One-on-One

Resistance Training Programming for Individuals with Hypertension

Paul Sorace, MS, ACSM RCEP, CSCS*D, Thomas P. Mahady, MS, CSCS, and Nicole Brignola Hackensack University Medical Center, Hackensack, New Jersey
data available suggests moderate-intensity RT (see Table 1) is indicated and should be a part of the lifestyle strategy to prevent and control HTN (1,2,6). The American Heart Association and American College of Sports Medicine recommend RT programs that include lower resistance with higher repetitions for individuals with HTN (see Table 1) (6,7). Many persons with HTN are older adults (.50 years of age), and the RT guidelines for this population should be considered. Dynamic forms of RT, such as circuit RT, which incorporate moderate resistance (e.g., 4060% 1-repetition maximum [1RM]) and high repetitions (e.g., 1215) with brief rest intervals (e.g., 30 seconds) are associated with decreases in resting blood pressure and considered by many to be the optimal form of RT for individuals with HTN. Circuit RT introduces a moderate aerobic component because of the sustained increase in heart rate. However, research has found no difference with changes in resting blood pressure when conventional RT was compared with circuit RT (2,3). Periodized, multi-set RT programs as well as circuit RT programs can be performed by individuals with HTN. High-intensity RT programs, which would likely induce the greatest increases in blood pressure, should be discouraged. As a result, 1-RM testing may pose unnecessary risks for individuals with HTN. See Table 1 for recommendations on setting initial loads for RT exercises. Static RT exercise has been shown to have a favorable effect on blood pressure. Isometric handgrip training at a moderate intensity (30% of the maximum voluntary contraction force) has been shown to produce a hypotensive response after exercise in both normotensive and hypertensive persons (4,5). Although this form of RT has limitations (e.g., need to train at several angles in the range of motion, time-consuming), it may be benecial and an option for persons with HTN and arthritic joints. It is prudent that the tness professional obtain medical clearance from the individuals physician prior to initiating a RT program. The physician may prescribe a blood pressure or ratepressure product (heart rate 3 systolic blood pressure) limit. A pre- and postexercise blood pressure reading should always be performed. Regular blood pressure monitoring will help detect any changes in resting or exercise blood pressure, possibly facilitating medical evaluation. Assessing exercise blood pressure during a seated lower body RT exercise, such as a leg press, will be most practical. If exercise blood pressure readings are within reference ranges, it may not be

Paul Sorace, MS, ACSM RCEP, CSCS*D Column Editor

SUMMARY
RESISTANCE TRAINING HAS BENEFICIAL EFFECTS ON BLOOD PRESSURE AND SHOULD BE PART OF LIFESTYLE INTERVENTION TO HELP PREVENT AND CONTROL HYPERTENSION. THIS COLUMN DISCUSSES RESISTANCE TRAINING PROGRAMMING GUIDELINES AND SAFETY PRECAUTIONS FOR INDIVIDUALS WITH HYPERTENSION. RESISTANCE TRAINING PROGRAMMING FOR HYPERTENSION

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he Special Populations Column in this issue reviews hypertension (HTN), prehypertension, its risks, medications, and the benets of resistance training (RT) on blood pressure and HTN. A review of the

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Table 1
American Heart Associations recommendations for resistance exercise in individuals with and without cardiovascular disease 1. Uncontrolled hypertension (.180/110 mm Hg) is an absolute contraindication for resistance training. 2. Uncontrolled hypertension (.160/.100 mm Hg) is a relative contraindication for resistance training (should consult a physician before participation). 3. An initial intensity that corresponds to 3040% of 1-RM for the upper body and 5060% of 1-RM for the hips and legs is recommended. When determination of 1-RM is deemed inappropriate, the load-repetition relationship for RT may be approximated. 4. The initial resistance should allow for and be limited to 812 repetitions per set for healthy sedentary adults or 1015 repetitions at a low level of resistance, for example, ,40% of 1-RM, for older (.5060 years of age), more frail persons, or cardiac patients. 5. Perform one set per exercise, 23 days per week. Multiple-set programs at a greater training frequency (.2 days/wk) may provide greater benets for healthy, younger individuals whose goals include maximum gains in strength, lean body mass, and athletic performance. 6. Perform exercises in a rhythmical manner at a moderate to slow controlled speed. Use a full range of motion, avoid breath holding and straining (Valsalva maneuver) by exhaling during the contraction or exertion phase of the lift and inhaling during the relaxation phase. 7. Aerobic training or an aerobic warm-up should be performed before RT. 8. Involve the major muscle groups of the upper and lower extremities. Exercise examples include: chest press, shoulder press, triceps extension, biceps curl, pull-down (upper back), lower-back extension, abdominal crunch/curl-up, quadriceps (leg) extension or leg press, leg curls (hamstrings), and calf raise. 9. Alternate between upper- and lower-body exercises to allow for adequate rest between exercises. 10. When the participant can comfortably achieve the upper limit of the prescribed repetition range, training loads may be increased by 5%. 11. Individuals should work to a perceived exertion during RT that approximates 11 to 14 (fairly light to somewhat hard) on the Borg category scale. The rating will increase throughout the set. 12. The type of resistance exercise equipment may vary considerably in cost, complexity, operational skill/coordination, and time efciency. Select equipment that is safe, effective, and accessible.
Information obtained from Williams et al. (7).

