1. Exercise Prescription for Weight Loss and Hypertension Jonathon Gilham, Kyle Kawahara, & Nahid Anee

2. Hypertension High blood pressure, defined as a sustained elevated blood pressure greater than 140mmHg (systolic) or greater than 90 mmHg (diastolic) High blood pressure, defined as a sustained elevated blood pressure greater than 140mmHg (systolic) or greater than 90 mmHg (diastolic) Effects approximately 50 million people in the U.S. and 1 billion individuals world wide Effects approximately 50 million people in the U.S. and 1 billion individuals world wide The higher the blood pressure, the higher the risk of MI, heart failure, stroke, and kidney disease The higher the blood pressure, the higher the risk of MI, heart failure, stroke, and kidney disease Separated in to 2 categories Separated in to 2 categories Primary Hypertension is a chronic, progressive disorder with no identifiable cause that often attacks the kidneys, heart, brain, and eyes Primary Hypertension is a chronic, progressive disorder with no identifiable cause that often attacks the kidneys, heart, brain, and eyes Often associated with increased mortality and morbidity Often associated with increased mortality and morbidity Secondary hypertension has a cause, which is often associated with chronic renal disease, renal vascular disease, coarctation (constriction of an artery) Secondary hypertension has a cause, which is often associated with chronic renal disease, renal vascular disease, coarctation (constriction of an artery) Secondary hypertension can be controlled once the cause is identified Secondary hypertension can be controlled once the cause is identified

3. Risk Factors for Developing Hypertension Age – arteries lose their elasticity, and blood pressure increases with age Age – arteries lose their elasticity, and blood pressure increases with age Diabetes – high incidence in diabetics with abdominal obesity Diabetes – high incidence in diabetics with abdominal obesity Heredity – higher incidence with a family history of hypertension Heredity – higher incidence with a family history of hypertension High blood lipids – contribute to atherosclerosis and hypertension High blood lipids – contribute to atherosclerosis and hypertension Obesity – excess body fat is closely associated with hypertension Obesity – excess body fat is closely associated with hypertension Race – prevalence differs among ethnic groups, however incidence in African Americans is among the highest in the world Race – prevalence differs among ethnic groups, however incidence in African Americans is among the highest in the world Sex – higher incidence in men and post-menopausal women Sex – higher incidence in men and post-menopausal women Smoking – increases the workload of the heart and blood pressure Smoking – increases the workload of the heart and blood pressure

4. Physical Activity and Hypertension Persons with hypertension should not participate in physical activity until cleared by a physician Persons with hypertension should not participate in physical activity until cleared by a physician Physical activity and exercise are recommend once the blood pressure is controlled Physical activity and exercise are recommend once the blood pressure is controlled Blood pressure should be checked by trainer on a weekly basis and by a physician every 2 to 4 months Blood pressure should be checked by trainer on a weekly basis and by a physician every 2 to 4 months

5. Exercise Prescription for Hypertension Aerobic exercise has been shown to reduce resting systolic blood pressure an average of 4 to 9 mmHg, and diastolic BP an average of 6mmHg Aerobic exercise has been shown to reduce resting systolic blood pressure an average of 4 to 9 mmHg, and diastolic BP an average of 6mmHg 30 min aerobic exercise at 55% to 70% of maximum heart rate, 5-6 sessions per week, is recommended 30 min aerobic exercise at 55% to 70% of maximum heart rate, 5-6 sessions per week, is recommended Begin your exercise session with a 5 to 10 minute warm- up and leave enough time for a5 minute cool down Begin your exercise session with a 5 to 10 minute warm- up and leave enough time for a5 minute cool down Gradually increase the intensity of the program Gradually increase the intensity of the program People with hypertension should avoid isometric exercises and heavy resistance training People with hypertension should avoid isometric exercises and heavy resistance training Stop exercise immediately if experiencing pain in the chest, jay, arm, or if feeling dizzy or short of breath Stop exercise immediately if experiencing pain in the chest, jay, arm, or if feeling dizzy or short of breath

6. Other Lifestyle Modifications Lifestyle modifications often made in collaboration with an exercise program Lifestyle modifications often made in collaboration with an exercise program Modifications include: Modifications include: Lose weight if overweight or obese Lose weight if overweight or obese Participate in regular aerobic physical activity Participate in regular aerobic physical activity Reduce alcohol intake to no more than 2 drinks per day Reduce alcohol intake to no more than 2 drinks per day Reduce sodium intake and maintain adequate potassium, calcium, and magnesium intake Reduce sodium intake and maintain adequate potassium, calcium, and magnesium intake Quit smoking Quit smoking Follow a diet rich in fruits, vegetables, and low fat dairy products Follow a diet rich in fruits, vegetables, and low fat dairy products

