Risk Stratification Flashcards
The PAR - Q+ is used as an ______ risk assessment tool.
initial
The questions in the PAR - Q+ are worded to obtain information that generally _____ an individual’s ____.
- stratifies
- risk
The PAR - Q+ ____ the assessment of risk, but we should perform a _____ ______ _____ ourselves as well.
- simplifies
- secondary risk assessment
Secondary risk assessment provides the health/fitness, clinical exercise, and health care professionals with important information for…
the development of an individual’s exercise prescription
Secondary risk assessment is important when making decisions about:
- the level of medical clearance
- the need for pre-exercise testing
- the level of supervision for exercise testing and exercise program participation
3 parts to the secondary risk factor assessment:
- do we KNOW there is pathology present?
- do we SUSPECT there is pathology present?
- are there other risk factors for CVD present? How many?
If we suspect that there is pathology present, then the patient immediately becomes…
high risk
Positive CVD risk factors (ACSM): Are they non-modifiable or modifiable?
- age (non-modifiable)
- family history (non-modifiable)
- cigarette smoking (modifiable)
- hypertension (modifiable)
- dyslipidemia (modifiable)
- prediabetes (modifiable)
- obesity (modifiable)
- sedentary lifestyle (modifiable)
Defining criteria for age:
- men: > (or equal to) 45 years
- women: > (or equal to) 55 years
Defining criteria for family history:
- myocardial infarction (heart attack)
- coronary revascularization (heart surgery)
- sudden death
- before 55 years of age for father or first degree male relative
- before 65 years of age in mother or other first degree female relative
Other non-modifiable risk factors:
- sex
- ethnicity
How is sex a non-modifiable risk factor?
sex hormones protect against CVD
Why is the defining criteria for age lower in males than females?
- menopause: lose protection from sex hormones
- women often catch up to and surpass men after menopause
How is ethnicity a non-modifiable risk factor?
- genetic predisposition
- African Americans have higher risk of renal disease, CVD
- Asians have higher risk of high BP during pregnancy
Defining criteria for cigarette smoking:
current smoker or those who quit with the previous 6 months
Defining criteria for hypertension:
- SBP > (or equal to) 140/90 mmHg
- or DBP > (or equal to) 90 mmHg
- measured on 2 separate occasions
- or taking anti-hypertensive medication
Defining criteria for dyslipidemia:
- LDL > 3.37 mmol/l
- or HDL < 1.04 mmol/l
- or on lipid lowering meds
- if total serum cholesterol is all that is available, use > 5.18 mmol/l
Defining criteria for prediabetes:
- impaired fasting blood glucose of > (or equal to) 5.5 mmol/L
- or impaired glucose tolerance > (or equal to) 7.7 mmol/L
- confirmed on 2 seperate occasions
Describe the interactive effect between LDL and HDL.
- LDL = bad
- as LDL gets higher, risk goes up
- HDL = good
- regardless of where your LDL is, the risk comes down if you have elevated HDL
Positive risk factor vs negative risk factor:
- positive risk factor contributes to risk
- negative risk factor takes away from risk
- negative risk factor is a positive thing
Defining criteria for obesity:
- BMI: > (or equal to) 30 kg/m^2
- or waist girth: > 102 cm for men and > 88 cm for women
Defining criteria for sedentary lifestyle:
- not participating in PA
- or not meeting the min. recommendation of 30 min of moderate exercise at least 3 days of the week for the last 3 months
If information is absent….
it should be counted as a risk factor
Prediabetes is counted as a risk factor if:
- age > (or equal to) 45 years and BMI > (or equal to) 25a
- OR age < (or equal to) 45 years and BMI > (or equal to) 25 and additional risk factors
Negative risk factor for CVD:
person with serum HDL-C > 60 mg/dL (1.6 mmol/L)
Low risk (ACSM risk stratification):
- apparently healthy
- asymptomatic men and women who have < 2 (ie. 1 or 0) CVD risk factors
Moderate risk (ACSM risk stratification):
- increased risk
- asymptomatic men and women who have > (or equal to) 2 risk factors
High risk (ACSM risk stratification):
- known disease
- individuals with one or more signs/symptoms or known cardiovascular pulmonary, or metabolic disease
ACSM risk stratification has bearing on….
- medical screening
- how exercise assessments are carried out
Differences between ACSM and ESSA pre-exercise screening tool:
- stage 2 is optional
- PA level > (or equal to) 150 min/week = - 1 risk factor
- stage 3 is optional
- HDL cholesterol > 1.55 mmol/L = -1 risk factor
If there are extreme or multiple risk factors, the exercise professional should…
use professional judgement to decide whether further medical advice is required
Example of tertiary (other) risk assessment:
ACSM health status and health history questionnaire
ACSM health status and health history questionnaire includes:
- personal information
- ACSM health screen
- medical history
- family history
- medications
- lifestyle
- other health history information
Other tertiary (other) risk assessments:
- smoking
- alcohol
- physical inactivity
- diet
What is the name of the website that calculates your life expectancy after assessing risk assessments?
The Big Life Project
