When Caroline came to me after being diagnosed with pre-hypertension, she was stunned. At 32, she seemed to live healthily, going to the gym four to five times a week to enjoy a cardio workout. So what went wrong?
For starters, Caroline had one major risk of cardiovascular disease, a father who died from a heart attack at 50. Even though her lipid profile came out relatively good, her diet needed improvement. Her HDL (good cholesterol) was a little bit low and her triglycerides were close to borderline dangerous levels.
It’s not all about cholesterol
Larry Santora, MD FACC, Medical Director, Interventional and Preventive Cardiology Orange County Heart institute, says that the traditional risk factors are part of the well-known Framingham risk scores (FRS): age, sex, systolic blood pressure, antihypertensive therapy, total cholesterol levels, HDL lipoprotein level and smoking history. These factors give a 10-year estimate of cardiac death or myocardial infarction (heart attack).
He says the cholesterol becomes less important if you exercise. Eating Omega-3 fatty acids keeps the blood sugar normal as does eating fruits and vegetables. The triglyceride level is a less potent risk factor and becomes more important compared to the rest of the lipid profile.
“For instance, if you have high triglycerides only, the risk is slight for CVD. But if you have high triglycerides and a low HDL, then the risk for CVD is worse than if you just had low HDL alone,” explains Santora.
This was the case of Caroline, who was advised to reduce sodium intake, not from the salt shaker, but from processed food. Caroline’s trouble used to be her one-TV-dinner-a-day habit. Her focus was limiting calories, sugars and saturated fats, but she was not paying attention to meals that had over 900 mg of sodium – around 39 percent of the 2,300 mg suggested upper limit for healthy people in one meal.
To counteract the sodium, she added more vegetables and fruits to every meal, in particular, produce high in potassium. Other nutrients that were not in place on a regular basis were fiber, Omega-3 fatty acids, vegetable protein sources and micronutrients like calcium, magnesium, vitamin C and D.
Caroline now starts her day with an old-fashioned oatmeal made with skim milk, add some berries, kiwi, apple chunks and chia seeds or flaxseeds for non-marine sources of Omega-3 fatty acids. For lunch, she has fish at least three times per week for her main dish. For dinner, she has some vegetable protein sources like beans, tofu or tempeh.
Lifting weights to really boost heart health
The most common exercise recommendation that doctors gave patients like Caroline was walk at least 30 minutes a day. But what about adding resistance training to her exercise routine?
Many in the medical field still believe that resistance training does not mix with the heart health quite well. This is because traditionally, weight lifting was associated with bodybuilding types of moves such as isometric exercises with held contractions. This type of training creates a pressure load in the cardiovascular system so the blood pressure goes up. This is because of the heart rate and peripheral vascular resistance increases and not due to blood volume increase.
But if one employs a resistance training circuit style of workout there’s a volume load on the heart, which also results in a progressive rise of the blood pressure but the reasons are different from more traditional, heavy load method of resistance training.
”There is an increase in cardiac output – increase in both stroke volume and heart rate- and a decrease in peripheral vascular resistance,” writes Paul Sorace, Jame R. Churilla and Peter M. Magyari in the article “Resistance Training for Hypertension,” published in the ACSM’s Health & Fitness Journal.
When two different types of moderate intensity were compared: 1. Lifting weights (8 exercises, 3 sets of 10 reps) and 30 minutes of cycling, the blood vessel response was different. Resistance exercise seems to increase the blood flow to the legs, while aerobic training may decrease the arterial stiffness. And most interesting was the fact that resistance training provided a longer lasting drop in blood pressure post-exercise compared to aerobic forms.
What should you consider?
Sorace, Churilla and Magyari point out that when doing resistance training for hypertension these are the elements that should be considered as they all affect the pressure load respond:
- percentage of one rep maximum
- size of the working muscle mass
- duration of the muscle contraction relative to rest between repetitions and sets
As for intensity: use a lighter weight for upper body exercise and a little bit higher for lower body exercises. Do 8-10 reps submaximally, which means that you’ll use an overall lighter weight that what can usually do for 8-10 reps. As you progress, you can increase the weight, maintaining the same reps.
a) Do not hold your breath. Consistent and rhythmical breathing is important.
b) If you have high blood pressure, consider unilateral moves, which tend to tax the cardiovascular system less than doing more compound moves.
c) Perform one set per exercise, until you progressively reach three sets submaximally.
d) Resting periods should be longer than a minute. This allows the blood pressure to return to base levels.
e) Work all muscles two to three times per week in non-consecutive days in a circuit-training format.
f) Beware of the effects of the anti-hypertension drugs on exercise response. Some tend to lower the blood pressure too much or to decrease the heart rate.
g) Measure your blood pressure before and after exercise.
After Caroline’s dietary changes and addition of resistance training to her aerobic activity, she was able to not to be part of the 75 million of Americans that have hypertension. Check with your doctor and take control of your life now!
Marta Montenegro is an exercise physiologist, certified strength and conditioning coach and master trainer, who teaches as an adjunct professor at Florida International University. Marta has developed her own system of exercises used by professional athletes. Her personal website, martamontenegro.com, combines fitness, nutrition and health tips, exercise routines, recipes and the latest news to help you change your life but not your lifestyle. She was the founder of nationally awarded SOBeFiT magazine and the fitness DVD series Montenegro Method.