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Considerations for Personal Training the Hypertensive Client Part 1

June 14, 2010 by NCSF 2 comments

The American Heart Association posts the following statistics:

The personal trainer today will undoubtedly encounter a significant number of hypertensive clients. This is a reality for any trainer working at corporate gyms, community health and wellness centers, and sport performance centers alike, as nearly 1 in every 3 individuals in the United States are hypertensive. Stage one (I) hypertension measures at, or above 140/90 mmHg, whereas Stage two (II) measures, at or above 160/100 mmHg. For the personal trainer, Stage I hypertension means that special or limited activities are used to manage high blood pressure. If a client presents Stage II hypertension the disease necessitates medical referral for pharmacological intervention. Although high blood pressure is not painful it promotes an increased risk for nonfatal and fatal cardiovascular diseases such as coronary artery disease and stroke, renal disease, and all-cause mortality. For many, hypertension with lead to a heart attack or stroke.

Personal trainers need to consider the special dynamics of the hypertensive condition to implement an effective and safe training program. Hypertension is commonly addressed through lifestyle modifications, increased physical activity, aerobic exercise, and/or pharmacological agents if necessary. Personal trainers need to address and understand each of these components to properly work with a hypertensive client.

To aid in the control of BP or overall cardiovascular risk reduction, it is recommended that the personal trainer educate clients in general lifestyle modifications and motivate them to engage in effective intervention strategies including:

Preventing high blood pressure is obviously the ideal situation, but managing and reversing the disease should occur at or before Stage I. Once Stage II hypertension is reached the ability to manipulate factors becomes more difficult. Although Stage II generally is considered the treatment phase, the decision to initiate drug therapy requires physician collaboration and is often indicated with the presence of multiple factors that can include severe BP elevation, the presence of cardiovascular disease or organ disease, and/or the presence of other medical conditions or cardiovascular risk factors. For this reason Stage II hypertension always requires a medical referral. When medications are used the homeostatic condition is manipulated and therefore it is crucial that personal trainers understand the side-effects these medications can produce; especially those associated with overall exercise tolerance.

Beta blockers, diuretics, and calcium antagonists are the primary medications prescribed dependent on condition severity. These medications do not substantially alter the acute systolic BP response to a single session of exercise, but they do lower resting levels which consequently decreases the absolute level attained. On the potentially negative side, some of these medications can result in post-exercise hypotension (low blood pressure), increased fatigue and lethargic behavior, and/or a stunted cardiovascular response with an increased workload (up to a 30bpm decrease below normal). Post-exercise hypotension can be prevented by avoiding high variability in workloads and with a longer cool-down period. Additionally to avoid abnormal cardiovascular responses during exercise the use of the Borg’s 6-20 Rate of Perceived Exertion scale may allow the personal trainer to properly track the inherent physiological stress encountered by the client that would not otherwise be effectively monitored with heart rates. It is the responsibility of the trainer to work with managing care givers to ensure the exercise routine reflects the desires of the therapies and functions to benefit intended outcomes.

The second part of this discussion will overview the effects of exercise training on reducing BP, and recommendations for testing and exercise programming for the hypertensive client.

2 comments

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NCSF
June 23, 2010, 05:38 PM
All personal trainer certifications need to cover the general etiology of the common cardiovascular and metabolic diseases. With this knowledge a professional is then able to determine if safe exercise participation is possible and factor in the proper programming considerations. This often adds a level of complexity to the exam preparation and testing process for most candidates as it requires a certain degree of terminology and an understanding of basic human physiology. The content is essential to qualifying an exam candidate for professional practice as diseases such as hypertension are so widespread that statically speaking most if not all personal trainers will work with the hypertensive client during their career.
Tony LaBonet
June 23, 2010, 03:12 PM
Hypertension is such a prevalent disease that I am sometimes concerned that a personal trainer with a lesser certification will not have adequate knowledge to understand the basics of the disease and in turn be ineffective in developing an exercise program that addresses their particular needs.