Pre-Appraisal Screening

Question 1

6 step client-centered process designed to do?

Answer 1

help individuals adopt and maintain a physically active lifestyle using client-centered coaching and motivational interviewing techniques

Question 2

Range of assessment and prescription options offered for inactive and already active clients which are?

Answer 2

Get Active Questionnaire - establish an environment for success.

Evidence-based assessment protocols - determine a client’s current physical activity, fitness and lifestyle status.

Systematic process for guiding clients through stages of behaviour - facilitate the outcomes that the client’s desire.

Question 3

What are the CSEP-PATH: 6 Key Steps?

Answer 3

Step 1 - ASK
Get to know client

Step 2 - ASSESS
Conduct physical activity, fitness, and/or lifestyle assessment

Step 3 - ADVISE
Summarize results and discuss

Step 4 - AGREE
Devise an action plan

Step 5 - ASSIST
Increase Motivation and Overcome Barriers

Step 6 - ARRANGE
Provide continuing support

Question 4

What is the Client Information Sheet (CIS)?

Answer 4

Record info about client, emergency contacts, pre-participation screening (informed consent, GAQ, resting HR & BP, etc.), data specific to the PASB-Q, anthropometry, aerobic and MSK tests

Question 5

What is Pre-Meeting?

Answer 5

Clients should receive a Welcome Letter and package with key forms and (if applicable) pre-test instructions

Consider contacting client in advance to fill out informed consent and GAQ (avoids disappointment if they do need medical clearance)

PASB-Q can also be included; can prime clients to think about issues

AAL-Q can also be included; can help start a conversation on functional limitations

Question 6

What is Informed Consent?

Answer 6

Completion of this step is a required element for the CSEP-CPT

Describes the nature of the assessment and outlines the client’s responsibilities in the safe administration of the procedures

Should be read, understood, and signed prior to undertaking any part of the CSEP-PATH process

It is not a waiver form and the CSEP-CPT is professionally responsible at all times

Individuals under the age of majority (18 yrs) must have a parent or guardian sign the Youth Consent Form

All consents must be witnessed at the time of signing

The witness must be of the age of majority and witnessed by a 3rd party

Question 7

What is the Get Active Questionnaire?

Answer 7

Completion of the Get Active Questionnaire (or other evidence-based screening tool) is a required element for the CSEP-CPT

Client must read and answer questions on Get Active Questionnaire without interpretation from the CSEP-CPT

Form must be signed with ink pen and witnessed by 3rd party on page 2

Form is valid for 12 months or unless health condition changes

Client’s answers determine whether client falls within the CSEP-CPT Scope of Practice or requires clearance from a physician before either doing the active portions of the fitness assessment or starting an exercise program

Question 8

What does ‘apparently healthy’ mean?

Answer 8

No diagnosed condition

No overt signs and symptoms suggesting any potential underlying medical conditions

Able to exercise independently

Question 9

What is a low risk client?

Answer 9

(meets all this criteria) – 1 stable medically managed with no change in meds/treatment plan in the past 6 months and can exercise independently with benefits of PA outweigh risks.

Question 10

What is a high risk client?

Answer 10

(meets all this criteria) – may not be medically managed, may be symptomatic, treatment may have recently changed, may not be able to exercise independently, and the benefits of PA may not outweigh the risks. Thus, clinical monitoring and restrictions may be set in place. * CANNOT WORK WITH THESE CLIENTS

Question 11

Client’s current PA levels can be understood by?

Answer 11

GAQ & PASB-Q (*more in a moment)

Exercise assessment

**REMEMBER: CV risks w/ exercise lessen as individuals do more PA (more is better)

Question 12

What is the reference document of the GAQ?

Answer 12

Designed to give the client advice about any YES responses

Allows the client to make an informed decision about the appropriateness of PA/exercise

Or client may be prompted to obtain guidance from an appropriate health care provider or QEP

Question 13

What is the cut off for HR and BP?

Answer 13

Above 100bpm and 160/90 mmHg is the cut off for HR and BP! – if diagnosed and treated within last 6 months, then you can continue with client

Question 14

Reasons to Refer?