7. Medications for Treating Hypertension Most people require more than 1 antihypertensive medications to get their blood pressure under control Most people require more than 1 antihypertensive medications to get their blood pressure under control Diuretics lower blood pressure by increasing fluid loss Diuretics lower blood pressure by increasing fluid loss Thiazide is often used in initial therapy, and is often more affordable than many of the other drugs Thiazide is often used in initial therapy, and is often more affordable than many of the other drugs Calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors are least likely to interact negatively with exercise Calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors are least likely to interact negatively with exercise ACE inhibitors are not recommended for individuals with exercise- induced bronchospasm or pregnant women ACE inhibitors are not recommended for individuals with exercise- induced bronchospasm or pregnant women Using calcium channel blockers while exercising may cause orthostatic problems, but this can be avoided by doing a thourough cool-down after exercise Using calcium channel blockers while exercising may cause orthostatic problems, but this can be avoided by doing a thourough cool-down after exercise

8. Overweight & Obesity Overweight is a difficult term to define Overweight is a difficult term to define Often described as having more body fat than is useful for optimal functioning Often described as having more body fat than is useful for optimal functioning BMI (body mass index) is a commonly used method for calculating ideal body weight BMI (body mass index) is a commonly used method for calculating ideal body weight BMI is calculated by dividing the subjects weight in kilograms by the square of his height in meters BMI is calculated by dividing the subjects weight in kilograms by the square of his height in meters An adult with a BMI between 25 and 29.9 is considered overweight (Center for Disease Control and Prevention) An adult with a BMI between 25 and 29.9 is considered overweight (Center for Disease Control and Prevention) Globally there are more than 1 billion overweight adults, and at least 300 million of them are obese (World Health Organization) Globally there are more than 1 billion overweight adults, and at least 300 million of them are obese (World Health Organization) Overweight is generally caused by taking in more calories than the body is burning Overweight is generally caused by taking in more calories than the body is burning  Other causes may include; cessation of smoking, limited physical activity, genetic predispositions, hormone imbalances, metabolic disorders, eating disorders, stress, insufficient sleep and high glycemic index

9. Obesity Defined as having a BMI of 30 or more Defined as having a BMI of 30 or more Obesity accounts for 2-6% of total health care costs in several developed countries, some estimates put it as high as 7% (World Health Organization) Obesity accounts for 2-6% of total health care costs in several developed countries, some estimates put it as high as 7% (World Health Organization) Obesity increases the likelihood of developing health problems such as respiratory difficulties, chronic musculoskeletal problems, skin problems and infertility, and osteoarthritis Obesity increases the likelihood of developing health problems such as respiratory difficulties, chronic musculoskeletal problems, skin problems and infertility, and osteoarthritis Obesity raises the risk of cancer of the breast, gall bladder, kidney, endometrium, colon and prostate Obesity raises the risk of cancer of the breast, gall bladder, kidney, endometrium, colon and prostate Life-threatening problems associated with obesity include cardiovascular disease, type 2 diabetes, and certain types of cancers Life-threatening problems associated with obesity include cardiovascular disease, type 2 diabetes, and certain types of cancers

10. What can you do about being overweight? Effective weight management involves a few long-term strategies such as prevention, management of co-morbidities, weight management and weight loss Effective weight management involves a few long-term strategies such as prevention, management of co-morbidities, weight management and weight loss Balancing caloric intake and calories used/burnt Balancing caloric intake and calories used/burnt Follow the new Canadian food guide which recommends that the diet consist of less than 30% fats, 40% to 50% simple carbohydrates, and 20% protein Follow the new Canadian food guide which recommends that the diet consist of less than 30% fats, 40% to 50% simple carbohydrates, and 20% protein A gradual reduction in food intake most effective combined with low to moderate exercise A gradual reduction in food intake most effective combined with low to moderate exercise

