7 Tips For Training Clients With High Blood Pressure

As a PT, training clients with high blood pressure presents some unique challenges in terms of safety and the programmes you design for them.

That’s why we’ve compiled a list of 7 tips for when you’re training someone with high blood pressure! These will not only be useful for clients with hypertension but will be significant for those avoiding high blood pressure too!

Before we start, you can train clients with high blood pressure at a deeper level by combining fitness with our Level 4 Sports Nutrition Course. Find out more about this and the many other health and fitness qualifications we offer by downloading our full course prospectus!

7 Tips for Training Clients with High Blood Pressure

#1 - Make Sure They Consult With a Doctor

When you’re training somebody with high blood pressure you should ensure that they’ve checked the safety of working out with a medical professional if they haven’t gone through the exercise referral process.

During training, clients with hypertension should avoid pushing themselves in the same way standard clients would. This is because of the higher risk of injury or exacerbation of their condition.

Clients should enquire with their GP or other specific medical professionals that they are safe to exercise in their condition and, depending on severity, their risk of injury.

Though exercise is healthy for most people with hypertension, and often encouraged, if you’re training clients with high blood pressure their condition may be too severe for certain exercises or any at all.

By ensuring they’ve checked with their doctor you’re not only protecting them but protecting yourself and your PT insurance too!

This should be one of the first things you do. You need to make sure that you have their safety confirmed before you’re able to go ahead with a plan.

You should have a full medical history as well as maintaining contact with your client’s healthcare professional in order to monitor their safety.

You can integrate this into your initial physical assessment and the questions and answers you have when you meet the client. 

#2 - Extend Warm Up and Cool Down Times When Training Someone with High Blood Pressure

In general, lengthening a client’s warm up just means preparing their body more gradually for the workout you’ve designed for them.

By extending both the warm up and cool down times you’re ensuring that the heart rate very steadily changes rather than there being any sudden changes that could put pressure on the heart vessels. 

By extending in this way then, you prevent any sudden spikes and ensure you’re preparing the client as fully as possible for their workout.

In terms of a cool down, if you stop too quickly this can lead to the client experiencing:

• Dizziness
• Lightheadedness
• In extreme cases, fainting

This gradual slowing down is especially important for people who are on medication for their blood pressure because their blood pressure needs to be as regulated as possible.

If you’re sensitive to this, and make sure that you include a longer warm up and cool down, your client will be a lot more comfortable and you’ll also see better results as well as avoiding risk. 

You’ll also avoid overtraining symptoms too, which would compromise their recovery time.

You’ll see better results ultimately, if your client can trust that you’re providing a safe environment because they’ll feel more comfortable pushing themselves and trusting your methods!

In order to do this you should include a warm up and cool down that last longer than five minutes.

Some exercises you can include in this are:

• Squats (with very small weights or as a bodyweight exercise like below)

• Heel-to-toe walk 
• Lunges (again, ideally this will be without a weight but you could build up to very small weights like below)

#3 - You Should Keep the Intensity Low When You’re Training Clients with High Blood Pressure

During training, clients with hypertension should avoid high intensity exercises as these are the most likely to put them in danger.

Essentially, you’re avoiding anything that increases the heart rate too quickly or too intensely as this will be dangerous for the client.

This way you’ll be getting the most out of your client without putting them at risk. This will also show your clients that you’re sensitive to their condition.

Some of the activities you should avoid with clients include things like squash. Fast directional changes and intense bursts of energy, with exercises like this, will put too much pressure on the heart and blood vessels.

During training, clients with hypertension should avoid the following exercises that may be commonly used in your regimes:

• HIIT
• Tabata training
• Lifting heavy weights

If you’re unsure about what you can and can’t include, you can work with your client more closely when training someone with high blood pressure.

Part of your initial physical assessment can be working to determine somebody’s limits. Ways you can do this include:

• Using the talking test
• Using the Borg Scale of Perceived Exertion
• Calculating the percentage of the client’s maximum heart rate

If in doubt about whether a particular exercise is too intense for a client, use a gentler, modified version and use the talking test. 

Can they talk whilst they’re doing it? If not, it’s too intense and should either be missed completely or modified further if possible. 

The Borg Scale of Perceived Exertion is a way of monitoring how a client feels whilst they’re working out.

