I’ve heard that exercise can help control hypertension. How much and what type of exercise is recommended for individuals with hypertension?

While drug therapy is traditionally considered to be the most effective form of treating high blood pressure, exercising on a regular basis has been found to be a valuable and safe additional therapy for many people with hypertension. In fact, a sound exercise programme may serve as an effective non-drug alternative for some people.

Over the past 15 years, substantial information has emerged concerning what constitutes an appropriate exercise prescription for individuals with hypertension. When choosing an exercise program, individuals with hypertension should:

• Avoid exercise if resting blood pressure exceeds 200 mmHg and/or diastolic blood pressure exceeds 115 mmHg.

• Emphasise non-weight-bearing activities (for example aquatic activities, stationary cycling) or low impact aerobic activities (including walking, elliptical cross-training, cycling) if you have lower-body orthopedic problems.

• Keep the intensity level at the low end of the intensity range (40 percent to 70 percent of O2 max or 50 percent to 75 percent of maximum heart rate. Evidence suggests that higher-intensity exercise (greater than 70 percent of VoO2 max or 80 percent of MHR) produces no greater reductions in blood pressure

• Use the ratings of perceived exertion (RPE) scale to monitor exercise intensity if taking antihypertensive medications (for example betablockers) that influence heart-rate response. The recommended RPE range is two to four (weak to moderate).

• Exercise for 20 to 30 minutes per session and progress to 30 to 60 minutes.

• Exercise at least four times per week (although exercising on a daily basis is preferable). A single bout of aerobic exercise may temporarily reduce blood pressure for several hours.

• Warm up longer than five minutes to ensure that the cardiovascular system is prepared for the upcoming physical activity. This will reduce the chance of experiencing an abrupt, sudden rise in blood pressure.

• Perform more than five minutes of cooldown exercises so that a gradual transition can be made from the conditioning activity to the resting state. Cooling down helps to prevent dizziness, feeling light headed or fainting, which are frequently associated with an abrupt cessation of exercise, especially for those who are taking certain medications such as vasodilating agents.

• Avoid isometric or high-tension, dynamic resistance strength-training exercises. All strength-training exercises should be performed at a low-to-moderate intensity (able to perform 12 to 20 repetitions per set).

• Maintain normal breathing patterns while exercising (particularly while engaged in strength training), since holding your breath can cause an excessive, transient rise in blood pressure.

• Start with a prolonged warm-up, especially before high-intensity, start-stop bursts of activity (for example squash, tennis, basketball).

Finally, make a firm commitment to exercise, because even a small amount of regular activity (and the subsequent reduction in blood pressure) can help diminish the long-term consequences of high blood pressure.

For example, lowering systolic blood pressure by a mere two millimeters of mercury has been shown to reduce deaths from stroke by 6 percent, heart disease by four percent and all causes by three percent.

The widespread tendency to treat hypertension has markedly reduced stroke mortality, but has not significantly reduced the mortality from coronary heart disease (CHD). Proper use of a non-drug therapy, such as exercise, in conjunction with drug therapy can offer hypertensive patients added protection against CHD.

Exercise has also been shown to favourably modify other CHD risk factors (including obesity, lipidlipoprotein profiles and glucose tolerance). In short, a sound exercise program is an excellent strategy for helping to treat and prevent high blood pressure.

Should I train my abdominal muscles every day? Also, how many repetitions of crunches should I optimally perform?

You should treat your abdominal muscles like any other muscle group, which means you shouldn't train them every day. Your abdominals, like all of your other muscle groups, need recovery time between workouts.

As with any resistance training exercise, you ideally want the last few repetitions to be difficult to complete.

Performed correctly, 10 to 25 repetitions for one to three sets of abdominal exercises provide a more than adequate training stimulus.

If you can perform more than 25 repetitions of an abdominal exercise, you are most likely performing the repetitions too rapidly or with improper form.

You can increase the challenge and intensity of abdominal exercises by using added resistance, moving more slowly or performing the exercises on a slant board or exercise ball so that your head is at a lower elevation than your legs.