Answer 14

1) Client is not able to exercise independently

2) Client is at higher risk for an adverse event or has an unstable health condition

3) Client wishes to engage in an assessment and/or training program requiring maximal or near-maximal aerobic or anaerobic effort [including near-maximal resistance training]

4) Client has co-morbid conditions

5) Client has resting HR or BP above the screening requirements

6) You do not feel that you have the knowledge, skills, or abilities to work with the client

Question 15

OVERALL: Assisting the Client with a YES Response?

Answer 15

Ensure you are QUALIFIED
(advice is within the scope of practice of your certification)

AND

COMPETENT
(you have the knowledge, skills and abilities)

to provide such advice.

Otherwise refer client to another professional.

Ex. if they have been diagnosed with high HR/BP – ask if they have been diagnosed in the last 6 months and if they have been prescribed a treatment as well if they are taking their medication. Do they know how to take the medication?
Dim room, feet flat, sitting, take it 5 times with breaks in between and take away first 2 measurements and average the last 3. (this is because the inflation of the cuff for BP is shaped for the previous person who used it).

Ex. if they said yes to shortness of breath at rest must ask if they are taking medication with a diagnosis in last 6 months? Do they know how to use medication? If yes, then you are good to continue.

HAVE TO ASK MEDICAL HISTORY!

Question 16

Limitations of GAQ?

Answer 16

Possible for clients to have a diagnosed medical condition or take medications despite answering NO all of the questions on page 1.

MUST ask all clients about their medical history

Any suspected or diagnosed conditions?

If yes, any symptoms associated with the condition?

Taking any medications (over the counter or prescribed)?
If yes, taking meds as directed?

CHART all of this information !

Question 17

If you need to refer to a physician what form do you use? What is it?

Answer 17

Use the Physician Physical Activity Readiness Clearance form

Form is used when clients need medical clearance before proceeding with the fitness assessment (aerobic fitness and musculoskeletal protocols) or physical activity program

Client must take completed Get Active Questionnaire as well as the Physician Clearance Form to physician

Pages 1-2 is to be completed and signed by the physician

Page 3 provides additional information about the CSEP-CPT qualifications, the CSEP-PATH, and the Canadian Physical Activity (and Movement) Guidelines

Question 18

What is the Physical Activity & Sedentary Behavior Questionnaire (PASB-Q)?

Answer 18

Provides an approximation of clients’ physical activity and sedentary behavior for a typical week

Use in conjunction with health benefit rating (HBR) – helps identify where gaps might be

Question 19

What is the Abilities for Active Living Questionnaire (AAL-Q)?

Answer 19

Used to identify a disability that may require some accommodation on the part of the facility or qualified exercise professional to facilitate a successful first meeting

Consider sending the AAL-Q in the Welcome Package

The AAL-Q is not a risk screening device and not a replacement for the Get Active Questionnaire

A ‘yes’ answer on the AAL-Q has no bearing on the client’s Get Active Questionnaire, nor does it necessarily require a CSEP-CPT to refer the client to another professional.

Question 20

AAL-Q Determines?

Answer 20

Trouble:
-Moving from place to place
-Picking up objects or moving hands/arms
-Cooperating, talking or being active with others
-Controlling emotions and reactions to others
-Performing physical activity the way others do
-Understanding/remembering instructions

Or:
-Not strong enough to do physical activity
-Cannot move for longs periods of time
-Cannot move/stretch joints
-Vision, hearing, or verbal impairments
-Another sensory input impairment

Question 21

How to work with Clients with Disabilities?

Answer 21

The most appropriate terminology is usually that used by the client in describing his/her disability

Avoid using negative value judgments, such as phrases that describe the individual as “suffering from …” or “confined to a wheelchair”

Use normal conversational phrases that refer to specific activities (e.g., a client in a wheelchair will “go for a walk”)

If a client is offended by the use of a particular term or phrase, ask for an alternative from the client

Question 22

What are the Objectives of Step 1: ASK?

