Exercise and Hypertension
The ACSM position statement on aerobic exercise and hypertension states that exercise causes a reduction in BP, but the magnitude of the reduction is complicated by many other factors. First, BP changes occur more significantly among the group that is hypertensive at baseline compared to normotensive subjects. Furthermore, during a training period, exercise intensity seems to have little effect on the magnitude of the BP reduction. As for the effect of resistance exercise on BP, the evidence is less clear and somewhat conflicting. Therefore, resistance exercise should be seen as a supplement to aerobic exercise for the reduction of hypertension.74
A female cohort (N = 4884) from the Aerobics Center Longitudinal Study that had normal BP was given a maximal treadmill test to assess cardiovascular fitness. The women completed a health survey approximately 5 years after the treadmill test, at which time 157 women were diagnosed with hypertension. The researchers reported that for each 1-MET increase in treadmill performance, there was a 19% reduction in the likelihood of becoming hypertensive. Higher levels of fitness were also associated with a reduction in hypertension in normal-weight and overweight women.
In 2007, a randomized, controlled trial of 464 sedentary overweight or obese women with elevated BP looked at the effect of exercise training on fitness levels and BP. Although the researchers reported a dose-response relationship between the amount of physical activity and fitness, the researchers found no significant changes in SBP or diastolic BP from baseline to the 6-month measurement. Participants did not significantly reduce weight or improve serum cholesterol. The expected benefits of physical activity were not realized by 6 months. The lack of difference between the exercising group and the control group could be due to in part to an unstable control group. The participants with the most activity (12 kcal/kg) showed a reduction in SBP. However, it was not significant when compared to the control group, which also had lower SBP even though they performed no physical activity.69 As stated in the ACSM position statement, many factors are involved in the reduction of BP, and the role of weight loss, fat metabolism, and gender needs further study.
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Exercise and Diabetes Mellitus
Although physical activity and diabetes mellitus are linked, diabetes mellitus is a multifaceted disease that cannot be predicted by one variable. Physical activity and diabetes mellitus have a strong relationship with each other, but so do BMI, central obesity, diet, and family history. All of these factors are important in any discussion about diabetes mellitus. The next section focuses on what is known about physical activity and T2DM.
From the Nurse’s Health Study, it was clear that even a single bout of vigorous physical activity/ a week lowered the risk of T2DM.76 Another cohort from the Nurse’s Health Study showed that when participants were divided into quintile physical activity groups, the highest quintile group had a 46% reduction in risk compared to the lowest physical activity group. Here, the physical activity did not have to be vigorous exercise to be effective; it just had to be greater than none. The low-quintile activity group (2.1 to 4.6 MET hours/week) showed a significant reduction in risk of 23% when compared to the sedentary group ( 2 hours/week) showing the least incidence rate compared to all other levels. The moderate group represented participants who regularly participated in 1 hour/week of physical activity.77 The moderate-to-high levels in this study hover just around the recommended physical activity guidelines, and with a risk reduction in diabetes mellitus, there is a risk reduction in heart disease. The Women’s Health Study looked at 37,878 women; 1361 developed T2DM in the 6.9-mean-year follow-up. Of that group, 12,936 women were considered active based on expending 1000 kcal/week. Of the women who were considered active, they showed a 15% decrease in diabetes mellitus risk. Also, 5 groups were formed based on time spent walking. Even in the group performing less than 1 hour/week of walking, there was a reduction in the risk of developing diabetes mellitus. However, the greatest reduction in risk was shown in the group that walked between 2 and 3 hours/week, which is in line with the Physical Activity Guidelines for Americans.78 In a large prospective study on 23,444 men, men who were physically active compared to sedentary were associated with decreased risk of diabetes mellitus. The men were separated into groups by the activity in which they participated or were placed in the sedentary group. The walking, jogging, running group and those who participated in sports/fitness activities had 56% and 40% reductions, respectively, in the risk of developing diabetes mellitus compared to the sedentary group. Also, when separated by fitness levels, the low-fitness group (bottom 20% of subjects) regardless of type of physical activity performed showed a 6-fold higher risk of diabetes mellitus compared to the high-fitness group (upper 40% of subjects).79 Although it is clear that physical activity reduces risk of developing diabetes mellitus, it also seems clear that higher fitness levels, regardless of type of physical activity performed, can reduce diabetes mellitus risk.
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