Discussion 1: Health History & Contradictions to Exercise Testing Flashcards
What is the first step when an individual is referred for an exercise test?
Obtain a health history to identify safety and procedural concerns
What are the primary exceptions that predispose individuals to not benefitting from exercise?
People w/ unstable, undiagnosed, or untreated diseases of the cardio-respiratory or metabolic systems
What is the goal of a pre-exercise medical history?
- To detect the presence of unstable, undiagnosed, or untreated diseases of the cardio-respiratory or metabolic systems
- Identify any other physical impairments that may modify how you proceed w/ exercise testing
What are you looking for when taking a health history for exercise testing and prescription?
- Signs or symptoms of CV disease
- Risk factors of CV disease
- Contraindications to exercise testing
Characterize each risk stratification category.
- Low risk: no symptoms, < 1 risk factor, no restrictions
- Moderate risk: no symptoms, > 2 risk factors
- Okay for low to moderate intensity exercise
- Needs medical clearance for vigorous exercise
- High risk: known CV disease or has symptoms
- Needs medical clearance for any exercise
What does it mean for an individual to have a relative contraindication?
Individual can participate in exercise testing if it’s determined that the potential benefits from info gained from test outweigh the potential risks of participating in the test
What does it mean for an individual to have an absolute contraindication?
Individual should not participate in an exercise test at all until the condition is resolved
What is informed consent?
Individual needs to be fully informed and they need to willingly give full consent
List the risk factors for CV disease.
- Age:
- Men > 45 years old
- Women > 55 years old
- Fam history of heart probs, sudden death of male 1st deg relative < 55 years old or female relative < 65 years old
- Cigarette smoking
- Current smoker
- Quit w/in previous 6 months
- Sedentary lifesyle: not doing at least 30 mins moderate intensity exercise at least 3 days/week for at least 3 months
- Obesity: BMI > 30 kg m2
- Hypertension: SBP > 140 and/or DBP > 90
- Dyslipidemia
- Prediabetes
List the major signs and symptoms suggestive of CV, pulmonary, or metabolic disease.
- Pain, disconfort in chest, neck, jaw, arms
- Shortness of breath at rest or w. mild exertion
- Dizziness or syncope (temp loss of consciousness b/c fall in BP)
- Difficulty or labored breathing
- Ankle edema
- Abnormally rapid HR
- Intermittent claudation (limping b/c inadequate blood supply to muscle)
- Heart murmur
- Unusual fatigue or shortness of breath w/ usual activities
List the absolute contraindications to exercise testing.
- A recent, significant change in the resting ECG suggesting significant ischemia, recent myocardial infarction, or other acute cardiac event
- Unstable angina
- Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
- Symptomatic severe aortic stenosis
- Uncontrolled symptomatic heart failure
- Acute pulmonary embolus or pulmonary infarction
- Acute myocarditis or pericarditis
- Suspected or known dissecting aneurysm
- Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
List the relative contraindications to exercise testing.
- Left main coronary stenosis
- Moderate stenotic valvular heart disease
- Electrolyte abnormalities
- Severe arterial hypertension at rest
- Tachydysrhythmia or bradydysrhythmia
- Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
- Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
- High-degree AV block
- Ventricular aneurysm
- Uncontrolled metabolic disease (diabetes)
- Chronic infectious disease (HIV)
- Mental or physical impairment leading to inability to exercise adequately
What is special about HDL as a risk factor for CVD?
If above 40 –> subtract one risk factor
