# Exercise as it relates to Disease/Continuous and interval aerobic exercises for treating hypertension in older people

This fact sheet will briefly outline appropriate continuous and interval training methods for men and women over 40 years old, and the benefits to health.

## Background

Hypertension describes high blood pressure, classified by groups found in table 1. This chronic condition has been reported to affect 29% of the Australian population with the risk of having hypertension rising sharply every decade after we are around 40 years old. Men and women over this age should have their blood pressure checked regularly as persistent hypertension is a risk factor for the development of life-threatening heart, kidney and metabolic conditions. Although hypertension is rarely a direct cause of death, it is a contributing factor in 10.6% of all male and 15.1% of all female deaths in Australia.
Table 1: Classification of hypertension by blood pressure (BP). :
| Category | Systolic BP mmHg | Diastolic BP mmHg |
| Normal | <120 | and <80 |
| Prehypertension | 120-139 | or 80-89 |
| Hypertension grade 1 | 140-159 | or 90-99 |
| Hypertension grade 2 | >160 | or >100 |
Fortunately, it is a treatable condition and medication, diet and exercise have all been shown to be effective at reducing blood pressure. There are many ways to exercise but cardiovascular exercises are a great way to get outdoors, and can be done in many ways which suit your lifestyle. Continuous and interval modes of exercises are both approachable and effective at treating hypertension.

## What are continuous and interval training?

Continuous training describes an activity which is performed at a steady pace for the duration of that activity. Interval training is the opposite; using short bursts of alternating high and low intensity levels throughout the duration of the activity.

## Benefits of training

Continuous and interval training methods may improve our health in a number of ways, including:
* DECREASING systolic and diastolic blood pressure, especially in those with higher blood pressure.
* DECREASING weight
* INCREASING exercise capacity
* INCREASING kidney, lung, and heart function, glucose and insulin control.
* INCREASING quality of life.
Research has shown interval exercises may be easier to approach for those with lower capacity to exercise, and may also be more effective than continuous methods at:
* DECREASING systolic and diastolic blood pressure.
* INCREASING exercise capacity.
* INCREASING muscle strength in the elderly.

## Recommendations

Depending on the mode of exercise you prefer both continuous and interval exercises are safe and appropriate for most people. Aerobic exercises might include walking, jogging or cycling but could include any cardiovascular activity that you enjoy. Table 2 found below shows how to approach and progress in your chosen mode of activity. To find your desired intensity first calculate your max heart rate (HR) using 220 - your age = maximum heart beats per minute. Desired intensity is then calculated using a percentage max HR in beats per minute. Heart rate can be measured using a personal monitoring device or one of the machines found at the gym.
Table 2: Appropriate starting levels and progression for an interval or continuous exercise program. :
| Mode | Frequency/Duration | Intensity | Instruction | Progression |
| Continuous | 3 days/week 15min/session adding 5 min/week until 30-60 min/session is reached | 50%-70% HR max | Perform aerobic activity at continuous heart rate for the entire duration of the activity, this may also be achieved with >10 minute bouts of activity with rest between bouts | 5–7 days/week 30-60 min/session |
| Interval | 3 days/week 15min/session adding 5 min/week until 30-60 min/session is reached | 40%->70% HR max | Perform aerobic activity at chosen lower HR (e.g. 40%) for 3 minutes and then increase activity to achieve higher chosen HR (e.g. 70%) for 3 minutes, alternating between low and high HR for the length of the activity | 5–7 days/week 30-60 min/session |
| Warm-up and Cool-down | Before and after exercise 2-3 min/session | Slow walking | Warming up and down is important in preventing sudden changes in heart function | - |

## Considerations before starting exercise

These training methods are suitable for most people over 40 years old. However, there are always some risks when starting a new exercise program and an initial physical assessment, and monitoring can ensure there are no underlying issues that may prevent you exercising. An assessment is especially important if any of the following apply to you:
* High resting blood pressure: A resting blood pressure of >180 mmHg systolic and >110 mmHg diastolic blood pressure.
* Age: Men >45 years and women >55 years old with >140 mmHg systolic and >90 mmHg diastolic blood pressure.
* Sedentary lifestyle: Have little or no physical activity as part of your regular lifestyle.
* Medications: Beta blockers and diuretics can impede your ability to regulate temperature and engage in activity.
* Chronic conditions: If you have an underlying long term condition which may affect your ability to participate in exercise.
During exercise it is important to wear cool, loose clothes and maintain adequate hydration 17, and avoid stopping exercise suddenly.. Cease exercise if you have an abnormal response, such as:
* Systolic blood pressure dropping >10 mmHg despite increasing exercise intensity.
* Systolic blood pressure only rises <30 mmHg during exercise.
* Blood pressure exceeds >250 mmHg systolic and >115 diastolic blood pressure.
* You experience chest pain, heart palpitations or shortness of breath beyond expected 17.

## Further reading

Printable PDF and RichText format versions of this fact sheet are available. Expanded information on hypertension and exercise: Here or here. More information on heart rate and exercise intensity here. Examples of continuous and interval training, and some other examples of interval training protocols can be found here. Video explaining interval training and techniques for increasing intensity.