The scale is traditionally 6 to 20 because if you take the number and multiply it by 10, this is a rough estimate of your heart rate. 

During training, clients with hypertension should avoid any exercises around the 14 mark or over, as these will raise the heart rate too much and strain them in a dangerous way.

You can also calculate how much of the client’s maximum heart rate a particular exercise will use to determine whether it’s safe for them.

You can do this with a heart rate monitor too! This can be an essential piece of personal trainer equipment when training a hypertensive client. 

You can use this to determine what to include and avoid! Some low intensity exercises include:

• Walking
• Cycling
• Gentle activity on the stepper and elliptical machine

Check out our YouTube channel for some inspiration and more tips on particular exercises you could use, like these gentle movements with the step!

#4 - Include Gentle Resistance Training with Clients with High Blood Pressure

A small study from The Journal of Human Hypertension suggests that doing resistance training can help improve hypertension as well as cardio exercise!

This is something that will be important for longer term management of hypertension because it’s important for:

• Maintaining weight loss
• Help to improve sleep (this is important because lack of, or interrupted, sleep can be a cause of hypertension)
• Help sustain levels of fitness

Including these in your workouts when you’re training clients with high blood pressure will not only help to get better results, and sustain their fitness levels, it will also keep things interesting! This will keep them motivated to train and in turn will help you make money as a personal trainer as they'll be more likely to recommend you to toehrs with similar conditions.

There’s nothing worse than a boring and repetitive workout and when you’re training someone with high blood pressure they might not have exercised for a long time. This makes it especially important to keep things fresh and engaging.

Using higher weights will spike somebody’s blood pressure too quickly and so, like the importance of a slower warm up and cool down, this is something to be aware of to manage your client’s safety and avoid injury. 

Your exercise programmes could include the following basic resistance exercises, which were used in the medical research mentioned earlier:

• Leg presses
• Bicep curls
• Chest presses

You should also compensate for the lighter weights with more reps so that you’re still pushing your clients to develop their stamina and strength. 

You will need to make sure you include a very low weight when doing these exercises as below:

As a general rule, you can make sure that you’re only including resistance exercises with weights that clients can lift 10 times. This is why endurance rather than strength training is better for hypertensive clients. 

------

If you're enjoying this article, why don't you explore these too?

• Writing A Personal Trainer Business Plan
• Setting Online Personal Trainer Prices
• Personal Trainer Nutritional Advice

#5 - You Can Get an Exercise Referral Qualification to Better Train Clients with Hypertension

One of the best ways to boost your knowledge, and inform your training with hypertensive clients, is to get an exercise referral qualification.

Otherwise known as GP referral, with a course like this you’d be qualified to receive clients via referral from their GP or other medical professionals.

Obviously, if you’re interested in training someone with high blood pressure, you’ll potentially get more clients this way because hypertensive clients will be sent to you via a healthcare professional!

A Level 3 Exercise Referral qualification like ours includes some of the vital skills you would need when training clients with high blood pressure including:

• Understanding medical conditions - this explicitly includes hypertension and will help deepen your knowledge of the condition so that you understand exactly how you can help your clients!
• Planning exercise referral programmes - as well as practical planning skills, you’ll also learn how to set SMART fitness goals with clients. This will help them maintain habits after working with you
• Instructing through GP referral - you’ll review case studies and examples in order to understand how to plan an effective 6 week programme, so that you can see the best results 

Make Body Good from Steven Harulow is a perfect example of somebody showcasing this qualification to legitimise their service and attract more clients!

This promotes his particular niche, allows him to specify conditions he’s qualified to help with, and promotes him as a specialist!

If you get qualified with OriGym’s Exercise Referral course then you’ll be able to promote yourself like Steven as an expert!

#6 - Encourage Daily Activity When Training Someone with High Blood Pressure

Part of your role when you’re training someone with high blood pressure is to encourage lifestyle changes that they can take forward!  

You want to encourage small, daily activity in order to help clients to maintain a healthy blood pressure and see the mental benefits of exercise as well as the physical.

Ideally, clients with hypertension should be doing some physical activity at least four times a week, if not everyday.

Encouraging them to integrate everyday activities into their routine will help them to see results and, in turn, boost your reputation for getting those results!

