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46 GUIDELINES FOR EXERCISE TESTING • www.acsm.org
pulmonary function are provided in the following section. For more detailed
descriptions of these assessments, the reader is referred to the work of Bickley (3).
BLOOD PRESSURE
Measurement of resting blood pressure (BP) is an integral component of the preexercise
test evaluation. Subsequent decisions should be based on the average of two
or more properly measured, seated BP readings recorded during each of two or more
office visits (11,14). Specific techniques for measuring BP are critical to accuracy
and detection of high BP and are presented in Box 3.4. In addition to high BP
readings, unusually low readings also should be evaluated for clinical significance.
The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC7) provides guidelines for
BOX 3.4
Procedures for Assessment of Resting
Blood Pressure
1. Patients should be seated quietly for at least 5 minutes in a chair
with back support (rather than on an examination table) with their
feet on the floor and their arm supported at heart level. Patients
should refrain from smoking cigarettes or ingesting caffeine during
the 30 minutes preceding the measurement.
2. Measuring supine and standing values may be indicated under
special circumstances.
3. Wrap cuff firmly around upper arm at heart level; align cuff with
brachial artery.
4. The appropriate cuff size must be used to ensure accurate measurement.
The bladder within the cuff should encircle at least 80% of the
upper arm. Many adults require a large adult cuff.
5. Place stethoscope bell below the antecubital space over the brachial
artery.
6. Quickly inflate cuff pressure to 20 mm Hg above first Korotkoff
sound.
7. Slowly release pressure at rate equal to 2 to 5 mm Hg per second.
8. Systolic BP is the point at which the first of two or more Korotkoff
sounds is heard (phase 1) and diastolic BP is the point before the
disappearance of Korotkoff sounds (phase 5).
9. At least two measurements should be made (minimum of 1 minute
apart).
10. Provide to patients, verbally and in writing, their specific BP numbers
and BP goals.
Modified from National High Blood Pressure Education Program. The Seventh Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).
Washington, DC: 2003; 03-5233. For additional, more detailed recommendations, see Pickering
TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans
and experimental animals. Hypertension. 2005;45:142–61.