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KIN 187 Clinical Exercise Physiology > Health Screening and Risk Factor Analysis > Flashcards

Health Screening and Risk Factor Analysis Flashcards

1
Q

Pre-participation Screen (ASCM guidelines- older version)

A
  1. Determine readiness for activity
  2. Identify signs and symptoms of disease
  3. Coronary/atherosclerosis cardiovascular risk factor analysis
  4. Disease Risk classification
  5. Medical History
  6. Lifestyle History
  7. Informed Consent
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2
Q

Pre -participation (6 steps)

A
  1. The individual’s current level of structured PA
  2. The presence of major signs and symptoms suggestive of CV, metabolic, or renal diseases
  3. Desired exercise intensity
  4. Medical history
  5. Lifestyle history
  6. Informed consent
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3
Q

Step 1:

A

Determine Readiness for Activity (PAR-Q)

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4
Q

PAR-Q

A

Physical Activity Readiness Questionnaire
7 questions
identify who needs medical clearance
-1 yes means that medical clearance is required
“NO” means that you are ready to be physically active

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5
Q

Step 2

A

Identify signs and symptoms of Disease

looking for cardiovascular, pulmonary, or metabolic disease or symptom thereof

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6
Q

CVD

A

Cardiac, peripheral artery or cerebrovascular disease (Stroke)

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7
Q

Pulmonary Disease

A

COPD
Asthma
Interstitial lung disease
Cystic Fibrosis

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8
Q

Metabolic

A 
Diabetes (type 1 or 2)
Thyroid disorders (ie hyper and hypothyroidism)
Renal or Liver disease
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9
Q

Major suggestive signs or symptoms suggestive of disease (Not risk factors)

A

Pain in chest, neck, jaw, arms, or other areas that may result from ischemia
Shortness of breath at rest
Dizziness or syncope
Orthopnea or paroxysmal nocturnal dyspnea
Ankle edema
Palpitations or tachycardia
Intermittent Claudication
Heart murmur
Unusual fatigue or dyspnea with usual activities

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10
Q

Pain; discomfort character

A

character: constricting squeezing burning heaviness or heavy feeling

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11
Q

Pain/discomfort location

A

substernal, across midthorax, anteriorly; in one or both arms, shoulder; in neck, cheeks, teeth; in forearms, fingers in interscapular region

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12
Q

ischemia

A

lack of blood flow to certain areas–> lack of O2—>cells die—->we die

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13
Q

Pain/discomfort provoking factors

A

exercise or exertion, excitement, other forms of stress, cold weather, occurrence after meals

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14
Q

Dyspnea

A

Shortness of breathe at rest or with mild exertion

  • an abnormally uncomfortable awareness of breathing
  • one of the principal symptoms of cardiac and pulmonary disease
  • during strenuous exertion in healthy, well-trained individuals
  • during moderate exertion in healthy untrained individuals
  • suggest left ventricular dysfunction and COPD
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15
Q

Syncope:

A
  • feeling dizzy and faint
  • defined by a loss of consciousness
  • caused by a reduced perfusion of the brain
  • result from cardiac disorders (during exercise) that prevent the normal rise or fall in cardiac output
  • may occur in healthy individuals as a result of a reduction in venous return to the heart
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16
Q

Orthopnea

A

-orthopnea is dyspnea occurring at rest in the recumbent position
-paroxysmal nocturnal dyspnea
(shortness of breath while sleeping)
symptoms of left ventricular dysfunction or sometimes COPD

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17
Q

3 ways to increase venous blood return

A
  1. skeletal muscle pump (contract the muscles)
  2. respiratory pump (Breathe harder)
  3. Vasoconstriction (squeeze)
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18
Q

Ankle Edema

A

-swollen ankles

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19
Q

General Edema

A

Nephrotic syndrome, severe heart failure or hepatic cirrhosis

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20
Q

Unilateral edema:

A

from venous thrombosis or lymphatic blockage

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21
Q

Bilateral ankle edema

A

at night is a characteristic sign of heart failure or bilateral chronic venous insufficiency