## References

* 1 2 3 4 5 Contractor, A.S. & Gordon, N.F. 2009, "Hypertension" in Clinical exercise physiology, eds. J.K. Ehrman, P.M. Gordon, P.S. Visich & S.J. Keteyian, 2nd edn, Human Kinetics, Australia, pp. 233-241.
* ↑ Barr, E.M., Magliano, D.J., Zimmet, P.Z., Polkinghome, K.R., Atkins, R.C., Dunstan, D.W., Murray, J.E. & Shaw, J.E. 2006, AusDiab 2005 The Australian diabetes, obesity and lifestyle study, International Diabetes Institute, Melbourne.
* ↑ Australian Institute of Health and Welfare 2010, Australia’s health 2010. Australia’s health series no. 12 cat. no. AUS 122, AIHW, Canberra.
* 1 2 3 4 5 6 Lamina, S. 2010, "Effects of continuous and interval training programs in the management of hypertension: A randomized controlled trial", The Journal of Clinical Hypertension, vol. 12, no. 11, pp. 841-849.
* 1 2 3 4 5 6 7 8 9 10 Nemoto, K., Gen-no, H., Masuki, S., Okazaki, K. & Nose, H. 2007, "Effects of high-intensity interval walking training on physical fitness and blood pressure in middle-aged and older people", Mayo Clinic Proceedings, vol. 82, no. 7, pp. 803-811.
* 1 2 3 4 5 Wisløff, U., Støylen, A., Loennechen, J.P., Bruvold, M., Rognmo, Ø., Haram, P.M., Tjønna, A.E., Helgerud, J., Slørdahl, S.A. & Lee, S.J. 2007, "Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients", Circulation, vol. 115, no. 24, pp. 3086-3094.
* ↑ Abernethy, B., Hanrahan, S.J., Kippers, V., Mackinnon, L.T. & Pandy, M.G. 2005, The biophysical foundations of human movement, 2nd edn, Human Kinetics, Australia
* 1 2 3 Ciolac, E.G., Guimarães, G.V., DīĀvila, V.M., Bortolotto, L.A., Doria, E.L. & Bocchi, E.A. 2009, "Acute effects of continuous and interval aerobic exercise on 24-h ambulatory blood pressure in long-term treated hypertensive patients", International Journal of Cardiology, vol. 133, no. 3, pp. 381-387.
* 1 2 3 4 5 Guimaraes, G.V., Ciolac, E.G., Carvalho, V.O., D'Avila, V.M., Bortolotto, L.A. & Bocchi, E.A. 2010, "Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension", Hypertension Research, vol. 33, no. 6, pp. 627-632.
* ↑ Beauchamp, M.K., Nonoyama, M., Goldstein, R.S., Hill, K., Dolmage, T.E., Mathur, S. & Brooks, D. 2010, "Interval versus continuous training in individuals with chronic obstructive pulmonary disease: A systematic review", Thorax, vol. 65, no. 2, pp. 157-164.
* 1 2 3 Lamina, S. 2011, "Comparative effect of interval and continuous training programs on serum uric acid in management of hypertension: A randomized controlled trial", The Journal of Strength & Conditioning Research, vol. 25, no. 3, pp. 719-726.
* ↑ Molmen-Hansen, H.E., Stolen, T., Tjonna, A.E., Aamot, I.L., Ekeberg, I.S., Tyldum, G.A., Wisloff, U., Ingul, C.B. & Stoylen, A. 2011, "Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients", European Journal of Cardiovascular Prevention & Rehabilitation.
* ↑ Borghouts, L.B. & Keizer, H.A. 2000, "Exercise and insulin sensitivity: A review", International Journal of Sports Medicine, vol. 21, no. 1, pp. 1-12.
* 1 2 Tjønna, A.E., Lee, S.J., Rognmo, Ø., Stølen, T.Ø., Bye, A., Haram, P.M., Loennechen, J.P., Al-Share, Q.Y., Skogvoll, E. & Slørdahl, S.A. 2008, "Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome", Circulation, vol. 118, no. 4, pp. 346-354.
* ↑ Centers for Disease Control and Prevention 2011, March 30-last update, Target heart rate and estimated maximum heart rate [Homepage of CDC], [Online]. Available: www.cdc.gov/physicalactivity/everyone/heartrate.html [2011, October 12].
* ↑ Durstine, J., Moore, G., Painter, P. & Roberts, S. 2009, ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities, 3rd edn, Human Kinetics, Champaign, IL.
* ↑ Park, S., Rink, L.D. & Wallace, J.P. 2006, "Accumulation of physical activity leads to a greater blood pressure reduction than a single continuous session, in prehypertension", Journal of Hypertension, vol. 24, no. 9, pp. 1761-1770.
* 1 2 3 4 5 6 7 8 Sharman, J.E. & Stowasser, M. 2009, "Australian association for exercise and sports science position statement on exercise and hypertension", Journal of Science and Medicine in Sport, vol. 12, no. 2, pp. 252-257.
* 1 2 3 Fletcher, G.F., Balady, G.J., Amsterdam, E.A., Chaitman, B., Eckel, R., Fleg, J., Froelicher, V.F., Leon, A.S., Pina, I.L. & Rodney, R. 2001, "Exercise standards for testing and training", Circulation, vol. 104, no. 14, pp. 1694-1740
* ↑ Thompson, P.D., Franklin, B.A., Balady, G.J., Blair, S.N., Corrado, D., Estes III, N.A., Fulton, J.E. & Gordon, N.F., Haskell, W.L. & Link, M.S. 2007, "Exercise and acute cardiovascular events: placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology", Circulation, vol. 115, no. 17, pp. 2358-2368.