Hypertension

Resistance TrainingProgramming forIndividuals withHypertensionPaul Sorace, MS, ACSM RCEP, CSCS*D, Thomas P. Mahady, MS, CSCS, and Nicole BrignolaHackensack University Medical Center, Hackensack, New Jersey

S U M M A R Y

RESISTANCE TRAINING HAS

BENEFICIAL EFFECTS ON BLOOD

PRESSURE AND SHOULD BE PART

OF LIFESTYLE INTERVENTION TO

HELP PREVENT AND CONTROL

HYPERTENSION. THIS COLUMN

DISCUSSES RESISTANCE

TRAINING PROGRAMMING

GUIDELINES AND SAFETY

PRECAUTIONS FOR INDIVIDUALS

WITH HYPERTENSION.

RESISTANCE TRAININGPROGRAMMING FORHYPERTENSION

The Special Populations Columnin this issue reviews hyperten-sion (HTN), prehypertension,

its risks, medications, and the benefitsof resistance training (RT) on bloodpressure and HTN. A review of the

data available suggests moderate-in-tensity RT (see Table 1) is indicatedand should be a part of the lifestylestrategy to prevent and control HTN(1,2,6). The American Heart Associa-tion and American College of SportsMedicine recommend RT programsthat include lower resistance withhigher repetitions for individuals withHTN (see Table 1) (6,7). Many personswith HTN are older adults (.50 yearsof age), and the RT guidelines for thispopulation should be considered.

Dynamic forms of RT, such as circuitRT, which incorporate moderate resis-tance (e.g., 40–60% 1-repetition maxi-mum [1RM]) and high repetitions (e.g.,12–15) with brief rest intervals (e.g., 30seconds) are associated with decreasesin resting blood pressure and consid-ered by many to be the optimal form ofRT for individuals with HTN. CircuitRT introduces a moderate aerobiccomponent because of the sustainedincrease in heart rate. However, re-search has found no difference withchanges in resting blood pressure whenconventional RT was compared withcircuit RT (2,3).

Periodized, multi-set RT programs aswell as circuit RT programs can beperformed by individuals with HTN.High-intensity RT programs, whichwould likely induce the greatest in-creases in blood pressure, should bediscouraged. As a result, 1-RM testing

may pose unnecessary risks for indi-viduals with HTN. See Table 1 forrecommendations on setting initialloads for RT exercises.

Static RT exercise has been shownto have a favorable effect on bloodpressure. Isometric handgrip trainingat a moderate intensity (30% of themaximum voluntary contraction force)has been shown to produce a hypoten-sive response after exercise in bothnormotensive and hypertensive per-sons (4,5). Although this form of RThas limitations (e.g., need to train atseveral angles in the range of motion,time-consuming), it may be beneficialand an option for persons with HTNand arthritic joints.

It is prudent that the fitness profes-sional obtain medical clearance fromthe individual’s physician prior toinitiating a RT program. The physicianmay prescribe a blood pressure or rate-pressure product (heart rate 3 systolicblood pressure) limit. A pre- andpostexercise blood pressure readingshould always be performed. Regularblood pressure monitoring will helpdetect any changes in resting orexercise blood pressure, possibly facil-itating medical evaluation. Assessingexercise blood pressure during a seatedlower body RT exercise, such as a legpress, will be most practical. If exerciseblood pressure readings are withinreference ranges, it may not be

Paul Sorace, MS, ACSM RCEP,CSCS*D

Column Editor

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VOLUME 31 | NUMBER 1 | FEBRUARY 2009 Copyright � National Strength and Conditioning Association36

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necessary to monitor exercise blood

pressure every session.

A postexercise hypotensive response

(reduced blood pressure) often occurs

after a circuit RT or conventional RT

session. This obviously is beneficial for

those who have HTN or prehyperten-

sion. Lightheadedness, dizziness, and

possible fainting (syncope) can occur

with large reductions in blood pressure,

adding to the importance of measuring

blood pressure after exercise or any-

time these symptoms are present. The

specific effects exercise has on lowering

blood pressure remain speculative but

are likely multifactorial (1,7).

A type of circuit RT, known ascardioresistance training, will workwell for many persons with HTN.Cardioresistance combines circuit RTand cardiopulmonary exercise in aninterval format. An example of a car-dioresistance training program is de-scribed in the side bar below.

