Study shows isometric exercise can lower blood pressure
Dear Doctors: My blood pressure is just a tiny bit high. Does that really matter? My doctor said I should think about taking a blood pressure drug, but I’d rather try to bring it down naturally. I just read that doing isometric exercises can lower blood pressure. Do you know if that’s true?
Dear Reader: A blood pressure reading measures the force exerted on the artery walls as the heart pumps blood through the body. It is composed of two different numbers that are displayed in the form of a fraction. The top number is a measurement known as systolic pressure; that is the force that blood exerts on the arteries at the peak of a heartbeat. The bottom number is diastolic pressure; it is how much pressure the blood vessels are absorbing while the heart is at rest. At this time, blood pressure readings under 120/80 are generally considered to fall into the normal range. Blood pressure higher than 130/80 enters the category of hypertension.
It’s natural for blood pressure to rise and fall throughout the day. But chronic high blood pressure poses a significant health threat. It can force your heart to constantly work harder than necessary to send blood throughout the body. Relentless pressure on the walls of the blood vessels can cause them to lose elasticity. If left untreated, high blood pressure can cause damage to the heart, kidneys, eyes and brain. For these reasons, blood pressure that is chronically high, even a little bit high, should not be ignored.
When it comes to improving blood pressure, the benefit of regular exercise has been clear for some time. Now, a new study has put an intriguing spin on what that exercise might entail. Researchers in England analyzed health data that had been collected in 270 studies over the course of 13 years. This gave them a robust participant pool of more than 15,000 adults. When they looked at which form of physical activity had the most favorable effect on blood pressure, the surprising answer was isometric exercise. This an exercise in which muscles are contracted but the surrounding joints remain stationary.
The trio of the exercises highlighted in the studies were pressing the legs against fixed resistance, squeezing a spring-loaded handgrip and maintaining a squat while pressing the back against a wall. The theory is that while a muscle remains contracted, blood flow naturally decreases. When that contraction is released, the return of blood flow sends metabolic signals that tell the blood vessels to relax. The net result is lower blood pressure.
Adding isometric exercise to your daily routine can be helpful. However, there is an important caveat: When a prolonged muscle contraction impedes blood flow, it results in a rise in blood pressure. Although this lasts for only the time the muscle is contracted, it may not be safe for someone with cardiovascular problems or uncontrolled high blood pressure. Anyone who falls into those categories should check with their doctor to see if isometric exercises are safe for them to perform.
Pinched nerve can impact quality of life
Dear Doctors: I have developed pain in my right hip that runs down my thigh and calf. An orthopedic specialist who looked at my scans says it may be a pinched nerve. But my physical therapist says it is inflammation. Can it be both? Is there a solution?
Dear Reader: We should start with a bit of anatomy. The hip joint is the largest weight-bearing joint in the body. It’s where the rounded top of the femur, or thigh bone, fits into a cuplike depression in the pelvis. This type of juncture, known as a ball-and-socket joint, allows a wide range of motion. Tendons, ligaments and muscles provide the hip with stability and structure.
Two main nerves — the femoral nerve at the front of the femur and the sciatic nerve at the back — help with movement and provide sensation in the hip, legs, ankles and feet. A smaller nerve, known as the obturator nerve, helps with movement and delivers sensation to the inner thigh.
A pinched nerve can cause the radiating pain that you have described. It can also result in a dull ache in the pelvis and buttocks, numbness or sharp tingling that extends down the hip, muscle weakness and limited range of motion. These symptoms arise due to excessive or sustained pressure on a nerve by any of the surrounding tissues. These may be bone, muscle, tendons, ligaments or a slipped or herniated disc in the spine. In some cases, symptoms can be severe enough to interfere with standing and movement.
This type of injury can have a variety of causes. They include prolonged sitting, repetitive motion, bone spurs, arthritis, overuse, injury, swelling and being overweight. Actions that put stress on the hips, such as lifting or carrying a heavy weight, can cause misalignment that can lead to a pinched nerve.
Your physical therapist is correct that a pinched nerve is often accompanied by inflammation. For that reason, treatment usually begins with rest. This allows time for the swelling that often arises with inflammation to begin to ease. Over-thecounter anti-inflammatory medications, such as ibuprofen or naproxen, can be helpful. For persistent pain, your doctor may prescribe an oral corticosteroid.
In addition to the work that you do together, your physical therapist will be able to give you gentle exercises to do at home. These will focus on both stretching and strengthening the muscles of your abdomen, pelvis and lower back. Some people find that working with a chiropractor can be helpful.
Staying aware of your posture is important. When standing, be sure to keep the spine properly aligned, with your weight evenly distributed between both feet. When sitting, avoid crossing your legs, as this creates torque on the pelvis. If you are carrying any kind of weight, such as a bag of groceries, remember to keep muscles of the core engaged.
Although a pinched nerve isn’t a threat to health, it can interfere with quality of life. If rest and gentle exercise don’t bring any relief, it’s a good idea to see your doctor again for further evaluation.
Clinical trials are used to advance medicine
Dear Doctors: I have been following your column for a few years now, and clinical trials get mentioned a lot. I know they are used to make sure that a new drug is safe, but other than that, I’m not sure what they are. What exactly is a clinical trial, and how does it work?
Dear Reader: A clinical trial is a scientific study designed to analyze the effects of a medical treatment. That is, not only whether it is effective, but also if it is safe.
You’re correct that clinical trials often focus on a newly developed drug. However, the scope of inquiry is actually broader than that. Clinical trials are also used to assess mechanical medical devices, new methods of diagnosing and screening for disease, and novel ways to use and combine existing medications to both treat and prevent disease. They are also used to explore treatments and techniques that can improve the lives of people who are living with a serious or chronic disease.
Like all research, a clinical trial begins with an idea. Successful examples include using an implanted mechanical device to manage heart rate and harnessing the immune system to fight cancer. This is followed by laboratory testing to see if that idea may be viable. If those initial tests show promise, then the researchers devise a detailed plan for a clinical trial. Known as a protocol, it describes every aspect of how the clinical trial will be conducted. It specifies the length of the trial, who is eligible to participate, exact details of the tests and procedures to be used, and any drugs that will be involved, along with their dosage, method and timing of delivery. The information will also include detailed information about any physical effects, good or bad, that a participant may experience.
Clinical trials take place in four separate and distinct phases. They may take place over the course of a few weeks or over several years. The sequence begins with initial tests on a small group of participants. This is to assess safety, and also to identify any side effects that may occur. If phase one is successful, the subsequent segments of the trial include progressively larger groups of participants. By phase four, the drug or device or technique has been approved by the FDA and is being evaluated in a large population.
As we have mentioned here before, the website clinicaltrials.gov offers information about future and ongoing trials. If you are interested in joining a clinical trial, there is information that you should consider. That includes the specific purpose of a study; the reasons why the researchers believe the medication, device or technique will be effective; and, of course, any potential risks to the participants. When someone is selected as a participant in a clinical trial, they are required to sign a detailed consent form that outlines all of this information.
It’s not an exaggeration to say that clinical trials are the backbone of medical advances. Participants often join a trial hoping for help with a problem. But no matter the outcome of a study, they have contributed to medical advancement.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.