# Exercise as it relates to Disease/Exercise prescription in obese hypertension patients
### What Is Obesity?

Obesity can be defined as the accumulation of excess body fat. It is generally accepted that obese people are those with a BMI (Body Mass Index) of 30 or more and in 2008 it was estimated that the overall cost of obesity in Australia was $58.2 billion. People who are obese are predisposed to higher rates of premature death, cardiovascular disease, high blood pressure, type 2 diabetes, sleep apnoea, osteoarthritis, psychological problems and reproductive problems for women.

### What is Hypertension?

Hypertension describes high blood pressure. Blood pressure describes the force exerted on the walls of arteries by blood as it travels around the body. It is expressed in the form of Systolic Blood Pressure (SBP), which is the pressure of blood in arteries as the heart beats, over Diastolic Blood Pressure (DBP), which is the pressure of blood in arteries as the heart relaxes, and is expressed in millimeters of mercury (mmHg). Hypertension is associated with coronary heart disease, stroke, heart failure, and chronic kidney disease and its major causes consist of obesity, insufficient physical activity, poor diet (high in salt) and excessive consumption of alcohol. In 2011-12 the Australian Health Survey found that 31.6% of Australians had hypertension. Classifications of blood pressure and BMI are as follows:
| Blood Pressure Classification | SBP | DBP | BMI Classification | BMI |
| Normal | <120 | and <80 | Normal | 20-25 |
| Prehypertensive | 120-139 | 80-89 | Overweight | 25-29.9 |
| Stage 1 Hypertension | 140-159 | 90-99 | Obese | ≥30 |
| Stage 2 Hypertension | ≥160 | or ≥100 | |

### Common Treatments

Obesity: A combination of calorie restrictive diet and regular aerobic exercise has been shown to be effective. Hypertension: The ultimate goal for the treatment of Hypertension is to reduce SBP to <140 mmHg. Once this has been achieved most people will also achieve DBP goal of <90 mmHg. Common treatments include: Antihypertensive drugs, Lifestyle Modifications such as; weight loss, diet(DASH diet), reducing alcohol intake and increasing physical activity and Surgery.

### Obesity and Hypertension Combined

Obese individuals are 1.5 times more likely to develop hypertension than overweight people (BMI≥25)and up to 2 times more likely than people with a BMI of <25. Approximately three-quarters of people diagnosed with hypertension are obese. Hypertension in obese patients has been found to be harder to treat than cases in non-obese populations.

## Exercise Prescription

Exercise, in conjunction with lifestyle modifications, should be the starting point for treatment of obesity related hypertension. Intervention programs that cater for obesity-hypertension will combine diet,behavioural adjustments (quit smoking) and physical activity with long term goals of improving health and healthy habits.

### Benefits

Benefits of regular physical activity for obese hypertension sufferers include:
* Weight loss.
* Reduced blood pressure.
* Post exercise Hypotension(PEH) can be provoked for up to six hours post-exercise.
* Lowers cardiovascular risk factors.
* Boosts antihypertensive drug effectiveness.

### Considerations

Obese people have a greater level of stress on the heart when exercising, which risks adverse cardiac events. This needs to be taken into account when exercising, with moderate intensity exercise designed to expend calories and maintain cardiovascular fitness being the main goal. Excess weight places extra burden on joints. This can be catered for through non-weight bearing exercises such as swimming or cycling. Resistance training has similar effects to aerobic exercise in reductions in blood pressure.

### Recommendations

Current guidelines recommend 150–300 minutes of physical activity per week and focus on weight loss and the prevention of weight gain. Moderate to high-intensity aerobic exercise for a minimum of 30 minutes a day is recommended. This does not have to be in one burst. It can be done in shorter segment to allow for busy lifestyles as long as it adds up to a minimum of 30 minutes. Activity points systems (APS) are a useful way to quantify physical activity. APS's take into account individual factors and can be put into action with the hep of your G.P. It is vitally important to take into account greater stresses on the heart and the fear of physical responses to exercise. Exercise programs should be developed with long term adherence as a primary consideration. If any issues occur, outside of normal responses to exercise, then exercise should be stopped and a visit to your G.P. may be necessary to review your exercise plan.

