The following lists provide some general guidelines for working with clients who have been diagnosed with high blood pressure:
• Obtain medical clearance: The American College of Sports Medicine recommends a pre-exercise screening and assessment before developing an exercise program for persons with hypertension. Since there are other factors to consider in older clients with hypertension (e.g., age, number of chronic conditions, and medication), their physician should provide specific guidelines for exercise intensity, frequency, and duration.
• Use perceived exertion to monitor intensity: Use RPE to monitor exercise intensity, especially in clients taking medications that alter heart rate response, such as beta-blocking drugs. Consult with their physicians to determine the RPE value that should be targeted.
• Check the client’s blood pressure before, during, and after exercise: Pay special attention to clients’ pre-exercise blood pressure to ensure they have taken their antihypertensive medication (older persons who have forgotten to take their medication may have an elevated blood pressure). To avoid potential problems, clients should not exercise on days when they have not taken their medication and/or when their SPB >200 mmHg and/or DBP >110 mmHg.
• Be aware of the potential for post-exercise hypotension (PEH). A single bout of mild to moderate exercise can lead to a post-exercise decrease in blood pressure in both normotensive and hypertensive individuals. In many cases, this is a positive effect of exercise training in that it helps to lower blood pressure for up to 13 hours after physical activity. However, for some hypertensive individuals on antihypertensive medication, blood pressure can be drastically reduced after a bout of exercise leading to syncope (loss of consciousness or fainting) or pre-syncope symptoms. Fitness professionals should stay with their older hypertensive clients for several minutes after the end of the exercise session to ensure that the clients have support if they do experience symptoms of syncope.
• Approach recommending high-intensity exercise with caution: Traditionally, the recommendation has been that hypertensive individuals avoid high-intensity exercise. However, several studies suggest that high-intensity interval training (HIIT), which consists of several bouts of high-intensity exercise (~85% to 95% of VO2max) lasting 1 to 4 minutes combined with intervals of rest or active recovery, is superior to continuous endurance exercise (e.g., moderate-intensity for 30 minutes) for improving cardiorespiratory fitness and cardiovascular function in hypertensive patients and normotensive individuals. Furthermore, research supports HIIT as a viable solution for improving physical work capacity as well as desirable metabolic responses even in older adults with disease-imposed limitations. Although the optimum dosage of HIIT still needs to be established, and as such fitness professionals should practice on the conservative side, this type of training for older adults with hypertension could result in better compliance with exercise because it decreases the time required pursuing increased fitness.
• Focus on low resistance: A resistance-training program for clients with limited strength should emphasize a high number of repetitions at a low resistance.
More specific recommendations from the American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription, 9th edition (2014) include:
• Frequency: Aerobic training most (preferably all) days of the week; resistance training 2 to 3 days per week.
• Intensity: Moderate-intensity aerobic exercise (i.e., 40 to 60% VO2R) supplemented by resistance training at 60 to 80% 1RM.
• Time: 30 to 60 minutes of continuous or intermittent aerobic exercise; resistance training should consist of at least 1 set of 8 to 12 reps.
• Type: Emphasis on aerobic exercise of preferred modality; resistance training using either machine weights or free weights to supplement aerobic training.
• Progression: Gradual, avoiding large increases in any of the FITT components.