Health Screening and Risk Factor Analysis Flashcards
What were the old guide lines for Exercise preparticipation Health Screening (7 steps)
- Determine readiness
- Identify signs and symptoms of disease
- Coronary/atherosclerotic cardiovascular risk factor analysis
- Disease risk classification
- Medical History
- Lifestyle history
- Informed Consent
What are the new guidelines for Exercise Preparticipation Health Screening (6 steps)
- The individuals 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
What is the purpose of health screening
There is risk inherent in any exercise program or exercise test
Detailed knowledge of your clients background and medical status allows you to prescribe exercise more effectively
What is step 1 (PARQ)
What is the purpose of it
What type of method is it
What does it involve
Determine readiness of activity
Purpose: To determine clients readiness for physical activity
Self guided method
7 questions
Identifies who needs medical clearance before fitness testing or exercise program initiation
One single yes means that medical clearance is required
No means you are ready to be physically active
What is step 2
What is the purpose of it
What is the definition
Identify signs and symptoms of disease
To identify those in need of medical clearance
Disease definition
Any established cardiovascular pulmonary or metabolic disease or symptom thereof
What are known diseases for CVD
Cardiac, peripheral artery (PAD)
Cerebrovascular disease (stroke)
What are known diseases for pulmonary
Chronic obstructive pulmonary disease (COPD)
Asthma
Interstitial lung disease
Cystic fibrosis
What are known diseases for metabolic
Diabetes
Thyroid disorders
Renal or liver disease
Is hypertension considered a known established cardiovascular disease
No
This is a risk factor that may or soon cause the previous disease - it is not a disease
Is obesity a disease
No
It is a risk factor
What are the major signs or symptoms suggestive of cardiovascular metabolic and renal disease
Pain/discomfort in chest, neck, jaw, arms or other areas that may result from ischemia
Shortness of breath
Dizziness or syncope
Orthopnea or paroxysmal nocturnal dyspnea
Ankle edema
Palpitations or tachycardia
Intermittent claudication
Known heart murmur
Unusual fatigue or dyspnea
The pain symptom has a ischemic origin if
Character:
Location:
Provoking factors:
Character: Constricting, squeezing, burning, heaviness
Location: Substernal, across midthorax, anteriorly in one or both arms, in neck, cheek, teeth, forearms, fingers, interscapular region
Provoking factors: Exercise or exertion, excitement, other forms of stress, cold weather, occurence after meals
What is ischemia
Lack of blood flow
Cells dying and causing pain
Dyspnea symptoms signs:
Classification/significance:
Shortness of breath 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 health well trained individuals
- During moderate exertion in healthy untrained individuals
What does dyspnea suggest the presence of
Left ventricular dysfunction
Chronic obstructive pulmonary disease
What is dyspnea
Shortness of breath
Syncope signs/symptoms
Classifications/significance:
Dizziness or feeling faint
- Loss of consciousness
- Caused by 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
What are the ways to increase venous return
Skeletal pump
Respiratory pump
Contractility of the veins - vasoconstriction
Orthopnea signs/symptoms
Classification/significance
Symptoms of:
Orthopnea or paroxysmal nocturnal dyspnea
- Orthopnea - dyspnea occuring at rest in the recumbent position
- Paroxysmal nocturnal dyspnea - dyspnea beginning usually 2-5 hr after the onset of sleep
Symptoms of:
Left ventricular dysfunction
Sometimes COPD
Ankle edema:
Classification/significance:
Flow limited
- Bilateral ankle edema at night - sign of heart failure or bilateral chronic venous insufficiency
- Unilateral edema - from venous thrombosis or lymphatic blockage
- General edema - nephrotic syndrome, severe heart failure or hepatic cirrhosis
Bilateral ankle edema at night is a sign of
Heart failure or bilateral chronic venous insufficiency
Unilateral edema comes from
Venous thrombosis
Lymphatic blockage
General edema is a sign of
Nephrotic syndrome
Severe Heart Failure
Nepatic cirrhosis
Classification/significance of Palpitations and tachycardia
What is it often a result from:
- Palpitations - unpleasant awareness of forceful or rapid beating of the heart
- Tachycardia, bradycardia of sudden onset
Result from anxiety state or high cardiac output state
Intermittent claudication classification/significance
Also known as:
Often due to:
The pain that occurs in a muscle with an inadequate blood supply that is stressed by exercise
Cramping
Due to:
Atherosclerosis
Coronary artery disease
Classification/significance of heart murmur
Valvular or other cardiovasuclar disease
- hypertropic cardiomyopathy
- aortic stenosis
- Cause of exertion-related sudden cardiac death
What are the ACSM preparticipation algorithm components (4)
Classify individuals who do or do not regularly exercise
Identify individuals with known CV, metabolic or renal diseases
Identify individuals with signs/symptoms suggestive of cardiac peripheral vascular, type 1/2 diabetes and renal disease
