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Creating Training Programs for Clients with Hypertension

Creating Training Programs for Clients with Hypertension

Programming for Individuals with Hypertension

Hypertension is a major health problem in around the world as it is a primary risk factor for cardiovascular disease, stroke, and renal disease. It is estimated that nearly half of U.S. adults have prehypertension and nearly one in three have hypertension. An individual is considered to be pre-hypertensive if their systolic blood pressure is between 120 and 139 mmHg and/or their diastolic pressure is between 80 and 89 mmHg and hypertensive if their systolic is above 140 mmHg and/or their diastolic is above 90 mmHg or if their BP is controlled with antihypertensive medication.

Exercise has both an acute and chronic effect on unmedicated people with hypertension. A single session of dynamic exercise usually induces a normal rise in systolic blood pressure in people with hypertension. Their diastolic blood pressure may not change or may slightly rise during exercise probably as a result of an impaired vasodilatory response. Blood pressure tends to decrease 10-20 mmHg 1-3 hours following exercise in individuals with hypertension. This transient decrease in blood pressure appears to be the result of a decrease in stroke volume rather than increased peripheral vasodilation. It should be noted, that untreated hypertension, as well as certain antihypertensive medications, may actually impair exercise tolerance. However, exercise, in conjunction with lifestyle modifications and medication if appropriate can have a positive effect on controlling hypertension.

Exercise has been shown to reduce the magnitude of increased blood pressure over time in individuals at risk for developing hypertension. The mechanism by which exercise helps to control hypertension is not well understood. Possibilities include decreases in plasma norepinephrine levels; increases in circulating vasodilator substances, enhanced control of elevated insulin levels; and, alterations in renal function.

The goals of any antihypertensive therapy program are to control blood pressure and to reduce cardiovascular risk by the least obtrusive means as possible. Modifying one’s lifestyle is the easiest and can be done with the following recommendations:

  1. Lose weight, if overweight
  2. Limit alcohol consumption to no more than two drinks a day in most men and one drink per day in most women.
  3. Perform aerobic physical activity at least 30 minutes daily.
  4. Reduce salt intake as much as possible. Ideally to 3.8 grams/day.
  5. Eat a diet rich high in fruits and vegetables and low-fat dairy products. Reduce the intake of saturated fats and increase the intake of potassium to 4.7 grams/day.
  6. Stop smoking.

Exercise programs should include a focus on low-level cardiovascular exercise. Interestingly, exercise at a somewhat lower intensity has as much, if not more, impact on lower BP than exercise at higher intensities. This is an important consideration for certain individuals that will not tolerate higher intensities of exercise. The frequency of an exercise program should be extensive, up to seven days a week, depending on the duration. The duration should be a minimum of 30 minutes of continuous exercise. The intensity should be 40-60% of V02 reserve. Strength or resistive training should not be the focus of a program for individuals with hypertension. Strength training has not consistently been shown to significantly lower blood pressure. Light resistance training as an adjunct to cardiovascular disease is recommended for a well-rounded program.


Beta blockers: attenuate HR by approximately 30 bpm

Alpha blockers, calcium channel blockers, and vasodilators may cause postexertional hypotension.

People should not exercise with resting systolic BP >200 mmHg or diastolic BP >115 mmHg

Exercise at 40-70% of V02 max appears to lower resting BP as much, if not more than exercise at higher intensities.

Programming for Individuals with Hypertension

You can learn more about training clients from Special Populations in the Personal Fitness Trainer course.