4 There is Class I, Level B evidence that 150 minutes of weekly physical activity offers an alternative that may be used to complement antihypertensive medication. The American College of Sports Medicine position stand on exercise and HTN 6 recommends dynamic aerobic endurance training for at least 30 minutes daily, preferably supplemented with dynamic resistance exercise. The effects of exercise training may vary with different exercise modalities (eg, endurance training or resistance exercise) and dose parameters, specifically program length, session duration, frequency, and workload or intensity. As such, the optimal exercise training prescription remains unclear. Dynamic aerobic endurance exercise involves large muscle groups in dynamic repetitive activities that result in substantial increases in heart rate and energy expenditure. Resistance training is activity in which each effort is performed against a specific opposing force generated by resistance and is designed specifically to increase muscular strength, power, and/or endurance. According to the type of muscle contraction, resistance training can be divided into 2 major subgroups: “dynamic” versus “static or isometric” resistance training. Dynamic resistance training involves concentric and/or eccentric contractions of muscles while both the length and the tension of the muscles change. Isometric exertion involves sustained contraction against an immovable load or resistance with no or minimal change in length of the involved muscle group. Current thinking varies with respect to the preferred type of physical activity for BP historically endurance training has been preferred.
Isometric activity has previously been associated with exaggerated hypertensive responses, but recent work has suggested isometric handgrip activity may become a new tool in the nonpharmacological treatment of high BP.
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