The following is a guest article from Dr. Spencer Nadolsky.
Hypertension, commonly referred to as “high blood pressure” or “high blood,” is one of the most common weight-related diseases you’ll come across as a personal trainer.
Pinpointed as the cause of around 13.5% of deaths, high blood pressure ranks as the leading risk factor for mortality (1, 2). Since exercise and nutrition play a crucial role in treating hypertension, your skills as a personal trainer are pharmaceutical-like. While fitness professionals aren’t technically allowed to treat disease, it’s still important for you to understand what the disease is and how you can help.
Hypertension can be broken up into two categories
- Primary/Essential — No obvious known cause but associated with risk factors e.g., race, body weight, etc. This is the majority (90-95%) of people with high blood pressure.
- Secondary/Identifiable — There’s a known cause, e.g. kidney issue, hormones, medicines, etc. This is 5-10% of people with high blood pressure.
Now you might be asking why most people fall under the category of primary hypertension with no known cause of their high blood pressure, especially since everyone knows that obesity is the cause of most blood pressure issues, right?
Unfortunately it’s much more complicated than that but having extra fat (especially visceral fat) can be a risk factor along with sedentary behavior and poor dietary habits (3,4,5).
Here’s the great thing about fitness professional working with folks with primary hypertension — every one of those patients should be getting lifestyle treatment. This means that no matter what medicine the doctor thinks is optimal (could be multiple medicines in many cases), every patient/client with primary hypertension should be receiving what a good personal trainer gives out. This means good exercise and diet advice and ultimately weight loss.
I know that as a personal trainer you’re not to prescribe diets that treat disease. Don’t worry you don’t have to. It just so happens that the diets you likely promote to all your clients already coincides with a diet that treats high blood pressure (emphasis on vegetables, fruit, lean proteins, etc.) (6).
If there are specific guidelines from the doctor then obviously don’t override them (e.g. salt reduction). Generally though, you’re likely already giving this good dietary advice.
The same advice goes for exercise. Obviously make sure the client is cleared to exercise by their doctor, but in general, both aerobic and resistance training can improve blood pressure (aerobic has better evidence but anything is better than nothing) (7).
There are situations where resistance training is considered a contraindication (a blood pressure above 180/110 mm Hg) due to the transient elevations of blood pressure during the workout, but this is why you get the doctor to clear these types of patients.
Now if you get the client to lose weight while eating better and exercising (the usual goal of clients), you hit the trifecta — long-term weight loss and maintenance leads to significant drops in blood pressure even without the specific dietary or exercise changes (8,9,10). Weight loss works but it must be maintained.
This reminds me of a good story. My supervisor doctor a few years back gave a lecture on hypertension and how to treat it. She went over all the different medicines and how to use them and what is optimal, etc.
At the end I mentioned that she forgot to talk about lifestyle changes. She said in front of the whole group that there isn’t really good evidence for it. Before my head exploded I asked her what she meant because surely she wasn’t serious. She said, “Well diet, exercise, and weight loss work, but they’re never maintained.” So basically we should all give up and just put people on meds! As you may tell I was pretty upset.
What I want you as fitness professionals to know is that you are essentially living pharmacies. Your skills are better than medicines when used properly. I truly believe this and the literature is clear that it works. I want personal trainers and doctors to work together because this will only improve the medical field. There needs to be integration.
If you want to learn more about the medical information, check out my new blog www.GetLeanRx.com. I created a place for fitness professionals to get trustworthy medical knowledge because it’s important to be well rounded. Feel free to contact me if you want to learn about a specific topic and I will try to make a good resource.
- Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217-223.
- Lawes CM, Vander Hoorn S, Rodgers A; International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371:1513-1518.
- Sonne-Holm S, SÃ¸rensen TI, Jensen G, Schnohr P. Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men. BMJ 1989; 299:767.
- Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009; 302:401.
- Carnethon MR, Evans NS, Church TS, et al. Joint associations of physical activity and aerobic fitness on the development of incident hypertension: coronary artery risk development in young adults. Hypertension 2010; 56:49.
- Lawrence AJ, Brands MW et al. Dietary Approaches to Prevent and Treat Hypertension: A Scientific Statement from the American Heart Association. Hypertension 2006;47:296-308.
- Brook RD, Lawrence AJ et al. Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure. Hypertension 2013.
- Aucott L, Rothnie H, McIntyre L, et al. Long-term weight loss from lifestyle intervention benefits blood pressure?: a systematic review. Hypertension 2009; 54:756.
- Straznicky N, Grassi G, Esler M, et al. European Society of Hypertension Working Group on Obesity Antihypertensive effects of weight loss: myth or reality? J Hypertens 2010; 28:637.
- Horvath K, Jeitler K, Siering U, et al. Long-term effects of weight-reducing interventions in hypertensive patients: systematic review and meta-analysis. Arch Intern Med 2008; 168:571.