血壓高
膽固醇
糖尿病
及運動

Hypertension Diabetes High Cholesterol and Exercise

Aerobic exercise proven effective in lowering blood pressure

Aerobic exercise is a priority management for patients with hypertension, which can lower blood pressure by 5-7 degrees1,2,3.

It can also reduce risk of cardiovascular diseases by 20-30%4.

1. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, et al. American college of sports medicine position stand: exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–53.
2. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46:667–75.
3. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2
4. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493–503.

Study on hypertensive patients exercising only 1 day per week

Studies have found that only exercising one day per week can reduce all-cause mortality in patients with hypertension comparable to drug therapies5.

5. Brown RE, Riddell MC, Macpherson AK, Canning KL, Kuk JL. The joint association of physical activity, blood-pressure control, and pharmacologic treatment of hypertension for all-cause mortality risk. Am J Hypertens. 2013;26:1005–10.

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Exercise recommendations for hypertension in major medical bodies

1. Report from Eighth Joint National Committee and American Heart Association

40 minutes of exercise each time6,7

2. American Heart Association

150 minutes total of exercise per week8

3. American College of Sports Medicine

Continuous exercise for 30-60 minutes per day can be 10 minutes bouts each time, gradually increase9

4. European Society of Hypertension / European Society of Cardiology

Exercise 30 minutes per day10

6. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth Joint National Committee (JNC 8) JAMA. 2014;311:507–20.
7. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;63:2960–84.
8. Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American heart association. Hypertension. 2013;61:1360–83.
9. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, et al. American college of sports medicine position stand: exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–53.
10. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC practice guidelines for the management of arterial hypertension. Blood Press. 2014;23:3–16.

Exercise and diabetes

People with type 2 diabetes should have moderate to vigorous aerobic exercise for more than 150 minutes and at least 3 days a week, but not for 2 consecutive days11.

Patients exercising under professional blood glucose monitoring have better outcomes12,13.

Apart from aerobic exercise, moderate to severe resistance training should be performed at least 2-3 days per week11.

11. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–e167.
12. Balducci S, Zanuso S, Nicolucci A, et al. : Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in type 2 diabetic subjects. A randomized controlled trial: The Italian Diabetes and Exercise Study (IDES). Arch Intern Med.
13. Gordon BA, Benson AC, Bird SR, Fraser SF: Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract 2009;83(2):157–75

Caution during exercising in people with diabetes

Studies have shown that people with diabetes who do not require medications rarely have low blood sugar (hypoglycemia) during exercise. Those injecting insulin or taking diabetic medicine should replenish carbohydrates according to personal situation to avoid hypoglycemic reactions during or after exercise14,15,16,17.

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In summary numerous literatures show aerobic exercise and resistance training can improve blood glucose control, body insulin response, fat oxidation and storage18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36。

High blood cholesterol and exercise

Exercise significantly reduces the risk of death (37)

The study followed up 1,005,791 patients with high cholesterol for 18.1 years. During the interview period, mortality in the exercise group decreased by 12-59%37.

Another study lasting 10 years, those taking cholesterol-lowering drugs plus aerobic exercise significantly reduced the risk of death compared to taking medication alone. Thus aerobic exercise should be required38.

Good cholesterol, triglyceride, PCSK9 cholesterol enzyme

One meta-analysis analyzed 25 randomized control trials concluded that even only moderate to intense aerobic exercise without medication or diet control, good cholesterol (HDL-C) increased by 2.53 mg / dl39.

Studies have also widely shown that exercise can reduce triglyceride concentrations40,41,42.

Another study found that after three months of exercise, volunteers' recently popular PCSK9 level and bad cholesterol (lower density cholesterol) both significantly decreased, so it was concluded that daily exercise has a significant relationship with lowering PCSK9 levels43.

Summarizing multiple meta-analyses, exercise has a positive effect on health in patients with hyperlipidaemia44。

11. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–e167.
12. Balducci S, Zanuso S, Nicolucci A, et al. : Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in type 2 diabetic subjects. A randomized controlled trial: The Italian Diabetes and Exercise Study (IDES). Arch Intern Med. In press
13. Gordon BA, Benson AC, Bird SR, Fraser SF: Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract 2009;83(2):157–75
14. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C: Physical activity/exercise and type 2 diabetes. Diabetes Care 2004;27(10):2518–39
15. American Diabetes Association Physical activity/exercise and diabetes. Diabetes Care2004;27(90001):S58–S62
16. Larsen JJ, Dela F, Madsbad S, Vibe-Petersen J, Galbo H: Interaction of sulfonylureas and exercise on glucose homeostasis in type 2 diabetic patients. Diabetes Care 1999;22(10):1647–54
17. Rosenstock J, Hassman DR, Madder RD, et al. : Repaglinide versus nateglinide monotherapy: a randomized, multicenter study. Diabetes Care 2004;27(6):1265–70
18. Winnick JJ, Sherman WM, Habash DL, et al. : Short-term aerobic exercise training in obese humans with type 2 diabetes mellitus improves whole-body insulin sensitivity through gains in peripheral, not hepatic insulin sensitivity. J Clin Endocrinol Metab 2008;93(3):771–8
19. Bajpeyi S, Tanner CJ, Slentz CA, et al. : Effect of exercise intensity and volume on persistence of insulin sensitivity during training cessation. J Appl Physiol 2009;106(4):1079–85
20. Evans EM, Racette SB, Peterson LR, Villareal DT, Greiwe JS, Holloszy JO: Aerobic power and insulin action improve in response to endurance exercise training in healthy 77–87 yr olds. J Appl Physiol2005;98(1):40–5
21. Galbo H, Tobin L, van Loon LJ: Responses to acute exercise in type 2 diabetes, with an emphasis on metabolism and interaction with oral hypoglycemic agents and food intake. Appl Physiol Nutr Metab2007;32(3):567–75
22. Houmard JA, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Kraus WE: Effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol 2004;96(1):101–639. Christ-Roberts CY, Pratipanawatr T, Pratipanawatr W, et al. : Exercise training increases glycogen synthase activity and GLUT4 expression but not insulin signaling in overweight non- diabetic and type 2 diabetic subjects. Metabolism 2004;53(9):1233–42
23. Christ-Roberts CY, Pratipanawatr T, Pratipanawatr W, et al. : Exercise training increases glycogen synthase activity and GLUT4 expression but not insulin signaling in overweight non- diabetic and type 2 diabetic subjects. Metabolism 2004;53(9):1233–42
24. Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JF, Dela F: Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes 2004;53(2):294–305
25. O'Gorman DJ, Karlsson HK, McQuaid S, et al. : Exercise training increases insulin-stimulated glucose disposal and GLUT4 (SLC2A4) protein content in patients with type 2 diabetes. Diabetologia2006;49(12):2983–92
26. Wang Y, Simar D, Fiatarone Singh MA: Adaptations to exercise training within skeletal muscle in adults with type 2 diabetes or impaired glucose tolerance: a systematic review. Diabetes Metab Res Rev2009;25(1):13–40
27. Duncan GE, Perri MG, Theriaque DW, Hutson AD, Eckel RH, Stacpoole PW: Exercise training, without weight loss, increases insulin sensitivity and postheparin plasma lipase activity in previously sedentary adults. Diabetes Care 2003;26(3):557–62
28. Goodpaster BH, Katsiaras A, Kelley DE: Enhanced fat oxidation through physical activity is associated with improvements in insulin sensitivity in obesity. Diabetes 2003;52(9):2191–7
29. Kelley GA, Kelley KS: Effects of aerobic exercise on lipids and lipoproteins in adults with type 2 diabetes: a meta-analysis of randomized-controlled trials. Public Health 2007;121(9):643–55
30. Braun B, Sharoff C, Chipkin SR, Beaudoin F: Effects of insulin resistance on substrate utilization during exercise in overweight women. J Appl Physiol 2004;97(3):991–7
31. Cohen ND, Dunstan DW, Robinson C, Vulikh E, Zimmet PZ, Shaw JE: Improved endothelial function following a 14-month resistance exercise training program in adults with type 2 diabetes. Diabetes Res Clin Pract 2008;79(3):405–11
32. Dunstan DW, Daly RM, Owen N, et al. : High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 2002;25(10):1729–36
33. Ibanez J, Gorostiaga EM, Alonso AM, et al. : Lower muscle strength gains in older men with type 2 diabetes after resistance training. J Diabetes Complications 2008;22(2):112–8
34. Ibanez J, Izquierdo M, Arguelles I, et al. : Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes Care2005;28(3):662–7
35. Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S: Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes Care 1998;21(8):1353–5
36. Snowling NJ, Hopkins WG: Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 2006;29(11):2518–27
37. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, Bauman A, Lee IM, Lancet Physical Activity Series 2 Executive Committe., Lancet Sedentary Behaviour Working Group. Lancet. 2016 Sep 24; 388(10051):1302-10.
38. Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study.Kokkinos PF, Faselis C, Myers J, Panagiotakos D, Doumas M Lancet. 2013 Feb 2; 381(9864):394-9.
39. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Kodama S, Tanaka S, Saito K, Shu M, Sone Y, Onitake F, Suzuki E, Shimano H, Yamamoto S, Kondo K, Ohashi Y, Yamada N, Sone H Arch Intern Med. 2007 May 28; 167(10):999-1008.
40. Kazeminasab F, Marandi M, Ghaedi K, et al. Endurance training enhances LXRα gene expression in Wistar male rats. Eur J Appl Physiol. 2013;113(9):2285–2290.
41. Ghanbari-Niaki A, Khabazian BM, Hossaini-Kakhak SA, et al. Treadmill exercise enhances ABCA1 expression in rat liver. Biochem Biophys Res Commun. 2007;361(4):841–846.
42. Kazeminasab F, Marandi M, Ghaedi K, et al. Effects of a 4-week aerobic exercise on lipid profile and expression of LXRα in rat liver. Cell J. 2017;19(1):45–49.
43. Kamani CH, Gencer B, Montecucco F, et al. Stairs instead of elevators at the workplace decreases PCSK9 levels in a healthy population. Eur J Clin Investig.2015;45(10):1017–1024.
44. Evidence for prescribing exercise as therapy in chronic disease. Pedersen BK, Saltin B Scand J Med Sci Sports. 2006 Feb; 16 Suppl 1():3-63.

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