA Pharmaceutical Company, 34(5). Contractor, A.S. and Gordon, N Hypertension in Clinical Exercise Physiology, 2 nd ed. J.K. Ehram, P.M. Gordon, P.S. Visich, and S.J. Keteyian, eds. Champaign, IL: Human Kinetics, Chapter 13. Merck Manuals Online Medical Library. (2007). Sherrill, C Adapted Physical Education, Recreation, and Sport,5 th ed. Dubuque, IA: WCB/McGraw- Hill, pp You Tube (2008). November 13. What is Blood Pressure [video file]. Retrieved from You Tube (2007). July 8. The Effects of High Blood Pressure On Your Body [video file]. Retrieved from