Top Things to Know: Physical Activity as a Critical Component of First-Line Treatment for Elevated Blood Pressure or Cholesterol: Who, What, and How?
Published: June 02, 2021
- Physical activity is recommended for all Americans, including as a lifestyle treatment among adults with mild-moderately elevated blood pressure and blood cholesterol.
- Recent guidelines released by the American Heart Association and the American College of Cardiology defined criteria for patients in whom lifestyle-only approaches may be appropriate as the first-line therapy for treating mildly-moderately elevated blood pressure and blood cholesterol.
- A sizable proportion of U.S. adults may be eligible for lifestyle-only therapy. This includes those with elevated or Stage I hypertension (~53 million or 21%) and adults with elevated LDL cholesterol otherwise low-intermediate cardiovascular risk (~71 to 94 million or 28 to 37%).
- The 2018 Physical Activity Guidelines for Americans are the most comprehensive and expert source for physical activity prescription. To improve health, patients should accumulate 150 minutes of moderate intensity aerobic exercise or 75 minutes of per week of vigorous aerobic activity and 2 or more strength training sessions including all major muscles groups each week.
- Increasing physical activity results in clinically meaningful average reductions in systolic and diastolic blood pressure, typically by 3 or 4 mmHg. Increasing physical activity also has a positive effect on blood cholesterol, decreasing LDL cholesterol by 3 to 6 mg/dL and triglycerides by 4 to 12 mg/dL, while increasing HDL cholesterol by 1 to 2 mg/dL.
- Clinicians and patients should be aware that individual responses to exercise training are variable and could range from larger benefits to adverse responses. Patients with lower baseline values may have smaller responses to exercise training, but increasing dose can intensify acute benefits, further reduce the risk of developing hypertension, and enhance blood cholesterol benefits.
- The average effect of increasing physical activity on blood pressure and blood cholesterol is comparable or superior to other lifestyle-only treatment options, including dietary modification, weight loss, smoking cessation, and alcohol moderation. Further, physical activity can be part of a comprehensive strategy that improves short-term weight loss and long-term weight maintenance.
- In addition to improving blood pressure and blood cholesterol, prescribing physical activity is an excellent lifestyle treatment choice given that physical activity reduces other cardiovascular risk factors, decreasing cardiovascular disease incidence and mortality, and has many more wide-reaching health benefits.
- Healthcare providers can play an important role in promoting physical activity in their patients. The first step is to ask patients to report current levels of physical activity using simple questions or wearable devices. The same methods can be used at each interaction to monitor progress.
- Healthcare providers and patients may need support to prescribe, promote, and achieve health-enhancing physical activity. Resources for clinicians are provided for simple patient counseling, but use of health behavior professionals (e.g., health coaches) and connecting patients to resources like local community centers or advocacy groups are additional strategies.
Citation
Barone Gibbs B, Hivert M-F, Jerome GJ, Kraus WE, Rosenkranz SK, Schorr EN, Spartano NL, Lobelo F; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Physical activity as a critical component of first-line treatment for elevated blood pressure or cholesterol: who, what, and how? A scientific statement from the American Heart Association [published online ahead of print June 2, 2021]. Hypertension. doi: 10.1161/ HYP.0000000000000196