Standards for controlling blood pressure have evolved greatly over the last 50 years, as medical professionals come to understand the importance of lower target thresholds. In 2017, the ACC/American Heart Association (AHA) released its updated guideline, shifting the target blood pressure threshold from <140/90 mm Hg to <130/80 mm Hg for most adults. In this article, we will delve into all of the facets that may contribute to a client’s elevated blood pressure, how personal trainers can contribute to lowering these numbers, and what to look for in terms of dangerous symptoms while training.
The Importance of the Downward Shift
In choosing to lower the threshold of appropriate blood pressure readings, the American Heart Association identified critical data. For every 10 mm Hg reduction in systolic blood pressure, individuals may experience a 17% reduction in their risk of coronary heart disease, a 27% reduction in stroke incidence, a 28% less chance of heart failure, a 20% reduction in any major cardiovascular events, and a 13% reduction in overall mortality. Hypertension Work Group.
These new guidelines also offer specific recommendations for patients whose blood pressure values range from 130-139/80-89 mm Hg AND whose lifestyles/histories estimate them to have a <7.5% risk of a blood pressure-related health incident over the course of 10 years. While medical professionals previously considered patients in this category as “safe”, the updated guideline now recommends hypertension medication to achieve a reading of <130/80 mm Hg if the reading remains elevated after 3-6 months of lifestyle modification.
The updated guidelines also point to the link between mild hypertension and one’s risk of cognitive impairment/dementia. A goal of achieving a systolic blood pressure reading of <130 mm Hg can help reduce the risk of cognitive challenges throughout life.
Earlier Onset Hypertension
Given the role of age in predicting one’s 10-year cardiovascular risk, these updated guidelines will no doubt give rise to a greater number of younger patients receiving medication for hypertension than under previous guidelines. This change underscores the fact that exposure to elevated blood pressure, even by early to mid-life, can have a direct effect on one’s risk of adverse cardiac outcomes in the future. If an individual presents with hypertension before the age of 45, they more than doubles his risk of cardiovascular disease and overall mortality.
Working with Hypertensive Clients
Now that the guidelines for an acceptable blood pressure reading have changed, a personal trainer will undoubtedly encounter a significant number of hypertensive clients. This reality holds whether a trainer works at a corporate gym, a community health and wellness center, or a sports performance center, as nearly 1 in every 3 individuals in the United States suffers from some degree of hypertension. Personal trainers need to consider the special dynamics of elevated blood pressure in order to implement an effective and safe training program. This involves an understanding of lifestyle modifications, increased physical activity, aerobic exercise, and/or suggestions for the client to consult with their healthcare provider regarding potentially beginning a blood pressure medication. It also means having a keen awareness of the symptoms which accompany severely elevated blood pressure, as often happens during intense exercise sessions ~
- Chest pain
- Back pain
- Numbness
- Shortness of breath
- Overall weakness
- Vision changes
- Difficulty speaking
Understanding What Blood Pressure Measures
Prior to taking a client’s blood pressure reading, trainers should familiarize themselves with the mechanisms of the process. The systolic reading (top number) refers to the pressure exerted against the arterial walls of the heart as the left ventricle contracts. An elevated reading indicates excess pressure on the heart, which, if allowed to continue unchecked, will cause the heart muscle to fatigue and potentially cease functioning.
The diastolic reading (bottom value) occurs as the left ventricle refills with blood; no force drives this process, even though blood continues to flow through the veins and arteries.
Diastolic blood pressure occurs when the left ventricle is refilling, so there is no driving force behind the blood, even though it is still flowing through the arteries and veins.
Preparing a Client for a Blood Pressure Analysis
In order to eliminate as many outside influences as possible, a personal trainer should have their client relax, sitting upright on a chair, with both feet flat on the floor. Ideally, the client should wear loose clothing; tight sleeves/collars and watchbands can throw off a reading.
Always take a blood pressure reading prior to any exercise, and remind the client in advance to avoid caffeine and tobacco before coming to the gym. Some individuals find having their blood pressure taken very stressful for any number of reasons, which can result in an inaccurately elevated reading. A personal trainer can strive to build a rapport with their client, talk them through the process, and try to make them feel at ease.
