Exercise Prescription for Exercise Prescription for Weight Loss and Weight Loss and

HypertensionHypertension

Jonathon Gilham, Kyle Jonathon Gilham, Kyle Kawahara, & Nahid AneeKawahara, & Nahid Anee

HypertensionHypertension

• High blood pressure, defined as a sustained elevated blood High blood pressure, defined as a sustained elevated blood pressure greater than 140mmHg (systolic) or greater than 90 pressure greater than 140mmHg (systolic) or greater than 90 mmHg (diastolic)mmHg (diastolic)

• Effects approximately 50 million people in the U.S. and 1 billion Effects approximately 50 million people in the U.S. and 1 billion individuals world wideindividuals world wide

• The higher the blood pressure, the higher the risk of MI, heart The higher the blood pressure, the higher the risk of MI, heart failure, stroke, and kidney diseasefailure, stroke, and kidney disease

• Separated in to 2 categoriesSeparated in to 2 categories• Primary Hypertension is a chronic, progressive disorder with no Primary Hypertension is a chronic, progressive disorder with no

identifiable cause that often attacks the kidneys, heart, brain, and identifiable cause that often attacks the kidneys, heart, brain, and eyeseyes

• Often associated with increased mortality and morbidityOften associated with increased mortality and morbidity• Secondary hypertension has a cause, which is often associated Secondary hypertension has a cause, which is often associated

with chronic renal disease, renal vascular disease, coarctation with chronic renal disease, renal vascular disease, coarctation (constriction of an artery)(constriction of an artery)

• Secondary hypertension can be controlled once the cause is Secondary hypertension can be controlled once the cause is identifiedidentified

Risk Factors for Developing HypertensionRisk Factors for Developing Hypertension

• Age – arteries lose their elasticity, and blood pressure increases with ageAge – arteries lose their elasticity, and blood pressure increases with age

• Diabetes – high incidence in diabetics with abdominal obesityDiabetes – high incidence in diabetics with abdominal obesity

• Heredity – higher incidence with a family history of hypertensionHeredity – higher incidence with a family history of hypertension

• High blood lipids – contribute to atherosclerosis and hypertensionHigh blood lipids – contribute to atherosclerosis and hypertension

• Obesity – excess body fat is closely associated with hypertensionObesity – excess body fat is closely associated with hypertension

• Race – prevalence differs among ethnic groups, however incidence in Race – prevalence differs among ethnic groups, however incidence in African Americans is among the highest in the worldAfrican Americans is among the highest in the world

• Sex – higher incidence in men and post-menopausal womenSex – higher incidence in men and post-menopausal women

• Smoking – increases the workload of the heart and blood pressure Smoking – increases the workload of the heart and blood pressure

Physical Activity and Physical Activity and HypertensionHypertension

• Persons with hypertension should not Persons with hypertension should not participate in physical activity until cleared participate in physical activity until cleared by a physicianby a physician

• Physical activity and exercise are Physical activity and exercise are recommend once the blood pressure is recommend once the blood pressure is controlled controlled

• Blood pressure should be checked by Blood pressure should be checked by trainer on a weekly basis and by a trainer on a weekly basis and by a physician every 2 to 4 monthsphysician every 2 to 4 months

Exercise Prescription for Exercise Prescription for HypertensionHypertension

• Aerobic exercise has been shown to reduce resting Aerobic exercise has been shown to reduce resting systolic blood pressure an average of 4 to 9 mmHg, systolic blood pressure an average of 4 to 9 mmHg, and diastolic BP an average of 6mmHgand diastolic BP an average of 6mmHg

• 30 min aerobic exercise at 55% to 70% of maximum 30 min aerobic exercise at 55% to 70% of maximum heart rate, 5-6 sessions per week, is recommendedheart rate, 5-6 sessions per week, is recommended

• Begin your exercise session with a 5 to 10 minute Begin your exercise session with a 5 to 10 minute warm-up and leave enough time for a5 minute cool warm-up and leave enough time for a5 minute cool downdown

• Gradually increase the intensity of the programGradually increase the intensity of the program• People with hypertension should avoid isometric People with hypertension should avoid isometric

exercises and heavy resistance trainingexercises and heavy resistance training• Stop exercise immediately if experiencing pain in the Stop exercise immediately if experiencing pain in the

chest, jay, arm, or if feeling dizzy or short of breathchest, jay, arm, or if feeling dizzy or short of breath

Other Lifestyle ModificationsOther Lifestyle Modifications

• Lifestyle modifications often made in Lifestyle modifications often made in collaboration with an exercise programcollaboration with an exercise program

• Modifications include:Modifications include:• Lose weight if overweight or obeseLose weight if overweight or obese• Participate in regular aerobic physical activityParticipate in regular aerobic physical activity• Reduce alcohol intake to no more than 2 drinks Reduce alcohol intake to no more than 2 drinks

per dayper day• Reduce sodium intake and maintain adequate Reduce sodium intake and maintain adequate

potassium, calcium, and magnesium intakepotassium, calcium, and magnesium intake• Quit smokingQuit smoking• Follow a diet rich in fruits, vegetables, and low fat Follow a diet rich in fruits, vegetables, and low fat

dairy productsdairy products

Medications for Treating Medications for Treating HypertensionHypertension

• Most people require more than 1 antihypertensive Most people require more than 1 antihypertensive medications to get their blood pressure under controlmedications to get their blood pressure under control