Identify desired exercise intensity
Someone who does not regularly exercise and has No CV, metabolic or renal disease AND no signs or symptoms requires…
No medical clearance
Light to moderate exercise
May progress to vigorous intensity exercise
Someone who does not regularly exercise and has known CV, metbolic or renal AND Asymptomatic requires…
Medical clearance
After medical clearance, light to moderate
May progress as tolerated
Someone who does not regularly exercise and has known CV, metbolic or renal AND has signs/symptoms requires…
Medical clearance
After medical clearance, light to moderate
May progress as tolerated
What are the 3 steps of diagnosing
- Does the person physically exercise
- Medical History
- Have sign or symptoms
Exercise professionals working with patients with known CVD in exercise based cardiac rehabilitation and medical fitness setting are advised to…
Use more in depth risk stratification procedures
Risk stratifications for patients with CV disease is broken down into…
Lowest risk
Moderate risk
Highest risk
What are the characteristics of patients at lowest risk for exercise participation WITH EXERCISE TESTING
Absence of complex ventricular dysrhythmias during exercise testing and recovery
Absence of angina or other significant symptoms
Presence of normal hemodynamics during exercise testing and recovery
Functional capacity is >= 7 metabolic equivalents (mets)
What are the characteristics of patients at lowest risk for exercise participation WITH NON EXERCISE TESTING
Resting ejection fraction >= 50%
Uncomplicated myocardial infarction or revascularisation procedure
Absence of:
- Complicated ventricular dysrthmias at rest
- Congestive heart failure
- Signs or symptoms of post event/post procedure ischemia
- Clinical depression
What are the characteristics of patients at Moderate Risk for exercise participation WITH EXERCISE TESTING
Presence of angina or other significant symptoms - shortness of breath, light headedness/dizziness orcuring only at high levels of exertion (>= 7 mets)
Mild to moderate level of silent ischemia during exercise testing or recovery (ST segment depression <2mm from baseline)
Functional capacity < 5 mets
What are the characteristics of patients at Moderate Risk for exercise participation WITH NON EXERCISE TESTING
Rest ejection fraction 40% to 49%
What are the characteristics of patients at Highest Risk for exercise participation WITH EXERCISE TESTING
Presence of complex ventricular dysrythmias during exercise testing or recovery
Presence of angina or other significant symptoms at low levels of exertion (< 5 METS)
High level of silent ischemia (ST segment depression >= 2mm from baseline)
Presence of abnormal hemodynamics with exercise testing or recovery
Presence of abnormal hemodynamics with exercise testing (highest risk) involves
with recovery involves
Chronotropic incompetence or flat/decreasing systolic BP with increasing workloads
Severe post exercise hypotension
What is post exercise hypotension
Dramatic reduction in blood pressure
What are the characteristics of patients at Highest Risk for exercise participation WITH NON EXERCISE
Rest ejection fraction <40%
History of cardiac arrest or sudden cardiac death
Complex dysrhythmias at rest
Complicated myocardial infarction or revascularisation procedure
Presence of congestive heart failure
Presence of signs or symptoms of postevent/postprocedure ischemia
Presence of clinical depression
With the different risk categories what does the person have to have in order to put them in a certain category
At least one of the issues to deem them that category
Hypertension new report as of 2017 has…
Which are
2 stages
stage 1:
SBP 130 - 139 mmHg
OR
DBP 80 - 89 mmHg
Stage 2:
SBP >= 140 mmHg
OR
DBP >= 90 mmHg
The new 2017 report states that SBP and DBP are for:
Normal
Elevated
Hypertension 1
Hypertension 2
Normal
SBP < 120 mmHg
AND
DBP < 80 mmHg
Elevated
SBP 120 - 129 mmHg
AND
DBP < 80 mmHg
Hypertension 1
SBP 130 - 139 mmHg
OR
DBP 80 - 89 mmHg
Hypertension 2
SBP >= 140 mmHg
OR
DBP >= 90 mmHg
What is step 3
Preparticipation screening algorithm
Risk factors
Risk stratification for patients with CVD
What is a risk factor
Sign, symptom or characteristic that increases or decreases the chance of developing a disease
What is a positive risk factor
What is a negative risk factor
Increase risk of disease
Decrease risk of disease
What is step 4
Medical history
What does medical history involve
Medical diagnosis
Previous physical examination findings
History of symptoms
Recent illness, hospitalisation, new medical diagnoses, surgical procedures
Orthopedic problems
Medication use including supplement including supplements and drug allergies
Other habits like caffeine alcohol tobacco or drugs
Exercise history
Work history
Family history
What is step 5
Lifestyle evaluation
What is involved with lifestyle evaluation
What physical activity are they doing
Other lifestyle behaviours and habits
e.g. smoking, diet and alcohol
What is step 6
Informed consent
What is the purpose of informed consent
What questions should they ask
To explain the risks and benefits of the assessment and to obtain permission for participation
What is the risk?