Attach the blood pressure cuff to the client’s left arm, allowing for two fingers’ width above the bend in the elbow, and ideally in contact with the skin. The plastic tube on the outside should fall in line with the brachial artery.
Once the personal trainer starts the machine, the cuff inflates. The pressure increases until the pulse gets cut off at the systolic limit. The machine decreases pressure, the flow of blood continues, and the diastolic reading comes at the point where the cuff can no longer sense the palpitation of the blood going through.
The trainer should repeat the reading three times, in order to secure an accurate average number. If any of the readings vary by more than 5mg of mercury, the personal trainer should continue until they get at least two readings within 5mg of each other.
How Can Exercise Help Lower Blood Pressure?
A regular exercise program helps to promote a stronger heart, which in turn can pump more blood with less effort. As the force on the blood vessels goes down, so too will the blood pressure readings. Studies show that drops of 5 to 8 mm Hg diastolic and 4 to 10 mm Hg systolic can occur with regular exercise. It can take anywhere from 1 to 3 months for regular exercise to have an observable impact on blood pressure. However, the benefits last only as long as the client continues to exercise.
According to Ian Del Conde Pozzi, M.D., a cardiologist and vascular medicine specialist at Baptist Health Miami Cardiac & Vascular Institute, “The human body has evolved to function optimally with daily physical activity. When we lead lifestyles for which our bodies were not designed—such as being sedentary or having constant access to high-calorie foods—our health can suffer. Regular exercise helps restore our bodies to their natural state, allowing them to function better and helping to prevent many chronic conditions that have become prevalent in modern life.”
For clients who already have a diagnosis of prehypertension or appear at risk for hypertension, exercise can serve as a powerful game-changer. Dr. Del Conde explains that “some individuals can potentially prevent high blood pressure altogether by adopting a healthy lifestyle that includes regular exercise.”
Designing a Safe and Effective Exercise Protocol
Before embarking on the design of a workout for a client with hypertension, consulting with his healthcare professional (with the client’s permission, of course) can clarify a number of potential trouble spots.
A personal trainer should insist on a consultation if the client presents with any of the following conditions:
- a long-term health condition such as diabetes, heart disease or lung disease
- high cholesterol levels
- already suffered a heart attack.
- a family history of heart disease before age 55 in men and age 65 in women
- experiences pain or discomfort in the chest, jaw, neck or arms during activity
- gets dizzy with activity
- smokes or has recently quit smoking.
- overweight/obese
- leads a sedentary lifestyle
As with any client, an exercise session with the hypertensive client should fit the overall needs of the individual, taking into account the following issues:
- age
- fitness level
- current physical activity
- skill level
- confidence
- preferences
- lifestyle
- personal goals
By understanding these specific considerations, trainers can design effective exercise programs that minimize risks and promote positive health outcomes for clients with high blood pressure.
The following suggestions adhere to the American College of Sports Medicine’s guidelines:
- Target Heart Rate: Aim for a target heart rate range of 40-59% of the maximum heart rate for individuals with high blood pressure. This range corresponds to the low to moderate-intensity exercise zone.
- Rating of Perceived Exertion (RPE): Implementing the Borg RPE scale, trainers can assess the client’s perceived exertion on a scale of 6 to 20. Aim for an RPE of 11-14 (moderate intensity) during exercise sessions.
- Warm-Up: Hypertensive clients require a warm-up of at least 5-6 minutes in order to prevent a dangerous spike in blood pressure.
- Endurance Training: Suggest the client aims to achieve several regular aerobic exercise sessions, totaling at least 150 minutes per week, spread across the course of a week. Incorporate activities such as brisk walking, cycling, swimming, or the use of elliptical machines
- Interval Training: Evidence points to the fact that interval training, which involves alternating between high-intensity and low-intensity intervals, can effectively lower blood pressure.
- Light-to-Moderate Intensity Resistance Training: Aim for 1-3 sets of 10-15 repetitions for each major muscle group. Avoid exercises that involve breath-holding or excessive straining, such as the Valsalva maneuver.