Answer 22

Gain insight on client’s goals and interests

Explain CSEP-PATH options and confirm the scope of the assessment

Discuss pre-assessment information / instructions

Complete pre-participation health-screening:
-Informed Consent & GAQ
-Observations
-Measure resting HR
-Measure resting BP

Question 23

Consider that your first ‘contact’ with a client may be over the phone or by email, how do you communicate?

Answer 23

Be prepared

Be sensitive to client

Be professional

Be authentic

Demonstrate interest and acceptance (active listening)

Engage client with strategic questions

Be inclusive and observant

Use open-ended questions

Active listening - strong and observational interview skills to help build rapport and better assessment of a client

Question 24

What are strategic questions? What does it help with?

Answer 24

Strategically engage with the client; goal at this step is to gain understanding of the client’s:

-Knowledge of the importance of physical activity to health

-Primary motivation (goals) and drivers (intrinsic or extrinsic)

-Level of commitment (readiness for change)

-Confidence that he/she can initiate and stick with physical activity plan (self-efficacy)

Question 25

How do you be inclusive?

Answer 25

Disability is a physiological impairment or environmental barriers result in a functional limitation By law in Canada, persons with disabilities have the right to equal treatment and equal access to facilities and services, including those offered by qualified exercise professionals. The existence of a disability does not necessarily mean the individual is ‘unhealthy’ or at greater risk for physical activity

Question 26

What are Open-Ended Questions to Engage Client?

Answer 26

Use open ended questions that start with ‘how’ or ‘what’ or ‘describe’ to get the client talking Demonstrate interest in the client’s responses to your questions and be non-judgmental What are some open-ended questions that you could ask your client at this stage of the PATH?

Question 27

Client’s have options with CSEP-PATH, what are they?

Answer 27

*Full fitness assessment: complete anthropometry, aerobic, and MSK assessment *Partial fitness assessment: choose fitness components to assess according to their needs and comfort level *Exercise program without a fitness assessment: move to Step 3 Lifestyle advice only: PASB-Q, SOC-Q, etc. *Completion of full or partial fitness appraisal or design of an exercise program assumes client meets screening requirements for physical activity readiness

Question 28

Lifestyle Advice: Questionnaires include?

Answer 28

Physical Activity & Sedentary Behavior Questionnaire (PASB-Q) Stage of Change Questionnaire (SOC-Q) Inventory of Lifestyle Needs and Activity Preferences Barriers to Physical Activity Healthy Sleep Assessment

Question 29

What are the Pre-Assessment Instructions?

Answer 29

(assuming the client has elected to have a full or partial fitness assessment) Wear clothes appropriate for exercise (e.g., shorts, t-shirt and running shoes) Do not smoke, eat or drink caffeinated liquids (e.g., coffee, tea, cola, or chocolate) within 2hrs Do not drink alcohol (e.g., beer, wine, or liquor) within 6hrs Do not engage in strenuous exercise within 6hrs of appointment

Question 30

Assessment should be cancelled or postponed if clients?

Answer 30

Demonstrate difficult breathing at rest Cough persistently Are ill or have a fever Have lower extremity swelling Have clearly ignored preliminary instructions May be predisposed to unnecessary risk Female clients: All females should be asked – Is there is any reason to believe you could be pregnant at this time? If so, a completed GAQ for Pregnancy is required

Question 31

What is the Resting Heart Rate Protocol?

Answer 31

Completion of this step is a required element for the CSEP-CPT Key points: -Sit in a comfortable chair with arm supported and feet flat on floor for ~ 5 minutes -> use this time to ‘get to know’ client! Stethoscope: -Earpieces point forward -Placed over the sternum or second intercostal space on left side Take a 15 second count with 1st beat as ‘0’ Alternative is radial or carotid artery palpation

Question 32

What is the Resting Heart Rate Ceiling Limit?

Answer 32

RHR 99 bpm or less  proceed to next step of assessment RHR is >100 bpm ask your client to sit quietly for an additional 5 minutes; then repeat the procedure If RHR is still >100 bpm, do not proceed with active portions of the assessment & refer client to their physician with the Physician Physical Activity Readiness Clearance Form SCREENING REQUIREMENT: those with RHR >100 bpm should not proceed with active portion of the assessment

Question 33

What happens during One cardiac cycle?

