Most research on exercise and hypertension recommends endurance exercise such as walking, jogging, running, or cycling as the chosen modality.² These forms of exercise may not be appropriate for everyone so any activity that uses large muscle groups and can be maintained continuously with an aerobic nature is recommended.² Exercise training emphasis should be placed on aerobic activity and supplemented with moderate intensity resistance training. Recommendations for flexibility training are to be incorporated after a warm-up and/or during a cool down period.³

Exercise Recommendations:

Frequency

According to ACSM, exercise training for individuals with hypertension should include aerobic activity on most or all days of the week anywhere from three to five days.² This should be supplemented with resistance training on two to three days per week. Aerobic activity includes any movement that involves large muscle groups continuously. Examples include walking, jogging, or cycling. An aerobic exercise session can reduce blood pressure for up to 22 hours post training.

Intensity

Individuals with hypertension are recommended to exercise at a moderate-intensity physical activity level. To maximize the benefits of exercise while avoiding any risk due to vigorous activity this level of intensity should be 40-<60% of the individuals VO2R or HRR also equivalent to 12-13 on the Borg RPE scale.² For resistance training, the intensity should be performed at 60-80% of the individuals one rep max.

Duration

The duration of exercise recommended for individuals with hypertension is 30-60 minutes of continuous or intermittent activity. If exercise cannot be completed in one session, 10 minute increments adding up to the total duration are fine. For resistance training, duration should include at least one set of eigh to 12 reps for each major muscle group.²

Type

Lowered blood pressure is seen most with aerobic activities such as walking, jogging, cycling, and swimming. Individuals with hypertension should focus on this type of activity and supplement with resistance training.

Progression

For individuals with hypertension, progression in an exercise program should be gradual for each component of frequency, intensity, time and type. Special consideration should also be given to progression due to level of blood pressure control and recent changes in antihypertensive drug therapy.³