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
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
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
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
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
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
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
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
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
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
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
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
13
Q
Lipids and Lipoproteins
A
-LDL is primary target of cholesterol-lowering therapy: powerful risk factor for CVD, LDL
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
15
Q
Pulmonary Function
A
- spirometry is simple and non-invasive
- recommended for all smokers >/45
- indications for spirometry noted table 3.5
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
