Doctors should 'prescribe' exercise for adults with slightly high blood pressure, cholesterol

Doctors should encourage otherwise healthy adults with slightly elevated blood pressure or cholesterol to sit less and move more to improve heart health, according to a new report.

The American Heart Association scientific statement suggests doctors write exercise "prescriptions" for people with mildly to moderately high blood pressure and cholesterol. The prescriptions would include suggestions for how they can increase daily physical activity along with resources, such as health coaches and connections to community centers.

"The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity," Bethany Barone Gibbs said in a news release. Gibbs is chair of the writing group for the report, published Wednesday in the journal Hypertension. She also is associate professor in the department of health and human development and clinical and translational sciences at the University of Pittsburgh.

An estimated 21% of U.S. adults – about 53 million people – have blood pressure that's considered a little too high. This is measured by the top number, known as systolic blood pressure, falling between 120-139 mmHg or the bottom number, called diastolic blood pressure, falling between 80-89 mmHg.

Likewise, roughly 28% of U.S. adults, or about 71 million people, have slightly high cholesterol levels. This is measured by a "bad" LDL cholesterol score above 70 mg/dL.

The guidelines for blood pressure and cholesterol both suggest people in those slightly high ranges who otherwise have a low risk of heart disease or stroke be treated through lifestyle changes only. These include increased physical activity, weight loss, improving diet, stopping smoking and moderating alcohol intake.

The new AHA statement recommends doctors ask patients about their physical activity levels at every visit, help them identify activities they enjoy and connect them to resources. It also calls upon doctors to encourage and celebrate small improvements, such as walking or climbing the stairs more often.

"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," Gibbs said.

Studies show increasing physical activity can lower systolic and diastolic blood pressure by an average of 3-4 mmHg and can decrease LDL cholesterol by 3-6 mg/dL. The statement highlights research showing physically active people have a 21% lower risk of developing cardiovascular disease and a 36% lower risk of death from cardiovascular diseases compared to inactive people.

Federal physical activity guidelines suggest people 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 to receive benefits.

"Every little bit of activity is better than none," Gibbs said. "Even small initial increases of five to 10 minutes a day can yield health benefits."

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