PT on the Net Research

Hypertension


Question:

I have a client who has a history of hypertension, but she is on medication and it is controlled. Do I treat my client as hypertensive or apparently healthy?

Answer:

Always remember that when there is a doctor involved, you have to play by different rules. Since your client is hypertensive and is on medication, it is your obligation to get a medical clearance from her physician. The physician will usually state she wants the patient to keep her heart rate under a certain number of beats per minute and only certain exercises to be performed. Because you mentioned she is on medication for high blood pressure, I am assuming she is on beta blockers of some kind. Whatever medication she is on you need to look up in the Physicians Desk Reference to see what implications there may be with exercise. The parody that exists in the health field is that most med schools don’t teach exercise and program design (exercise prescription). We as fitness experts must take the advice of someone who in many instances has had less training than us. I deal with this in my clinic all the time. Always remember, if you go against what the doctor has recommended or if you negate getting the medical clearance, the liability is solely your responsibility.

The trainer must be familiar with the RPE scale. The Rate of Perceived Exertion scale was developed for situations such as this one. The scale is based on the client's perceived thought on how hard she is working. When she feels mild exertion, you delineate this feeling with the number 2. As her intensity increases, the number goes up accordingly. You may also want to use METS calculations because METS don’t lie. Because your client is on medication, she will not have a significant elevation in heart rate dependent of exercise. No matter how hard she works, her heart rate will not rise significantly. Thus, you cannot use heart rate as a guide to designing her program. METS calculations are another way to truly tell how much work she is capable of doing. Unfortunately, METS calculations are much too detailed to go over in this correspondence. You may want to get a copy of the book called Metabolic Calculations put out by the ACSM.

I want to give you some advice on how to approach the training. Remember the ACSM guidelines on exercises: seven to 10 resistance training exercises and cardiovascular training for about 20 to 30 minutes at a moderate rate to start. If you document your training sessions accurately and thoroughly and progress at a rate of 10 percent every other week, you can rest assured you are on the right track.