There’s plenty of ways you could do this by designing things for your clients to do in between sessions with a bespoke home workout guide.

You can do this by assigning homework for your clients so you can work with them to see which activities fit best with their existing schedule and responsibilities. 

You will probably already be familiar with some of the best exercises to integrate into everyday routines.

However, there’s some activities that are especially suitable for training clients with high blood pressure including:

• Walking
• Cycling
• Gardening

Walking or cycling is a great way for clients to incorporate some exercise into their daily routine. They can either start commuting by foot or bike, if the journey isn’t too long, or going for a short walk or cycle in the evenings.

Gentle gardening and yard work, so long as there’s not too much heavy lifting, is a great way of utilising a client’s existing routine to boost their fitness levels!

There’s a huge variety of stretching, strength exercises, and cardio done when gardening whether that’s pulling weeds or digging soil. 

You can also encourage clients to grow fruits and vegetables to kill two birds with one stone: boosting their fitness and contributing to their dietary changes!

We’ll look a little closer at this now!

#7 - You Can Combine Your Training for Clients with High Blood Pressure with Nutrition

Another thing you can do to boost your knowledge and inform your sessions with hypertensive clients is to get qualified with one of the best nutrition courses in the UK.

As you will already know, the significance of combining changes in diet with an exercise regime can help a huge variety of issues. This is especially true when training clients with high blood pressure.

This is because there’s only so much you can do with physical activity if some drastic changes aren’t being made to diet and lifestyle too.

Plenty of medical research shows that diet is a huge contributory factor in terms of high blood pressure and that improving diet sees fast results in improving people’s conditions.

If you can provide a plan for your clients that includes dietary information and nutritional plans, as well as exercise, you’ll be helping to transform their lifestyle a lot more than with just exercise.

This will mean that you can help them to improve their blood pressure and improve their general health at the same time, and longer term!

You want to make sure you’re helping people retain new habits and see long term results so that they improve as well as contributing to your reputation for success!

It’s important to remember, however, that you’re limited in giving nutritional advice as a personal trainer as opposed to a dietician.

The difference between a nutritionist and a dietician is that ‘dietician’ is a term protected by law, with very strict rules determining the qualification and experience you need to give yourself this title.

However, this doesn’t mean that you can’t decide meal plans for clients and help them to improve their diet!

With our Level 4 Sports Nutritionist course, you’ll be expanding your knowledge and learning practical skills for training clients with high blood pressure.

The most important thing to remember is the language you use to ensure you’re not prescribing your meal plans or advice but merely making suggestions. 

For example, you could phrase your advice like the following examples: 

I would suggest that you cut out highly processed added sugars like fructose

My advice is to lower your cholesterol by cutting down on saturated fats"

I advise you to make sure you eat more of certain fruits and vegetables to lower your blood pressure

Somebody who prefaces the significance of diet in their own practice is Angela Hartley! Despite being a trained nurse, she’s still got a nutritional qualification to focus her training on diet as well as exercise programmes:

Having nutrition in her roster of expertise lends even further legitimacy to her medicalised approach and means that she can call her programme a holistic method to improve cardiovascular health.

You only have to look at her success stories and testimonials to see what a difference she’s made and what combining diet and exercise can do:

Skills Needed When Training Someone with High Blood Pressure

Now that we’ve covered our top tips for training clients with high blood pressure we’ll look at some of the soft, interpersonal skills you’ll need to be successful.

Some of these will be familiar to you from planning a PT session, but there’s some that deserve particular attention, and specific application, when training hypertensive clients!

#1 - You’ll Need to be Patient When Training Someone with High Blood Pressure

During training clients with hypertension, you should avoid making them feel nervous or pressured in any way. 

They may be nervous or apprehensive about the training sessions and it may well be their first time exercising in a while following their diagnosis or medical emergency.

For this reason, you should ensure you’re patient and aware that a client’s pace might be slower than with standard clients.

If you can develop your patience this will develop several other important aspects of your relationship with your client including:

• Developing trust
• Rapport building as a personal trainer
• Showing that you’re invested and dedicated to your client’s progress

We’ve already indicated ways in which sessions may look different, with longer periods allocated for particular exercises.

-----

If you're enjoying this read, why don't you give these other articles a go?

