Exercise For Special Populations
Dr. Chaloupka T/R 10:50
Cynthia Nieves
Fall 08’
John Stevenson
Kim Brozosky
Ryan Dunphy
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Hypertension Is: Chronic High Blood Presure
at a level above 140/90
OVER 50YRS:
NORMAL = Less
than 160/90
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Systolic
Diastolic
/
Normal
Less than 120
Less than 80
120/80
Prehypertension
120-139
80-89
120/80 
139/89
Hypertension
(Stage 1)
140-159
90-99
140/90 
159/99
Hypertension
(stage 2)
Higher than 160
Higher than 100
160/100
Authors: Kazuko Ishikawa-Tawata, Toshiki Ota,
Hirofumi Tanaka
American Journal of Hypertension, Volume 16,
August 2003 (pp. 629-633)
To determine the amount of aerobic exercise
needed to lower BP in hypertensive individuals
Subjects:
207 hypertensive individuals
5 Groups (studied over 8 weeks @ 50%
VO2max)
Control group
30-60 min/wk aerobic exercise
61-90 min/wk aerobic exercise
91-120 min/wk aerobic exercise
>120 min/wk aerobic exercise
Control
30-60
Group: No change in BP
min/wk: Moderate drop in BP
Remaining
Groups: Significant drop in BP
Even
minimal activity can lower BP in
sedentary hypertensives
Exercise
beyond 61-90 min/wk yields
diminishing returns in decreased BP
Frequency
is not important, as long as weekly
exercise amount is consistent
Limiting
Factor-subjects were not assigned to
groups at random
Moderate-intensity aerobic exercise for 60
minutes or more per week is sufficient to
significantly lower BP
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8147 men and 1268 women aged 18 to 84 years
old- majority was white and from middle and
upper socioeconomic strata
Between 1971 and 2002 at Cooper Clinic, Dallas,
TX.
Free of CVD, normal resting electrocardiograms,
were able to complete an exercise stress test at
least 85%, and had HTN based on physician
diagnosis or measured resting blood pressure over
140/90 mmHg.
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Low- 20%
Moderate- 40%
High- upper 40%
Highly correlated with measured maximal oxygen
uptake.
Max heart rate was achieved during exercise
testing (101% ± 8% in men) and (100% ± 9% in
women)
To standardize exercise performance, estimated
maximal metabolic equivalent from final treadmill
speed and grade.
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Follow up- Mail back health survey between 1982 and 2004.
Conducted after an overnight fast of at least 12h.
BMI was computed from measured height and weight.
Resting BP was measured in the seated position using
auscultator methods with a mercury sphygmomanometer.
Serum samples were analyzed for lipids and glucose using
standardized bioassays.
Diabetes and dyslipidemia was based on a history of
physician diagnosis or measured phenotypes that met clinical
thresholds for each condition.
Smoking habits and alcohol intake were obtained from a
questionnaire. (drinks per wk of alcohol intake were
computed with one drink standardized to 12 ounces of beer,
5 ounces of wine, and 1.5 ounces of hard liquor.
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Non fatal CVD end points were obtained using case finding
questions for a physician diagnosis of myocardial infarction
or stroke, and for having coronary revascularization
procedure.
Participates were asked whether a physician had ever told
them that they had a heart attack or stroke, or if they had
undergone any coronary interventions. (if yes participants
were asked to report the yr of the diagnosis or procedure)
Primary outcome was CVD events (MI, coronary
revascularization, and stroke.)
Also examined coronary heart disease events as a separate
end point.
The percentage of agreement between reported events and
medical record review was 88%, 100%, and 89% for MI,
revascularization procedures, and stroke.
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Low fit individuals were slightly younger than those in the
moderate and high fitness categories and CVD risk factors
were often less favorable.
Compared with noncases, individuals who developed CVD
were older, had lower CRF, and had higher prevalence of
major CVD risk factors.
Men with moderate and high CRF had a 14% and 34% lower
risk of CVD events than men with low CRF.
The inverse association between CRF and CVD events
remained significant after additional adjustment for BMI,
resting BP, diabetes, and dyslipidemia.
In women, rates of total CVD events were inversely associated
with CRF. Women with moderate and high CRF had a 6% and
51% lower risk of CVD events than women with low CRF.
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In men, a significant inverse gradient of age
and examination year adjusted CVD rates
were seen across incremental CRF levels
within each HTN group.
Men in the lowest CRF group had a 1.6- to
2.6 fold higher rate of total CVD events
than men in the highest CRF group.
