Cardiovascular disease: exercise prescription and factors to consider
Due to the physiological changes that occur in the heart and blood vessels during exercise, improving the function of these organs via regular exercise has tremendous health benefits to patients affected by diseases of these organs. Obviously, exercise prescription in those suffering from CVD should be individualised according to risk and with due consideration of other risk factors to exercise and each patient’s prescribed medication.
Hypertension, or chronically high blood pressure, increases the risk of several other CVDs and is often co-morbid with obesity or Type 2 diabetes. Thankfully, exercise has proven to be incredibly effective as a treatment for hypertension, lowering blood pressure both immediately after exercise (known as post-exercise hypotension) and over longer periods of time.
Hypertensive individuals who take up regular exercise can expect to see decreases in blood pressure of 5-10mmHg over several months.
It should be cautioned that the response to exercise in individuals varies widely across the population and these responses are not observed in every patient. Anti-hypertensive drug therapy plays a very important part in management of hypertension in many people.
- Broad recommendations indicate that those suffering from hypertension should perform moderate intensity aerobic exercise most days of the week.
- Intensive resistance exercise such as heavy weightlifting can raise blood pressure significantly during exercise and should be avoided in those with elevated blood pressure.
- Common antihypertensives including beta-blockers and diuretics may impact on thermoregulation and regulation of blood glucose during exercise so patients should be mindful of this and take special care to warm-up and cool-down adequately.
The aerobic capacity of patients with heart disease is typically less than healthy adults of similar age, meaning that engagement in even occupational and leisure activities is compromised. These patients therefore have the most to gain by increasing aerobic capacity through exercise training.
The most consistent benefits to such patients appear to be associated with exercise training at least 3 times per week for 3 or more months.
Sustained activity is required in order to prevent deconditioning or reversal of these benefits. Regular walking at moderate intensity appears to be a beneficial regime to begin with, reducing anginal pain and improving measures of quality of life. Depending on the patient, effort (intensity and duration) can be increased over time as fitness improves.
It has been well-established that exercise is a safe and effective way to treat CVD and in some cases is as effective as drug therapy. The good news is that even small increases in physical fitness are associated with a significant reduction in cardiovascular risk, even in patients with existing disease.
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