Exercise in hypertension. A clinical review.

The current exercise prescription for the treatment of hypertension is: cardiovascular mode, for 20-60 minutes, 3-5 days per week, at 40-70% of maximum oxygen uptake (VO2(max)). Cardiovascular exercise training is the most effective mode of exercise in the prevention and treatment of hypertension. Resistance exercise is not the preferred mode of exercise treatment, but can be incorporated into an exercise regime provided the diastolic blood pressure response is within safe limits. It is inconclusive whether durations longer than 30 minutes produce significantly greater reductions in blood pressure. A frequency of three exercise sessions per week has been considered to be the minimal frequency for blood pressure reduction. Higher frequencies tended to produce greater reductions, although not significantly different. Evidence still exists that high intensity exercise (>75% VO2(max)) may not be as effective as low intensity exercise (<70% VO2(max)) in reducing elevated blood pressures. Exercise can be effective without a change in bodyweight or body fat. Bodyweight or body fat loss and anti-hypertensive medications do not have an added effect on blood pressure reduction associated with exercise. beta-blockade is not the recommended anti-hypertensive medication for effective exercise performance in non-cardiac patients. Not all hypertensive patients respond to exercise treatment. Differences in genetics and pathophysiology may be responsible for the inability of some hypertensive patients to respond to exercise. Ambulatory technology may allow advances in individualising a more effective exercise prescription for low-responders and non-responders.