In women CRF was inversely associated with
CVD rates within HTN groups; however, the
rate differences were not statistically
significant.
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The CRF is inversely associated with the risk of all-cause and CVD
mortality in initially asymptomatic women and men.
Statistical power often is insufficient to examine the association
between CRF and CVD within populations groups that have higher
CVD rates because of the presence of clinically manifest disease,
such as HTN.
This suggest that physical activity and CRF may favorably influence
the etiologic pathway between HTN and fatal clinical CVD events.
CRF is inversely associated with the incidence of nonfatal CVD
events in women and men with HTN.
The CRF can be enhanced in most individuals, including those with
HTN, through participation in physical activities such as brisk
walking, cycling, and jogging, for 30 min or more on most days of
the week.
Believe that clinicians should consider the potential independent
cardio protective benefits of physical activity and CRF and counsel
their sedentary hypertensive patients to become more physically
active and improve their CRFs cornerstone of HTN management and
primary CVD prevention.
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Made a routine visit to the Cardiology Clinic at Tzanio
Hospital, Women’s Social Welfare clinic and a private
Cardiology Clinic between 1998 and 2003.
923 subjects gave a written consent to undergo an exercise
tolerance test and wear an ambulatory monitor for 24h.
Of the 923 subjects, identified 650 pre hypertensive men and
women with no evidence of coronary heart disease.
243 were women and 407 were men (30-79 years old)
Subjects were included if they were: 1)not taking any cardiac,
antihypertensive, or other medication that would affect BP, 2)
had resting systolic BP of 120 to 139 mm Hg or resting
diastolic BP of 80 to 89 mmHg, 3) had no apparent chronic
disease, 4) did not use tobacco products for at least 1 yr, 5)
were not alcoholics.
Those who achieved 90% or more of the age predicted max
heart rate had a normal exercise tolerance that were included
in final analysis.
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Had a ETT- exercise Tolerance test
Assessed exercise capacity and 24-h BP in 407 men (51 +11 years) and 243 women (age 54 +-10 years) with resting
systolic BP 120 to 139 mm Hg and diastolic BP of 80 to 89
mm Hg, defined as hypertension.
Fitness categories: low, moderate, and high; were established
according to exercise time and age.
To determine whether increased fitness is associated with
lower BP during 24 h, assessed the relationship between peak
exercise time as assessed by a graded exercise test and 24 h
BP in pre-hypertensive men and women.
24 hr arterial BP readings were obtained using a noninvasive
ambulatory monitor.
The risk for developing hypertension in sedentary men with
normal BP at rest is approximately 35% to 70% higher when
compared to their physically active peers.
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Resting BP and HR were recorded before the
graded exercise test. The BP measurements
began after subjects were seated in a chair
for 5 min with their backs supported and
arms supported at heart level. Three BP
readings were taken at 2 min intervals
between readings. The third reading was
recorded as the rest BP. The HR at this time
was recorded as the resting HR. Standing
BP and HR were than assessed after the
subject was standing for at least 1 min.
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Physical fitness was assessed by the Bruce Protocol. Exercise
HR was recorded continuously and exercise BP was assessed
at the end of each stage and at peak exercise. Exercise
capacity was recorded as peak exercise time in minutes. Peak
exercise workload was estimated on the basis of the speed
and grade of the treadmill and recorded as metabolic
Equivalents.
For more accurate estimated workload assessment of fitness,
participants were not allowed to lean against handles of the
treadmill.
During exercise BP was recorded at 2 min of each exercise
stage and peak exercise, and within 1 min after the cessation
of exercise.
All resting and exercise BP assessments were made by
indirect arm- cuff sphygmomanometer in the right arm.
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Fitness status was inversely associated with ambulatory BP in both
genders.
Individuals in the lowest fitness category had significantly higher
24h, daytime, and night time BP than those in the moderate and
high fitness categories.
For men, differences between low and moderate fitness categories
were 6/4 mm Hg, 8/4 mm Hg, and 7/3 mm Hg for 24 h daytime,
and night time BP.
For women, the differences were 8/5 mm Hg, 9/5 mm Hg, and 8/7
mm Hg for 24 h daytime, and night time BP.
Similar differences were evident in both genders between low and
high fitness category.
Men were significantly younger and had higher body weight, BMI,
but lower resting HR than women. After adjusting for age, BMI, and
resting HR, the daytime, night time, and 24 h systolic BP were
significantly Lower in men and women therefore the analysis was
stratified by gender.
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MEN
In moderate fitness category were significantly
younger than men in the low and high fitness
categories. Body weight and BMI were lower in
the high fitness category when compared to
those in the moderate and low fitness
categories.
