Physical Training in Programs of Secondary Prevention and Cardiac Rehabilitation of Patients with Hypertension

The prevalence of hypertension among patients of working age with cardiovascular diseases (CVD) is 41%. Ischemic heart disease (IHD) is combining with essential arterial hypertension in 60% of cases. According to the results of the Framingham Heart Study, 80-85% of chronic heart failure is due to hypertension, IHD or a combination of these. Thus, persons with hypertension account a significant part of patients with indications to involvement in cardiac rehabilitation (CR) and secondary prevention programs. Criteria for choosing exercises, intensity and duration of physical training programs (PTP) in patients with hypertension continue to be studied. A review of the scientific literature deals with studying the effectiveness of different PTP on patients with hypertension and systematizing the recommendations of international communities of cardiologists regarding a physical activity of patients with hypertension. Material and methods. We researched scientific publications on the selected topic for in such databases as PubMed, Cochrane Library, Web of Science, Scopus and official electronic resources of international communities of cardiologists. The search was conducted according to the terms: exercise, physical activity, physical training, hypertension, blood pressure. Results and discussion. The results of the studies, systematic reviews and meta-analyses confirm the positive effect of PTP on the effectiveness of blood pressure control (BP), lipid profile, exercise tolerance, duration, and quality of life of patients with hypertension. We also detected how different types of PTP influenced on the blood pressure and systematized recommendations of the international communities of cardiologists. Conclusions. Patients with hypertension are recommended regular physical activity of moderate intensity of at least 30 minutes a day, 5 days a week or 15 minutes of intensive exercise, or a combination of them. The advantage is given to dynamic endurance aerobic training (DEAT) (walking, jogging, cycling, and swimming) of moderate intensity (40-59% VO2max, 12-13 Borg PRE Scale), in addition, dynamic resistance (DRE) or isometric resistance exercises (IRE) can be used. DEAT, DRE and IRE reduce systolic (SBP) and diastolic blood pressure (DBP), and the combined training mainly promotes a decrease in DBP. Hypotensive effect and safety of IRE is less studied compared to DEAT and DRE. Therefore, not all international cardiologic guidelines contain recommendations for their appointment. DRE can be used 2-3 times a week in the combination with DEAT. But the advantage of combined training (CT) compared with the isolated use of DEAT is not proved. In some studies, the predominant impact of CT on diastolic blood pressure was detected. It was established that attracting specialists from physical and rehabilitation medicine to the creation of the curriculum provided additional benefits for patients with high cardiovascular risk. Further research should be aimed at studying the peculiarities of the effects of PTP in patients with different stages of HT, depending on the damage of the target organs, the daily blood pressure profile, individual patient characteristics, and comorbidity. The information given in the article can be used to simplify creating a prescription of training in patients with hypertension.