Health Screening and Risk Factor Analysis Flashcards
Pre-participation Screen (ASCM guidelines- older version)
- Determine readiness for activity
- Identify signs and symptoms of disease
- Coronary/atherosclerosis cardiovascular risk factor analysis
- Disease Risk classification
- Medical History
- Lifestyle History
- Informed Consent
Pre -participation (6 steps)
- The individual’s current level of structured PA
- The presence of major signs and symptoms suggestive of CV, metabolic, or renal diseases
- Desired exercise intensity
- Medical history
- Lifestyle history
- Informed consent
Step 1:
Determine Readiness for Activity (PAR-Q)
PAR-Q
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
Step 2
Identify signs and symptoms of Disease
looking for cardiovascular, pulmonary, or metabolic disease or symptom thereof
CVD
Cardiac, peripheral artery or cerebrovascular disease (Stroke)
Pulmonary Disease
COPD
Asthma
Interstitial lung disease
Cystic Fibrosis
Metabolic
Diabetes (type 1 or 2) Thyroid disorders (ie hyper and hypothyroidism) Renal or Liver disease
Major suggestive signs or symptoms suggestive of disease (Not risk factors)
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
Pain; discomfort character
character: constricting squeezing burning heaviness or heavy feeling
Pain/discomfort location
substernal, across midthorax, anteriorly; in one or both arms, shoulder; in neck, cheeks, teeth; in forearms, fingers in interscapular region
ischemia
lack of blood flow to certain areas–> lack of O2—>cells die—->we die
Pain/discomfort provoking factors
exercise or exertion, excitement, other forms of stress, cold weather, occurrence after meals
Dyspnea
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
Syncope:
- 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
Orthopnea
-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
3 ways to increase venous blood return
- skeletal muscle pump (contract the muscles)
- respiratory pump (Breathe harder)
- Vasoconstriction (squeeze)
Ankle Edema
-swollen ankles
General Edema
Nephrotic syndrome, severe heart failure or hepatic cirrhosis
Unilateral edema:
from venous thrombosis or lymphatic blockage
Bilateral ankle edema
at night is a characteristic sign of heart failure or bilateral chronic venous insufficiency
Palpitation
unpleasant awareness of forceful or rapid beating of the heart
Tachycardia
heart beating more than 100 times per minute
brachycardia
slow heart rate
Intermittent Claudication
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
Known Heart Murmur
suggests Valvular or other cardiovascular disease (hypertrophic cardiomyopathy)
Aortic Stenosis
Cause of exertion-related sudden cardiac death
Aortic Stenosis
valve doesn’t close all the way
Step 3:
ACSM pre-participation screening ALGORITHM
- identify who can participate
- identity individuals who have signs or symptoms of suggested disease
- Identify desired exercise intensity
Cardiac Rehab or Medical Fitness Facilities Patients
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
Lowest Risk stratification criteria (Exercise Testing)
- 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
Lowest Risk stratification criteria (NON Exercise Testing)
- 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
Rest Ejection Fraction
Stroke Volume/ End Diastolic Volume
Moderate Risk stratification criteria (W/ exercise testing)
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
Moderate Risk stratification criteria (W/out exercise testing)
Rest Ejection Fraction 40% to 49%
Q wave
Ventricle Depolarization/atrial repolarization
R-R interval
time between heartbeats
S wave
Depression after the ‘R’ peak
T-wave
Ventricle Repolarization
Highest Risk stratification criteria (w/ exercise testing)
- 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)
Abnormal hemodynamics
hypotension after workout, abnormal dynamics of blood flow.
Highest Risk stratification (w/out exercise testing)
- Rest ejection fraction <40%
- History of cardiac arrest or sudden cardiac death
- Complex dysrhythmias during rest
Atherosclerotic Cardiovascular Disease (Risk Factors)
8 Possible Risk
CVD- used to be called coronary heart disease
Age Risk Factor
Men > or equal to 45
Women > or equal to 55
Cigarette Smoking Risk Factor
Current smoker or those we quit within the last 6 months, or exposed to smoke in the environment
Dyslipidemia Risk Factor
LDL > or equal to 130 mm HG
HDL <40 mm HG
or total cholesterol >or equal to 200 mm HG
Hypertension Risk Factor
Systolic > or eal to 140 mm HG
and diastolic > or equal to 90 mm HG
or they are on hypertension medication
Obesity Risk Factor
BMI > or equal to 30
Family History Risk Factor
Father: <55 years old
Mother: <65 years old
if they experienced an MI, coronary revascularization or sudden death before these ages
Definition of first degree relative
Sibling or Child
Physical Inactivity Risk Factor
Not participating in at least 30 min of moderate intensity,3 times a week for 3 months
Hemodynamics
The dynamics of blood flow
Resting Ejection Fraction
A factor for non-exercise risks
Step 4 Medical History
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
Step 5. Lifestyle History
PA history/involvement and lifestyle behaviors like alcohol and drug use
Step 6 Informed Consent
Explain the risks and behaviors
Clinical tests (6 of them)
- Physical examination
- Blood chemistry profile
- Blood pressure assessment
- 12-lead ECG
- Graded exercise test
- Additional lab tests
Risk
potential hazards
Benefit
Why should this person do this test, what information will it give them
What to say when terminating the testing
“The participant is free to withdraw from the procedure at any time’
Graded Exercise Test is recognized for…
- 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
The test: Patients should be able to… (Minimum)
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
Minimum Recommendations when test isn’t available (Aerobic Training)
- 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
Minimum Recommendations when test isn’t available (Strength Training)
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
barely detectable breathing, increased depth of breath
light work… 1.5-3 METS
Can pass the talk test (Mod)
2-6 METS
Can pass the talk test (Vig)
6 -9 METS
Heavy Breathing
High intensity (>9 METS)
Exercise Programming Steps
- assess current health status
- assess current level of PA
- Identify exertional symptoms that limit PA
- Eval physical function and performance
ADL
activities of daily living
NYHA
New York Heart Association
RPE
rate of perceived exertion
Approximate range of aerobic capacity
ranges from <10 to > or equal to 20… ‘Needs aid in physical functioning to mild to no aid in physical functioning
Tests of physical functioning
walking test Gait speed Core and lower-extremity functional test Chair to stand test timed up and go test Arm curl test
Step 6 to exercise programming
considerations for formal exercise tolerance test
- low level constant increment protocol
- continuous low -level ramping protocol
- branching low level protocol
Step 7 for exercise programming
Consideration for program referral
Step 8 for exercise programming
develop a strategy for monitoring progress