Peak exercise time and met level were
significantly different among all fitness
categories. Resting systolic BP and HR were
similar among all fitness categories. Age and
resting HR were inversely associated with
fitness status, even after adjusting for BMI.
Exercise tie was inversely related with all
ambulatory BP values. BP values were higher
in the low fitness versus moderate and high
fitness men.
Men in low fitness category had higher 24 h,
daytime systolic and diastolic BP than men in
the moderate and high fitness categories.
Comparisons between moderate and high
fitness categories revealed no significant
differences in any BP values.
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WOMEN
In moderate and high fitness category had
lower body weight and BMI than women in low
fitness category. High fitness women were
older than those in the moderate fitness
category. Resting diastolic BP was also lower
in the high versus low fitness women.
Peak exercise time and met level were
significantly different amount the 3 fitness
categories. Resting systolic BP was similar, the
distribution of the daytime ambulatory systolic
BP was normal.
Age, resting diastolic BP, and HR were
inversely associated with exercise time, even
after adjusting for BMI. No association was
observed between fitness status and resting
systolic BP. BP values were significantly higher
in the low fitness versus moderate and high
fitness women. After adjusting for age,
resting diastolic BP, HR, and BMI, women in the
moderate and high fitness categories had
significantly lower 24 h, daytime, and night
time systolic BP and night time only diastolic
BP than women in the low fitness category. All
BP values were similar between those in the
moderate and high fitness categories.
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Moderate physical activity promotes lower BP during a 24 h period in
pre hypertensive men and women.
The risk for developing hypertension is likely to be lowered if
moderate intensity physical activity in this vulnerable population is
encouraged.
Higher levels are associated with lower BP during a 24 h period in
pre hypertensive, middle aged men and women.
The daytime, night time, and 24h systolic BP and night time diastolic
BP for men in the moderate fitness category were 8/4, 7/3, and 6/4
mm Hg lower than men in the low fitness category. The BP values
were very similar between the moderate and high fitness categories.
Women in the moderate fitness category were 9/5, 6/7, and 6/6 mm
Hg, lower than the BP of women in the lowest fitness category. BP
values were very similar between the moderate and high fitness
category.
Only the 24h diastolic BP was lower by 2 to 3 mm Hg in those who
reported engaging in some physical activity for at least once a week
during the previous 2 months versus those who reported engaging
in no physical activity during the same period.
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Title:
Effects of School-Based Aerobic Exercise on
Blood Pressure in Adolescent Girls at Risk for
Hypertension.
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Authors:
Craig Ewart, Deborah Young, James Hagberg
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Source:
American Journal of Public Health: June 1998
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Effects of aerobic exercise physical education
on blood pressure
Who: High-risk, predominantly AfricanAmerican adolescent girls.
Age=9th grade.
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88 girls split into 2 sections.
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1 group STANDARD gym class
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1 group AEROBIC EXERCISE specific class
-vs-
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Technicians were unaware of the girls
experimental status.
All measures assessed in a quiet lab room at
the school.
BP was assessed in a sitting position after
15min of rest.
Ave of 3 readings determined eligibility
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3 YEARS!
Alternating semesters to allow all students to
experience everything
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ONLY the aerobic students increases their
estimated cardiorespiratory fitness.
The aerobic group also had a greater
decrease in systolic blood pressure than
standard education group!
C-R Fitness
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Systolic B-P
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Not enough follow up.
“Aerobic exercise physical education is a
feasible and effective health promotion
strategy for high-risk adolescent girls.”
HES conclusion: PREVENTION IS KEY!!!
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By: Kimberly A. Brownley,
Sheila G. West, Alan L. Hinderliter, and
Kathleen C. Light
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13 Men
◦ 7 white
◦ 6 black
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18 Women
◦ 9 white
◦ 9 black
 Subjects reported minimal physical activity
 Filled out consent forms, medical history, and physical
activity questionnaires
 All subjects were considered normotensive or borderline
hypertensive
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TEST GROUP
◦ 20 minutes of
moderate intensity
bicycle ergometer
◦ Rate of 50 rpm
◦ Workload between
60-70%
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CONTROL GROUP
◦ Rest day
◦ Both days wore an
Accutracker II
monitor
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SBP
DBP
Heart Rate
Accutracker II
recorded:
 Work
 Home
 Sleep
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Exercise Day vs. Control Day
◦ The 11 subjects with elevated BP had lower
readings on exercise days
◦ The effects of exercise were effective for 5 hours
◦ No significant differences in normotensive group