Advanced fitness assessment and exercise prescription by Vivian Heyward, Ann Gibson

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Continue reducing the pressure slowly (no more than 2 mmHg∙sec−1), noting when the metallic tapping sound becomes muffled (Phase IV diastolic pressure) and when the sound disappears (Phase V diastolic pressure). Typically, the Phase V value is used as the index of diastolic pressure. However, both Phase IV and V diastolic pressures should be noted. During rhythmic exercise, the Phase V pressure tends to decrease because of reduction in peripheral resistance. In some cases, it may even drop to zero.

Use the average of the two measurements for each of the three values. 2 Sources of Measurement Error Sources of error in measuring BP are numerous (Reeves 1995). You need to be aware of the following sources of error and do as much as possible to control them: •• Inaccurate sphygmomanometer •• Improper cuff width or length •• Cuff not centered, too loose, or over clothing •• Arm unsupported or elbow lower than heart level •• Poor auditory acuity of technician •• Improper rate of inflation or deflation of the cuff pressure •• Improper stethoscope placement or pressure •• Expectation bias and inexperience of the technician •• Slow reaction time of the technician •• Parallax error in reading the manometer •• Background noise •• Client holding treadmill handrails or cycle ergometer handlebars The following section addresses questions about measuring BP and provides tips for taking more accurate BP measurements during rest or exercise.

Are heart rate monitors accurate? uu What is an ECG, and does every client need to have one before taking an exercise test? uu Is it safe to give a graded exercise test to all clients? When does a physician need to be present? uu What are the major components of the lifestyle evaluation, and how can this information be used? uu What are the purposes of informed consent? measuring heart rate and blood pressure at rest and during exercise and for conducting a resting 12-lead electrocardiogram (ECG).

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