pre-participation exercise screening Flashcards
purpose of exercise screening
Identify who should receive medical clearance before initiating an exercise program or increasing the frequency, intensity, and/or volume of their current program;
Identify those with clinically significant disease(s) who may benefit from participating in a medically supervised exercise program; and
Identify individuals with medical conditions that may require exclusion from exercise programs until those conditions are abated or better controlled.
pre part health screening
Pre-participation health screening before initiating PA or an exercise program is a two-stage process:
The need for medical clearance before initiating or progressing exercise programming is determined using the updated and revised ACSM screening algorithm and the help of a qualified exercise or health care professional. In the absence of professional assistance, interested individuals may use self-guided methods.
If indicated during screening, medical clearance should be sought from an appropriate health care provider (e.g., primary care or internal medicine physician, cardiologist). The manner of clearance should be determined by the clinical judgment and discretion of the health care provider. Preparticipation health screening before initiating an exercise program should be distinguished from a periodic medical examination, which should be encouraged as part of routine health maintenance.
ACSM screening algorithm
The new evidence-informed model for exercise pre-participation health screening is based on a screening algorithm with recommendations for medical clearance based on:
an individual’s current PA level,
presence of signs or symptoms and/or known CV, metabolic, or renal disease, and
the anticipated or desired exercise intensity.
These factors are included because among adults, the risk for activity-associated SCD and AMI is known to be highest among those with underlying CVD who perform unaccustomed vigorous PA. The relative risk of SCD and AMI during vigorous-to-near maximal intensity exercise is directly related to the presence of CVD and/or exertional symptoms and is inversely related to the habitual level of PA. The relative and absolute risks of an adverse CV event during exercise are extremely low even during vigorous intensity exercise in asymptomatic individuals.
gradual progress to vigorous activity following ACSM guidelines
When previously sedentary individuals initiate an exercise program, such individuals are strongly recommended to begin with light-to-moderate intensity (e.g., 2–3 metabolic equivalents [METs]) and gradually increase the intensity of exertion (e.g., 3–5 METs) over time (2-3 months), provided that the individual remains symptom free.
This “progressive transitional phase” will help to minimize the risk of musculoskeletal injury as well as allow sedentary individuals to improve their cardiorespiratory fitness without going through a period during which each session of vigorous exercise is associated with large spikes in relative CV risk
definitions
Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure.
Exercise is a subcategory of physical activity. Exercise is physical activity that is planned, structured, repetitive, and purposive in the sense that improvement or maintenance of one or more components of physical fitness is an objective
Sedentary behaviour is any waking behaviour characterized by an energy expenditure ≤1.5 metabolic equivalents (METs), while in a sitting, reclining or lying posture
One MET isdefinedas 1 kcal/kg/hour and is roughly equivalent to the energy cost of sitting quietly. A MET also isdefinedas oxygen uptake in ml/kg/min with one MET equal to the oxygen cost of sitting quietly, equivalent to 3.5 ml/kg/min
METS
categories
<1 to <1.5
sedentary + standing
lying sitting staitonary stanting
sitting quietly - work
<1.5-<3
light intensity p a
slow walking sitting tasks + mod effort
/ standing with minor effort
<3 - <6
mod intensity p a
moderate and fast walking
bicycle and walking
<6 vigorous physical acitvity very fast walking running swimming carrying heavy load
major signs or symptoms suggestive of CVD
Pain; discomfort (or other angina equivalent) in the chest, neck, jaw, arms or other areas that may result from ischemia
Shortness of breath at rest or with mild exertion
Dizziness of syncope
Orthopnoea or paroxysmal nocturnal dyspnoea
Ankle oedema
Palpitations and tachycardia
Intermittent claudication
Known hear murmur
Unusual fatigue or shortness of breath with usual activities
physical exam and lab tests
Physical examination
- Anthropometrics
- Heart rate and rhythm
- Blood pressure (seated, standing and supine)
- Auscultation of heart and lungs
- Palpation and auscultation of carotid, abdominal, and femoral arteries
- Abdominal evaluation (swelling, tenderness)
- Palpation and inspection of lower extremities for edema and presence of arterial pulses
- Tests of neurologic function including reflexes and cognition (as indicated)
- Inspection of the skin, especially of the lower extremities in known patients with diabetes mellitus
- Follow-up examination related to orthopedic or other medical conditions that would limit exercise testing
- Absence or presence of tendon xanthoma and skin xanthelasma
lab test
All Individuals
-Fasting serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides
-Fasting plasma glucose.
Individuals with Signs/Symptoms or Known Cardiovascular Disease
-Preceding tests plus pertinent previous cardiovascular laboratory tests as indicated (e.g., resting 12-lead ECG, Holter ECG monitoring, coronary angiography, radionuclide or echocardiography studies, previous exercise tests)
-Carotid ultrasound and other peripheral vascular studies as indicated
-Chest radiograph, if heart failure is present or suspected
-Comprehensive blood chemistry panel and complete blood count as indicated by history and physical examination
Patients with Pulmonary Disease
-Chest radiograph
-Pulmonary function tests
-ABG’s
