At present, in fitness classes, many instructors face the need to use exercise as a means of rehabilitation and to help relieve pain through physical activity. As professional educators, it's essential to understand and master the sports rehabilitation techniques for common conditions. This will allow us to better serve our members and enhance their performance. Today, we will introduce simple rehabilitation methods for hypertension and peripheral arterial disease (this article is intended for coaches with a solid professional foundation).
Exercise rehabilitation plays a crucial role in managing hypertension. Since 1988, the United States Hypertension Association has recognized exercise therapy as an effective method for comprehensive treatment. Research shows that regular physical activity can reduce sympathetic tone, lower catecholamine release, and improve vascular compliance and baroreceptor sensitivity, leading to reduced total peripheral resistance. It also helps lower plasma renin and aldosterone levels, reducing vasoconstriction and sodium retention. Long-term exercise can regulate brain cortex activity, improve neuromodulation, and reduce risk factors like high cholesterol, blood viscosity, and weight. It also promotes better physical and psychological adaptability, regulates microcirculation, and delays the progression of arteriosclerosis.
**Q: What is the adaptation syndrome for hypertension rehabilitation?**
**A:** Patients with mild to moderate hypertension who respond well to exercise can use exercise as a primary antihypertensive treatment. For those with higher blood pressure or longer disease duration, exercise can be used alongside medication. The goal is to keep blood pressure within the normal range (≤140/90 mmHg). However, patients with uncontrolled hypertension (>180/110 mmHg) or unstable angina should avoid exercise. During or after exercise, if blood pressure exceeds 230/100 mmHg or symptoms like angina, hypotension, bradycardia, muscle weakness, paralysis, or bronchial asthma occur, exercise should be stopped immediately.
**Q: What is the appropriate intensity and duration of exercise?**
**A:** Studies show that low to moderate intensity exercise (around 40-70% VO2max or 60-85% of maximum heart rate) is effective in lowering blood pressure. A 2004 study found that both low-intensity (40% VO2max) and moderate-intensity (60% VO2max) exercises helped reduce high blood pressure. Generally, patients are advised to exercise for 20–60 minutes, 3–5 times per week, with intensity tailored to individual health conditions.
**Q: What type of exercise is best?**
**A:** Aerobic exercises such as walking, jogging, swimming, and cycling are most beneficial for lowering blood pressure. A meta-analysis of 54 studies showed that aerobic exercise reduced systolic and diastolic blood pressure by 3.84 mmHg and 2.58 mmHg respectively. Resistance training, such as lifting weights or using resistance bands, also helps. Combining aerobic and resistance training is recommended for optimal results.
**Q: How should safety be monitored during exercise?**
**A:** Before starting any exercise program, hypertensive patients should undergo a comprehensive assessment, including a treadmill test, to determine their suitability and appropriate intensity. Safety education is vital, especially for those with heart or brain conditions. If during exercise, systolic blood pressure exceeds 220 mmHg or diastolic exceeds 110 mmHg, the session should be stopped.
**Q: What are the precautions for hypertensive patients during exercise?**
**A:** There are five key points to consider:
1. Many patients take medications like ACE inhibitors or beta-blockers, which can affect how their bodies respond to exercise.
2. Warm-up activities should be included to prevent sudden changes in blood pressure.
3. Cool-down sessions are important to return the body to its pre-exercise state and avoid dizziness.
4. Proper breathing should be maintained, especially during resistance training, to avoid the Valsalva maneuver.
5. Resistance training should follow guidelines, focusing on 8–10 different exercises, 2–3 days per week, with 10–15 repetitions until moderate fatigue is achieved.
**Q: How should exercise be evaluated before training for peripheral arterial disease (PAD)?**
**A:** Before starting any exercise program, PAD patients should undergo functional assessments, including treadmill tests, to determine their claudication threshold and how their body responds to exercise. This helps identify any signs of arrhythmia or ischemic changes. Doctors should also monitor cardiovascular symptoms, blood pressure, and heart rate during testing. Checking the skin and feet for any issues and ensuring proper footwear is essential.
**Q: What are the recommendations for exercise testing?**
**A:** According to the Chinese Expert Consensus, treadmill tests are effective in evaluating lower limb function and the effectiveness of treatment. A standard protocol should be used to ensure consistency. For elderly or unable-to-test patients, a 6-minute walk test can be used instead.
**Q: What are the recommendations for home and international exercise training?**
**A:** Guided exercise training is the most effective way to alleviate claudication symptoms. Walking at least 30–45 minutes, three times a week for 12 weeks, can significantly improve walking distance and time. The American Heart Association (AHA) and ACC recommend similar programs. Unsupervised training may not be as effective. Exercise should include large muscle groups, 3–4 times a week, at 50–85% of maximum heart rate, for 20–60 minutes.
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