Blood pressure assessment guidelines and recommendations - Tech Brief

The American Heart Association reports that one in rive Americans (one in four adults) has high blood pressure. Unfortunately, 31.6 percent are not aware of their condition. Furthermore, of all people with high blood pressure, 14.8 percent are not in therapy (i.e. special diet or medication), 26.2 percent have inadequate therapy and only 27.4 percent are in adequate therapy. With high blood pressure being such a widespread problem in the United States, how often should blood pressure be assessed and monitored in clients involved in exercise programs?

Before starting an exercise program, all clients should be pre-screened to assess their cardiovascular risk status and establish baseline physiological measurements, including blood pressure. Blood pressure is the product of CO (cardiac output) times TPR (total peripheral resistance). From an exercise standpoint, blood pressure assessment during exercise may be a more sensitive indication of overall cardiovascular stress compared to heart rate alone. Thus, blood pressure measurements should be assessed in normal and hypertensive clients on a regular basis (before, during and after exercise). All personal trainers should be experienced in taking blood pressure measurements at rest and during exercise.

Normal Blood Pressure

It is difficult to define a normal blood pressure reading. For example, a petite woman might have a resting blood pressure of 90/60 mmHg, which is normal for her, but would be considered hypotensive by reference standards. However, normal resting blood pressure for most adults averages 120/80 mmHg. Even if a client has normal blood pressure on more than one occasion, it is important to periodically check blood pressure before, during and after exercise. Many factors can affect blood pressure, including stress, diet, drug abuse, disease and environmental conditions.

Hypertension

Hypertension is defined as having a systolic [greater than or equal to] 90 mmHg or diastolic [greater than or equal to] 90mmHg reading on two separate occasions. If your client has a history and/or diagnosis of hypertension, you should get recommendations from their physician, regarding the type, amount and intensity of exercise appropriate for them. If your client is currently taking medication for controlling blood pressure, make sure to know the type and dosage. This is important because there is a variety of medication for lowering and controlling blood pressure, and each type can have a different effect on exercise response. Basic rules to follow with hypertensive clients during exercise include: (1) an extended warm-up and cool-down, (2) slow transitions from floor to standing exercises, (3) starting with a conservative low intensity aerobic exercise, (4) remind them not to hold their breath during movements, (5) careful monitoring of blood pressure before, during and after exercise and (6) using low weights and higher repetitions during resistance training. Clients should be encouraged to report any abnormal signs and symptoms during exercise, as well as any changes in their medications. For more information on exercise and hypertension, the American College of Sports Medicine (ACSM) has a position paper titled, Physical Activity, Physical Fitness and Hypertension, available at www.acsm.org.

Abnormal Blood Pressure Responses During Exercise

The normal response to exercise for systolic blood pressure is to increase with increasing work and then plateau at peak effort, whereas diastolic pressure generally stays the same or decreases slightly. If a client's blood pressure fails to rise with increasing work or drops consistently (10 to 20mmHg), exercise should be curtailed until the client is evaluated by a physician. An excessive rise or drop in blood pressure during exercise can be an indication of moderate to severe underlining cardiovascular disease. Symptoms of exertional hyper/hypotension (dizziness and shortness of breath) should be critically monitored and documented. The generally accepted indication to avoid exercises includes a resting systolic blood pressure of > 20 mmHg or a resting diastolic blood pressure > 110 mmHg.

Conclusion

Hypertension is a common condition and all personal trainers should gain the necessary knowledge and skills to work safely and effectively with this population. Assessing and recording blood pressure readings should be considered a vital and regular activity for any personal trainer. If you do not feel comfortable taking blood pressure or working with clients with hypertension, refer them to a trainer who does. Contact your local hospital, university, local American Heart Association or American Red Cross to learn about blood pressure training opportunities.

Scott Roberts, Ph.D., FACSM, FAACVPR, is an assistant professor in the Department of Physical Education and Exercise Physiology at California State University Chico. His primary area of expertise is Clinical Exercise Physiology. He has authored and co-authored ten fitness and exercise science books and over a hundred articles and chapters in books Roberts has contributed three chapters to the Fitness: Theory & Practice textbook, authored two home study courses and contributed numerous articles to American Fitness magazine.

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