Side Bar

* Perform a 5- to 10-minute cardiopul-monary warm-up

* Perform 4–5 RT exercises for thelower body

* Perform 5 minutes of cardiopulmo-nary exercise

* Perform 5–6 RT exercises for theupper body

* Perform 5 minutes of cardiopulmo-nary exercise

* Perform 3–4 RTexercises for the coremuscles

* Perform a 5- to 10-minute cardiopul-monary cool down

Resistance exercises are performed witha moderate resistance (e.g., 40–60% 1-RM), 12–15 repetitions, one set perexercise, and short rest intervals (e.g., 30seconds), while keeping cardiopulmo-nary intensity at 40–,60% of _VO2R(oxygen uptake reserve). Resistanceexercise intensity should be maintainedat a rating of perceived exertion of 11–14 on the Borg category scale. Muscularand cardiopulmonary endurance areemphasized with this style of RT.

Table 1American Heart Association’s recommendations for resistance exercise in individuals with and without

cardiovascular disease

1. Uncontrolled hypertension (.180/110 mm Hg) is an absolute contraindication for resistance training.

2. Uncontrolled hypertension (.160/.100 mm Hg) is a relative contraindication for resistance training (should consulta physician before participation).

3. An initial intensity that corresponds to 30–40% of 1-RM for the upper body and 50–60% of 1-RM for the hips andlegs is recommended. When determination of 1-RM is deemed inappropriate, the load-repetition relationship forRT may be approximated.

4. The initial resistance should allow for and be limited to 8–12 repetitions per set for healthy sedentary adults or 10–15repetitions at a low level of resistance, for example, ,40% of 1-RM, for older (.50–60 years of age), more frailpersons, or cardiac patients.

5. Perform one set per exercise, 2–3 days per week. Multiple-set programs at a greater training frequency (.2 days/wk)may provide greater benefits for healthy, younger individuals whose goals include maximum gains in strength,lean body mass, and athletic performance.

6. Perform exercises in a rhythmical manner at a moderate to slow controlled speed. Use a full range of motion, avoid breath holdingand straining (Valsalva maneuver) by exhaling during the contraction or exertion phase of the lift and inhaling during therelaxation phase.

7. Aerobic training or an aerobic warm-up should be performed before RT.

8. Involve the major muscle groups of the upper and lower extremities. Exercise examples include: chest press,shoulder press, triceps extension, biceps curl, pull-down (upper back), lower-back extension, abdominalcrunch/curl-up, quadriceps (leg) extension or leg press, leg curls (hamstrings), and calf raise.

9. Alternate between upper- and lower-body exercises to allow for adequate rest between exercises.

10. When the participant can comfortably achieve the ‘‘upper limit’’ of the prescribed repetition range, training loadsmay be increased by �5%.

11. Individuals should work to a perceived exertion during RT that approximates 11 to 14 (‘‘fairly light’’ to ‘‘somewhat hard’’)on the Borg category scale. The rating will increase throughout the set.

12. The type of resistance exercise equipment may vary considerably in cost, complexity, operational skill/coordination,and time efficiency. Select equipment that is safe, effective, and accessible.

Information obtained from Williams et al. (7).

Strength and Conditioning Journal | www.nsca-lift.org 37


CONCLUSION

Resistance training has been provensafe and effective for persons withHTN. Resistance training should beincluded in a complete exercise pro-gram designed to prevent or lowerHTN. Following the guidelines pre-sented in this column will ensure safeand effective RT for individuals withHTN, resulting in improved health,fitness, and quality of life.

Paul Sorace is a clinical exercisephysiologist at Hackensack UniversityMedical Center and an instructor for theAmerican Academy of Personal Training(AAPT).

Thomas P. Mahady is the seniorexercise physiologist for The CardiacPrevention & Rehabilitation Program atHackensack University Medical Centerand an adjunct professor at WilliamPaterson University in Wayne, New Jersey.

Nicole Brignola is a recent graduatefrom William Paterson University. Shereceived her bachelor’s degree in exercisescience and is currently continuing hereducation.

REFERENCES1. American College of Sports Medicine.

Position Stand: Exercise and Hypertension.

Med Sci Sports Exerc 36: 533–553, 2004.

2. Cornelissen VA and Fagard RH. Effect of

resistance training on resting blood

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3. Kelley GA and Kelley KS. Progressive

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controlled trials. Hypertension 35: 838–

843, 2000.

4. Ray CA and Carrasco DI. Isometric handgrip

training reduces arterial pressure at rest

without changes in sympathetic nerve

activity. Am J Physiol Heart Circ Physiol

279: H245–H249, 2000.

5. Taylor AC, McCartney N, Kamath MV, and

Wiley RL. Isometric training lowers resting

blood pressure and modulates autonomic

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6. Whaley, MH, Brubaker PH, and Otto RM,

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Amsterdam EA, Bittner V, Franklin BA,

Gulanick M, Laing ST, and Stewart KJ;

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Clinical Cardiology; American Heart

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Circulation 116: 572–584,

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