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22
Q

Palpitation

A

unpleasant awareness of forceful or rapid beating of the heart

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23
Q

Tachycardia

A

heart beating more than 100 times per minute

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24
Q

brachycardia

A

slow heart rate

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25
Q

Intermittent Claudication

A

the pain that occurs in a muscle with inadequate blood supply that is stressed by exercise

  • due to atherosclerosis
  • symptom of Coronary artery disease
  • its more of a sharp pain than a crampy pain
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26
Q

Known Heart Murmur

A

suggests Valvular or other cardiovascular disease (hypertrophic cardiomyopathy)
Aortic Stenosis
Cause of exertion-related sudden cardiac death

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27
Q

Aortic Stenosis

A

valve doesn’t close all the way

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28
Q

Step 3:

A

ACSM pre-participation screening ALGORITHM

  1. identify who can participate
  2. identity individuals who have signs or symptoms of suggested disease
  3. Identify desired exercise intensity
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29
Q

Cardiac Rehab or Medical Fitness Facilities Patients

A

are advised to use more in-depth risk stratification procedures
Criteria from American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)
- low, moderate and highest risk

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30
Q

Lowest Risk stratification criteria (Exercise Testing)

A
  • Absence of complex ventricular dysrhythmias during exercise testing and recovery
  • Absence of angina or significant symptoms
  • Presence of normal hemodynamics during testing/recovery (ex. appropriate increase and decrease of HR/systolic BP with increasing workloads and recovery).
  • Functional capacity > or equal to 7 METS
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31
Q

Lowest Risk stratification criteria (NON Exercise Testing)

A
  • Resting ejection fractioning > or equal to 50%
  • Uncomplicated myocardial infarction or revascularization procedure
  • Absence of complicated ventricular dysrhythmias, congestive heart failure, symptoms or postevent/postprocedure ischemia, and clinical depression
32
Q

Rest Ejection Fraction

A

Stroke Volume/ End Diastolic Volume

33
Q

Moderate Risk stratification criteria (W/ exercise testing)

A

Presence of Angina
Mild to moderate level of silent ischemia during Exer. Testing or recovery (,2mm from baseline for ST-segment depression)
Functional capacity <5 METS

34
Q

Moderate Risk stratification criteria (W/out exercise testing)

A

Rest Ejection Fraction 40% to 49%

35
Q

Q wave

A

Ventricle Depolarization/atrial repolarization

36
Q

R-R interval

A

time between heartbeats

37
Q

S wave

A

Depression after the ‘R’ peak

38
Q

T-wave

A

Ventricle Repolarization

39
Q

Highest Risk stratification criteria (w/ exercise testing)

A
  • Presence of complex ventricular dysrhythmias during exercise testing or recovery
  • Presence of angina or other significant symptoms
  • High level of silent ischemia (baseline >2mm)
  • Presence of abnormal hemodynamics (hypotension)
40
Q

Abnormal hemodynamics

A

hypotension after workout, abnormal dynamics of blood flow.

41
Q

Highest Risk stratification (w/out exercise testing)

A
  • Rest ejection fraction <40%
  • History of cardiac arrest or sudden cardiac death
  • Complex dysrhythmias during rest
42
Q

Atherosclerotic Cardiovascular Disease (Risk Factors)

A

8 Possible Risk

CVD- used to be called coronary heart disease

43
Q

Age Risk Factor

A

Men > or equal to 45

Women > or equal to 55

44
Q

Cigarette Smoking Risk Factor

A

Current smoker or those we quit within the last 6 months, or exposed to smoke in the environment

45
Q

Dyslipidemia Risk Factor

A

LDL > or equal to 130 mm HG
HDL <40 mm HG
or total cholesterol >or equal to 200 mm HG

46
Q

Hypertension Risk Factor

A

Systolic > or eal to 140 mm HG
and diastolic > or equal to 90 mm HG
or they are on hypertension medication