necessary to monitor exercise blood pressure every session. A postexercise hypotensive response (reduced blood pressure) often occurs after a circuit RT or conventional RT session. This obviously is benecial for those who have HTN or prehypertension. Lightheadedness, dizziness, and possible fainting (syncope) can occur with large reductions in blood pressure, adding to the importance of measuring blood pressure after exercise or anytime these symptoms are present. The specic effects exercise has on lowering blood pressure remain speculative but are likely multifactorial (1,7).

A type of circuit RT, known as cardioresistance training, will work well for many persons with HTN. Cardioresistance combines circuit RT and cardiopulmonary exercise in an interval format. An example of a cardioresistance training program is described in the side bar below.
Side Bar

* Perform 5 minutes of cardiopulmonary exercise * Perform 34 RT exercises for the core muscles * Perform a 5- to 10-minute cardiopulmonary cool down Resistance exercises are performed with a moderate resistance (e.g., 4060% 1RM), 1215 repetitions, one set per exercise, and short rest intervals (e.g., 30 seconds), while keeping cardiopulmo_ O2R nary intensity at 40,60% of V (oxygen uptake reserve). Resistance exercise intensity should be maintained at a rating of perceived exertion of 11 14 on the Borg category scale. Muscular and cardiopulmonary endurance are emphasized with this style of RT.

* Perform a 5- to 10-minute cardiopulmonary warm-up * Perform 45 RT exercises for the lower body * Perform 5 minutes of cardiopulmonary exercise * Perform 56 RT exercises for the upper body

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One-on-One

CONCLUSION

Resistance training has been proven safe and effective for persons with HTN. Resistance training should be included in a complete exercise program designed to prevent or lower HTN. Following the guidelines presented in this column will ensure safe and effective RT for individuals with HTN, resulting in improved health, tness, and quality of life.

4. Ray CA and Carrasco DI. Isometric handgrip training reduces arterial pressure at rest without changes in sympathetic nerve activity. Am J Physiol Heart Circ Physiol 279: H245H249, 2000. 5. Taylor AC, McCartney N, Kamath MV, and Wiley RL. Isometric training lowers resting blood pressure and modulates autonomic control. Med Sci Sports Exerc 35: 251256, 2003. 6. Whaley, MH, Brubaker PH, and Otto RM, eds. ACSMs Guidelines for Exercise Testing and Prescription (7th ed). Baltimore, MD: Lippincott Williams, & Wilkins, 2005. pp. 215.

Paul Sorace is a clinical exercise physiologist at Hackensack University Medical Center and an instructor for the American Academy of Personal Training (AAPT). Thomas P. Mahady is the senior exercise physiologist for The Cardiac Prevention & Rehabilitation Program at Hackensack University Medical Center and an adjunct professor at William Paterson University in Wayne, New Jersey. Nicole Brignola is a recent graduate from William Paterson University. She received her bachelors degree in exercise science and is currently continuing her education.
REFERENCES
1. American College of Sports Medicine. Position Stand: Exercise and Hypertension. Med Sci Sports Exerc 36: 533553, 2004. 2. Cornelissen VA and Fagard RH. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens bibitem259, 2005. 3. Kelley GA and Kelley KS. Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Hypertension 35: 838 843, 2000.

7. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, Gulanick M, Laing ST, and Stewart KJ; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: A scientic statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 116: 572584, 2007.

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