ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 42 of 61
УЖМБС 2018, 3(5): 214–220
Medicine. Reviews

Physical Training in Programs of Secondary Prevention and Cardiac Rehabilitation of Patients with Hypertension

Dolynna O. V. 1,3, Kolisnyk P. F. 1,3, Kolisnyk S. P. 2,3

The prevalence of hypertension among patients of working age with cardiovascular diseases (CVD) is 41%. Ischemic heart disease (IHD) is combining with essential arterial hypertension in 60% of cases. According to the results of the Framingham Heart Study, 80-85% of chronic heart failure is due to hypertension, IHD or a combination of these. Thus, persons with hypertension account a significant part of patients with indications to involvement in cardiac rehabilitation (CR) and secondary prevention programs. Criteria for choosing exercises, intensity and duration of physical training programs (PTP) in patients with hypertension continue to be studied. A review of the scientific literature deals with studying the effectiveness of different PTP on patients with hypertension and systematizing the recommendations of international communities of cardiologists regarding a physical activity of patients with hypertension. Material and methods. We researched scientific publications on the selected topic for in such databases as PubMed, Cochrane Library, Web of Science, Scopus and official electronic resources of international communities of cardiologists. The search was conducted according to the terms: exercise, physical activity, physical training, hypertension, blood pressure. Results and discussion. The results of the studies, systematic reviews and meta-analyses confirm the positive effect of PTP on the effectiveness of blood pressure control (BP), lipid profile, exercise tolerance, duration, and quality of life of patients with hypertension. We also detected how different types of PTP influenced on the blood pressure and systematized recommendations of the international communities of cardiologists. Conclusions. Patients with hypertension are recommended regular physical activity of moderate intensity of at least 30 minutes a day, 5 days a week or 15 minutes of intensive exercise, or a combination of them. The advantage is given to dynamic endurance aerobic training (DEAT) (walking, jogging, cycling, and swimming) of moderate intensity (40-59% VO2max, 12-13 Borg PRE Scale), in addition, dynamic resistance (DRE) or isometric resistance exercises (IRE) can be used. DEAT, DRE and IRE reduce systolic (SBP) and diastolic blood pressure (DBP), and the combined training mainly promotes a decrease in DBP. Hypotensive effect and safety of IRE is less studied compared to DEAT and DRE. Therefore, not all international cardiologic guidelines contain recommendations for their appointment. DRE can be used 2-3 times a week in the combination with DEAT. But the advantage of combined training (CT) compared with the isolated use of DEAT is not proved. In some studies, the predominant impact of CT on diastolic blood pressure was detected. It was established that attracting specialists from physical and rehabilitation medicine to the creation of the curriculum provided additional benefits for patients with high cardiovascular risk. Further research should be aimed at studying the peculiarities of the effects of PTP in patients with different stages of HT, depending on the damage of the target organs, the daily blood pressure profile, individual patient characteristics, and comorbidity. The information given in the article can be used to simplify creating a prescription of training in patients with hypertension.

Keywords: cardiac rehabilitation, physical exercise, physical training, blood pressure, hypertension

Full text: PDF (Ukr) 249K

  1. Bjarnason-Wehrens B, McGee H, Zwisler A, Piepoli M, Benzer W, Schmid J, et al. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. European Journal of Cardiovascular Prevention & Rehabilitation. 2010; 17 (4): 410-8.
  2. Cifu A, Davis A. Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. JAMA. 2017; 318 (21): 2132-34.
  3. Cléroux J, Feldman RD, Petrella RJ. Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999; 4; 160 (9 Suppl): S21-8.
  4. Cornelissen V, Smart N. Exercise Training for Blood Pressure: A Systematic Review and Meta-analysis. Journal of the American Heart Association. 2013; 2( 1): e004473.
  5. Corra U, Piepoli M, Carre F, Heuschmann P, Hoffmann U, Verschuren M et, al. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: Key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. European Heart Journal. 2010; 31 (16): 1967-74.
  6. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension. 2013; 31 (7): 1281-357.
  7. Sharman JE, La Gerche A, Coombes JS. Exercise and Cardiovascular Risk in Patients With Hypertension. American Journal of Hypertension. 2014; 28 (2): 147-58.
  8. Golbidi S, Laher I. Exercise and the Cardiovascular System. Cardiology Research and Practice. 2012; 2012: Article ID 210852.
  9. Gabb G, Mangoni A, Anderson C, Cowley D, Dowden J, Golledge J, et al. Guideline for the diagnosis and management of hypertension in adults — 2016. The Medical Journal of Australia. 2016; 205 (2): 85-9.
  10. Galve E, Cordero A, Bertomeu-Martínez V, Fácila L, Mazón P, Alegría E, et al. Update in Cardiology: Vascular Risk and Cardiac Rehabilitation. Revista Española de Cardiología (English Edition). 2015; 68 (2): 136-43.
  11. Kisner C, Colby L. Therapeutic Exercise: Foundations and Techniques (6th ed.). FA Davis Company; 2012.
  12. Inder J, Carlson D, Dieberg G, McFarlane J, Hess N, Smart N. Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertension Research. 2015; 39 (2): 88-94.
  13. Leung A, Daskalopoulou S, Dasgupta K, McBrien K, Butalia S, Zarnke K, et al. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Canadian Journal of Cardiology. 2017; 33 (5): 557-76.
  14. Malinovskaya IE, Shumakov VA. Cardiological rehabilitation of patients with acute myocardial infarction: the possibility of increasing the effectiveness of treatment and improving the prognosis. Ukrainian Journal of Cardiology. 2015; 1: 16-25.
  15. Niebauer J. Cardiac rehabilitation manual. London: Springer; 2011.
  16. Piepoli M, Corrà U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, et al. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. European Journal of Cardiovascular Prevention & Rehabilitation. 2010; 17 (1): 1-17.
  17. Piepoli M, Hoes A, Agewall S, Albus C, Brotons C, Catapano A, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Atherosclerosis. 2016; 252: 207-74.
  18. Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation. European Journal of Cardiovascular Prevention & Rehabilitation. 2004; 11 (4): 352-61.
  19. Reprint: 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Journal of the American Pharmacists Association. 2014; 54 (1): e4.
  20. Thomas R, King M, Lui K, Oldridge N, Piña I, Spertus J. AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services. Journal of the American College of Cardiology. 2010; 56 (14): 1159-67.