The Beta-Blocker Intake

Run today

• Confirm and expand the health history verbally: what the chest pain felt like, what the stress test showed, the date and wording of the clearance, and whether anything has changed since.
• Resting HR and BP before exercise; repeat BP after the session. He is on two blood-pressure medications, so a pre/post comparison is more informative than a single reading.
• RPE and talk-test familiarization. This is the highest-value 'assessment' for him, because it will become his intensity anchor.
• A light movement screen at bodyweight: overhead squat with a dowel, single-leg stance, seated shoulder mobility. Look for pain and gross asymmetry, not for a score.
• Waist circumference, offered rather than imposed.

Defer

• Any submaximal HR-based aerobic test (YMCA cycle, 3-minute step, Rockport walk). Beta-blockade flattens the HR-to-workload relationship these tests depend on, so the estimate would be confidently wrong. A wrong number is worse than no number.
• 1RM or any maximal testing. He is cleared for moderate intensity only and is deconditioned.
• Skinfolds or body-fat testing at week one. It is optional data, and with a client who is nervous about judgment, the cost to rapport is likely higher than the value of the measurement.

Reasoning: the goal of intake is to establish a safe baseline and a relationship, not to complete a battery. Every test you add should change what you do next week; the ones above don't.

On paper, 220 − 52 = 168 bpm, and that is the number he expects to hear. Do not hand it to him as a training target. Metoprolol blunts both resting and exercise heart rate, so his HR at any given workload will sit well below what the age formula predicts, and his true HRmax is likely different as well. If you build zones off a predicted max, you will systematically under-prescribe: he could be working genuinely hard at 110 bpm while your chart calls it easy. His resting HR of 58 is the drug and his fitness talking together, not a clean baseline.

What to use instead

• RPE 11–13 on the 6–20 scale for the first several weeks, calibrated by the talk test: full sentences comfortably = aerobic; short phrases = threshold; gasping = back off.
• Direct observation - breathing rate, facial color, speech, whether he can answer a question.
• If you record HR at all, treat it as a within-person trend (his 118 today versus his 118 in six weeks at a heavier load), never as a percentage of a predicted maximum.

Explain it to him plainly: 'Your medication changes how fast your heart beats, so we'll use how hard you feel like you're working instead of a formula.' Document the decision so the next person reading the file understands why no HR zones are written down.

It authorizes programming and supervision of moderate-intensity aerobic and moderate-intensity resistance exercise, which is exactly what his goal requires. You can build a plan at RPE 11–13, roughly 20–30 minutes of aerobic work 3–4 days per week plus light resistance training, and progress it within moderate limits.

It does not authorize maximal or near-maximal testing, vigorous-intensity training, or anything that pushes him past moderate without a new conversation with his physician. 'Cleared' is not a permanent state: it is tied to his condition, his medications, and the date it was written. If his symptoms change, his medications change, or he later wants to train vigorously, re-screen and go back to the physician.

Also outside your scope: interpreting the stress test results, adjusting anything about his medications, or telling him his chest pain 'sounds like nothing.' If he describes symptoms, you report them to him as something to raise with his doctor, not as a diagnosis.

Document: the date of clearance, who issued it, the specific restriction ('moderate intensity'), and where the written copy is stored. If a question ever arises about why he was trained the way he was, that record is the answer.