The Effect of Endurance Exercise on Hypertension - Essay Example

Running head: EXERCISE AND HYPERTENSION The effect of endurance exercise on hypertension Ghaliah Alajmi MMU-2009] Introduction The affects of urbanization and modern lifestyle have led to a higher prevalence of sedentary lifestyle and less exercise. Hypertension is typically defined as a systolic pressure greater than 149mmHg or a diastolic pressure greater than 90 mmHg. (Frank J. Cerny Harold W. Burton). And this disease call silent killer because patients have not any symptoms related to their high Bp. However, Jonathan K. Ehrman stated that Headache is popular considered a symptom of hypertension also he mentioned dizziness and easy fatigability can occurred. Absolute training can induce changes in BP and HT and according to Jonathan K. Ehrman “ it is believed that exercise training may decrease BP by improving renal function in patients with essential hypertension ” So even a modest reduction of BP by endurance or resistance training decreases cardiovascular risk by 5-9%, stroke 8-14% and all cause mortality by 4 % (Vivian H.Heyward) BP is determined by cardiac output and total peripheral resistance; moreover it is elevated as result of one of the determinate or both. Therefore, non-pharmacological treatment for HT patients, needs to include theprovision for losing weight if overweight, limit alcohol intake to no more than 1 ounce of ethanol per day, reduce sodium intake to less than 100 mmol per day, maintain adequate dietary potassium, calcium, and magnesium intake, stop smoking and reduce dietary saturated fat and cholesterol intake for an overall cardiovascular health. Reducing fat intake also helps reducing caloric intake it is also important to control weight and non-insulin depended diabetes (Williams and Wilkins). Mode, frequency; duration and intensity of exercise are generally the same only in healthy population. Increasing exercise intensity to above 70% VO2 doesn’t have additional impact on BP. In addition, absolute sudden death during any particular episode of heavy exercise is low. Peripheral vascular disease includes vascular insufficiencies such as arteriosclerosis, arterial stenosis, Raynaud phenomena and Burger’s dieses. It’s usually correlated with hyperlipidemia and hypertension in older patients. Peripheral vascular disease manifests ischemia pain during physical activity and is due to mismatch between muscle supplies and demands. In treatment weight bearing exercise and medication is included. According to Roy J. Shephard, observing middle age and older post coronary patient over three years of vigorous and progressive endurance exercise. He established a decrease of resting provision at normal HT and patient SP followed with a small increase of resting DP. At the maximum tolerated power output, arterial stenosis, Raynaud SP showed a small increase, whereas DP was same and HT showed same SP with decreasing DP. According to data from Ward Hason and Einerson’s treadmill exercise, it has been found that more than 50% showed same SP with decreasing SP in both mild and moderate HT. In 100 % treadmill exercise SP increase in both and DP remains the same. In addition, isometric Handgrip mild HT was 180-190/120-130 mmHg and moderate HT was 190/130 mmHg. In normal patient treadmill exercise, 50% didn’t change anything and in 100% it decrease SP without changing DP. During meta-analyses of exercise training in HT there are bigger changes in BP caused in sustained HT than in mild HT. The production of nitric oxide (NO) from endothelial cells and it’s attainment as antihypertensive anti-atherosclerotic and antithrombotic effects as vasodilator capacity is important for cardiovascular disease. On the other hand, NO achieve regulation of vascular tonus and reducing aging, establishing intense aerobic exercise training; by producing increased of plasma nitrite/nitrate. Measuring the plasma concentration of NO and the plasma concentration of cyclic guanosine mono phosphate in mild aerobic exercise for 3 month, among elderly women, shows that there is an increasein the blood pleasure at rest that decreased after exercise training. It is therefore significant for exercise to be part of health promotion on elder and sedentary lifestyle (Seiji Maeda et al.) Knowing that chain reaction angiotensin converting enzyme (ACE) catalyses the conversion of angiotensin I to angiotensin II and the breakdown of the vasodilator bradykinin to kinin degradation products; it can be determined that both angiotensin II and bradykinin have several acute and chronic effects on the cardiovascular system. added