• Diuretics lower blood pressure by increasing fluid lossDiuretics lower blood pressure by increasing fluid loss• Thiazide is often used in initial therapy, and is often more Thiazide is often used in initial therapy, and is often more

affordable than many of the other drugsaffordable than many of the other drugs• Calcium channel blockers and angiotensin-converting Calcium channel blockers and angiotensin-converting

enzyme (ACE) inhibitors are least likely to interact enzyme (ACE) inhibitors are least likely to interact negatively with exercisenegatively with exercise

• ACE inhibitors are not recommended for individuals with ACE inhibitors are not recommended for individuals with exercise-induced bronchospasm or pregnant womenexercise-induced bronchospasm or pregnant women

• Using calcium channel blockers while exercising may cause Using calcium channel blockers while exercising may cause orthostatic problems, but this can be avoided by doing a orthostatic problems, but this can be avoided by doing a thourough cool-down after exercisethourough cool-down after exercise

Overweight & ObesityOverweight & Obesity

• Overweight is a difficult term to defineOverweight is a difficult term to define• Often described as having more body fat than is useful for optimal Often described as having more body fat than is useful for optimal

functioningfunctioning• BMI (body mass index) is a commonly used method for calculating BMI (body mass index) is a commonly used method for calculating

ideal body weightideal body weight• BMI is calculated by dividing the subjects weight in kilograms by BMI is calculated by dividing the subjects weight in kilograms by

the square of his height in metersthe square of his height in meters• An adult with a BMI between 25 and 29.9 is considered overweight An adult with a BMI between 25 and 29.9 is considered overweight

(Center for Disease Control and Prevention)(Center for Disease Control and Prevention)• Globally there are more than 1 billion overweight adults, and at Globally there are more than 1 billion overweight adults, and at

least 300 million of them are obese (World Health Organization)least 300 million of them are obese (World Health Organization)• Overweight is generally caused by taking in more calories than the Overweight is generally caused by taking in more calories than the

body is burningbody is burning Other causes may include; cessation of smoking, limited physical Other causes may include; cessation of smoking, limited physical

activity, genetic predispositions, hormone imbalances, metabolic activity, genetic predispositions, hormone imbalances, metabolic disorders, eating disorders, stress, insufficient sleep and high disorders, eating disorders, stress, insufficient sleep and high glycemic indexglycemic index

ObesityObesity

• Defined as having a BMI of 30 or moreDefined as having a BMI of 30 or more• Obesity accounts for 2-6% of total health care costs in Obesity accounts for 2-6% of total health care costs in

several developed countries, some estimates put it as high several developed countries, some estimates put it as high as 7% (World Health Organization)as 7% (World Health Organization)

• Obesity increases the likelihood of developing health Obesity increases the likelihood of developing health problems such as respiratory difficulties, chronic problems such as respiratory difficulties, chronic musculoskeletal problems, skin problems and infertility, and musculoskeletal problems, skin problems and infertility, and osteoarthritisosteoarthritis

• Obesity raises the risk of cancer of the breast, gall bladder, Obesity raises the risk of cancer of the breast, gall bladder, kidney, endometrium, colon and prostatekidney, endometrium, colon and prostate

• Life-threatening problems associated with obesity include Life-threatening problems associated with obesity include cardiovascular disease, type 2 diabetes, and certain types cardiovascular disease, type 2 diabetes, and certain types of cancersof cancers

What can you do about being What can you do about being overweight?overweight?

• Effective weight management involves a few Effective weight management involves a few long-term strategies such as prevention, long-term strategies such as prevention, management of co-morbidities, weight management of co-morbidities, weight management and weight loss management and weight loss

• Balancing caloric intake and calories used/burntBalancing caloric intake and calories used/burnt• Follow the new Canadian food guide which Follow the new Canadian food guide which

recommends that the diet consist of less than recommends that the diet consist of less than 30% fats, 40% to 50% simple carbohydrates, 30% fats, 40% to 50% simple carbohydrates, and 20% proteinand 20% protein

• A gradual reduction in food intake most A gradual reduction in food intake most effective combined with low to moderate effective combined with low to moderate exerciseexercise

Health Threats Associated with Health Threats Associated with ObesityObesity

• Cardiovascular: congestive heart disease, enlarged heart and its Cardiovascular: congestive heart disease, enlarged heart and its associated arrhythmias and dizziness, cor pulmonale, varicose veins, associated arrhythmias and dizziness, cor pulmonale, varicose veins, pulmonary embolism, heartburn high blood pressure (hypertension), high pulmonary embolism, heartburn high blood pressure (hypertension), high cholesterol cholesterol

• Endocrine: polycystic ovarian syndrome (PCOS), menstrual disorders and Endocrine: polycystic ovarian syndrome (PCOS), menstrual disorders and infertilityinfertility

• Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasis (gallstones) hernia and colorectal cancerdisease, cholelithiasis (gallstones) hernia and colorectal cancer

• Renal & Genitourinary: urinary incontinence, glomerulopathy, Renal & Genitourinary: urinary incontinence, glomerulopathy, hypogonadism (male), breast cancer (female), uterine cancer (female), hypogonadism (male), breast cancer (female), uterine cancer (female), stillbirthstillbirth

• Integument: stretch marks, acanthosis nigricans, lymphedema, cellulites, Integument: stretch marks, acanthosis nigricans, lymphedema, cellulites, carbuncles, intertigocarbuncles, intertigo

• Muskuloskeletal: hyperuricemia (gout), immobility, osteoarthritis, lower Muskuloskeletal: hyperuricemia (gout), immobility, osteoarthritis, lower back pain, other orthopedic problems, gum diseaseback pain, other orthopedic problems, gum disease

• Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia 10syndrome, dementia 10

• Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome, Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome, Pickwickian syndrome, asthmaPickwickian syndrome, asthma

• Psychological: depression, low self esteem, body dysmorphic disorder, Psychological: depression, low self esteem, body dysmorphic disorder, social stigmatizationsocial stigmatization

Main Exercise ActivitiesMain Exercise Activities

• The exercise activities used in lab #9 will The exercise activities used in lab #9 will all be included into a circuit. There will all be included into a circuit. There will be two cycles of the circuit, each stage be two cycles of the circuit, each stage of the circuit will be performed for 30 of the circuit will be performed for 30 seconds. The circuit is designed with the seconds. The circuit is designed with the help of professional trainer JC Santana help of professional trainer JC Santana and Local Push trainer Jenn Pochailo. and Local Push trainer Jenn Pochailo. The goal of this circuit is to get the The goal of this circuit is to get the participants working hard and burning participants working hard and burning calories.calories.

Activity 1Activity 1BikingBiking

• Equipment: Equipment: Stationary bikeStationary bike

• Circuit 1: Up-hill Circuit 1: Up-hill climbclimb

• Circuit 2: Circuit 2: Endurance Speed Endurance Speed

Activity 2Activity 2PlatformPlatform

• Equipment: Equipment: Platform (adjusted Platform (adjusted to the individuals to the individuals needs)needs)

• Circuit 1: Step-upsCircuit 1: Step-ups

• Circuit 2: Step-over Circuit 2: Step-over TapsTaps

Activity 3Activity 3Stability Ball UtilizationStability Ball Utilization

• Equipment: Equipment: Stability ball, soft Stability ball, soft matmat

• Circuit 1: Circuit 1: Windshield WipesWindshield Wipes

• Circuit 2: Stability Circuit 2: Stability Ball Sit-ups Ball Sit-ups (touching toes)(touching toes)

Activity 4Activity 4BreakBreak

• Equipment: Water, Equipment: Water, Soft matSoft mat

• Circuit 1: RestCircuit 1: Rest

• Circuit 2: RestCircuit 2: Rest

Activity 5Activity 5Mix: Crooked Stick/Stability Mix: Crooked Stick/Stability

BallBall• Equipment: Tape, Equipment: Tape,

Stability ballStability ball

• Circuit 1: Crooked Circuit 1: Crooked StickStick

• Circuit 2: Stability Circuit 2: Stability Ball Knee TuckBall Knee Tuck

Activity 6Activity 6Dumbbell SquatsDumbbell Squats

• Equipment: Equipment: Dumbbells Dumbbells (Ranging 2.5lbs to (Ranging 2.5lbs to 10lbs)10lbs)

• Circuit 1: Burpee Circuit 1: Burpee Squat PressSquat Press

• Dumbbell Squat Dumbbell Squat PressPress

Activity 7Activity 7Stability BallStability Ball

• Equipment: Equipment: Stability BallStability Ball

• Circuit 1: Push-ups Circuit 1: Push-ups (feet on stability (feet on stability ball)ball)

• Circuit 2: Back Circuit 2: Back Extensions (on Extensions (on stability ball)stability ball)

Activity 8Activity 8Mix: Run/HurtlesMix: Run/Hurtles

• Equipment: Cones, Equipment: Cones, HurdlesHurdles

• Circuit 1: Shuttle Circuit 1: Shuttle RunRun

• Circuit 2: Hurdle Circuit 2: Hurdle JumpingJumping

Activity 9Activity 9Resistance Band UtilizationResistance Band Utilization

• Equipment: Equipment: Resistance band x2Resistance band x2

• Circuit 1: Chest Circuit 1: Chest PressPress

• Circuit 2: Back PullCircuit 2: Back Pull

Activity 10Activity 10Dumbbell UtilizationDumbbell Utilization

• Equipment: Equipment: Dumbbells Dumbbells (Ranging: 2.5lbs to (Ranging: 2.5lbs to 10lbs10lbs

• Circuit 1: Dumbbell Circuit 1: Dumbbell Cross PunchCross Punch

• Circuit 2: Contra Circuit 2: Contra Lateral Reach (with Lateral Reach (with step)step)