47
Q

Obesity Risk Factor

A

BMI > or equal to 30

48
Q

Family History Risk Factor

A

Father: <55 years old
Mother: <65 years old
if they experienced an MI, coronary revascularization or sudden death before these ages

49
Q

Definition of first degree relative

A

Sibling or Child

50
Q

Physical Inactivity Risk Factor

A

Not participating in at least 30 min of moderate intensity,3 times a week for 3 months

51
Q

Hemodynamics

A

The dynamics of blood flow

52
Q

Resting Ejection Fraction

A

A factor for non-exercise risks

53
Q

Step 4 Medical History

A 
Medical Diagnosis
Previous Physical Examination findings
History of Symptoms 
Recent illness, hospitalizations, , new medical findings, recent surgeries, 
Orthopedic Problems
current medications
Habits such as drug/alcohol use

Exercise/work/Family history

54
Q

Step 5. Lifestyle History

A

PA history/involvement and lifestyle behaviors like alcohol and drug use

55
Q

Step 6 Informed Consent

A

Explain the risks and behaviors

56
Q

Clinical tests (6 of them)

A
  1. Physical examination
  2. Blood chemistry profile
  3. Blood pressure assessment
  4. 12-lead ECG
  5. Graded exercise test
  6. Additional lab tests
57
Q

Risk

A

potential hazards

58
Q

Benefit

A

Why should this person do this test, what information will it give them

59
Q

What to say when terminating the testing

A

“The participant is free to withdraw from the procedure at any time’

60
Q

Graded Exercise Test is recognized for…

A
  • Detection of CAD in people with chest pain syndrome or potentially equivalent symptoms
  • Eval of anatomic and functional severity of CAD
  • prediction of CV events and all cause death
  • Eval of physical capacity and effort tolerance
  • Eval of exercise related symptoms
  • Assessment of chronotropic competence, arrythmias and response to implanted device therapy
  • Assessment of the response to medical interventions
61
Q

The test: Patients should be able to… (Minimum)

A

6 or 8 m gait >.6 m/s
8 sit to stand repetitions in 30 s
8 arm curls with a 4 kg mass
Ascending a flight of 10 steps in under 30 seconds
Chair sit and reach to the toes on both sides

62
Q

Minimum Recommendations when test isn’t available (Aerobic Training)

A
  • 2-4 METS
  • Exercise HR= resting HR +20 contractions/min
  • RPE no higher than 11-14 on the 6-20 scale (this is light to somewhat hard)
  • Start slow, go slow and be alert for symptoms
63
Q

Minimum Recommendations when test isn’t available (Strength Training)

A

2 sets of 30 s of sit to stand reps
2 sets of 8 arm curls with 4 kg mass
10 step ups 2 times
chair sit and reach 2 times, holding for 30 s

64
Q

barely detectable breathing, increased depth of breath

A

light work… 1.5-3 METS

65
Q

Can pass the talk test (Mod)

A

2-6 METS

66
Q

Can pass the talk test (Vig)

A

6 -9 METS

67
Q

Heavy Breathing

A

High intensity (>9 METS)

68
Q

Exercise Programming Steps

A
  • assess current health status
  • assess current level of PA
  • Identify exertional symptoms that limit PA
  • Eval physical function and performance
69
Q

ADL

A

activities of daily living

70
Q

NYHA

A

New York Heart Association

71
Q

RPE

A

rate of perceived exertion

72
Q

Approximate range of aerobic capacity

A

ranges from <10 to > or equal to 20… ‘Needs aid in physical functioning to mild to no aid in physical functioning

73
Q

Tests of physical functioning

A 
walking test 
Gait speed 
Core and lower-extremity functional test 
Chair to stand test
timed up and go test 
Arm curl test
74
Q

Step 6 to exercise programming

A

considerations for formal exercise tolerance test

  • low level constant increment protocol
  • continuous low -level ramping protocol
  • branching low level protocol
75
Q

Step 7 for exercise programming

A

Consideration for program referral

76
Q

Step 8 for exercise programming

A

develop a strategy for monitoring progress

KIN 187 Clinical Exercise Physiology (16 decks)

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