to this 50% of plasma ACE levels is accounted for by a major gene effects. Insertion (I) allele of theI/deletion (D) polymorphism of the angiotensin converting enzyme (ACE) gets correlated with endurance exercise and increased physical condition. According to data, ACE I/D polymorphism is a specific genetic factor associated with physical activity levels in free. It is related to the process of living borderlines and mild hypertensive subjects. The deletion allele is associated with diminished levels of physical activity, in power exercise group where excess prevalence of the D allele is present. While in the endurance group there was a higher prevalence of theI allele. Endurance training as intervention for mild hypertension, may correlate with genotype and blood pressure. It can be explained through the blood pressure from physical activity (Mikolaj Winnicki et al.). Baroreflex buffering (BB) is an important mechanism by which the central nervous system controls arterial BP. Autonomic nervous system, such as buffering the BP response to pressure stimuli. BB is reduced in patients with autonomic dysfunction and essential HT; and it is here that the decreased BB was showed with aging in healthy humans. The exercise-trained men a lower resting heart rate and higher maximal oxygen consumption and heart rate variability than the sedentary subjects. The data showed that habitual vigorous endurance exercise does not modulate in vivo BB in healthy humans. In addition, no adverse effects on baroreflex-mediated BP control were found and will not occur as consequence of vigor regular aerobic exercise in health human. Recommendation is moderate and vigorous exercise as a way of reducing chronic cardiovascular and metabolic disease; with progressing work capacity without bad consequences on BP of which the effects are gratified. (Demetra D. Chirstou et al.) Obesity is a risk for cardiovascular disease and a key in metabolic syndrome that increases visceral adipose tissue, peripheral insulin resistance, hyperlipidemia and high pressure. The important control paths are endocannabinoid system and peroxisome proliferation activated receptors. Observing rats on high-fat diet showing typical metabolic syndrome as obesity and HT (Zhen Cheng Yan et al.) Left ventricular hypertrophy (LVH) is adaptive process of HT, and characterized as large increase on LV wall thickness, without significant increase of LV cavity diameter. The result of elevation of BP and systolic overload is increase in LV wall thickness to radius radio (concentric remodeling) and LV mass (concentric LVH). Endurance exercise training is effective by lowering BP in mild and moderate HT and regress LVH in older HT patients. During training is increased aerobic power by 16% and it is decreased systolic and diastolic BP, LV wall thickness and the wall thickness to radius radio, but in the control group there weren’t significant changes. Therefore, the data showed that exercise training is reducing BP and indicate regression of LVH and LV concentric remodeling with older adult, with mild or moderate hypertension. This is due to the reduction in cardiac reserve. In addition, data on the study suggested reduction of LV mass and concentric remodeling that is further correlated by trained induced lowering of SBP and removing of systolic overload. (Michael J. Turner et al.) Diet was less effective in reducing body mass index than combined. It accurse that exercise is less effective than diet and adding exercise to diet doesn’t reduce BP. (R.H. Fafard) Effects were observed in 16-weeks endurance exercise training on ambulatory BP in older adult, normotensive, without renal or cardiovascular disease and without vasoactive and diuretic medication. Therefore, the data showed that endurance exercise training can improve both aerobic fitness and real life blood pressure in healthy older adults and could inhibit increasing BP correlated with aging. Because of 16 weeks of moderate exercise, training by older man and women can produce modest reduction of ambulatory BP then long-term exercise can inhibit increase in BP correlated with aging. (James V. Jessup et al.) Mild to moderate endurance exercise generally reduce blood pressure on HT individuals. This was showed by data where HT men and women had a significant reduced SP and systolic DP, but normotensive patients showed no significant reduction. On average, the HT subject maintained significant systolic BP reductions for 13 hours after the 75% bout compared to 4 h after the 50% intensity. From other side, diastolic BP was reduced for an average of 11 h following the 75% bout