Young adults must step up their exercise routines to reduce their chances of
developing high blood pressure or hypertension—a condition that may lead to
heart attack and stroke, as well as dementia in later life.
Current guidelines indicate that adults should have a minimum of
two-and-a-half hours of moderate intensity exercise each week, but a new
study led by UCSF Benioff Children's Hospitals reveals that boosting
exercise to as much as five hours a week may protect against hypertension in
midlife—particularly if it is sustained in one's thirties, forties and
fifties.
In the study publishing in American Journal of Preventive Medicine on April
15, researchers followed approximately 5,000 adults ages 18 to 30 for 30
years. The participants were asked about their exercise habits, medical
history, smoking status and alcohol use. Blood pressure and weight were
monitored, together with cholesterol and triglycerides.
Hypertension was noted if blood pressure was 130 over 80 mmHg, the threshold
established in 2017 by the American College of Cardiology/American Heart
Association.
The 5,115 participants had been enrolled by the Coronary Artery Risk
Development in Young Adults (CARDIA) study and came from urban sites in
Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif. Approximately
half the participants were Black (51.6 percent) and the remainder were
White. Just under half (45.5 percent) were men.
Fitness Levels Fall Fast for Black Men Leading to More Hypertension
Among the four groups, who were categorized by race and gender, Black men
were found to be the most active in early adulthood, exercising slightly
more than White men and significantly more than Black women and White women.
But by the time Black men reached age 60, exercise intake had slumped from a
peak of approximately 560 exercise units to around 300 units, the equivalent
to the minimum of two-and-a-half hours a week of moderate intensity exercise
recommended by the U.S. Department of Health and Human Services. This was
substantially less exercise than White men (approximately 430 units) and
slightly more than White women (approximately 320 units). Of the four
groups, Black women had the least exercise throughout the study period and
saw declines over time to approximately 200 units.
"Although Black male youth may have high engagement in sports,
socio-economic factors, neighborhood environments, and work or family
responsibilities may prevent continued engagement in physical activity
through adulthood," said first author Jason Nagata, MD, of the UCSF Division
of Adolescent and Young Adult Medicine. Additionally, Black men reported the
highest rates of smoking, which may preclude physical activity over time, he
noted.
Physical activity for White men declined in their twenties and thirties and
stabilized at around age 40. For White women, physical activity hovered
around 380 exercise units, dipping in their thirties and remaining constant
to age 60.
Rates of hypertension mirrored this declining physical activity.
Approximately 80-to-90 percent of Black men and women had hypertension by
age 60, compared with just below 70 percent for White men and 50 percent for
White women.
"Results from randomized controlled trials and observational studies have
shown that exercise lowers blood pressure, suggesting that it may be
important to focus on exercise as a way to lower blood pressure in all
adults as they approach middle age," said senior author Kirsten
Bibbins-Domingo, MD, Ph.D., of the UCSF Department of Epidemiology and
Biostatistics.
"Teenagers and those in their early twenties may be physically active but
these patterns change with age. Our study suggests that maintaining physical
activity during young adulthood—at higher levels than previously
recommended—may be particularly important."
More Exercise from Youth to Midlife Offers Best Protection Against Hypertension
When researchers looked at the 17.9 percent of participants who had moderate
exercise for at least five hours a week during early adulthood—double the
recommended minimum—they found that the likelihood of developing
hypertension was 18 percent lower than for those who exercised less than
five hours a week. The likelihood was even lower for the 11.7 percent of
participants who maintained their exercise habits until age 60.
Patients should be asked about physical activity in the same way as they are
routinely checked for blood pressure, glucose and lipid profiles, obesity
and smoking, Nagata said, and intervention programs should be held at
schools, colleges, churches, workplaces and community organizations. Black
women have high rates of obesity and smoking, and low rates of physical
activity, he said, and should be an important group for targeted
intervention.
"Nearly half of our participants in young adulthood had suboptimal levels of
physical activity, which was significantly associated with the onset of
hypertension, indicating that we need to raise the minimum standard for
physical activity," Nagata said. "This might be especially the case after
high school when opportunities for physical activity diminish as young
adults transition to college, the workforce and parenthood, and leisure time
is eroded."
Reference:
American Journal of Preventive Medicine (2021).
doi.org/10.1016/j.amepre.2020.12.018