Sport therapy for hypertension. Why, How, How much?

Many pathologic conditions are associated with inactivity and sedentary lifestyle. Exercise may increase physical fitness and cardiovascular efficiency, and improve body composition, lipid profiles and insulin resistance, thus preventing or reducing the effects of metabolic and cardiovascular diseases, including hypertension. Both acute and chronic exercise, alone or combined with lifestyle modifications, are effective in blood pressure reduction, as well as in avoiding or reducing the need for pharmacologic therapy in hypertensive patients. The hypotensive effect of aerobic exercise is observed in a large percentage of subjects, with some differences due to age, gender, race, health conditions, parental history and genetic factors. Physical training regulates autonomic nervous system activity and, by increased blood flow and shear stress, increases nitric oxide production in endothelial cells and its bioavailability for vascular smooth muscle, up-regulating the level of antioxidant enzymes. Different types of exercise have been proposed. Endurance training is primarily considered effective, and resistance training can be combined with it. Low or moderate intensity training in sedentary patients with hypertension is necessary, and tailored programs can also make exercise safe and effective in special populations. Exercise programs, either under supervision or home-based, allow an effective non-pharmacological reduction of hypertension, together with a reduction of risk factors, with possible beneficial effects on cardiovascular morbidity and mortality.