Blood Pressure

Blood Pressure: what is it?

Blood pressure is one of the few measurements a coach can take that genuinely changes what happens next. A reading well above the usual thresholds is one of the clearest reasons to pause and send someone to a doctor before you write them a program. It is also the measurement most likely to get a coach into trouble, because the line between "I measured this and I am sending you to your GP" and "you have high blood pressure" is a line between screening and diagnosis. Get the protocol right, record what you saw, and refer.

The measurement protocol

Blood pressure is enormously sensitive to how it is taken. A client who ran up the stairs, drank a coffee and is chatting while you inflate the cuff can read tens of mmHg above their real resting value. Most bad readings are protocol failures, not physiology.

Two readings a minute apart, averaged, is the standard approach. If they differ substantially, take a third. Record which arm you used, because a difference between arms is normal and comparing left to right later produces a change that isn't real.

• No caffeine, nicotine or exercise in the 30 minutes before.
• Seated quietly for 5 minutes first, back supported, legs uncrossed, feet flat on the floor.
• Arm supported at heart level, cuff on bare skin, correct cuff size for the arm.
• Nobody talks during the measurement, including you.
• Two readings a minute apart, averaged. Note the arm and the time of day.

The categories, and why there are two sets

There is no single global threshold table, and a coach should know that before quoting one. The European approach and the 2017 American approach both remain in wide use and they draw the lines in different places, which means the same client can be "high-normal" under one and "stage 1 hypertension" under the other. Neither is wrong, they reflect different judgements about where to start intervening. Present a reading as a number, not as a category you assigned.

Where a coach's job starts and stops

You may own a validated monitor, take a reading, write it down, tell the client the number, tell them it sits above a widely used screening threshold, and recommend they discuss it with their doctor. All of that is reporting a measurement, which is squarely within scope.

You may not diagnose hypertension, tell a client whether they need medication, tell them to stop or change a treatment they are already on, or reassure them that a high reading is nothing to worry about. A single high reading is common and is not a diagnosis: white-coat effect, a stressful morning, a full bladder or a badly sized cuff can all produce one. Diagnosis requires repeated readings under medical supervision, which is exactly why the referral exists.

What to do with a high reading in the gym

For moderately raised readings, the practical answer is usually to train sensibly and refer in parallel. Steady aerobic work and general resistance training are broadly appropriate, while very heavy loads taken close to failure with a held breath produce the largest acute pressure spikes and are the obvious thing to postpone until the client has been seen.

There is one clear stop line. A reading around 180 systolic or 110 diastolic and above is not a session to work around, it is a session that does not happen. Have the client sit quietly, re-measure after a few minutes to rule out a protocol artefact, and if it holds, send them to a doctor that day rather than starting the workout. Write down what you measured and what you advised.