Exercise Intervention for Hypertension:

Benefits:

• Conditioning is also associated with an increased endothelium-derived nitric oxide biosynthesis with an increased vasodilator capacity of the skeletal muscle
• The joint national committee on prevention, detection, evaluation, and treatment of high blood pressure report states that engaging in regular aerobic physical activity at least 30 minutes a day most days of the week can lower systolic blood pressure 4-9 mm Hg 14.
• A reduction of 3 mm Hg in systolic blood pressure has been estimated to reduce coronary heart disease by 5-9%, stroke by 8-14%, and all cause mortality by 4% 59 . 
• Large artery stiffness, which is an important modulator of myocardial blood supply and demand, can be reduced in young individuals by moderate intensity aerobic training 33.  Large artery stiffness reduces maximal cardiac output 33.
• Cholesterol is improved with aerobic exercise 35.  Improvements are:  decreases in the concentration of LDL particles, increased size of LDL particles, increases in the average size and concentration of HDL particles, and decreased concentrations of triglycerides 35.  The amount of exercise makes a greater difference than the intensity of exercise on plasma lipoprotein concentration 35. 
• Chronic blood pressure reductions are due to decreased total peripheral resistance by an increased vessel diameter 45.  Decreases in vascular resistance after training are mediated by neurohumoral and structural adaptations and altered vascular responsiveness to vasoactive stimuli.  Chronic exercise decreases endothelin-1 levels and attenuates stimulation of norepinephrine from alpha receptors 13,39.  Structural changes due to exercise training include vascular remodeling to increase length, cross sectional, and diameter of arteries and veins, or new growth of blood vessels 45 .  These structural changes decrease peripheral resistance and decrease blood pressure 45 . 
• Strength training has similar effects on blood pressure as aerobic exercise.  Martel et al (1999) found a 10 mm Hg decrease in systolic blood pressure and 6 mm Hg in diastolic blood pressure 24 hours after their last exercise session.
• A trial of isometric training 5 days/week for 5 weeks found significant reductions of 10 mm Hg in systolic blood pressure and 9 mm Hg in diastolic blood pressure 45. 
• Blood pressure can be reduced for a few hours by a single bout of exercise, which is termed post exercise hypotension 45 .  People with hypertension can have the benefits of lower blood pressure throughout the day from exercise training through post exercise hypotension 11. 

Other benefits of exercise 2:

• Increased VO2max
• Lower myocardial cost for a given exercise intensity
• Increased capillary density in skeletal muscle
• Reduced body fat
• Improved insulin action
• Decreased anxiety and depression
• Enhanced feelings of well-being
• Enhanced performance of work, recreational, and sport activities
• Resistance training increases strength and lean body mass

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General guidelines for exercise from the American College of Sports Medicine (ACSM) and American Heart Association (AHA):

Aerobic exercise:
Frequency: 3-7 days/week
Duration: 30-60 min., can be broken down to 10 min. intervals.
Intensity: 40-70% VO2 max or 12-13 rate of perceived exertion.  Rating of perceived exertion is a scale from 6-20 on what the intensity feels like to the participant, 6 meaning very light and 20 meaning very hard.  13 would have a feeling of somewhat hard. (American College of Sports Medicine)

Resistance Training:
Frequency: 2-3 days/week (Allow at least 48 hrs. rest)
Intensity: 1 set, 10-15 repetitions at 40-60% one rep maximum in 8-10 different exercises. (American Heart Association)
Avoid high resistance
Use lower weight and higher repetitions
Avoid valsalva maneuvers and isometric exercises.

Other exercise precautions:
Do not exercise if resting SBP > 200 mm Hg or DBP > 115 mm Hg