L4 Contraindications to Exercise Conducting a Fitness Assessment PDF

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Contraindications to Exercise Conducting a Fitness Assessment When is it risky to exercise? -

During an acute febrile illness Complicated pregnancy Recovering from heat illness Too soon post-injury Unstable chronic disease

Absolute Contraindications to Exercise -

Recent MI or change in resting ECG Unstable angina Uncontrolled cardiac arrhythmias Symptomatic aortic stenosis Uncontrolled symptomatic heart failure Acute pulmonary embolus Acute myocarditis or pericarditis Suspected or known dissecting aneurysm Acute infections

Absolute Contraindications to Exercise -

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Recent MI or change in resting ECG; o Myocardial infarction = heart attack). Blocked coronary artery heart tissue dies interference of electrical activity Recent MI or change in resting ECG Unstable angina o Heart not getting adequate BF (& O2). Can lead to heart attack

Uncontrolled cardiac arrhythmias

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Symptomatic aortic stenosis o Obstruction of blood flow across the aorta because the aortic valve has thickened

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Uncontrolled symptomatic heart failure

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Acute pulmonary embolus

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Acute myocarditis or pericarditis o Inflammation of the pericardium (sac surrounding the heart) or myocardium (heart muscle)

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Suspected or known dissecting aneurysm o Blood vessel balloons and ruptures

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Acute infections

Relative contraindications to exercise -

Relative contraindications can be superseded in benefits outweigh risks of exercise. Use low-intensities only. Must be asymptomatic at rest. Use caution! Monitor! o Coronary stenosis o Stenotic valvular disease o Electrolyte abnormalities o Severe hypertension (180/110) o Tachycardia (>100bpm) or bradycardia (2mm ST segment depression o Any chest pain that in increasing o Physical or verbal manifestations of severe fatigue or shortness of breath o Wheezing o Leg cramps or intermittent claudication (3 on a 4-point scale) o Hypertensive response (SBP>230mmHg; DBP>115mmHg) o Less serious arrhythmias such a supraventricular tachycardia o Exercise-induced bundle branch block that cannot be distinguishes from ventricular tachycardia

BP during an Exercise Test -

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Normal response during graded exercise test o Progressive increase in SBP o ~10mmHg/MET o No change (slight reduction) in DBP Unexpected BP responses indicate problems at the heart or in the peripheral circulation

Things to look out for When SBP fails to increase as expected

Exercise-induced hypotension i.e. drop in SBP >10mmHg

Increase in DBP> 15mmHg, or DBP >115mmHg Post Exercise Procedures -

What it could mean? Myocardial ischemia, severe LV systolic dysfunction, aortic outflow obstruction Drug therapy (β-blockers) Severe myocardial ischemia, valvular heart disease, cardiomyopathy If no evidence of clinically significant heart disease then dehydration, antihypertensive therapy, prolonged strenuous exercise Worsening left ventricular function myocardial ischemia

At this stage, you should always use a cool down; (there are some test protocols in a clinical environment that do not use a cool down) Patient is seated or placed in supine positions Monitoring continued for at least 6-8 minutes If CET/ST then ECG must return to baseline HR and BP must return to near baseline Signs and symptoms must resolve The post-exercise period can provide important information for diagnosis and prognosis ECG changes, esp. ST segment changes HR recovery

Vasovagal Syncope in recovery -

Syncope = fainting What happens? o o o o

BP, and HR  to compensate But then HR due to a massive burst of vagal (PNS) activity This will compromise blood flow to the brain Dizziness/light-headedness (pre-syncope)  fainting and loss of consciousness

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Note: Signs (HR then ) and symptoms (paleness, pt feels warm, sweaty, nauseous or has blurred vision) precede fainting; Immediately lie client down and raise legs

Information to Record -

The following information is usually recorded o Symptoms reported o Reason for ending the text o Estimate of exercise capacity in METS o Pre Ex HR and BP o Exercise HR and BP response o Recovery HR and BP o RPE

A note on Professionalism -

Ethical (always ask permission) Be polite Know your client’s limits Listen to your client Observe your client It is the client’s needs, not yours...