2010 Hong Kong Reference Framework for Hypertension Care for ...
2010 Hong Kong Reference Framework for Hypertension Care for ... 2010 Hong Kong Reference Framework for Hypertension Care for ...
Module 6Exercise Recommendations to People with Hypertension (Adopted fromDepartment of Health Central Health Education Unit ExercisePrescription 2011 Edition)PhysicalActivityProfileRecommendations*Intensity • Aerobic exercise should be at least at moderate intensity (e.g. briskwalking), corresponding approximately to 40-60% of maximal aerobiccapacity (VO 2 max ) 6 . Relatively, moderate-intensity activity could beexpressed as a level of effort of 5 or 6 on a scale of 0 to 10 (where 0 is thelevel of effort of sitting, and 10 is maximal effort) or 50–70% of maximumheart rate 7,8 .• Resistance exercise should be at moderate intensity 6 , which could beexpressed as 50-70% of 1-repetition maximum (1-RM– maximum amountof weight one can lift in a single repetition for a given exercise) 8 .Time • Perform 30 to 60 min per day of aerobic exercise continuously orintermittently in bouts of at least 10 min accumulated to total of at least 30min per day 6 .• Each session of resistance exercise should minimally include 8–10exercises and should consist of at least 1 set of 8–12 repetitions perexercise 6 .Type • Emphasis on aerobic exercises such as walking, jogging, cycling andswimming 6 . Rope skipping is also a very good option that can beperformed every day, requires little equipment and learning, and involves alot of muscle group. However, any activity that uses large muscle groups,can be maintained continuously, and is rhythmical and aerobic in nature isrecommended as the primary modality for those with hypertension 9 .• Resistance exercise should involve the major muscle groups (legs, hips,chest, back, abdomen, shoulders, and arms) 6 . Either machine weights orfree weights might be used while the former is likely the safest approach 10 .Resistance exercise performed should be alternating between upper- bodyand lower-body works to allow for adequate rest between exercises. Someexamples of resistance exercise include chest press, shoulder press, tricepsextension, biceps curl, pull-down (upper back), lower-back extension,abdominal crunch/curl-up, quadriceps extension or leg press, leg curls(hamstrings), and calf raise 10 .HK Reference Framework for Hypertension Care for Adults in Primary Care Settings2
Module 6Exercise Recommendations to People with Hypertension (Adopted fromDepartment of Health Central Health Education Unit ExercisePrescription 2011 Edition)Regular physical activity of even lower intensity and duration, however, has beenshown to be associated with about a 20% decrease in mortality in cohort studies 11 .Individuals engaging in resistance exercise should seek guidance by a trainedprofessional, for appropriate machine adjustment, selection of specific exercises,appropriate initial exercise prescription, and subsequent exercise progression 10 .Resistive isotonic activities, when done as the only form of exercise training,are not recommended for lowering blood pressure in hypertensive patients 12 . Anexercise prescription for achieving and maintaining flexibility, such as properstretching for all the major joints, may be advised after a thorough warm-up andduring the cool-down period 6 .3. Rate of ProgressionIn November 2010, the American College of Sports Medicine and theAmerican Diabetes Association published a joint position statement on exerciserecommendations for patients with Type 2 diabetes mellitus which covers rate ofprogression 13 . Their general principles, as outlined below, can also be applied topatients with hypertension:• To avoid injury, progression of frequency and intensity of resistance exerciseshould occur slowly 13 .• Gradual progression of intensity of aerobic exercise is also advisable toenhance compliance 13 .4. Evaluation of patient with hypertension before recommending an exerciseprogrammeThe need for and scope of pre-exercise evaluation of the cardiovascular status willdepend on the extent of the envisaged exercise and on the patient’s symptoms andsigns, total cardiovascular risk and associated clinical conditions 14 . The risk ofcardiovascular disease in patients with hypertension is determined not only by thelevel of blood pressure, but also by the presence or absence of target organ damageand other risk factors such as smoking, dyslipidaemia and diabetes, as shown in3 HK Reference Framework for Hypertension Care for Adults in Primary Care Settings
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Module 6Exercise Recommendations to People with <strong>Hypertension</strong> (Adopted fromDepartment of Health Central Health Education Unit ExercisePrescription 2011 Edition)Regular physical activity of even lower intensity and duration, however, has beenshown to be associated with about a 20% decrease in mortality in cohort studies 11 .Individuals engaging in resistance exercise should seek guidance by a trainedprofessional, <strong>for</strong> appropriate machine adjustment, selection of specific exercises,appropriate initial exercise prescription, and subsequent exercise progression 10 .Resistive isotonic activities, when done as the only <strong>for</strong>m of exercise training,are not recommended <strong>for</strong> lowering blood pressure in hypertensive patients 12 . Anexercise prescription <strong>for</strong> achieving and maintaining flexibility, such as properstretching <strong>for</strong> all the major joints, may be advised after a thorough warm-up andduring the cool-down period 6 .3. Rate of ProgressionIn November <strong>2010</strong>, the American College of Sports Medicine and theAmerican Diabetes Association published a joint position statement on exerciserecommendations <strong>for</strong> patients with Type 2 diabetes mellitus which covers rate ofprogression 13 . Their general principles, as outlined below, can also be applied topatients with hypertension:• To avoid injury, progression of frequency and intensity of resistance exerciseshould occur slowly 13 .• Gradual progression of intensity of aerobic exercise is also advisable toenhance compliance 13 .4. Evaluation of patient with hypertension be<strong>for</strong>e recommending an exerciseprogrammeThe need <strong>for</strong> and scope of pre-exercise evaluation of the cardiovascular status willdepend on the extent of the envisaged exercise and on the patient’s symptoms andsigns, total cardiovascular risk and associated clinical conditions 14 . The risk ofcardiovascular disease in patients with hypertension is determined not only by thelevel of blood pressure, but also by the presence or absence of target organ damageand other risk factors such as smoking, dyslipidaemia and diabetes, as shown in3 HK <strong>Reference</strong> <strong>Framework</strong> <strong>for</strong> <strong>Hypertension</strong> <strong>Care</strong> <strong>for</strong> Adults in Primary <strong>Care</strong> Settings
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