As a certified personal trainer, you may be expected to take blood pressure readings of new clients during an initial assessment. If you have a private studio or work as an independent contractor and you haven’t been taking blood pressure readings with new clients, you may want to strongly consider including this measurement in your physical evaluations. The following article will walk you through what blood pressure is, how to properly measure it, and how to explain results to your clients.
What is Blood Pressure?
Blood Pressure (BP) is usually expressed as one number over another. The top number is the systolic pressure and measures the systole phase of the heartbeat. The systole is when the heart muscle contracts and pumps blood from its chambers into the arteries; the systolic pressure refers to the amount of pressure in the human body’s arteries when the heart contracts. It is the maximum pressure exerted upon the walls of the blood vessels in the body.
The bottom number is the diastolic pressure and measures the diastole part of the heartbeat. The diastole is the phase of the heartbeat when the heart muscle relaxes and allows its chambers to fill with blood; the diastolic pressure indicates the pressure in the arteries between heartbeats. Since the heart is exerting less force on the fluids against arterial walls, the diastolic value is lower than the systolic value.
Simply put, the systolic pressure is the pressure when the human body’s heart pushes blood out, while the diastolic pressure is the pressure when the heart rests between beats.
Both the systolic and diastolic pressures are measured in millimeters of mercury (mm HG). This is because mercury is much denser than water or blood. Since mercury is the denser substance, even a case of very high blood pressure will not rise it more than approximately one foot.
According to the American Heart Association (AHA), the gold standard for healthy blood pressure in adults is 120/80, but hypotension (low blood pressure) would be anything that falls under 90/60.
What is hypertension?
Hypertension is the term for high blood pressure (HBP). Elevated blood pressure is a systolic number of 120-129 and a diastolic number of less than 80. This is sometimes referred to as prehypertension.
Stage 1 hypertension is a systolic number of 130-139 or a diastolic number of 80-90.
Stage 2 hypertension is a systolic number of 140 or higher or a diastolic number of 90 or higher.
Finally, a hypertensive crisis is higher than 180 systolic number and/or a diastolic higher than 120 reading.
|BLOOD PRESSURE CATEGORY
|SYSTOLIC mm Hg (upper number)
|DIASTOLIC mm Hg (lower number)
|LESS THAN 120
|LESS THAN 80
|120 – 129
|LESS THAN 80
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 1
|130 – 139
|80 – 89
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 2
|140 OR HIGHER
|90 OR HIGHER
|HYPERTENSIVE CRISIS (consult your doctor immediately)
|HIGHER THAN 180
|HIGHER THAN 120
The human body’s blood pressure changes throughout the day based on activity levels. For example, blood pressure tends to be lower at night while the body is at rest and sleeping. This is because activity level is lower and the heart does not need to work as hard as the body is slowing down.
Conversely, blood pressure tends to rise in stressful situations and during exercise because the heart needs to work harder to supply the body with the blood it needs during movement.
While blood pressure fluctuates during the day, if it measures consistently above normal, this may substantiate a hypertension diagnosis or high blood pressure (HBP).*
*It is important to see a credentialed medical provider in order to be diagnosed with HBP and to receive proper treatment for it.
Why is hypertension risky for health?
HBP exerts shear stress on the human body’s blood vessels. This can damage the blood vessel walls leading to formation of arterial plaques over time, thereby narrowing the blood vessels and restricting blood flow.
When cholesterol/arterial plaques rupture, the formation of blood clots occurs. Blood clots can block blood flow and if this happens with blood flow to the brain, a stroke can occur.
If this happens where blood flow is blocked to the heart, a heart attack (myocardial infarction) can occur. Therefore, hypertension is linked to an increased risk for stroke and heart attack.
What causes high blood pressure?
Hypertension typically develops over time due to an unhealthy lifestyle. For example, a poor diet and/or not getting enough regular physical activity is associated with hypertension.
There is also a genetic component that should be acknowledged. If HBP runs in your client’s family, then the likelihood of your client having hypertension would be higher than if it didn’t. This is why it is important to gather a health history at the onset of training; you can ask the client what the family’s lifestyle has been historically.
If the family has had a healthy lifestyle and the client still exhibits hypertension, you may choose to refer/defer to a medical provider prior to starting a training protocol with the client. On the other hand, if the family involves a sedentary lifestyle and poor nutrition choices, these habits are likely contributing to a family history of hypertension. In this case, adjusting the client’s lifestyle could and should lower blood pressure.
Health conditions such as diabetes and obesity increase the risk for developing high blood pressure. If the human body is carrying excess weight and fatty tissue, the heart needs to work harder to circulate blood, thereby increasing blood pressure.
Other lifestyle risk factors for hypertension include and are not limited to:
If your client has a high-stress work environment or is facing stressful life situations, this may contribute to elevated BP due to a constant fight-or-flight stress response. Typically, once a stressful experience is over, blood pressure should lower back to a normal level.
Even though exercise is healthy for the circulatory system, it would raise BP during exercise. However, the BP should go back to ‘standard’ once the body recovers from the session. Similarly, BP may rise if the client has an important evaluation or presentation to do and then returns to ‘standard’ once it’s over. However, if the stress is prolonged and the body is not able to recover, BP can remain elevated.
