Blood pressure response to exercise

According to ACSM, the normal response to exercise is a progressive increase in Systolic BP, typically 10 +/-2 mmHg/MET with a possible plateau at peak exercise. In pts on any blood pressure medication, including Beta Blockers, the blood pressure response to exercise is variably attenuated & cannot be accurately predicted in the absense of clinical test date i.e., stress test.
Given the above statement, I don't think you can rely on the blood pressure response in an individual taking Beta Blockers to give you any indication of effort.

Here In "Cardiac Valley" (midwestern US), I would estimate that about 30-40 percent of my population over 40 is on some level of Beta Blocker. Although I agree that rises in heart rate for beta blocker medicated client's should not increase in proportion to the normal population (can't use norms), there is no scientific reason (in my limited knowledge) that a rise in heart rate for one activity that involves repetitive use of large muscle groups (stair climbing, ladder climbing, advanced treadmill walking during cardio testing), should not be expected to rise similarly for another-with a relative eqivalence in exertion.

For example, if my mild to moderately obese, 1 pack a day smoking beta blocker taking over 40 patient is found to be safe to perform an FCE, I almost always have them perform a ladder climb (if safe), as a measure of how their heart rate will respond to exertion. I document this number under ladder climb and the pace they demonstrated (HR; 122, slowed, moderate, quick), and ask them how they feel ("fine, woosy, light headed, nauseous", etc.). When it then comes time for the lifting evaluation, I now have some frame of reference as to how their HR responded when they;

a. Exerted themselves
b. Claimed fatigue
c. Were SOB
d. Threw up (just kidding)

In my opinion, there is no valid reason to dismiss the heart rate component of an FCE just because the HR is suppressed via Beta Blocker medication-provided the client demonstrates exertion during some portion of the test. I use the comparison of HR, as discussed, to both support full effort and to dismiss full effort. There are, of course, exceptions to this statement. In addition, never objectively state someones cardio test placed them in a certain category of work without the "However, these results should no be considered valid, as the client's heart rate was most likely skewed by beta blocker medication" statement.

If anyone knows of any research that contradicts from my personal opinion, please let me know, so that I may change/adjust my thinking. Have a great day!

On a similar note, one of our Cardiologist has advised that individuals on medication for hypertension should still show a similar heart rate response with required exertion (sufficient reps using large muscle groups). He supported the use of MET testing to raise heart rate to a ?steady state? . Practicality and utility doesn't always make this feasible for our facility to administer, and we therefore rely more heavily on the mCAFT test.

A helpful hint for those dealing with individuals with hypertension.
Tanya

Elevated blood pressure is not useful as a sincerity indicator. This is clearly stated in the article, "Sensitivity and Specificity of the Indicators of Sincere Effort of the EPIC Lift Capacity Test on a Previously Injured Population", by Marc A. Jay, MS, PT, et al. in SPINE Volume 25, Number 11, pp 1405 - 1412. When an evaluee is on Beta blockers, heart rate is not used in the battery of tests to determine effort. Effort statements are then based on other effort criteria such as isometric tests and behavioral observations.

I think that's what Scott is asking! Not to second-guess your physiatrist, but I think you're out of luck in terms of using HR or BP on a client on Beta Blockers, in terms of attempting to measure level of effort...

How much of a change in Blood Pressure would you look for in order for it to be suggestive of full effort? Has anyone found any guidelines? Thanks!

I asked that question to one of our physiatrist. His response was that with the beta-blocker medication, HR was definitely out. However, he felt that BP would be minimally effected by the medication and would likely be a viable method to evaluate effort. How much "minimally effected" means is up in the air I guess.

I would think that the beta-blocker would compromise the use of the BP as an indicator of effort, wouldn't it?