### Further reading

http://www.health.harvard.edu/fhg/updates/how-much-exercise-do-you-need.shtml, http://www.obesityaction.org/, http://www.heartfoundation.org.au, http://dashdiet.org/

## References

* 1 2 WHO. (2013, 3). Obesity and Overweight Fact Sheet N311. Retrieved 10 19, 2013, from World Health Organization: http://www.who.int/mediacentre/factsheets/fs311/en/
* 1 2 Australian Bureau of Statistics. (2011, 05 27). 4842.0.55.001- Overweight and Obesity in Adults in Australia: A Snapshot, 2007-08. Retrieved 10 19, 2013, from Australian Bureau of Statistics: http://www.abs.gov.au/ausstats/abs@.nsf/Products/C90B898458D9EF8DCA25789C0023DC12?opendocument
* ↑ Dugdale, D. C. (2013, 3 22). Hypertension. Retrieved 10 21, 2013, from Medline Plus: http://www.nlm.nih.gov/medlineplus/ency/article/000468.htm
* ↑ NHLBI. (n.d.). What are High Blood Pressure and Prehypertension. Retrieved 10 21, 2013, from Your Guide to Lowering High Blood Pressure: http://www.nhlbi.nih.gov/hbp/hbp/whathbp.htm
* 1 2 3 4 Australian Bureau of Statistics. (2011-12, March 26). 4364.0.55.002- Australian Health Survey: Health Service Usage and Health Related Actions. Retrieved October 19, 2013, from Australian Bureau of Statistics: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/322DB1B539ACCC6CCA257B39000F316C
* 1 2 Delaney, J. (2013). Hypertension and Obesity: How Weight-loss Affects Hypertension. Retrieved 10 19, 2013, from Obesity Action Coalition: http://www.obesityaction.org/educational-resources/resource-articles-2/obesity-related-diseases/hypertension-and-obesity-how-weight-loss-affects-hypertension
* 1 2 3 4 5 6 7 Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. (2003). JNC 7 Express. USA: U.S Department of Health and Human Services
* 1 2 3 4 5 6 7 8 The Obesity Society, The American Society of Hypertension. (2013). Obesity-Related Hypertension: Pathogenesis, Cardiovascular Risk, and Treatment. Obesity Journal, 8-24.
* ↑ Henry, S. L.-B. (2012). Developmental Origins of Obesity-Related Hypertension. Clinical and Experimental Pharmacology and Physiology, 799-806.
* ↑ Faraji, H. N. (2012). Effect of concurrent exercise on post-exercise hypotension in borderline hypertensive women: Influence of Exercise Intensity. Kinesiology, 166-172.
* 1 2 3 4 Vella, C. A. (2012). Cardiac response to exercise in normal-weight and obese, hispaninc men and women: implications for exercise prescription. Acta Physiologica, 113-123.
* ↑ FAGARD, R. H. 2006. EXERCISE IS GOOD FOR YOUR BLOOD PRESSURE: EFFECTS OF ENDURANCE TRAINING AND RESISTANCE TRAINING. Clinical & Experimental Pharmacology & Physiology, 33, 853-856.
* ↑ Australian Government. (2013, 5 17). Physical Activity Guidelines. Retrieved 10 23, 2013, from The Department of Health: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines
* ↑ Ehrsam, R. H.-K. (2009). Exerise prescription for the overwieght and obese: how to quantify and yet keep it simple. Br Journal of Sports Medicine, 951-953.
* ↑ The Harvard Medical School. (2006). How much exercise do you need? Retrieved 10 23, 2013, from Harvard Medical School Family Health Guide: http://www.health.harvard.edu/fhg/updates/how-much-exercise-do-you-need.shtml
* ↑ Brooks, C. e. (2011). Fear of physical response to exercise among overweight and obese adults. Qualitative researh in sport, exercise and health, 174-192.
* ↑ Colley, R. C. (2008). Variability in adherence to an unsupervised exercise prescription in obese women. International Journal of Obesity, 837-844.