compared to 4 h after the 50% intensity. So conclusion is that an exercise bout conducted between 50–75% VO2 max significantly decreases SBP and DBP on HT subjects and that a greater and longer-lasting absolute reduction is evident following a 75% of maximum bout of exercise. Therefore, exercise is a valuable tool for short –term control of BP in HT adults (T.J. Quinn). Increase of high frequency power normalized during tilt and decrease of the ratio of low frequency-to-high frequency power of heart rate variability point to an enhanced parasympathetic tone after training, which could be responsible for the relief of symptoms of disease, including benefit effects of heart pump. Therefore, endurance exercise should be considered as treatment of orthostatic intolerance patients (Robert Winker et al.) Exercise capacity is reduced in patients with renal failure and could be determined by cardiopulmonary exercise tests and reflected in peak oxygen uptake (peakVO2). According to data values of exercise duration, peak VO2 and maximum work rate was lower than in health population. Peak VO2 was correlated with serum phosphorus levels. Phosphorus is a component of ATP, part of energy retaliated mechanism operative in muscles of respiratory and musculoskeletal system. Therefore low exercise capacity might be related to low serum phosphorus level, so optimal control of serum phosphorus therapy would increase exercise capacity, exercise duration, and oxygen consumption resulting in a decrease of postoperative mortality in renal transplantation candidates. (G Ulubay et al). According to Dr. Kenneth H., scientific studies have shown that oral calcium supplement can lower the pressure of mild and moderate HT patients. His advice to avoid natural licorice that contain glycyrrhizin acid; to get involved in a smoking cessation program, consider taking Q10 supplement, avoid alcohol, get involved in a regular aerobic exercise program, to use relaxation and biofeedback therapy. According to Frank j Cerny and Harlod W. Burton preventing and reducing of risk factors could be established by reducing smoking, high level of lipids, hypertension, obesities, sedentary life stress and some personal characteristics. Dynamic exercise is followed by increased stoke volume, cardinal contractility and BP. So consequences are rising in systolic, with little changes in diastolic BP and decrease in vascular resistance. In mild and moderate hypertension systolic and diastolic BP and vascular resistance are higher compared with normotensive patients. During isometric exercise normal response is rise in systolic and diastolic BP proportional to muscular mass and maximal effort mediated by presser response with no significant vascular resistance. In hypertensive patient pressor response is correlated to increase peripheral resistance. So hypertensive patients have greater systolic and diastolic BP, and vascular resistance during treadmill exercise and isometric handgrip. Exercise BP response may provide diagnosing and managing hypertension. Earlier treatment may be established in borderline resting BP who has elevated BP response during increased activity. BP as 180/120 mmHg at 50 % of maximum hadgrip and treadmile BP values 180/89 mmHg at 15 % intensity or 220/80 mmHg at 100% intensity are established as hypertensive response. Patient with mild hypertension showed earlier rise in systolic BP to level to 180/200 mmHg during sub maximal exercise and maintained in at maximal exercise. So these patients with elevated BP response showed evidence of LVH and risk for hypertension. Measuring leisure-time activities and BP showed that resting Bp decried with each increase in reported activity. During dynamic exercise have reported beneficial effect of dynamical exercise on BP. Significant decrease is marked at MP as 2 weeks training during continued their lifestyle. According to meta analysis data showed a reduction of 8mmHg systolic and 5 mm hg diastolic BP and it is marked and increased gradient of BP reduction from normal patient to mild and moderate hypertension. Following resistance exercise showed reduction in systolic Bp after completing endurance exercise training program. So weight training also could be effective on lowering BP in hypertensive patient (Michael L. Pollock) Physical inactivity is a risk factor for coronary hard dieses and mortality in middle age people, so preventing concerned regular physical activity. Beneficial effects of regular exercise are many as reduction of blood pressure (BP) reduction of left ventricular hypertrophy, improving hypertension mild and moderate even