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Exercise for Cardiovascular Conditions

February 16, 2021

Due to recent research findings this article aims to include new evidence based material to help individuals better understand the treatment option for cardiovascular disease.

Cardiovascular disease is a term used to cover a broad range of conditions that affect the heart and vasculature system. Some common conditions include coronary artery disease, Hypertension,  Type 2 Diabetes and peripheral artery disease. One third of Australians aged 18 years and older have hypertension, 68% of which have uncontrolled hypertension. Hypertension is more likely to develop in individuals with a BMI ⩾30kg/m, waist circumference 102cm (men), or 88cm (women).

Table 1 Classification of clinical High Blood pressure levels in adults

Diagnostic Category

Systolic (mmHg)

 

Diastolic (mmHg)

Optimal

<120

and

<80

Normal

120-129

and/or

80-84

High-Normal

130-139

and/or

85-89

Grade 1 (mild) Hypertension)

140-159

and/or

90-99

Grade 2 (Mod) Hypertension

160-179

and/or

100-109

Grade 3 (severe) Hypertension

>180

and/or

>110

Isolated Systolic hypertension

>140

and

>90

When a patient’s systolic and diastolic blood pressure levels fall into different categories, the highest category and recommended actions apply.

Reproduced with permission from the Heart Foundation

Exercise has been used for many years to help manage and treat symptoms of cardiovascular disease. However what is common amongst this population is the fear or uncertainty around what exercise is ok and will I be safe especially for those who have had either angina or suffered a heart attack.

Where do I begin?

Now this may be a question you have considered either upon diagnosis of your condition or after a serious cardiac event. No matter the reason it’s important to know that there are practitioners who can help. They include:

  • General practitioner – they usually have a known list of common referrers that they work with and trust.
  • Cardiologist
  • Physiotherapist
  • Exercise Physiologist
  • Podiatrist – for those with type 2 diabetes is very important that you see your Podiatrist once per year.
  • Dietitian
  • Diabetes educator

It will be your GP who will assist you in getting the care you need based on your current concerns and goals. Ultimately the above mentioned practitioners all have a combined goal to get you feeling in control of your life, help you understand any current limitations and how to best move forward.

What form of exercise is best?

Aerobic Exercise:

Aerobic exercise even when done at low intensities (50% VO2 max) lead to a reduction of ↝7/6mmHg. This may seem small but ultimately leads to a reduction in all cause mortality rates. Aerobic exercise includes activities such as walking, running, cycling, swimming, skipping, boxing to name a few.

Resistance Exercise:
Evidence in this domain is conflicting however this is what is currently understood. Low to moderate resistance training can be safe and effective in assisting with controlling blood pressure. It is important to note that activities such as heavy lifting that elicits breath holding techniques known as Valsalva is contraindicated in individuals with HP. Consult with your practitioner on how to tailor your resistance training to your needs.


High intensity interval Training (HIIT)
HIIT training has been found to be just as effective as moderate intensity continuous training (MICT). What this means is you have more options that might suit your ability, your likes and time available to exercise. HIIT usually follows a format of 4 x 4mins of work periods around 85-95% peak heart rate, with 3mins of recovery placed in between. Think short burst or hard work followed by rest. The benefit of this modality is you can achieve the same workload of someone training for 1hour plus at moderate intensity in less than 30mins.


Isometric Resistance Training (IRT)
Meta-analyses of trials relating to IRT have confirmed these anti-hypertensive effects, suggesting a reduction of SBP of −5 to −11 mmHg, DBP −4 to −6 mmHg and MAP −4 mmHg.
Isometric resistance training is where a muscle is contracted to a certain position against resistance and held static for a time period. The proposed method is to perform IRT 3 x weekly, 4 x 2mins each exercise at 10-30% maximum voluntary contraction.

Conclusions:

So it can be seen that individuals suffering from cardiovascular disease have a plethora of conservative options that have been proven to reduce and improve their condition. The most important takeaway message is that this disease is treatable and preventable.

References:
Cornelissen, V. A., & Smart, N. A. (2013). Exercise training for blood pressure: a systematic review and meta‐analysis. Journal of the American heart association, 2(1), e004473.
Sharman, J. E., Smart, N. A., Coombes, J. S., & Stowasser, M. (2019). Exercise and sport science australia position stand update on exercise and hypertension. Journal of human hypertension, 33(12), 837-843.
Smart, N. A., & Cornelissen, V. (2012). Exercise Training for Blood Pressure: A Systematic Review and Meta-Analysis.

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