Blood-pressure measurement seems to be a reasonable parameter of fitness
assessment. It remains, however, an elusive measurement. Blood pressure is difficult to
accurately evaluate, especially during exercise. To justify this belief, it is best that I
relate my personal experiences with blood-pressure testing.
In 1972, I served as a volunteer subject as my father taught a medical student to take
blood-pressure measurements. After attempting a few readings, the student asked if my
blood pressure was not slightly high, especially with regard to the diastolic. My father
answered that a diastolic of 88 might be deemed borderline hypertensive if it was not
evaluated within the context of a low pulse of 50-beats-per minute.
During my Air Force career (1976), an anesthetist measured my blood pressure immediately
before/after an intense workout. The before readings were:
pulse = 50 systolic = 122
diastolic = 88.
The after readings were:
pulse = 210 systolic = 140 diastolic <
40.
He failed to obtain a confident diastolic because the pitch had no discernible break point
— there was continuous pitch change down to a level barely audible around 20 mm. Hg.
The anesthetist then commented that if he had taken these readings at the emergency room
without foreknowledge of the workout he had just observed, he would have concluded me to
be in life-threatening shock. Technically, I indeed was in shock. It was not life
threatening because it was self imposed under clinical control, not as the result of
hemorrhaging due to trauma.
In 1980, a sales rep from a medical equipment company visited Nautilus® headquarters and
demonstrated a $7,000 automated blood-pressure measuring device. We connected it to David
Liskin as he performed a set of Nautilus Leg Extension to failure. David's systolic
reading during the exercise was alarmingly high, much higher than we had previously
supposed, although he endeavored to control excess elevation by relaxation of hands, neck,
face, and avoidance of Val Salva. We later realized that as long as the diastolic did not
grossly elevate, the systolic elevation should not be so alarming.
Before the rep left the Nautilus compound, I begged the opportunity to have my blood
pressure measured as I played Bach's Brandenburg Concerto #2 on Trumpet. This proved more
alarming to Liskin, Wolf, Darden, the rep, and me than Liskin's measurement. Not aware of
the origin of the music, the rep commented that whoever wrote my material must have been
mad. My blood-pressure readings were far higher and demonstrated more rise from normal
while playing trumpet than did Liskin's all-out effort during exercise. Of course there
were non-comparable differences. Liskin was addressing his lower body while attempting to
relax everything else. I was deliberately contracting most of my torso structures, face,
and deliberately applying a trained Val Salva technique to play my instrument.
This story seems to support the notion that reading blood pressure during exercise is a
reasonably simple procedure. It really is not. The involved apparatus was on a large cart
which required electricity from a wall socket. It incorporated automated cuff inflation
that jolted the subject somewhat each time a reading was made. The hoses for the cuff had
to be snaked around the exercise equipment with cart in tow. It required application to a
limb not involved in the exercise and not in the path of moving equipment parts.
During trumpet performance the cuff was placed on my left arm — supporting the
trumpet — and I was forewarned at each inflation. I, therefore, had to stop playing
briefly, thus permitting a noncontinuous exertion and biased results, to permit inflation.
Still, inflation nearly jolted the trumpet out of my hand. In short, this expensive,
so-called automated device, was a clumsy affair; but it was a far cry better than the
typical cuff-and-stethoscope technique otherwise required.
In late 1982, the Nautilus Osteoporosis Project began. We were expected to take the
before/after workout pulse and blood pressure of each subject. We complained that this was
a meaningless chore. I argued that any feared elevation occurred during an exercise(s),
per se, and that such was impossible to predict, record, and control. The before reading
would be elevated due to anxiousness regarding the workout. The after reading would show a
slightly elevated systolic and a greatly depressed diastolic. The after readings were both
variable with respect to the subject's competence and will, the exercise sequence, and the
subject's degree of muscularity. In addition, the pulse and pressure readings would vary
with regard to which of the two measurements was most immediate after the exercise.
Keith Johnson went further. He stated that what the researchers feared the blood-pressure
cuff' could not measure. To this day I do not understand his explanation, but he convinced
the principal investigator that the danger issue was the direct force on the arterial
walls which cuff and stethoscope could not detect.
For several years after the Osteoporosis Study I maintained a reasonable respect for
blood-pressure measurement as long as it was conducted in the doctor's exam room, at rest,
while sitting or lying. Though my personal reading had always been slightly high
(diastolic), Dr. Michael Fulton advised many of the muscular males at the Nautilus
headquarters that such readings were due to a too-small cuff originally fitted for the arm
of a normal man. Most physicians do know this. However, many paramedical personnel who
actually take the readings do not use the properly sized cuff. They then report biased
readings from which a physician may then diagnose hypertension or borderline hypertension
when normal readings would be otherwise obtained with a properly sized cuff.
Even so, in 1987 I was diagnosed by a Dallas physician to be hypertensive and was
prescribed medication. I refused the prescription pending proof that I was hypertensive. I
demanded more readings with a larger cuff. My father became involved and outlined that I
was to:
• Enter the exam room and remove my shirt
• Sit upright in an armed straight chair
• Avoid all conversation, reading, or other activity for five minutes while sitting
alone
• Permit the nurse or doctor to enter the room and read my blood pressure without the
slightest acknowledgment or verbal interaction.
He also suggested readings in other positions for comparison. Following these controls my
readings were found to be normal.
The previous discussion leaves us in somewhat of a quandary. Physicians sometimes ask
regarding the safety and magnitude of blood pressure elevation during exercise, especially
SuperSlow Exercise. Apart from my suspicions, beliefs, and experiences, I can give them no
hard data nor can anyone else.