• Personal Training For Hypermobile Clients
• Personal Training For Clients With Fibromyalgia
• Helping Clients With Eating Disorders

For example, allowing more time for a warm up and cool down to ensure the safety of your clients. 

You can also allow more time for the exercises themselves as you want the client to be able to go at their own pace and not push themselves too hard. 

The time scale of their improvements may also be longer as small, incremental changes are important when training clients with high blood pressure.

This is something you can preface when you meet clients in order to reassure them that you’re dedicated and understand the pace that they will need to go at in order to train safely!

This can also be reflected in the goals you set with clients. For example, you may choose smaller goals in order to show you appreciate your client’s efforts and encourage them to keep going!

#2 - Be Motivational When Training Clients with High Blood Pressure

One of the most important skills you’ll need as a personal trainer for hypertensive clients is the ability to motivate them.

Though this is important for any personal trainer role, it’s especially important when training clients with high blood pressure. This is because, as we’ve already said, you’ll need to help clients sustain effort over potentially a longer period of time.

The fact that it may take longer to see results, and reach goals, may often be demotivating for clients and lead to them to become impatient.

You’ll need to find strategies to keep clients motivated so that they feel encouraged and notice small changes and improvements.

This will also mean that you retain clients and they don’t stop their sessions because they become impatient or lose motivation!

You need to find the balance between a heightened awareness of the risks and the pace that is needed, whilst also pushing your clients so that they do see improvements.

Once you’ve found that balance, one of the best things to do is to develop your communication skills as a PT, specifically the way you motivate your clients outside of sessions.

You can use personal trainer software to maintain appropriate contact between sessions and motivate clients to continue with their hard work and workouts outside of your time in the gym!

Most decent PT software, like Workout Labs pictured below, will have an in-app messaging service where you can motivate them to fulfil the homework you’ve set for them!

This software will also give clients a chance to ask questions about exercises you’ve asked them to do outside of sessions. This open dialogue will motivate them to complete these workouts alone!

#3 - Sensitivity is Important for Training Clients with High Blood Pressure

It’s worth remembering that a lot of clients with hypertension will be elderly, overweight, or obese and may well have been predominently sedentary before coming to you.

In order to cater to their needs, and make them comfortable, you’ll need to be sensitive to not only their health condition but also any of these contributory factors that they may be nervous around.

This will make the client feel more comfortable and at ease. Feeling more supported in your sessions will then keep them motivated to complete exercise routines and see improvements!

It will also help with your standard sessions as well as having to cater to specific needs and being extra sensitive will help with generally being a supportive trainer!

Whether you’re personal training older clients or training obese clients you can show your sensitivity in initial assessments and throughout training.

Clients with high blood pressure may need reminding throughout training that you’re aware of the risks and that you’re there to help. 

You should therefore check in with clients whilst you’re training them so they feel completely comfortable and there is no risk of injury from pushing themselves too hard.

Some examples of phrases you can use, or ways you can approach this, include:

Remember to just tell me if you feel short of breath or if there’s any pain, we can stop any time

I understand you’re working really hard and you’re doing really well

How are you feeling?

This will also help with the talk test as if you maintain conversation you’ll be able to monitor how well the client is coping with the workout.

Before You Go!

With our tips for training clients with high blood pressure, you can feel prepared when designing and delivering, sessions with hypertensive clients! Continue providing the right care to these clients by combining health & fitness with our Level 4 Sports Nutrition Course.

Alternatively, you can find out more with our free course prospectus and see all of the courses we offer!

References

• Moraes MR, Bacurau RF, Simões HG, Campbell CS, Pudo MA, Wasinski F, Pesquero JB, Würtele M, Araujo RC. Effect of 12 weeks of resistance exercise on post-exercise hypotension in stage 1 hypertensive individuals. J Hum Hypertens. 2012 Sep;26(9):533-9. doi: 10.1038/jhh.2011.67. Epub 2011 Jul 7. PMID: 21734721.
• Appel, Lawrence J. et al. "A Clinical Trial Of The Effects Of Dietary Patterns On Blood Pressure". New England Journal Of Medicine, vol 336, no. 16, 1997, pp. 1117-1124. Massachusetts Medical Society, https://doi.org/10.1056/nejm199704173361601. Accessed 27 Apr 2022.