Prescription’ to sit less, move more advised for mildly high blood pressure and cholesterol
A “prescription” to sit less and move more is the optimal
first treatment choice for reducing mild to moderately elevated blood pressure
and blood cholesterol in otherwise healthy adults, according to the new
American Heart Association scientific statement published today in the American
Heart Association’s journal Hypertension.
“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. The first treatment
strategy for many of these patients should be healthy lifestyle changes
beginning with increasing physical activity,” said Bethany Barone Gibbs,
Ph.D., FAHA, chair of the statement writing group and associate professor in
the department of health and human development and clinical and translational
sciences at the University of Pittsburgh in Pittsburgh, Pennsylvania.
An estimated 21% of U.S. adults, about 53 million, have systolic (top
number) blood pressure between 120-139 mm Hg or diastolic (bottom number) blood
pressure between 80-89 mm Hg; both values are abnormally high. Individuals in
this range who have an otherwise low risk of heart disease or stroke meet the
American College of Cardiology (ACC)/American Heart Association (AHA) High
Blood Pressure Guideline criteria for lifestyle-only treatment for elevated
Likewise, the scientific statement authors estimate that 28% of U.S.
adults, or about 71 million, have an LDL cholesterol score above 70 mg/dL and
otherwise meet criteria for low risk of heart disease or stroke. These people
would meet the 2018 AHA/ACC Cholesterol Treatment Guidelines criteria for
lifestyle-only treatment. Lifestyle changes highlighted in the blood pressure
and cholesterol guidelines include increased physical activity, weight loss,
improving diet, stopping smoking and moderating alcohol intake.
“Increasing physical activity can help lower blood pressure and
cholesterol, along with many other health benefits.” Gibbs said. Physical
activity also has benefits beyond cardiovascular health, including a decreased
risk of some cancers, improved bone, brain and mental health, and better sleep.
Increasing physical activity results in clinically meaningful reductions
in systolic and diastolic blood pressure, typically an average reduction of 3
or 4 mm Hg. Similar improvements are seen with blood cholesterol. For example,
increased physical activity typically decreases LDL cholesterol by 3 to 6
The statement highlights research concluding 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
To improve health, the U.S. Department of Health and Human Services 2018
Physical Activity Guidelines for Americans suggest individuals participate in
either a cumulative 150 minutes of moderate intensity aerobic exercise, or 75
minutes of vigorous aerobic activity weekly plus two or more strength training
sessions each week.
However, there is no minimum amount of time to receive benefits from
physical activity. “Every little bit of activity is better than
none,” said Gibbs. “Even small initial increases of 5 to 10 minutes a
day can yield health benefits.”
The statement provides suggestions for clinicians to provide exercise
“prescriptions” such as patient counselling, incorporating health
behavior professionals (e.g., health coaches) and connecting patients to local
resources like community centers to help meet their physical activity needs.
According to the statement, prescribing exercise includes:
- Screening patients about physical activity at every interaction, as
recommended by the American College of Sports Medicine’s ‘Exercise is Medicine’
campaign. Clinicians can ask patients to report their physical activity with a
few questions or by using a wearable device.
- Providing ideas and resources for supporting patients to improve and
sustain regular physical activity;
- Meeting patients where they are by exploring activities that the patient
enjoys and provide ideas for early success; and
- Encouraging and celebrating small increases in physical activity, such
as walking more or taking the stairs.
“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,” said Gibbs.
- Bethany Barone
Gibbs, Marie-France Hivert, Gerald J. Jerome, William E. Kraus, Sara K.
Rosenkranz, Erica N. Schorr, Nicole L. Spartano, Felipe Lobelo. Physical
Activity as a Critical Component of First-Line Treatment for Elevated Blood
Pressure or Cholesterol: Who, What, and How?: A Scientific Statement From the
American Heart Association. Hypertension, 2021; DOI: 10.1161/HYP.0000000000000196