preventing, bettering exercise capacity, also combined with dietary cause reduction of oxidative stress, increase nitric oxide availability improves metabolic profile and quality of life. Also regular exercise is a part of therapeutic method of obesity, metabolic syndrome, McArdley disease, peripheral vascular disease, orthostatic intolerance and patient with renal failure. Implementation of recommended physical activity might involve the community through short time intensive program of physical as motivating patient to change lifestyle risk factors, reduce BP and improve their metabolic profile and so reducing cardiovascular risk factors. References: Chirstou, Demetra D. et al. (2003). Baroreflex Buffering in Sedentary and Endurance Exercise-Trained Healthy Men. Hypertension, 41: 1219-1222. Title: Baroreflex buffering in sedentary and endurance exercise-trained healthy men. Source: Hypertension [0194-911X] Christou yr:2003 vol:41 iss:6 pg:1219 -22 Fafard, R.H. (2005). Effects on exercise, diet and their combination on BP. Journal of Human Hypertension, 19: 20-24. Title: Effects of exercise, diet and their combination on blood pressure. Source: Journal of human hypertension [0950-9240] Fagard yr:2005 vol:19 Suppl 3 pg:S20 -4 Jessup, James V. et al. (1998). The effects of endurance exercise training on ambulatory BP in Med. Sci. Sports Exerc., Vol. 33, No. 6, Suppl., pp. S484-S492, 2001. normotensive older adult. Geriatric Nephrology and Urology, 8 (2): 103-109. لازم اتاكد Maeda, Seiji et al. (2004). Moderate Regular Exercise Increases Basal Production of NO in Title: Moderate regular exercise increases basal production of nitric oxide in elderly women. Source: Hypertension research [0916-9636] Maeda yr:2004 vol:27 iss:12 pg:947 -53 Elderly Women. Hypertension research 27 (12): 947-953. Quinn, T.J. (2000). Twenty four hours, ambulatory BP responses following acute exercise: impact of exercise intensity. Journal of Human Hypertension, 14 (9): 547-553. Title: Twenty-four hour, ambulatory blood pressure responses following acute exercise: impact of exercise intensity. Source: Journal of human hypertension [0950-9240] Quinn yr:2000 vol:14 iss:9 pg:547 -53 Turner, Michael J. et al. (2000) Effect of Endurance Exercise Training on Left Ventricular Size and Remodeling in Older Adult with HT. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 55: 245–251. Title: Effect of endurance exercise training on left ventricular size and remodeling in older adults with hypertension. Source: The journals of gerontology. Series A, Biological sciences and medical sciences [1079-5006] Turner yr:2000 vol:55 iss:4 pg:245 -51 Basic اكمل باقي اسماء العلماء Ulubay, G. et al. (2006). Factors Affecting Exercise Capacity in Renal transplantation Candidates on Continued Ambulatory Peritoneal Dialysis Therapy. Transplantation proceedings, 38: 401-405. Title: Factors affecting exercise capacity in renal transplantation candidates on continuous ambulatory peritoneal dialysis therapy. Source: Transplantation proceedings [0041-1345] Ulubay yr:2006 vol:38 iss:2 pg:401 -5 Winker, Robert et al. (2005). Endurance Exercise Training in Orthostatic Intolerance. Title: Endurance exercise training in orthostatic intolerance: a randomized, controlled trial. Source: Hypertension [0194-911X] Winker yr:2005 vol:45 iss:3 pg:391 -8 Hypertension, 45: 391-398. Winnicki, Mikolaj et al. (2004) Physical activity and Angiotension-Converting Enzyme Gene Polymorphism in Mild HT. American Journal of Medical Genetics, 22 (3): 661- Title: Physical activity and angiotensin-converting enzyme gene polymorphism in mild hypertensives. Source: American journal of medical genetics. Part A [1552-4825] Winnicki yr:2004 vol:125A iss:1 pg:38 -44 662. Yan, Zhen Cheng et al. (2007). Exercise reduces adipose tissue via cannabinoid receptor type 1 which is regulated by peroxime proliferator- activated receptor –b. Biochemical and biophysical research communications, 354 (2): 427-433. Title: Exercise reduces adipose tissue via cannabinoid receptor type 1 which is regulated by peroxisome proliferator-activated receptor-delta. Source: Biochemical and biophysical research communications [0006-291X] Yan yr:2007 vol:354 iss:2 pg:427 -33 Roy j. shephard, ageing, physical activity and health chapter 11 Williams & Wilkins 1995, ACSMS GUIDE LINES FOR EXERCISE TESTING AND Prescription ,5th edition, American College of sport medicine, a waverly company Frank j Cerny and Harlod W. Burton . exercise physiology for health care professionals Chapter14. Jonathan K. Ehrman , Paul M. Gordon. 2003 . Clinical exercise physiology. Leeds. Champaign, IL Read More