Exercise Prescription Lecture 1/27

Introduction

• Setup problems with Zoom camera; slides will be provided.

• Review of blood pressure measurement from previous class.

Blood Pressure Overview

• Importance of knowing your equipment for blood pressure measurement.

• Stethoscope

  • Quality:

    • High-quality stethoscope is essential (example: Littmann that can record sounds).

  • Ear Tips: Must be curved correctly to point away from the face for proper hearing.

  • Drum and Bell:

    • Bell: Used for higher frequencies; not primarily used for blood pressure due to smaller surface area.

    • Diaphragm: Preferred for blood pressure as it has larger surface area.

    • Check if the switch is set properly between diaphragm and bell.

Equipment Setup for Blood Pressure Measurement

• Sphygmomanometer

  • Function: Essential for measuring blood pressure.

  • Setup Steps:

    • Cuff must align correctly with artery marking for even pressure.

    • Incorrect cuff fitting can lead to inaccurate readings:

      • Undercuffing: Use of a cuff too small for a large arm leads to artificially high readings.

      • Overcuffing: Use of a cuff too large for a small arm leads to artificially low readings.

Types of Sphygmomanometers

• Mobile Sphygmomanometers:

  • Benefits for exercise measurement (not attached to individual).

  • No disturbance of readings during movement.

  • Variations include mercury vs. spring-loaded devices.

• Automated Blood Pressure Cuffs:

  • Utilize oscillometric methods based on volume change.

  • Movement can adversely affect reading accuracy.

  • Exercise-capable oscillometric cuffs are available but are expensive.

Blood Pressure Measurement Technique

• Listening for Korotkoff Sounds

  • Sounds used to determine systolic and diastolic pressures.

  • Measurement Process:

    • Inflate cuff until blood flow is occluded, generally above systolic level.

    • Gradual deflation to hear:

      • First sound: Systolic pressure (turbulence starts).

      • Last sound: Diastolic pressure (blood flows freely).

    • Errors can occur with sudden movement or improper placement.

Interpretation of Blood Pressure Values

• Classifications

  • Normal: Less than 120/80.

  • Elevated: Systolic 120-129 and diastolic <80.

  • Hypertension Stage 1: Systolic 130-139 or diastolic 80-89.

    • Note: Must refer potential hypertensive individuals to a clinician; not within fitness professionals' scope to diagnose.

Mean Arterial Pressure (MAP)

• MAP must be over 60 mmHg for organ perfusion.

• Equations to calculate MAP based on diastolic and systolic pressures.

Heart Rate Measurement

• Overview

  • Normal resting heart rate: 60-100 bpm.

  • Bradycardia: <60 bpm; Tachycardia: >100 bpm.

  • Most accurate measurement points: Radial and brachial arteries.

• Measurement Process

  • Use index and middle fingers to palpate.

  • Importance of using consistent pressure and measuring during rest:

    • Measure for 30 seconds, or 15 seconds during exercise (multiply for bpm).

    • Typical heart rate observations during exercise; high rates warrant further checks.

Medications Impacting Blood Pressure

• Common classes:

  • Diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and vasodilators.

• Important to note medications affecting heart rate combined with blood pressure assessments.

Sources of Error in Blood Pressure Measurement

• Equipment issues (calibration problems, cuff size, placement)

• Patient positioning (standardized seated position required).

• Proper technique critical for accuracy (e.g., centering the cuff).

Key Practices for Blood Pressure Measurement

• Ensure bladder is empty prior to measurement.

• Gather practice on audible Korotkoff sounds before assessments.

• Use visual aids (dials/meter readings) with direct eye contact for accuracy.

Conclusion

• Importance of understanding protocols for taking accurate blood pressure readings.

• Prepare for upcoming class on EKGs.