Considerations for Personal Training the Hypertensive Clients Part 2
In the initial segment of this discussion the principle factors of lifestyle modification and pharmacological intervention were identified. As were the key considerations a professional personal trainer should be aware of while working with hypertensive clients. In this section, the recommendations pertaining to the practical exercise programming will be examined.
For personal trainers to work with hypertensive clients in a safe and effective manner, the pathophysiology of the disease’s and its effect on the exercise response must be understood. As would be expected, hypertensive clients experience greater absolute blood pressure (BP) readings during exercise due to higher baseline pressure and reduced vascular compliance. This means that the personal trainer must be careful when attempting to select appropriate methods of exercise and proper intensities (<70%) so that the vascular pressures do not lead to damage. For instance, utilizing heavy resistance or implementation of prolonged isometric contractions within the weightlifting component of a program is contraindicated. Personal trainers should educate the client on proper breathing techniques and the importance of avoiding the valsalva maneuver or compressive garments/belts. Furthermore, the personal trainer must understand that the selection of exercises that provide for a significant compression element, such as an inclined leg press and heavy machine chest press can cause dangerously high spikes in BP in the hypertensive client. Due to its potential aid in lowering BP, it appears that utilizing lighter resistance for 12-15 repetitions or higher per set in a circuit-training continuous format is most appropriate and productive for the hypertensive client.
Studies have documented a 10 to 20 mmHg post-exercise reduction in systolic BP for up to 3 hours following a 30-45 min training session consisting of moderate-intensity endurance training. This response may persist for up to 9 hours. Long-term endurance training has been found to reduce BP by an average of 10 mmHg in both systolic and diastolic measures; as well as improve blood lipid profile and insulin sensitivity. This illustrates to the personal trainer that aerobic training must be an integral component of any structured exercise program with a hypertensive client, as it aids in significantly reducing the risk for inherently elevated cardiovascular disease. Most trainers do not include aerobic exercise in the training session which is an error in programming. The first emphasis of any health/fitness program should be reducing or preventing disease. Due to the fact that it takes about 5 minutes past steady-state to create a parasympathetic benefit post exercise, it makes sense to include cardiovascular training at the end of the workout for 15 minutes.
The reduction in peripheral resistance seen with routine endurance training is believed to occur via attenuation of sympathetic nervous system activity (reduced plasma norepinephrine levels), an increase in circulating vasodilator substances, a reduction in renin-angiotensin system activity (hormonal action from the kidneys to control BP), and baroreceptor adjustments (brain’s BP monitoring system). Interestingly, it appears that lower-intensity aerobic training lowers BP just as much as, if not more than, exercise at higher intensities. Furthermore, the aerobic activity does not have to be performed in one single bout per day for optimal results. Personal trainers can use this information to develop appropriate plans for their clients inside and outside of the gym. Trainers should be aware that it is recommended to have clients accumulate 40-60 min of aerobic exercise on most days of the week, using 50-80% heart rate reserve (HRR) or 11-14/20 RPE. The weekly goal should be to expend 700-2000 kcal per week depending on the client’s current fitness level.
The general personal training guidelines for hypertensive clients:
- Aerobic exercise – accumulate 40-60 min using 50-80% HRR on most days, use RPE when medications are present
- Resistance training – use 12-15 repetitions in circuit format, avoid heavy resistance training, prolonged isometric activities, or the Valsalva maneuver
- Emphasize caloric expenditure – 700-2000 kcal per week depending on fitness level
- Avoid caffeine and pro-diuretics before and during exercise.
Proper programming for a hypertensive client can significantly reduce the progression of the condition as well as reduce the risk for cardiovascular complications. Implementing a program with aerobic training as the staple component; supplemented with light to moderate intensity resistance training in circuit fashion, will allow the personal trainer to provide a service that promotes vital benefits for the hypertensive.