Ch 2 Flashcards
Objectives
• Understand the process and outcomes of the ACSM Preparticipation Physical Activity Screening
• Explore importance of and issues with preparticipation physical activity screening
• Investigate the tools that may be used (PAR-Q+, Health history questionnaire
• Determine course of action with client once risk has been established
• Discuss concept of absolute and relative contraindications to exercise testing
Introduction
• Preparticipation PA screening helps ensure that the risks of an increased physical activity do not outweigh the benefits of this healthy behavior
• The process of preparticipation PA screening has been increasingly professionalized over time and many changes to the approach have occurred
• This chapter explores the preparticipation PA screening concept so the EP-C can make informed decisions about the readiness of an individual to undertake PA
Importance of Preparticipation Screening
• Conducting preparticipation screenings is prudent to reduce the likelihood of the occurrence of negative events
• Preparticipation screening focuses on demographic and health-related information and completion of appropriate medical/health assessments
• Preparticipation screening is dynamic in part because efforts vary based on how the client presents with respect to health risk
Importance of Preparticipation Screening
• Some Reasons to Conduct Preparticipation PA Screenings
– ID those with contraindications to PA participation.
– ID those who should receive a formal evaluation and clearance
– ID those who should participate in a medically supervised PA program.
– ID those with other/significant health or medical concerns
.
History of PA Preparticipation Screening
• Guidelines have been published for many years and are important tools
• The two most widely recognized guidelines are put forth were by the ____ and the ____
• Guidelines are only recommendations and the EP-C should devise a screening scheme that best meets the needs of their clients and environments.
• ACSM guidelines have been modified over time to reflect current understanding and scientific evidence
Levels of Screening
• ACSM recommends screenings for anyone about to initiate a PA program
• Two primary screening levels
– Self-guided (no direct input from exercise
professional)
– Professionally supervised (involves interaction with exercise professional)
• Not mutually exclusive
– Self-guided efforts often lead an individual to seek
out an EP-C for professional guidance
Self Guided Screening
• This approach is suggested as a minimum starting point for anyone who wishes to increase their level of PA
• PAR-Q+
– A newly revised version of the original PAR-Q
• ePARmed-X+Physician Clearance Follow-Up Questionnaire
– An extension of the PAR-Q+ designed for use when PAR-Q+ responses suggest further medical clearance is appropriate
• Both tools are new and require ongoing evaluation and validation
2 pArQ sheets
Professional Supervised Screening
• The EP-C can be involved at lower levels of risk
• More advanced professionals should evaluate higher risk • Health History Questionnaire
– Represents a comprehensive evaluation of health and medical history
• Medical Examination/Clearance
– Led by a physician or other qualified professionals
– Particularly recommended for clients ____
.acsm, AHA
At higher risk
Health History Questionnaire (HHQ)
• Forms vary but should be tailored to fit needs of the program
• Should minimally assess client’s
– Family hx of CMR disease
– Personal hx of various diseases and illnesses
– Surgicalhx
– Past/presenthealthbehaviors(e.g.,smoking,PA)
– Current use of various medications
– Hx of S/S suggestive of CMR disease
Sheet.
PA History
• Current PA represents lower risk when compared to a sedentary lifestyle
• Current PA defined as occurring over the last 3 months
• PA threshold for lower risk status
– Frequency: 3 days per week
– Duration: 30 minutes or more
– Intensity: at least moderate (______% HR reserve or VO2max; RPE of _____)
YES or NO?
Known CV, Metabolic, or Renal Disease
• CMR diseases most relevant to screening
– Heart attack, surgery, catheterization, or angioplasty
– Pacemaker/implantable cardiac defibrillator/rhythm disturbance
– Heart valve disease, failure, or transplantation
– Congenital (from birth) heart disease
– Type 1 or 2 diabetes mellitus
– Renal disease such as renal failure
• Pulmonary? No longer listed
– Less likely to cause adverse event during exercise
YES or NO?
.40-60, 12-13
Major Signs/Symptoms Suggestive of CMR
• Presence of any sign or symptom indicates higher risk and should be medically cleared prior to initiating PA
• Eight Signs and symptoms most relevant to screening
– Pain or discomfort indicative of myocardial ischemia
– Dyspnea at rest or mild exertion
– Syncope or dizziness during exercise
– Orthopnea or paroxsymal nocturnal dyspnea
Chart
Pitfalls of ACSM Preparticipation Screening
• The greatest pitfall is the potential to overlook risk of some kind (e.g., S/S) that ultimately leads to an adverse event while under the supervision of the EP-C
• The EP-C can minimize risk by obtaining as much information as possible related to the client or patient
• Better to be conservative than endanger someone
• Conservativism must be balanced by concerns that
obstacles can drive the client away from PA
• One approach to address competing concerns: encourage low- to moderate-intensity program where overall risk is minimal before they undergo further medical evaluation
Recommendations Versus Requirements
• The goal of the GETP is to provide recommendations on how to screen participants not to provide requirements
• The EP-C should exercise caution and use their best judgment and when in doubt refer a client for medical evaluation and clearance
• The new guidelines have not yet been evaluated and thus exist as valuable guidance and recommendations rather than specific professional requirements
.
Contraindications to Exercise Testing
• The process of evaluating risk can lead to the identification of characteristics that make PA risky (thus contraindicated)
• These characteristics are known as contraindications and often revealed only through sophisticated medical testing
• Contraindications generally applied to exercise testing • Categories of Contraindications
– Absolute: present when risks outweigh benefits
– Relative: present when benefits outweigh risks
Chart of contraindicTions etc
What Does Contraindication Really Mean?
• Clinical characteristic that individual may have that might make PA and exercise testing more risky
• Ex: if an individual has unstable angina (chest pain that is not well controlled or is unpredictable), then if they exercise, their heart may become ischemic
– May lead to myocardial infarction (heart attack) • CV complications are rare, but still prudent to follow
contraindications listed
Repurposing Risk Factor Assessment
• ACSM guidelines no longer require CVD risk factor assessment is no longer required but are important for disease prevention and management
• New guidelines shift risk factor assessment away from use for risk stratification to determine exercise participation and towards use to identifying and managing CVD risk
• Additional value is provided by risk factor assessment
– Might impact exercise prescription
– Educates clients of their own health for the purposes
of lifestyle modification (diet, PA, smoking, etc.)
Review of Risk Factors For Atherosclerotic CVD
• Risk for future CVD is determined by risk factors
– Low Risk: 0 or 1 CVD risk factor
– Increased Risk: 2 or more CVD risk factors
• Important Notes:
– Only 1 positive risk factor can be assigned per area
– Positive does not mean “good”
• It means the factor is “present”
– Presence of elevated HDL-C offsets one positive risk factor
Review of Risk Factors For Atherosclerotic CVD • Age • Family History • Smoking Status • Sedentary Lifestyle • Obesity • Hypertension • Dyslipidemia • Diabetes • Elevated HDL-C (negative risk factor)
Summary
• Preparticipation PA screening is a process that may include health/medical history and informed consent
• The process prepares the client for the upcoming PA program
• There is a need to evaluate the client’s medical readiness to undertake the PA program planned for them
• Thus, preparticipation PA screening gives assurance that the client is ready and able to participate in PA
• It is important that the EP-C performs a preparticipation PA screening on their client
.
