Hypertension and cardiovascular disease

Hypertension affects ~half of US adults

Many clients walk into the gym with elevated or hypertensive BP, often unaware. Trainers don't diagnose hypertension, but you screen, refer appropriately, and adjust programming.

BP categories and trainer actions

Normal (<120/<80): Standard programming. Elevated (120-129 / <80): Standard programming. Lifestyle emphasis. Stage 1 hypertension (130-139 or 80-89): Strongly encourage medical evaluation. Can train with moderate intensity. Avoid heavy maximal-effort Valsalva work. Stage 2 hypertension (≥140 or ≥90): Medical clearance required. Once cleared, conservative starting volumes. Hypertensive crisis (>180 or >120): Do not train. Refer immediately. This is an emergency situation.

How exercise helps

Aerobic exercise can lower BP 5-10 mmHg in hypertensive clients. Resistance training adds another 2-5 mmHg drop. Effects accumulate over 3-6 months and require consistency.

Programming for hypertensive clients

Aerobic exercise (the primary BP-lowering modality):

5+ days/week
30-60 min/session
Moderate intensity (zone 2, conversational)
Walking, cycling, swimming, elliptical

Resistance training:

2-3×/week
Moderate load (40-80% 1RM)
8-12 reps
Multiple muscle groups
Avoid Valsalva (breath-holding) on heavy lifts
Slow controlled tempo
Avoid exercises that put the head below the heart (BP spikes)

Medications to know

Many hypertensive clients are on medications. Common ones:

Beta-blockers — lower HR. Use perceived exertion, not HR, to gauge intensity. Client may feel lightheaded on standing. ACE inhibitors / ARBs — generally don't affect training much. Diuretics — increased urine output, potential dehydration and electrolyte loss. Encourage hydration. Calcium channel blockers — may cause swollen ankles, dizziness. Watch for orthostatic hypotension on standing.

Always ask about meds and side effects.

Signs to stop a session

BP rising above 180/110 during exercise
Chest pain
Severe shortness of breath
Dizziness, fainting feeling
Irregular pulse
Excessive sweating beyond normal

Stop, sit, monitor. Refer to medical care if symptoms persist.

Cardiovascular disease (CVD)

Clients with known CVD (heart attack, stent, bypass) need a different protocol:

Medical clearance is mandatory
Cardiac rehab graduation strongly preferred before independent training
Start very conservatively
HR limits prescribed by cardiologist often apply
Avoid maximum-effort work

For these clients, build a relationship with their cardiologist or cardiac rehab team.

Lifestyle factors trainers can influence

Reduce sodium (<2,300mg/day for general; <1,500mg/day for hypertensives)
Reduce alcohol (<2 drinks/day men, <1/day women)
Lose body fat if overweight
Sleep 7+ hours
Manage stress (training itself helps)
Stop smoking (refer to cessation programs)

TL;DR

BP ≥140/90 = Stage 2 = medical clearance required. Aerobic exercise lowers BP 5-10 mmHg in hypertensives; resistance adds 2-5 more. Avoid Valsalva and head-below-heart positions. Know client's medications and side effects. Stop session if BP signs become alarming.