I’m Dr. Bethany Barone Gibbs, chair of the writing group for the American Heart Association’s new scientific statement on sitting less and moving more being a ‘prescription’ for elevated blood pressure and cholesterol! Ask me anything!

Is all sitting equal? Are there differences between traditional chair sitting, "Indian" style sitting, sitting while jiggling your legs in an anxious manner, or sitting on an inflatable exercise ball?

This is a great question! Though it’s not entirely clear, it looks like anything that can promote circulation through muscle contraction while sitting is probably better than prolonged sitting in a chair for a long time. So something like fidgeting, and under-desk cycle that you can do for a few minutes here and there, changing between different postures of sitting, or sitting on an exercise ball that makes you use your leg muscles can help. Though not a cardiovascular risk factor, we should also consider ergonomics and some things like standing all day or sitting on an exercise all day are also not recommended because they can lead to strain on your back or other spots. A great saying is, ‘the best posture is the next posture’ and this is a nice way to think about it – try to change your posture often to promote circulation and musculoskeletal health.

-BBG

I have to sit for my job, sometimes 12 hours a day, in addition to just routine sitting for things like dinner. How bad is this in the long term future and can small five or ten minute standing breaks during the day actually do anything to offset any damage or problems the constant sitting will cause?

Thanks for this great question! I am focusing on exactly this research question right now – how does prolonged sitting affect blood pressure and other cardiovascular health metrics. Our research shows that blood pressure increases across a day of prolonged sitting and that breaking sitting up can keep this from happening. To make it work in your life, the good news is there are different kinds of breaks that all seem to be effective. Short walk breaks (<5 minutes), intermittent standing (15-30 min each hour, say at a sit-stand desk), or even a short resistance exercise break like desk push-ups! Anything that engages your muscles and gets your circulation going seems to help. I am now studying whether these one day effects can turn into longer-term benefits on blood pressure – hopefully that research will be out in the next 2 years.

I myself try not to sit for more than an hour at once if I can help it. When working, I stand 15-30 minutes each hour and try to walk around or even do some jumping jacks once an hour during the workday. I use my Apple watch to remind me if I haven’t moved! Also, I try to break up a lot of sitting at night by doing dishes between shows or taking a walk/playing outside with my kids after dinner.

-BBG

Is it bad that I am reading this AMA laying on a couch? I feel like this is the world telling me to stop being lazy.

You can become immediately un-lazy with just a quick activity break. Try a few jumping jacks or some yoga poses. And rest is important too :) It’s all about moderation and balance!

-BBG

What types of exercise would help lower hbp if you have orthopedic issues in your feet and can’t run or walk?

Thanks for this great question! Any kind of aerobic activity that gets your breathing and heart rate up can help lower blood pressure – for example swimming or recumbent biking. Also, resistance exercise is another great option that also can help lower blood pressure. This can be done with inexpensive free weights or resistance exercise bands. Working with an exercise professional or health coach for your specific situation can also help – ask your doctor if you can get a referral for this kind of service. Also, check out your local community YMCA or a gym for some extra guidance and motivation!

- BBG

All things come at a cost, so can you forecast out-- if everyone were to get a standing desk and fulfill this 150 minutes of exercise per week, would the human race perhaps become TOO powerful?

I *am* participating in this AMA from my standing desk and it makes me feel very powerful...

-BBG

Will we have a pandemic of elevated blood pressure and cholesterol in the years following the COVID pandemic?

This is a great question too! Though we are still understanding the cardiovascular effects of COVID, I have been doing some research about lifestyle behaviors during this strange time. Certainly social restrictions and more work from home might open up more time to exercise, but also could create less opportunities and ‘built in’ moving on the way to and at work. We studied desk workers and found that they sat more and had worsened mood and mental health during the initial months of COVID-19 shut downs. As we get back to ‘normal,’ I think making sure to keep activity in our lives is a critical component of cardiovascular health! Also, the added stress and decreased mental health could have detrimental effects on cardiovascular health. Since physical activity improves mental health and can help manage stress, even another reason to be active now more than ever!

AHA's immediate past president, Dr. Mitch Elkind, a stroke neurologist at Columbia University, briefly explains how COVID-19 impacts the whole body, including the heart and brain https://youtu.be/B7_R6zZysbo

-BBG

I have mitral valve prolapse with moderate symptoms. My cardiologist encourages me to exercise as per normal but I find that aerobics or cardio quickly gets my palpitations going and I get out of breath very fast. I’ve voiced this out to my cardiologist but he doesn’t seem to listen. I’ve tried yoga but I don’t find it enough as an exercise. Should I just soldier on with the cardio like my cardiologist says so or is there anything else I can try?

Thank you very much for doing this and you’re doing amazing work!

Thanks so much for your question! Staying active even at lower intensity can help your cardiovascular health, so try to get the intensity up as well as you can, but know that anything is better than nothing. Also, you might ask your cardiologist whether resistance exercise would be a good alternative – it has similar blood pressure benefits to aerobic exercise and you might be able to tolerate it better. Lastly, the latest evidence suggests yoga can be quite beneficial to cardiometabolic health. Research done by my colleagues here at the University of Pittsburgh found that more intense types of yoga, like Vinyasa yoga, falls within an intensity level similar to brisk walking and clinical studies show that cardiovascular risk factors like blood pressure improve with yoga training. And importantly – find something you like doing! Best of luck to you!

