Chapter 2 Notes - Exercise Pre-participation Health Screening PDF

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Exercise Pre-participation Health Screening...

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Chapter 2 Exercise Preparticipation Health Screening

Important: The preparticipation health screening process is based on 1. The individual's current level of structured physical activity 2. The presence of major signs or symptoms suggestive of CV, metabolic, or renal diseases (Table 2.1) 3. The desired exercise intensity

Major Signs or Symptoms Suggestive of Cardiovascular, Metabolic and Renal Disease • Pain; discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may result from ischemia • Shortness of breath at rest or with mild exertion • Dizziness or syncope • Orthopnea or paroxysmal nocturnal dyspnea • Ankle edema • Palpitations or tachycardia • Intermittent claudication • Known heart murmur • Unusual fatigue or shortness of breath with usual activities Anginal equivalent - is a symptom such as shortness of breath (dyspnea), diaphoresis, extreme fatigue, or pain at a site other than the chest, occurring in a patient at high cardiac risk. Anginal equivalents are considered to be symptoms of myocardial ischemia. Symptom – described by the person Sign – measurable, such as heart rate, breathing rate Ischemia – inadequate blood supply to an organ – especially the heart Syncope – dizziness or temporary loss of consciousness caused by a fall in blood pressure Edema – swelling of ankles and feet Palpitations – rapid, strong, or irregular heartbeat due to exertion or illness Claudication – cramping in the leg induced by exercise, typically caused by obstruction of arteries AMI – acute myocardial infarction MSI – musculoskeletal injury SCD – sudden cardiac death

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This preparticipation process is based on the outcomes of a scientific roundtable sponsored by the American College of Sports Medicine (ACSM) in 2014 – The relative risk of a CV event is transiently increased during vigorous intensity exercise as compared with rest but that the absolute risk of an exercise-related acute cardiac event is low in healthy asymptomatic individuals (Figure 1.2) – Among adults, the risk for activity-associated SCD and AMI is known to be highest among those with underlying CVD who perform unaccustomed vigorous PA – Insufficient evidence is available to suggest that the presence of CVD risk factors without underlying disease confers substantial risk of adverse exercise-related CV events – CVD risk factor–based exercise preparticipation health screening may be overly conservative due to the high prevalence of risk factors and may generate excessive physician referrals, particularly in older adults • Exercise professionals are encouraged to complete a CVD risk factor assessment with their patients/clients as part of the preexercise evaluation (see Chapter 3)

Preparticipation Health Screening Preparticipation health screening before initiating PA or an exercise program is a two-stage process: 1. The need for medical clearance before initiating or progressing exercise programming is determined using the ACSM screening algorithm (see Figure 2.2) a) In the absence of professional assistance, interested individuals may use self-guided methods 2. If indicated during screening (see Figure 2.2), medical clearance should be sought from an appropriate health care provider a) The manner of clearance should be determined by the clinical judgment and discretion of the health care provider

Self-Guided Methods for Health Screen • •

Preparticipation health screening by self-reported medical history or health risk appraisal should be done for all individuals wishing to initiate a physical activity program. This self-guided method can be easily accomplished by using the PAR-Q+ (see Figure 2.1)

American College of Sports Medicine Preparticipation Screening Algorithm • The ACSM preparticipation screening algorithm (Figure 2.2) is a new instrument designed to identify participants at risk for CV complications during or immediately after aerobic exercise •

Although resistance training is growing in popularity, current evidence is insufficient regarding CV complications during resistance training to warrant formal prescreening recommendations

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– CV complications during resistance training, this risk cannot currently be determined but appears to be low Algorithm components – Classifying individuals who do or do not currently participate in regular exercise – Identifying individuals with known CV, metabolic, or renal diseases or those with signs or symptoms suggestive of cardiac, peripheral vascular, or cerebrovascular disease, Types 1 and 2 diabetes mellitus (DM), and renal disease – Identifying desired exercise intensity

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When medical clearance is needed • Refer client to physician • Testing is left to discretion and clinical judgement of the provider o Stress electrocardiogram (ECG) o Angiography • You may request written clearance with special instructions or restrictions for your client • Communication between physician and exercise professionals is strongly encouraged

Risk Stratification for Patients in cardiac Rehabilitation and Medical Fitness Facilities • •

Exercise professionals working with patients with known CVD in exercise-based cardiac rehabilitation and medical fitness settings are advised to use more in-depth risk stratification procedures Risk stratification criteria from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) are presented in Box 2.2

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