Chapter 2- Preparticipation Physical activity screening guidelines Flashcards
Preparticipation physical activity screening
Involves gathering and
analyzing demographic and health-related information on a client along
with some medical/health assessments such as the presence of signs and
symptoms in order to aid decision making on a client’s physical activity
future (3). The preparticipation physical activity screening is a dynamic
process in that it may vary in its scope and components depending on the
client’s needs from a medical/health standpoint (e.g., the client has some
form of cardiovascular, metabolic, and/or renal disease, abbreviated as
CMR) as well as the presence of signs and symptoms suggestive of CMR
disease (e.g., chest pain of an ischemic nature) and their physical activity
program goals (they currently participate in moderate physical activity for
the past 3 months
Importance of screening clients for participation in physical activity programs
-To identify those with medical contraindications (exclusion criteria) for
performing physical activity
-To identify those who should receive a medical/physical
evaluation/exam and clearance prior to performing a physical activity
program
-To identify those who should participate in a medically supervised
physical activity program
-To identify those with other health/medical concerns (i.e., orthopedic 72 injuries, etc.)
PAR-Q
-useful tool for
individuals to gauge their own “medical” readiness to participate in
physical activity programs
-However, since the PAR-Q may be best used to screen those who are at high risk for exercise and thus may need a medical exam, it may not be as effective in screening low- to moderate risk individuals - Thus, the PAR-Q has recently morphed into the PAR-Q+ with some word changes among the seven YES/NO questions to
better classify all individuals
ePARmed-X+Physician Clearance Follow-Up Questionnaire
-form was designed to be
used in those cases where a YES answer on one of the seven questions in
the PAR-Q+ necessitates further medical clearance using the self-guided
method.
-It is also worth noting, that not while required, the ePARmedX+Physician Clearance Follow-Up Questionnaire (Fig. 2.2) could be used
for medical clearance in a professionally supervised preparticipation
physical activity screening
Health History Questionnaire purpose
s necessary to use with a client to establish his or
her medical/health risks for participation in a physical activity program
(13,28). The HHQ, along with other medical/health data, is also used in the
process of preparticipation physical activity screening. The HHQ should
be tailored to fit the needs of the program as far as asking for the specific
information needed from a client.
What does the health history questionnaire assess?
- Family history of CMR disease
- Personal history of various diseases and illnesses including CMR disease
- Surgical history
- Past and present health behaviors/habits (such as history of cigarette smoking and physical activity)
- Current use of various drugs/medications
-Specific history of various signs and symptoms suggested of CMR
disease among other things
Medical examination/ clearance
For
-Clients who are
at a higher risk for exercise complications
Preparticipation Physical Activity Screening Process
1.individual’s past physical activity history
-The individual can be queried about his or her physical activity history
using the HHQ and/or by questioning.
- Evaluate for CMR disease
- assessed using the HHQ and/or by questioning. - in the process is
the assessment of the individual’s presence of signs and symptoms that can be suggestive of CMR disease
CMR disease
Cardiovascular
Metabolic
Renal
Preparticipation table for clients with no physical activity history
Physical activity history
No
For no CMR disease
- NO s/s you can start at light to moderate physical activity
- S/S present requires medical clearance then lt/mod physical activity
For CMR disease
- No S/S medical clearance then light/moderate PA
- IF s/s present medical clearance then light/moderate PA
Preparticipation table for clients with physical activity history
Physical activity history yes
For no CMR disease
-No S/S continue to moderate/vigorous physical activity
-S/S present stop for medical clearance
For CMR disease
- No S/S a medical clearance for vigorous physical activity is required
- Sign/symptoms present would require stoppage and medical clearance
Physical activity
Has to be within the last three months
Moderate physical activity
- 40-60% HRR
- 3-6 METS
- 12-13 RPE
CMR related disease/ conditions
- Heart attack
- Heart surgery
- cardiac catheterization or coronary angioplasty
- Pacemaker/implantable cardiac defibrillator/rhythm disturbance
- Heart valve disease
- Heart failure
- Heart transplantation
- Congenital heart disease (congenital refers to birth)
- Diabetes, type 1 and 2
- Renal disease such as renal failure
Signs/ symptoms of CMR disease
- Pain or discomfort in the chest, neck, jaw, arms, or other areas that may be due to ischemia or lack of oxygenated blood flow to the tissue, such as the heart
- Dyspnea: shortness of breath
- Syncope: fainting, and dizziness during exercise may indicate poor blood flow to the brain due to inadequate cardiac output from a number of cardiac disorders
- Orthopnea: trouble breathing while lying down.
-Ankle edema, or swelling, that is not due to injury is suggestive of heart
failure, a blood clot, insufficiency of the veins, or a lymph system blockage (27). Generalized edema (known as anasarca) occurs in individuals with the nephrotic (from the kidneys) syndrome, severe heart failure, or hepatic (from the liver) cirrhosis.
- palpitations/tachycardia: both refer to rapid beating or fluttering of the heart
- Intermittent claudication refers to severe calf pain when walking
- Heart murmurs: unusual sounds caused by blood flowing through the heart
- unusual fatigue/shortness of breath
Bilateral ankle edema
most evident at night is a characteristic sign of heart failure or bilateral chronic venous insufficiency.
Unilateral edema
often results from venous thrombosis or lymphatic blockage in the limb
Vigorous exercise
-greater than or equal to 60% of your client’s functional capacity (≥6 METs, ≥14 on a 6–20 RPE scale, and cause substantial increases in heart rate and breathing)
Certification for exercise testing
AHA Advanced
Cardiac Life Support Certification) as well as experience in exercise
testing interpretation and emergency plan practice
Characteristics of patients at lowest risk for exercise participation
- absence of complex ventricular dysrhythmias during exercise testing and recovery
- absence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness, during exercise testing and recovery
- Presence of normal hemodynamics during exercise testing and recovery (i.e., appropriate increases and decreases in heart rate and systolic blood pressure with increasing workloads and recovery)
- functional capacity greater than or equal to 7 METs
Non exercise test finding
- resting ejection fraction less than or equal to 50%
- uncomplicated myocardial infraction or revascularization procedure
- absence of complicated ventricular dysrhythmias at rest
- absence of congestive heart failure
- absence of signs or symptoms of post event/post procedure myocardial ischemia
- absence of clinical depression
Characteristics of patients at moderate risk for exercise participation
Exercise test findings
- presence of angina, shortness of breath, light headedness, or dizziness occurring only at high levels of exertion 7 or more METS
- mild-moderate level of silent ischemia during exercise testing or recovery
- functional capacity less than or equal to 5 METS
Nonexercised Test findings
- Rest ejection fraction 40%-49%
Characteristics of patients at high risk for exercise participation
Exercise test findings
- presence of complex ventricular dysrhythmias during exercise testing/recovery
- Presence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, dizziness at low levels of exertion [
absolute contraindications
- acute myocardial infarction within 2 days
- ongoing unstable angina
- uncontrolled cardiac arrhythmia with hemodynamic compromise
- active endocarditis
- symptomatic severe aortic stenosis
- decompensated heart failure
- acuter pulmonary embolism, pulmonary infarction, or deep venous thrombosis
- acute myocarditis or pericarditis
- acute aortic dissection
- physical disability that precludes safe and adequate testing
contraindications
clinical characteristic that individuals may have that may make physical activity
and thus, exercise testing, more risky than if the individual did not have
that clinical characteristic.
For instance, if an individual has unstable
angina, or chest pain (unstable angina refers to chest pain that is not well
controlled or predictable), then if they exercise their heart may become
ischemic which could lead to a myocardial infarction, or heart attack