Recommendations Summary

HTN: Physical Activity 2015

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  HTN: Physical Activity

  The registered dietitian nutritionist (RDN) should encourage adults with hypertension (HTN) to engage in regular aerobic activity to lower blood pressure (BP). Physical activity should be of moderate intensity to vigorous intensity three to four times per week for an average of 40 minutes per session. Research indicates that among adult men and women at all BP levels, including individuals with HTN, aerobic physical activity decreases systolic BP and diastolic BP, on average by 2mm Hg to 5mm Hg and 1mm Hg to 4mm Hg, respectively. Typical interventions shown to be effective for lowering BP include aerobic physical activity of, on average, at least 12 weeks of duration, with three to four sessions per week, lasting on average 40 minutes per session and involving moderate-intensity to vigorous-intensity physical activity.  

  Rating: Strong
  Imperative

  • Risks/Harms of Implementing This Recommendation

    Physician consultation is warranted prior to beginning any exercise program.

  • Conditions of Application

    This recommendation applies unless medically contraindicated.

  • Potential Costs Associated with Application

    If the physician recommends a graded exercise test with electrocardiogram (ECG), additional costs may be incurred.

  • Recommendation Narrative

    The following evidence to support the Physical Activity recommendation is based on the 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Eckel et al, 2014):
    
    Blood Pressure ES1. 
    
    Among adult men and women at all BP levels, including individuals with hypertension, aerobic physical activity decreases systolic BP and diastolic BP, on average by 2mm Hg to 5mm Hg and 1mm Hg to 4mm Hg, respectively. Typical interventions shown to be effective for lowering BP include aerobic physical activity of, on average, at least 12 week duration, with three to four sessions per week, lasting on average 40 minutes per session and involving moderate-intensity to vigorous-intensity physical activity. Strength of Evidence: High.

  • Recommendation Strength Rationale

     Conclusion statement from the AHA/ACC Prevention Guideline Strength of Evidence: High.

  • Minority Opinions

    None.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  • References
  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    • Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TA, Yanovski SZ, Kendall KA, Morgan LC, Trisolini MG, Velasco G, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Jun 24; 129(25 Suppl 2): S76-S99. doi: 10.1161/01.cir.0000437740.48606.d1. Epub 2013 Nov 12. No abstract available. Erratum in: Circulation. 2015 Jan 27; 131(4): e326. Circulation. 2014 Jun 24; 129 (25 Suppl 2): S100-S101. PMID: 24222015.
    • Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA; American College of Sports Medicine. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc. 2004 Mar; 36 (3): 533-553. Review. PMID: 15076798.