By encouraging patients to find activities they enjoy and celebrating small improvements, health care professionals can help patients improve mild to moderate hypertension and elevated cholesterol.
The first step to address mild to moderately elevated blood pressure and cholesterol in otherwise healthy adults should be advising them to sit less and move more, according to a new scientific statement published in Hypertension.
An estimated 21% of adults in the United States have systolic blood pressure between 120- and 139-mm Hg, or diastolic blood pressure between 80- and 89-mm Hg, according to the American Heart Association (AHA). Both of these values are abnormally high and meet the American College of Cardiology (ACC)/AHA High Blood Pressure Guideline criteria for lifestyle-only treatment for elevated blood pressure.
Similarly, the scientific statement authors estimated that 28% of adults in the United States have an LDL cholesterol score above 70 mg/dL and otherwise meet criteria for low risk of heart disease or stroke. This patient population would meet the 2018 ACC/AHA Cholesterol Treatment Guidelines criteria for lifestyle-only treatment, which includes increased physical activity, weight loss, improving diet, smoking cessation, and moderating alcohol intake.
“The current American Heart Association guidelines for diagnosing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks,” said Bethany Barone Gibbs, PhD, FAHA, chair of the statement writing group, in a press release. “The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity.”
Increasing physical activity has been shown to result in clinically meaningful reductions in both systolic and diastolic blood pressure, typically with an average reduction of 3- or 4-mm Hg. Similar improvements have been seen with blood cholesterol, according to the press release. The statement emphasized research demonstrating that physically active people have a 21% lower risk of developing cardiovascular disease and a 36% lower risk of death from cardiovascular diseases compared to those who are not physically active.
According to the AHA, a “prescription” for increased exercise includes several steps. Health care providers should screen patients about their physical activity at every interaction, whether by asking a few questions or by having patients use a wearable device. Health professionals should also provide ideas and resources for supporting patients to improve and sustain regular physical activity.
Importantly, providers should help patients find activities that they enjoy and should provide ideas for early success in order to optimize the patient’s chances of implementing a life-long change. Similarly, encouraging and celebrating small improvements and increases in physical activity, such as walking more or taking the stairs, can keep patients motivated.
“Even small initial increases of 5 to 10 minutes a day can yield health benefits,” Gibbs said in the press release.
To improve overall health, the US Department of Health and Human Services 2018 Physical Activity Guidelines for Americans recommend that individuals participate in either a cumulative 150 minutes of moderate intensity aerobic exercise or 75 minutes of vigorous aerobic activity weekly, in addition to 2 or more strength training sessions each week.
“In our world where physical activity is increasingly engineered out of our lives and the overwhelming default is to sit—and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus—the message that we must be relentless in our pursuit to ‘sit less and move more’ throughout the day is more important than ever,” Gibbs concluded.
“Prescription” to sit less, move more advised for mildly high blood pressure & cholesterol [news release]. American Heart Association; June 2, 2021. https://newsroom.heart.org/news/prescription-to-sit-less-move-more-advised-for-mildly-high-blood-pressure-cholesterol?preview=9fe0. Accessed June 2, 2021.