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DPT 728 Clinical Exercise Physiology > Pre-Exercise Evaluations > Flashcards

Pre-Exercise Evaluations Flashcards

1
Q

Introduction to Pre-Exercise Evaluations

A
  • serves as bridge between health appraisal/risk stratification and exercise testing and prescription
  • consists of: medical hx, physical exam, lab tests
  • abbreviated versions often used in low risk populations seen in health and fitness settings
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2
Q

Medical History

A
  • thorough and include…
  • medical dx
  • previous exam findings
  • hx of symptoms
  • orthopedic problems
  • medications, drug allergies
  • other habits (caffeine, tobacco, recreational drug use)
  • exercise history
  • work history
  • family hx of cardiac, pulmonary, metabolic diseases
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3
Q

S&S of Disease and Medical Clearance

A
  • ask clients if they have any conditions or symptoms

- refer to physician to obtain signed medical clearance/prescription before any exercise testing or participation

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4
Q

Analysis of Medical Hx

A
  • evaluate each item in ASCP table 2.1 carefully
  • guidelines for: BP, blood cholesterol levels
  • subtract 1 from total positive risk factors if HDL greater than or equal to 60
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5
Q

Medical Hx and Disease Risk Classification

A
  • based on results of coronary risk factor analysis
  • should classify clients as low, moderate, or high risk
  • low: asymptomatic with no more than 1 major risk factor (males younger than 45, females younger than 55)
  • moderate: older individuals or those having 2+ risk factors (males older than or as old as 45, females older than or as old as 55)
  • high: 1+ S&S of CV and pulmonary disease or individuals with known CV, pulmonary, or metabolic disease
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6
Q

Thoughts on Lifestyle Evaluation

A
  • must obtain information concerning client’s living habits
  • appropriate exercise prescription depends upon it
  • used to pinpoint patterns and habits needing modification
  • also used to assess client’s likely adherence to program
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7
Q

Clinical Tests

A
  • test battery will vary depending on clinical setting, focus of testing, etc
  • testing often includes: physical, lab tests, resting BP, EKG, graded exercise tests
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8
Q

Physical Examination

A
  • prospective participants should obtain physician exam and medical clearance if high risk
  • PT should include thorough systems review with particular emphasis on CP systems
  • medical exam commonly consists of: medical Dx, previous exam findings, history of symptoms, orthopedic problems, medications, habits, exercise and work history, and family history of cardiac, pulmonary, or metabolic diseases
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9
Q

Lab Tests: Low and Moderate Risk Individuals

A
  • fasting total cholesterol, LDL, HDL, triglycerides
  • fasting glucose: >/ 45 yo, younger overweight >/ 25 BMI
  • thyroid function
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10
Q

Lab Tests: High Risk Individuals

A
  • pertinent CV lab tests: resting 12 lead EKG, holter monitoring, coronary angiography, radionuclide or echocardiographic studies, previous exercise test results
  • carotid US and other peripheral vascular studies
  • additional blood tests: Lp(a), high-sensitivity C-reactive protein, LDL particle size and number, HDL subspecies
  • chest radiographs: particularly if heart failure known or suspected
  • comprehensive blood chemistry panel and CBC
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11
Q

Lab Tests: Common Additional Tests for Individuals with Pulmonary Disease

A
  • chest radiograph
  • pulmonary function tests
  • other specialized pulmonary studies: oximetry or blood gas analysis
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12
Q

Resting Blood Pressure

A
  • conducted to establish baseline hemodynamic function
  • record BP function for all clients
  • note use of any medications likely to affect BP status: diuretics, beta blockers, SNS inhibitors, vasodilators, ACE inhibitors
  • normal: SBP 160 DBP >/100
  • decisions should be made based on 2+ measures on 2+ occasions
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13
Q

Lipids and Lipoproteins

A

-LDL is primary target of cholesterol-lowering therapy: powerful risk factor for CVD, LDL

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14
Q

Blood Profile Analyses

A
  • common component of pre-exercise testing in clinical environments
  • use caution in comparing tests from different labs
  • meds commonly used to treat dyslipidemia and hypertension affect liver and kidneys
  • liver function values: alanine transaminase (ALT), aspartate transaminase (AST), bilirubin
  • kidney function values: creatinine, glomerular filtration rate, blood urea nitrogen (BUN), BUN/creatinine ratio
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15
Q

Pulmonary Function

A
  • spirometry is simple and non-invasive
  • recommended for all smokers >/45
  • indications for spirometry noted table 3.5
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16
Q

EKG

A
  • used to monitor heart rate at rest and during exercise
  • most systems provide a continuous digital display of heart rate
  • 3, 6, or 12 lead EKG may be used depending on clinical rationale
  • exercise professionals and healthcare providers can administer EKG
  • but qualified physician should interpret the results
17
Q

Graded Exercise Tests

A
  • CAD often not detectable from resting EKG
  • GXT should be performed by only trained, professionally certified personnel
  • use clients risk classification to determine: submax or maximal test, need for physician supervision
  • note conditions that are relative and absolute contraindications to testing
18
Q

ASCM Guidelines for GXT

A
  • for low-risk individuals of any age: submax testing may be done without physician supervision
  • results of max and submax tests provide a basis for exercise prescription
  • max GXT recommended for older men and women before starting a vigorous exercise program (men: >/ 45; women >/55; >/6 METS or >60% VO2max)
  • should be administered with physician supervision
19
Q

Contradictions to Exercise Testing

A
  • absolute: no testing until stabilized or treated

- relative: weigh risk/benefit ratio, look at other risks before deciding on testing

20
Q

Absolute Contradictions to Exercise Testing

A
  • recent significant change in resting EKG suggesting: significant ischemia, recent MI (within 2 days), other acute cardiac events
  • unstable angina
  • uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
  • uncontrolled symptomatic heart failure
  • severe symptomatic aortic stenosis
  • suspected or known dissecting aneurysm
  • acute myocarditis or pericarditis
  • acute pulmonary embolus or pulmonary infarction
21
Q

Relative Contradictions for Exercise Training

A
  • left main coronary stenosis
  • moderate stenotic valvular heart disease
  • known electrolyte abnormalities
  • severe arterial HTN
  • tachy or brady dysrhythmias
  • hypertrophic cardiomyopathy and other forms of outflow tract obstruction
  • high-degree AV block
  • ventricular aneurysm
  • uncontrolled metabolic disease
  • chronic infectious disease
  • neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
22
Q

Informed Consent

A
  • each client must sign informed consent
  • prior to any physical tests or exercise programs
  • form explains: purpose and nature of each test, any inherent risks of testing, expected benefits of these tests
  • also assures clients results will remain confidential
  • also clearly states all participation is strictly voluntary
  • parent or guardian must co-sign if client is under 18
  • all consent forms should be reviewed by institutional IRB or legal counsel
23
Q

Participant Instructions

A
  • typically complied in handout
  • drink plenty of fluids in prior 24 hours
  • avoid partaking in following within 3 hours: food, alcohol, caffeine, tobacco
  • rested prior to testing
  • clothing that permits freedom of movement
  • running/walking shoes
  • may have someone else to drive home
  • may be asked to forgo CV meds (requires MD approval)
  • bring list of all meds
24
Q

Take Home Messages

A
  • supervised exercise testing and prescription involves a complete and extensive screening process
  • pre-exercise testing evaluations include a thorough medical history and physical exam
  • blood pressure and lipid profiles are typically assessed before exercise testing
  • PTs should be able to appropriately screen individuals-including some hands on testing-before individuals participate in aerobic exercise programs

DPT 728 Clinical Exercise Physiology (13 decks)

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