Answer 33

each chamber goes through systole (contraction; blood ejected out through arteries) and diastole (relaxation; heart fills with blood) Frequency of cardiac cycle described by heart rate

Question 34

Portions of cardiac cycle?

Answer 34

Systolic pressure (SP): Arterial pressure of blood during ventricle contraction (systole) Diastolic pressure (DP): arterial pressure of blood during ventricle relaxation (diastole) Mean Arterial Pressure (MAP): average pressure of blood in arteries

Question 35

What is the Resting Blood Pressure Protocol?

Answer 35

Completion of this step is a required element for the CSEP-CPT Key points: -Same body position as resting HR -Choose appropriate size of cuff -Locate and note brachial artery by palpation -Wrap cuff evenly and snugly around upper left arm with the lower margin 2.5cm above antecubital fossa (elbow) -Take it on the left side because it is standard procedure. But you can also take on the right side if needed

Question 36

How to take BP?

Answer 36

While taking a radial pulse with one hand, rapidly inflate the cuff to 70 mmHg and then continue to inflate by 10 mmHg increments thereafter feeling for the radial pulse with each 10 mmHg inflation When the radial pulse is no longer palpable, inflate another 20-30 mmHg above this point Release the cuff pressure at a rate of about 2 mmHg / second The systolic blood pressure (SBP) is determined by the first perception of sound (1st Korotkoff sound) as the pressure drops The diastolic blood pressure (DBP) is determined when there is disappearance of sound (5th Korotkoff sound) Read SBP and DBP to the nearest 2 mmHg

Question 37

Things that affect the BP?

Answer 37

Cuff too tight Cuff over clothing Back/feet unsupported Feet not flat Not resting for 3-5 minutes Patient talking Laboured breathing Full bladder Pain Arm below heart level Arm above heart level

Question 38

Natural variations in BP include?

Answer 38

from one heartbeat to another (i.e., beat-to-beat variation) throughout the day (i.e., circadian rhythms) in response to stress, nutritional factors, drugs, disease, exercise, and momentarily from standing up sometimes the variations are large

Question 39

What is the Resting Blood Pressure Ceiling Limit?

Answer 39

SBP <160 mmHg & DBP <90 mmHg  proceed to next step SBP >160 mmHg and/or DBP >90 mmHg ask your client to sit quietly for an additional five minutes; then repeat the procedure If SBP >160 mmHg and/or DBP >90 mmHg, do not proceed with active portions of the assessment & refer client to their physician with the Physician Physical Activity Readiness Clearance Form SCREENING REQUIREMENT: those with SBP >160 mmHg and/or DBP >90 mmHg should not proceed with active portion of the assessment

Question 40

What to do with Clients with SBP between 140-160mmHg?

Answer 40

If client has not seen a physician recently about their BP, encourage them to discuss this recent resting BP reading with a physician. The QEP can still proceed with the fitness assessment. Hypertensive clients may have variability in blood pressure (BP) readings between arms; thus, it is recommended in this case that both arms are measured initially and then subsequently only the arm with the higher pressure should be used for BP monitoring

Question 41

What are the CPT Examination Tolerances?

Answer 41

Resting HR must be measured within ± 1 bpm over 15 s reading BP must be measured within ± 4mmHg

Question 42

What is the Role of CPT in Pre-Participation Health Screening?

Answer 42

Conducts prescreening to reduce liability exposure and inform exercise program -This should include, at minimum, use of an evidence-based screening tool to identify clients who should first seek advice from another professional; determination of medical history; measurement of resting HR (<100bpm) & BP (<160/90mmHg); assessment of current PA levels (regularly active or inactive) Works within his/her knowledge, skills, and abilities and ensures that this falls under established scope of practice Charts information about client’s medical history (hard copy or electronic record; must be dated/signed) Considers client’s risk of an adverse event (lower or higher risk) and takes steps to mitigate this risk (assuming this falls within QEP’s scope of practice)