Nicotine is a stimulant, so it raises BP. Also, breathing in carbon monoxide, a byproduct from smoking tobacco, lowers the amount of oxygen carried by the blood. This forces the heart to work harder. Finally, smoking tends to damage blood vessels and the heart.
Excessive Alcohol Consumption
Alcohol consumption increases the hormone renin in the blood. This causes the blood vessels in the human body to constrict, making them become smaller in diameter. Another function of renin is that it lowers the amount of fluid eliminated in urine creating a higher level of fluid in the body and smaller blood vessels (vasoconstriction) thereby increasing blood pressure.
If the body is not moving, the heart would need to work harder within the circulatory system to function. It needs to pump blood to the body but the circulatory system also needs to return the blood back to the heart, like from the feet and legs to the upper body. This is why activities such as cycling and walking can help. Too much inactivity could lead to difficulty getting the blood from the extremities back to the heart thereby making it work harder.
Poor Nutritional Choices
A client who eats a diet rich in sodium and low in potassium creates an imbalance in the body’s sodium-potassium pump. Sodium is a key element in table salt and increases blood pressure. Processed foods and food from restaurants are prime culprits for high sodium content. and these foods tend have low potassium values. Instead of eating fast foods and processed foods your clients can eat foods rich in potassium such as bananas, beans, yogurt, and potatoes.
They can also focus on eating whole foods and adding more plant-based foods to reduce hypertension.
Demographic information on Hypertension
Age: BP tends to rise with age
Sex: Women and men are both as likely to get hypertension
Ethnicity: Black people tend to develop high blood pressure more often and earlier in life than Caucasian people, Hispanic, Asian, American Indians, Pacific Islanders, or Alaska Natives.
What is Phase 1 Hypertension versus Phase 2 Hypertension
If your client has a blood pressure falling in phase 1 hypertension, then according to AHA, they have less than 10% calculated 10-year risk of getting atherosclerotic cardiovascular disease (ASCVD) if they have not been able to reach a BP goal of less than 130/80 Hg after 6 months of lifestyle changes.
Phase 2 hypertension would require a combination of healthy lifestyle changes (such as exercise and nutrition) and BP-lowering medication. The medication would be prescribed by a physician or other qualifying medical practitioner and need to be qualified as two first-line agents of different classes). This is the recommended care plan for clients with stage 2 hypertension. As personal trainers, it’s important to know that a client with a reading of 150/100 shouldn’t be trained without a signed medical consent form.
How is blood pressure measured?
As certified personal trainers we can offer a BP screening during the initial Medical/Health Risk Assessment and as part of our information collecting from General Client Information and Par-Q when we first start working with a client and develop a training protocol for them.
Offering a BP screening will help you create a training protocol but even before that, you will know if your client is ‘at-risk,’ needs a referral, or a release form. It will also impact your training protocol depending on the BP outcomes.
You can take BP manually, or with a manual cuff and stethoscope, or with an automatic BP device.
You should take a client’s BP both at rest and following an activity.
According to the NFPT Manual, it is recommended to have the client perform an aerobic activity such as ergometer cycling. Take the client’s BP at three separate stages. In an ideal situation, the systolic number should rise slightly and the diastolic number shouldn’t change too much.
If something alternative occurs, it is recommended to have the client slow down on the cycle and come to a stop. The fit pro should then recommend the client see a medical provider for a medically supervised “maximal” pre-exercise test.
Fortunately, hypertension can be addressed and managed through lifestyle changes most of the time. Even in cases where medication is required, by having an active and healthy lifestyle, you may be able to help your client decrease their medication or help them stay on a minimal maintenance dose.
Movement: Exercise will help the circulatory system remain active and the movement will help the circulatory system return blood back to the heart from the body’s extremities (the opposite of sedentary lifestyle).
Proper Nutrition: By lowering sodium intake and having adequate potassium, the human body’s sodium-potassium pump can work optimally thereby balancing these two electrolytes in a healthy manner to help regulate blood pressure.
Eating healthy fats helps to prevent damage to the heart and blood vessels thereby allowing them to function well.
If your client maintains a healthy lifestyle, is active, makes good nutritional choices, then the likelihood is they have a healthy BMI. By not carrying extra fatty tissue, the chances of fatty plaque building up in the vessels are less likely coupled with the heart not needing to work extra at rest.
Mindfulness/Managing Stress: By managing stress levels and having recovery days, the circulatory system can recover. Also having recovery periods within training sessions allows BP to be managed.
Medication: As stated, in some cases, medication is needed, especially if there is a genetic component or if the client is in hypertension II. Even still, working with a fit pro and maintaining a healthy lifestyle can assist by keeping the dose to a minimal level to still be effective.
Coaching your personal training clients on healthy lifestyle is part and parcel of your scope. While high blood pressure is a medical condition that requires the guidance of trained medical professionals, you are on the front lines working with the general population on a regular basis and have much influence on the lifestyle choices your clients make. Be sure to broach topics that can have an impact on their overall health and longevity, among which blood pressure and its impact on life, is certainly relevant.
NFPT Manual, 7th Edition.