The bp is increased with UE exercise since the muscle contractions increase the peripheral vascular resistance to a greater degree than what is found in LE muscle contraction. Muscle volume has an impact, and the muscles in the UE are generally smaller in volume than those in the LE. When working with patients with compromised cardiac status one should always be cognizant of the impact on cardiac function of increased peripheral vascular resistance, as well as the negative impact of increased blood pressure with isometric exercise in the absence of adequate cardiac monitoring. In Quebec an excellent course is given regarding this topic (Exercise Prescription) by two physios from the Universite de Montreal.