Considerations for Personal Training the Hypertensive Client Part 1
The American Heart Association posts the following statistics:
- About 74.5 million people in the United States age 20 and older have high blood pressure (1 in 3 Adults).
- Of those people with high blood pressure, almost 25% are unaware of their condition.
- Of all people with high blood pressure almost 70% are under current treatment, of them 55.9 percent do not have it under control.
- High blood pressure is easily detected and usually controllable.
- From 1996 to 2006 the death rate from high blood pressure increased 19.5 percent, and the actual number of deaths rose 48.1 percent.
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:
- Lose weight if the individual is considered overweight (commonly a 10% weight reduction can reduce pressure significantly)
- Limit alcohol intake
- Increase total physical activity (10 min. continuous)
- Increase aerobic physical activity to at least 30-45 min most days of the week
- Reduce salt intake to less than 2400mg per day (1500mg ideal)
- Maintain adequate dietary potassium(4700mg), calcium(1200mg), and magnesium intake
- Reduce processed foods and increase fruits and vegetables
- Stop smoking and reduce saturated fat and cholesterol intake for overall cardiovascular health
- Avoid caffeine when exercising
- Resistance training less than 70% (1RM) >12 repetitions
- Avoid compression exercises (Leg Press)
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.