What is a benefit?
When to terminate the testing?
You don’t participate in regular exercise. And, you don’t have any known CV, metabolic or renal disease AND no signs or symptoms suggestive of these diseases. Following ACSM preparticipation screening algorithm, your recommended exercise intensity is moderate to vigorous level
False
Clint has a coronary artery disease, and he had an exercise testing at the cardiac rehab. The testing result indicates that he had 1.5mm of ST segment depression during exercise testing. He is at _______ based on risk stratification criteria
Moderate risk
Having dyspnea typically suggests the presence of ____
Left ventricular dysfunction
If your patient has unilateral edema, it indicates that he/she may have lymphatic blockage
True
________ is shortness of breath at rest in the recumbent position and is suggestive of cardiovascular disease
Orthopnea
Dona is a 54 years old woman and her father had a heart attack when he was 45 years old. Her risk factor for family history is ______
Positive Present
According to the new report from American Heart Association, Stage 1 hypertension is determined if
SBP is between 130 and 139 mmHg or DBP is between 80 and 90 mmHg
If your client’s HDL level is 45 mg/dL, his risk factor for dyslipidemia is absent neutral
True
Your client’s body weight is 220 lbs and height is 5’9’’. What is his body mass index
33 kg/m^2
You forgot to record your client’s weight and height on the file, but recorded information on gender and waist circumference. Can you identify your client’s risk factor for obesity
Yes
Your client’s body weight is 220 lbs and height is 5’9’’. How does the BMI classify the level of obesity
Obese Class 1
What is graded exercise test recognised for
Detection of CAD in people with CHEST PAIN syndromes or potentially equivalent symptoms
Evaluation of the anatomic and functional severity of CAD
Prediction of CV event and all cause death
Evaluation of physical capacity and effect tolerance
Evaluation of exercise related symptoms
Assessment of chronotropic competence, arryhthmias and response to implanted device therapy
Assessment of the response to medical interventions
CDD4 recommendations for evaluation of physical functions states that patients at a minimum should be able to:
6 or 8m gait > 0.6m/s
8 sit to stand repetitions in 30 secs
8 arm curls with a 4kg mass
Ascending a flight of 10 steps in under 30s
Chair sit and reach to the toes on both sides
What are the recommendations for activity when Test Not Available for aerobic training
Activities in the range of 2 to 4 METs
Exercise HR = resting HR +20 contraction/min
RPE no higher than 11 to 14
Start slow, go slow, and be alert for symptoms
What are the recommendations for activity when Test Not Available for strength training
2 sets of 30s of sit-to-stand repetitions
2 sets of 8 arm curls with 4kg mass
10 step ups 2 times
Chair sit and reach 2 times, holding for 30 secs
Intensity of physical activity and breathing for:
Light
Moderate
Vigorous
High
Light = 1.5-3 METs
Barely detectable increased depth
Moderate = 3-6 METs
Can pass the talk test
Vigorous = 6-9 METs
Cant pass the talk test
High = > 9 METs
Heavy breathing
What is Step 1 of the essential steps for exercise programming
Step 1: Assess current health status (history of the disease, current symptoms and physical and cardiovascular restrictions and treatments)
What is Step 2 of the essential steps for exercise programming
Step 2: Assess current level of physical activity
What is Step 3 of the essential steps for exercise programming
Identify exertional symptoms that limit physical activity
What is Step 4 of the essential steps for exercise
Evaluate physical function and performance
Mildly impaired to normal = >=6 METs
Moderately impaired, low functioning = 4-5 METs
Severely impaired, very low functioning = 3-4 Mets
Needs aid, debilitated = <=3 METs
What is Step 5 of the essential steps for exercise programming
Select recommended physical performance assessments
What are the commonly used tests of physical functioning
Walking test Gait speed test Core and lower extremity functional test Chair to stand test Timed up and go test Arm curl test
Someone who regularly exercises, has no CV, metabolic or renal disease AND no signs or symptoms what is required
Medical clearance not necessary
Continue moderate or vigorous intensity exercise
May progress following ACSM guidelines
Someone who regularly exercises, has known CV, metabolic or renal disease AND Asymptomatic
Medical clearance for moderate intensity exercise not necessary
Medical clearance (within the last 12 months if no chance in signs/symptoms) recommended before engaging in vigorous intensity exercise
Continue with moderate intensity exercise
Following medical clearance may progress as tolerated
Someone who regularly exercises, has signs or symptoms regardless of disease status is required
Discontinue exercise and seek medical clearance
May return to exercise following medical clearance
Progress as tolerated
