Let’s get physical!

A healthy lifestyle is the cornerstone of cardiovascular health.

Lifestyle interventions are already a key component of primary prevention in low-risk cardiovascular disease groups, and serve as an important aide to pharmacotherapy in higher-risk groups. 

But according to the new guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC)1, a first line of therapy for mild to moderate–risk groups are lifestyle-only approaches for a proper blood pressure and blood cholesterol management.

As such, the next time you go to the doctor, you might get an exercise prescription instead of an order to visit the pharmacy. 

This is a major change in the idea of health, promoted by not taking a pill, but having a look at lifestyle in order to improve health – and avoid the numerous side-effects that certain medications can have. 

An exercise prescription is an individualized physical activity program designed using the Frequency (how often?), Intensity (how hard?), Time (how long?), and Type (what kind?), or the FITT principle developed by the American College of Sports Medicine (ACSM). 

Although most health care professionals and patients are aware that physical activity is recommended for good health, the abundance of scientific and lay recommendations for activity can be difficult to distil. As such, framing the exercise prescription by the FITT principle provides clinicians with more structured guidance on how to recommend exercise to their patients. 

The updated FITT exercise recommendations for adults with elevated blood pressure are the following: 

  • Frequency: in most, preferably all days of the week due to the transient Blood Pressure lowering effects that last for up to 24 hours after an exercise session; 
  • Intensity: Moderate, any intensity of exercise has been shown to lower Blood Pressure;
  • Time: >20 to 30 minutes per day to total >90 to >150 minutes per week of continuous or accumulated exercise of any duration;
  • Type: Emphasize aerobic or resistance exercise alone or combined, due to the recent evidence showing the Blood Pressure lowering effects of exercise do not vary by exercise modality2

The updated FITT exercise prescription recommendations propose more exercise options in less time, that hopefully will translate to better exercise adherence.

As a plus, we should be reminded of the advantageous effects of exercise on brain functions. Acute bouts of physical activity can stimulate transient Serotonin, Dopamine and Norepinephrine activity in the brain3

Furthermore, long-term exercise produces changes in the availability of receptors that can control the release of monoamines, like the Serotonin-1A receptor of the Raphe Nuclei4, and Dopamine-2 receptor in the Striatum5

Regular exercise has antidepressant/anxiolytic properties, and results in dramatic alterations in physiological stress responses. 

In addition to antidepressant and anxiolytic properties, the Serotonin system (5-HT) has also been linked to cognitive function; since, a distress of the 5-HT system is associated with cognitive syndromes, such as Alzheimer’s disease6

So, don’t shy away, and take at least a 20 min quick walk today. 

It’s free, and it’s good for you!

My boots were made for walking!

References:

1          Gibbs, B. B. et al. 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 0, HYP.0000000000000196, doi:doi:10.1161/HYP.0000000000000196.

2          Pescatello, L. S. et al. Physical Activity to Prevent and Treat Hypertension: A Systematic Review. Med Sci Sports Exerc 51, 1314-1323, doi:10.1249/mss.0000000000001943 (2019).

3          Buhr, T. J. et al. The Influence of Moderate Physical Activity on Brain Monoaminergic Responses to Binge-Patterned Alcohol Ingestion in Female Mice. Front Behav Neurosci 15, 639790-639790, doi:10.3389/fnbeh.2021.639790 (2021).

4          Greenwood, B. N. et al. Freewheel running prevents learned helplessness/behavioral depression: role of dorsal raphe serotonergic neurons. J Neurosci 23, 2889-2898, doi:10.1523/jneurosci.23-07-02889.2003 (2003).

5          Clark, P. J. et al. Wheel running alters patterns of uncontrollable stress-induced cfos mRNA expression in rat dorsal striatum direct and indirect pathways: A possible role for plasticity in adenosine receptors. Behav Brain Res272, 252-263, doi:10.1016/j.bbr.2014.07.006 (2014).

6          Meltzer, C. C. et al. Serotonin in aging, late-life depression, and Alzheimer’s disease: the emerging role of functional imaging. Neuropsychopharmacology 18, 407-430, doi:10.1016/s0893-133x(97)00194-2 (1998).

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