- BBG

I have always had a higher than normal blood pressure due to being overweight. I also used to smoke cigarettes but going on 5 years free of them after quitting. However I still consume cannabis normally and I believe this does attribute to a higher than normal HR/BP. I am 34 years old and lived a younger life of not much exercise and poor dieting.

I recently have been working on my weight by dieting and stopping of eating sugary and processed foods.

I recently went to a doctor because after not going to one for over 10 years. Thankfully everything came out normal on a blood/urine test but he did note a bit higher than normal blood pressure. I did tell him I used cannabis regularly as well.

He didn't start me on medication but told me he advised exercise.

Right now I am brisk walking 45 minutes everyday. Is this enough exercise to bring down my BP? Do you recommend anything else to help (such as vitamins, anything really) to help?

Hello and thanks for your question! Elevated blood pressure is very common – 2 in 3 Americans have blood pressure above optimal – so you are not alone. Great work increasing your exercise – 45 minutes a day of brisk walking is definitely meeting guidelines for improving your health and your blood pressure. Doing this exercise every day or every other day is great because you can get both immediate post-exercise blood pressure benefits for about 24 hours in addition to long-term blood pressure lowering.
Adding other lifestyle strategies can also help reduce blood pressure further.

The other strategies recommended for elevated blood pressure are improving diet (sounds like you are already doing this), quitting smoking (sounds like you are doing this), losing weight, and moderating alcohol intake. Diet patterns that are rich in fruits, vegetables, and whole grains and lower in sodium are recommended.

Though maintaining weight loss is a challenge, physical activity helps with long-term weight maintenance so these are great strategies to pursue together.
Keep up the good work in pursing your best health!

-BBG

Good morning Dr.

Long ago I read a few articles that stated something like plaque around the heart is more detrimental than high blood pressure, cholesterol and the like. Is there any truth to this or is it junk science?

Second question is regarding exercise habits. Would you say it's better to do one long stretch of exercise (say over 1 hour) plus minimal activity throughout the day OR do continuous activity all day long but skip one long session of aerobic exercise?

Lastly, every year during my physical my Dr. runs an EKG (I think that's the one - small sticky foam pads all over my body that are hooked up to cables), HDL/LDL/triglyceride panel on me in addition to BP. I know what cholesterol numbers mean as well as BP but the EKG read out is completely foreign. Is there any tutorial a commoner can go through so I can understand what all those squiggly lines mean? Also, is one of those things more important than another?

Thank you for doing this.

Great questions! Blood pressure is one of many clinical markers that reflects your cardiovascular health. While cardiovascular risk factors often occur together and can interact, blood pressure has more to do with the amount of pressure in your arteries from a variety of sources like the stiffness of your arteries, hormones, and your nervous system that all work together to keep your blood pressure in a good range to promote circulation so that your blood can provide nutrients and oxygen to your whole body. Plaques on the other hand can cause blockages in your vessels that lead to events like heart attacks or strokes. I wouldn’t say one is more important than the other, but I would say that you’d like to avoid both high blood pressure and plaques!

Regarding whether to accumulate exercise throughout the day or do it all at once, the research is still unclear. Really we are just hoping people DO exercise either way! If you can get an hour or more of exercise each day, the best research suggests that this can offset needing to sit for the rest of the day. If you get less than an hour of exercise a day, it looks like moving around more and breaking up sitting is likely going to have a more measurable effect on improving your blood pressure. Right now – the U.S. Guidelines say that every minute of exercise counts toward your weekly goal, so any way you’d like to accumulate it is fine. However, researchers like me are looking at this really great question you had and hopefully we’ll know better soon about whether one pattern of exercising is better than the other. Either way – keep it up!

Lastly -here is a resource on the AHA's website that explains what an EKG is :)

-BBG

Hello doctor, thanks for the AMA!

Why is it that the upper extremities seem to be largely resistant to clinically significant atherosclerosis?

Thank you!

This is not my area of expertise or the topic of the Statement we are discussing today, but I could speculate. Circulation relies partly on a muscle pump mechanism that helps our blood flow back to our heart through muscular contractions. We are usually contracting muscles in our arms all day, but especially with the prolonged sitting common in our current society, we can go very long without contracting the muscles in our lower extremity. This leads to less blood flow and shear stress in our legs, and this could eventually result in more lower extremity atherosclerosis. This comes to mind because of my research focus on prolonged sitting and cardiovascular health (typing this from standing desk).

More information about peripheral artery disease here https://www.heart.org/en/health-topics/peripheral-artery-disease

- BBG

Is it necessary to exercise each day or can one catch up after a long period?

Great question! A few studies have looked at this, but not many. From the little available, it seems the ‘weekend warriors’ – those who get all of their exercise on the weekends – get the same benefits on outcomes like mortality as people that space it out across the week. This is why the U.S. Guidelines say that you need to try to get at least 150 minutes of exercise per week (and do not give a daily goal). On the other hand, there are immediate benefits of exercise that you can realize more regularly if you do it every day or every other day. We know physical activity improves mood, sleep, and even cognitive function! You can also get transient short-term benefits on your blood pressure and cholesterol So, for these reasons and to get the most frequent benefits, you might consider trying to spread it across the week if you are able. Most important though is to just do it, so whatever schedule allows you to get consistent exercise every week is a great choice.

-BBG

As a doctor, what is your opinion on the fact that every 60 seconds, a minute passes in Africa?

Yes!

- BBG