Home-based physical activity to improve blood pressure control in adults aged 60 and over during the winter: a quality improvement project in a rural hypertension clinic

Abstract

Hypertension affects over 70% of older adults in the United States and is a primary cause of cardiovascular disease, the top cause of death worldwide. Regular moderate physical activity is recommended as first-line hypertension treatment, but many older adults do not meet exercise recommendations. In a rural hypertension clinic, providers identified older adults often struggle to remain physically active during winter months and clinicians lack exercise guidance for this population. In response to these challenges, a quality improvement project was developed based on a literature review of effective home-based blood pressure-lowering exercises, resulting in a standardized exercise template comprising aerobic, dynamic, and isometric exercises. Over 13- weeks, providers used the template to educate adults aged 60 and over. Data collected included the number of eligible patients educated, exercise log completion, and ambulatory blood pressure. The intervention enhanced current practice by creating a structure for ongoing support through consistent exercise recommendations and a log to track exercise, with a goal of three 20- minute sessions/week, returned at follow-up visits. Quality improvement was assessed through participation rates and log results. Over 13 weeks, 40 patients meeting the inclusion criteria were seen in the clinic. Although findings included poor log completion among the 14 patients seen within the follow-up timeframe, patients and clinicians gave positive feedback, and education goals exceeded expectations. A standardized exercise education template was feasible to implement and improved the consistency of lifestyle counseling. With ongoing agency support, future studies should explore increasing patient engagement and establishing sustainable strategies for long-term support.