- Proper Technique: Emphasize controlled movements and appropriate breathing patterns during resistance training exercises to maintain stability and minimize risk.
- Cool-Down: Hypertensive clients likewise require a longer cool-down process. Stopping activity too abruptly can bring on symptoms such as light-headedness, dizziness, and fainting. Gradual transitions work best for these clients.
- Stretching and Flexibility: Incorporate appropriate exercises into the program to enhance flexibility and joint range of motion.
- Balance and Stability: Including balance exercises, such as single-leg stands and yoga poses, can reduce the risk of falls. Ensure a safe environment with proper support during these exercises.
Weight Management and High Blood Pressure
If a client seems willing, trainers can bring up the topic of weight management/diet and its role in controlling hypertension. Exercise will help hypertensive clients in their efforts towards losing weight, but trainers can feel free to likewise encourage a well-rounded plan with additional healthy lifestyle habits. Help the client establish reasonable goals for weight loss; as they lose weight, their blood pressure should come down.
The DASH diet (Dietary Approaches to Stop Hypertension) serves as a popular and largely successful option for some individuals. Clients with high blood pressure can always benefit from cutting back on sodium and reducing alcohol intake.
Cautionary Notes
Most personal trainers possess a good deal of knowledge about a lot of medical and health -related topics. However, we must also keep in mind remember that we lack the qualifications to dispense medical advice. When working with anyone presenting with a serious or chronic medical condition, stay within the scope of the personal training practice.
Below we list some special considerations for trainers to keep in mind when working with this particular demographic:
- Adapt: if the client feels tired and cannot pinpoint the feeling specifically to overexertion, prepare to change the activities by starting out at a lower level. Balance activities with appropriate rest intervals.
- Keep Intensity Low: avoid steep hills during exercise, whenever possible.
- Regress: reduce activity level if the client had to interrupt his workouts for a few days, either due to illness, work, holidays, or inclement weather. Gradually increase back to his regular activity pace as tolerated.
- Rest: if a client continues to have shortness of breath or develops a rapid/irregular heartbeat, stop training right away and have the client contact their medical provider.
In addition to the rest component listed above, personal trainers should prepare to cease the exercising program immediately if the client displays any of the following symptoms:
- Pain, whether in the chest or anywhere else in his body
- Weakness, dizziness or light- headedness
- Unexplained swelling
- Pressure in the chest, neck, arm, jaw or shoulder
Final Thoughts
Training clients with hypertension can bring about many positive results for both the personal trainer and the individual. While the client improves his health, the trainers can see firsthand how exercise can help reduce blood pressure levels, ideally without the need for prescription medication. Encouraging the client by marking incremental successes goes a long way towards developing a strong, continued relationship.
References:
parallelcoaching.co.uk/5-important-facts-to-know-before-training-a-client-with-hypertension
my.clevelandclinic.org/health/diagnostics/25068-blood-pressure-measurement
honorhealth.com/healthy-living/6-best-exercises-control-high-blood-pressure
cmsfitnesscourses.co.uk/blog/guidelines-for-personal-trainers-taking-blood-pressure/
nfpt.com/blood-pressure-and-personal-training-clients/#:~:text=As%20a%20certified%20personal%20trainer%2C%20you%20may,assessment.%20If%20you%20have%20a%20private%20studio
cdc.gov/high-blood-pressure/prevention/index.html#:~:text=Physical%20activity%20can%20help%20keep,day%2C%205%20days%20a%20week
baptisthealth.net/baptist-health-news/how-exercising-regularly-lowers-blood-pressure#:~:text=Del%20Conde.,of%20heart%20disease%20and%20stroke
mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045206#:~:text=Regular%20exercise%20makes%20the%20heart,This%20lowers%20blood%20pressure
ahajournals.org/doi/10.1161/CIR.0000000000001356
health.harvard.edu/heart-health/the-new-blood-pressure-guidelines-what-you-need-to-know
heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/high-bp-top-10
.acc.org/latest-in-cardiology/articles/2025/10/01/01/new-in-clinical-guidance-hbp
