Phase 1
Patients initially cycled for 5 to 10 minutes at 60 percent of their
maximal heart rates. The duration of exercise increased progressively
and on an individual basis as patients tolerated longer exercise sessions.
The duration and intensity of the actual exercise phase were
maintained for 20 to 60 minutes at 60 to 80 percent of the predicted
maximal heart rate. Heart rate was measured continuously with a
portable heart-rate monitor (Pacer). Blood pressure was monitored
periodically during each workout to ensure that it was within safe limits
(systolic blood pressure, 220 mm Hg; diastolic blood pressure,
110 mm Hg). The workload was adjusted to maintain the target
heart rate and blood pressure within the prescribed limits throughout
the exercise session.
Phase 2
This phase consisted of continued exercise and follow-up for an additional
16 weeks. If the diastolic blood pressure fell below 90 mm Hg
and at least 5 mm Hg below the base-line value in any patient, the
dose of antihypertensive medication was reduced. The reduction generally
started with enalapril, in a stepwise fashion and in the reverse
of the order in which the medications had been initiated, and occurred
at weeks 20, 24, and 28 of the training program. During the
period of medication reduction, blood pressure was measured weekly
and during routine monthly follow-up visits to the clinic.