Some blood pressure medicines can lower your target heart rate, the range of beats per minute you aim for during exercise, so the range that is right for you may sit below the one on an age chart. On one of those medicines, a count under the chart's range does not by itself show that you held back. If you take medicine for high blood pressure, ask your doctor, the one who prescribes it, what range is healthy for you.
Why your pulse stays under the range however hard you push
However hard you push, your pulse is being compared with a range calculated from your age and nothing else. To find your approximate maximum heart rate, you subtract your age from 220, and your target heart rate is about 50% to 85% of that maximum. For moderate exercise the target is 50% to 70% of the maximum, and for vigorous exercise it is 70% to 85%. In beats per minute, the range is 100 to 170 at age 20, 85 to 145 at 50 and 75 to 128 at 70. Someone starting out aims for the lower number for their age and works slowly toward the higher one as they get more fit, but if you take medicine for high blood pressure, the range to aim for is the one your doctor tells you is healthy for you.
The formula takes no account of any medicine you take, and some blood pressure medicines act on the heart itself. Beta blockers help your heart beat slower and with less force, which means it pumps less blood through your blood vessels. They are typically used only as a backup option or if you also have certain other conditions, and the other commonly used types, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers and diuretics, work in different ways. Ask your doctor which type you take, and whether it is one that can lower your target heart rate.
A heart rate under your target may mean you are not exercising hard enough to benefit your heart. On a blood pressure medicine that lowers your target heart rate, it may instead mean that your own target is lower than the chart's. Until you know your own range, the count alone cannot tell you which of the two is true.
Whether the count at your wrist is still any use
Yes, once your doctor gives you a range that is healthy for you on your medicine: the count at your wrist is then what you check against it, in place of the chart's. To take it, place your index and middle fingers on the inside of your opposite wrist, below the base of the thumb, count the beats you feel for 10 seconds and multiply by 6.
If you have heart disease, the count does a second job: taking your pulse during exercise lets you see whether your heart is beating at a safe exercise rate, a rate to know alongside your resting pulse rate. If your pulse is too high, slow down, then take it again after exercise to see whether it comes back to normal within about 10 minutes. Without heart disease, ask your doctor whether these checks apply to you.
Signs to stop for, and when to call 911 or your doctor
If you have heart disease, warning signs that exercise is putting too much strain on your heart include:
- dizziness or lightheadedness
- chest pain
- an irregular heartbeat or pulse
- shortness of breath
- nausea
If any of them comes on, stop what you are doing and rest. Know how to treat your heart symptoms if they happen, and if your doctor has prescribed nitroglycerin pills, always carry some with you. Whether or not you have heart disease, treat chest pain as a possible heart attack: chest discomfort is among the most common symptoms of a heart attack, it can feel like pressure, squeezing, fullness or pain, and it may go away and come back. Discomfort elsewhere in the upper body and shortness of breath are among the most common symptoms too, and you may also have other symptoms, such as nausea, dizziness, lightheadedness or a cold sweat. For the sign you have, take the first step in the table that fits:
| What you notice | What to do |
|---|---|
| Chest pain or discomfort, even if it eases when you stop | Call 911, even if you are not sure it is a heart attack |
| Pain or discomfort in either arm or both, your back, shoulders, neck, jaw or upper stomach, shortness of breath, nausea, dizziness, lightheadedness or a cold sweat that you think could be a heart attack | Call 911 |
| With heart disease, any other sign that is very bad, or that does not go away when you stop | Let your doctor's office know right away |
| With heart disease, numbness in your arms, gas pains or indigestion, feeling sweaty or losing color, or finding you cannot exercise as much as you are used to | Contact your doctor's office |
| With heart disease, any other sign that goes away once you rest | Write down what you were doing and the time of day, and share it with your doctor |
Measuring effort by your breath, or by a score from 0 to 10
Effort can also be judged by your breathing and your voice, or by a number you give it from 0 to 10, and neither uses your pulse. Intensity affects your breathing as well as your heart rate, and the talk test judges it by the breath you have left for words. As a rule of thumb, at moderate intensity you have the breath to talk but not to sing, and at vigorous intensity you can get out only a few words before you have to pause for a breath. For the number, rate the effort from 0, the effort of sitting, to 10, maximal effort: relatively moderate activity is a 5 or 6, and relatively vigorous activity begins at a 7 or 8.
The talk test is a simple way to measure relative intensity, the effort an activity takes for you, and the 0 to 10 scale measures it too. Measured that way, an activity that is vigorous for a person of average fitness may only be moderate for a very fit person. Neither needs a heart rate range, so ask your doctor whether you can judge your sessions by them on your medicine (see How hard does a walk have to be to count as moderate?).
Once your doctor has said exercise is safe for you, aim for at least 30 minutes of moderate aerobic exercise on most days to benefit your heart, with a target of 150 minutes a week, or at least 75 minutes a week if all your exercise is vigorous.
Questions for your doctor about exercise on your medicine
Your doctor is the one to ask what heart rate range is healthy for you while you exercise. If it has been a while since you were active, check with your doctor before starting any new activity. Check with your doctor too, to make sure you are healthy enough for exercise, if your conditions include high blood pressure, diabetes, a heart condition or another health problem, so taking medicine for high blood pressure is reason enough to check.
Take these with you:
- What heart rate range is healthy for me during exercise, on this medicine?
- Is my medicine one of the types that can lower my target heart rate?
- Can I judge my sessions by the talk test or a 0 to 10 effort rating?
- If I have heart disease, what are my resting pulse rate and a safe exercising pulse rate, and what should I do if my pulse is slow to come back to normal after exercise?
If you have heart disease, ask whether it is OK before you do a harder activity. You may also be eligible for a formal cardiac rehabilitation program, so ask your doctor whether you can have a referral. If you check your blood pressure at home as well, bring that log to your doctor too (see Why your prescriber needs your home blood pressure log).
If NicoCares looks after your weight care, send the care team the name of your blood pressure medicine, and any range your doctor sets, through Spruce, the secure messaging app NicoCares invited you to by email. NicoCares promises no reply time for those messages, so a warning sign during a session is never one to message about first: take the step the table gives for it, and tell the care team afterwards.