11. Health Threats Associated with Obesity Cardiovascular: congestive heart disease, enlarged heart and its associated arrhythmias and dizziness, cor pulmonale, varicose veins, pulmonary embolism, heartburn high blood pressure (hypertension), high cholesterol Cardiovascular: congestive heart disease, enlarged heart and its associated arrhythmias and dizziness, cor pulmonale, varicose veins, pulmonary embolism, heartburn high blood pressure (hypertension), high cholesterol Endocrine: polycystic ovarian syndrome (PCOS), menstrual disorders and infertility Endocrine: polycystic ovarian syndrome (PCOS), menstrual disorders and infertility Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasis (gallstones) hernia and colorectal cancer Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasis (gallstones) hernia and colorectal cancer Renal & Genitourinary: urinary incontinence, glomerulopathy, hypogonadism (male), breast cancer (female), uterine cancer (female), stillbirth Renal & Genitourinary: urinary incontinence, glomerulopathy, hypogonadism (male), breast cancer (female), uterine cancer (female), stillbirth Integument: stretch marks, acanthosis nigricans, lymphedema, cellulites, carbuncles, intertigo Integument: stretch marks, acanthosis nigricans, lymphedema, cellulites, carbuncles, intertigo Muskuloskeletal: hyperuricemia (gout), immobility, osteoarthritis, lower back pain, other orthopedic problems, gum disease Muskuloskeletal: hyperuricemia (gout), immobility, osteoarthritis, lower back pain, other orthopedic problems, gum disease Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia 10 Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia 10 Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome, Pickwickian syndrome, asthma Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome, Pickwickian syndrome, asthma Psychological: depression, low self esteem, body dysmorphic disorder, social stigmatization Psychological: depression, low self esteem, body dysmorphic disorder, social stigmatization

12. Main Exercise Activities The exercise activities used in lab #9 will all be included into a circuit. There will be two cycles of the circuit, each stage of the circuit will be performed for 30 seconds. The circuit is designed with the help of professional trainer JC Santana and Local Push trainer Jenn Pochailo. The goal of this circuit is to get the participants working hard and burning calories. The exercise activities used in lab #9 will all be included into a circuit. There will be two cycles of the circuit, each stage of the circuit will be performed for 30 seconds. The circuit is designed with the help of professional trainer JC Santana and Local Push trainer Jenn Pochailo. The goal of this circuit is to get the participants working hard and burning calories.

13. Activity 1 Biking Equipment: Stationary bike Equipment: Stationary bike Circuit 1: Up-hill climb Circuit 1: Up-hill climb Circuit 2: Endurance Speed Circuit 2: Endurance Speed

14. Activity 2 Platform Equipment: Platform (adjusted to the individuals needs) Equipment: Platform (adjusted to the individuals needs) Circuit 1: Step-ups Circuit 1: Step-ups Circuit 2: Step-over Taps Circuit 2: Step-over Taps

15. Activity 3 Stability Ball Utilization Equipment: Stability ball, soft mat Equipment: Stability ball, soft mat Circuit 1: Windshield Wipes Circuit 1: Windshield Wipes Circuit 2: Stability Ball Sit-ups (touching toes) Circuit 2: Stability Ball Sit-ups (touching toes)

16. Activity 4 Break Equipment: Water, Soft mat Equipment: Water, Soft mat Circuit 1: Rest Circuit 1: Rest Circuit 2: Rest Circuit 2: Rest

17. Activity 5 Mix: Crooked Stick/Stability Ball Equipment: Tape, Stability ball Equipment: Tape, Stability ball Circuit 1: Crooked Stick Circuit 1: Crooked Stick Circuit 2: Stability Ball Knee Tuck Circuit 2: Stability Ball Knee Tuck

18. Activity 6 Dumbbell Squats Equipment: Dumbbells (Ranging 2.5lbs to 10lbs) Equipment: Dumbbells (Ranging 2.5lbs to 10lbs) Circuit 1: Burpee Squat Press Circuit 1: Burpee Squat Press Dumbbell Squat Press Dumbbell Squat Press

19. Activity 7 Stability Ball Equipment: Stability Ball Equipment: Stability Ball Circuit 1: Push-ups (feet on stability ball) Circuit 1: Push-ups (feet on stability ball) Circuit 2: Back Extensions (on stability ball) Circuit 2: Back Extensions (on stability ball)

20. Activity 8 Mix: Run/Hurtles Equipment: Cones, Hurdles Equipment: Cones, Hurdles Circuit 1: Shuttle Run Circuit 1: Shuttle Run Circuit 2: Hurdle Jumping Circuit 2: Hurdle Jumping

21. Activity 9 Resistance Band Utilization Equipment: Resistance band x2 Equipment: Resistance band x2 Circuit 1: Chest Press Circuit 1: Chest Press Circuit 2: Back Pull Circuit 2: Back Pull

22. Activity 10 Dumbbell Utilization Equipment: Dumbbells (Ranging: 2.5lbs to 10lbs Equipment: Dumbbells (Ranging: 2.5lbs to 10lbs Circuit 1: Dumbbell Cross Punch Circuit 1: Dumbbell Cross Punch Circuit 2: Contra Lateral Reach (with step) Circuit 2: Contra Lateral Reach (with step)