Managing postural hypotension during exercise

How to reduce the risk of blood pressure-related falls during physical activity.

The beginning of fall means back to school and new fall workout class offerings for many local fitness centers or YMCAs. When starting a new workout program, individuals with chronic diseases or that are on certain medications need to be aware of postural hypotension and the associated increased risk of falling. Postural hypotension, also known as orthostatic hypotension, is when your blood pressure drops when you go from lying down to sitting up or from sitting to standing. Postural refers to the change in posture and hypotension means low blood pressure so when your blood pressure drops, less blood is going to your organs, making falls more likely. According to a 2010 article by Figuroa, Basford, and Low from the Cleveland Clinic Journal of Medicine, the consensus criteria for postural hypotension is at least a 20mmHg decrease in systolic blood pressure (top number) and at least a 10mmHg decrease in diastolic blood pressure (bottom number) within three minutes of standing. An example of this would be if an individual goes from sitting to standing and has a subsequent decrease in blood pressure from 120/80 to at least 100/70 within three minutes of the change in posture.

Symptoms of Postural Hypotension include:
  • Dizziness of light-headedness
  • Blurry vision
  • Confusion
  • Weakness
  • Fatigue (feeling tired)
  • Nausea
  • Feeling faint or fainting

According to the National Heart, Lung, and Blood Institute, Dehydration is the most common cause of postural hypotension, though it can also occur during pregnancy and in older adults because of normal aging or after meals. Individuals are at an increased risk of postural hypotension if they: are on medications for blood pressure or heart disease, have a heart condition, have anemia, are diabetic, or have Parkinson’s. If you fall into one of these higher risk groups, it is important to be aware of symptoms while exercising and take precautions to avoid more serious outcomes like falling or fainting.

What to do:
  • Take your time when changing position, like getting up out of a chair or up off the floor
  • Hold onto something when you stand up
  • Stay hydrated by drinking plenty of water
  • Exercise gently before getting up, by moving feet up and down or marching in place after standing
  • Consider modifying workouts to group standing exercises, seated exercises and supine (laying down) exercises
  • Allow sufficient time between exercises for careful movement from seated to standing or standing to laying down
  • Workout in supine or seated positions, like swimming or recumbent bicycling
What to avoid:
  • Getting up rapidly from sitting or lying down
  • Exercises with rapid changes in posture such as jump squats or burpees, where participants move quickly from sitting to standing or from laying down to standing
  • Circuits that combine exercises with rapid changes in posture such as squats to sit-ups or push-ups to lunges, etc.
  • Walking or exercising if experiencing symptoms of postural hypotension or dizziness

While postural hypotension is best treated by your primary care provider, taking precautions can help you manage your workouts so you can safely continue them. Communicating with personal trainers, especially notifying them when experiencing symptoms of postural hypotension, instead of pushing through workouts is also important to avoid falls or fainting. For additional information on physical activity and health, visit Michigan State University Extension

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