Kin 311: Lecture 2 Pre Screening and Risk Assessment

These flashcards cover key vocabulary terms related to fitness and health assessment as discussed in the lecture notes.

Pre-Screening

The process of identifying individuals at risk for cardiovascular events or injuries before beginning an exercise program.

ACSM

American College of Sports Medicine, which provides guidelines for exercise testing and prescription.

Cardiac Rehab

A supervised program that helps improve the health and fitness of people with heart problems.

Moderate Intensity Exercise

Physical activity that raises your heart rate to a level where you can talk, but not sing, while doing the activity.

Vigorous Intensity Exercise

Physical activity that causes a large increase in heart rate and breathing. You cannot say more than a few words without pausing for breath.

CVD Risk Factors

Attributes or conditions that increase the likelihood of developing cardiovascular disease, such as physical inactivity or high blood pressure.

Sudden Cardiac Death

An unexpected death caused by loss of heart function, often related to underlying cardiac conditions.

Dyspnea

Shortness of breath that can occur at rest or with exertion and may indicate underlying health issues.

Angina

Chest pain or discomfort resulting from reduced blood flow to the heart muscle, often provoked by stress or exertion.

Medical Clearance

A recommendation from a healthcare provider that a patient may safely engage in exercise based on their medical history.

Intermittent Claudication

Pain in the legs or buttocks that occurs during exercise due to inadequate blood flow, typically relieved by rest.

Risk Assessment

The process of evaluating individuals' health status based on personal and family medical history to determine exercise safety.

Exercise Paradox

The concept that while exercise can pose risks, it also offers profound health benefits for most individuals.

Orthopnea

Shortness of breath that occurs when lying flat but is relieved by sitting or standing.

Edema

Swelling caused by excess fluid trapped in the body's tissues, particularly noticeable in the legs or abdomen.

Arrhythmias

Irregular heartbeats that may be benign or indicative of underlying heart disease.

The Exercise Paradox

Refers to the phenomenon where physical activity increases the risk of acute cardiovascular events in individuals with cardiovascular disease, despite the well-established health benefits of regular exercise.

Why Pre Screen

Asses Safety, ID those who may need medical clearance or supervision, choose appropriate assessment, minimize risk, provide effective exercise program

What does a proper risk assessment require

A prediction of how things could go wrong and what you will do to mitigate those risks

How can we decide who needs medical clearance

Using the ACSM guidelines for exercise testing Pre- Participation screening

What are the two things that are asked about in the ACSM Pre- Participation screening

Individual's current level of exercise/physical activity and Presence of signs or symptoms and/or known disease cardiovascular disease, metabolic disease, renal disease

Examples of Cardiovascular disease (CVD)

Cardiac disease, peripheral vascular disease, cerebrovascular disease

Example of Metabolic Disease

• Diabetes (type 1 & 2)

• Thyroid disorders

• Renal or liver disease

Examples of Pulmonary Disease

• Chronic Obstructive Pulmonary Disease (COPD)

• Asthma

• Interstitial lung disease

• Cystic fibrosis

What are the 9 major symptoms of Cardiovascular Disease

Angina (chest discomfort), dyspnea, unusual fatigue, dizziness or syncope, edema, orthopnea or proximal nocturnal dyspnea, arrhythmias, intermittent claudication, known heart murmur

Angina

mismatch between supply and demand of blood in the heart which results in oxygen deficit

Characteristics of Angina

•Constricting

•Squeezing

•Burning

•“Heaviness”

•“Heavy Feeling”

•Broad and general

•Dull

•“knife like”

•Sharp

•Stabbing

•“Jabs” aggravated by respiration

Provoking factors of angina

• Exercise or activity

•Excitement

•Other forms of stress

•Cold weather

•Occurs after meals

•Is provoked by a specific position

•Comes on after completion of exercise

common pain locations related to angina

•Substernal

•Across mid thorax, anteriorly

•In on or both arms, shoulders

•Neck

•Cheeks, teeth

•Interscapular region

•One side sub mammary

•One side of the chest / thorax

When to send someone to the hospital for suspected angina

when it is Accompanied by

•Dyspnea

•Fast Irregular Heartbeat

•Sweating / pale / ashen in colour

•nausea / vomiting

•Light-headedness / sudden

weakness

• No previous diagnosis of heart disease

•Resolves with rest with no other

symptoms

•Unable to exclude that its heart related

•Unable to determine if MSK

Dyspnea (shortness of breath) at rest, with mild exertion or usual activities

An abnormally uncomfortable awareness of breathing

factors to consider with dyspnea

Typically occurs with moderate to strenuous exertion health trained/untrained adults, Abnormal when it occurs at levels of exertion not expected to evoke this symptom

When to send someone to the hospital for Dyspnea

• Sudden on set

• Doesn’t improve with rest

• Accompanied by

• Chest pain

• Weakness / Feeling Faint

• Nauseous

• Fast Irregular Heart Rate

• Confusion / Drowsiness

• Blue or ashen in colour

Unusual fatigue with usual activities

• May be benign and caused by deconditioning

• May signal of change in cardiovascular or metabolic disease

Factors to consider with unusual fatigue

•Often accompanied by dyspnea

•Activity level

•Sleep

•What’s normal for them?

•How many flights of stairs can you do?

•How many blocks can walk without stopping?

•Is it accompanied by other cardiovascular symptoms?

Dizziness or Syncope (loss of consciousness)

Can be caused by:

• A blunted or reduced cardiac output

• Results in reduced perfusion to the brain

Light headed

typically associated with poor blood pressure, or not enough oxygen in the brain

Dizziness

something that is more closely related to the vestibular complex in the ear

provoking factors of dizziness or syncope during exercise

may be cardiac disorder

provoking factors of dizziness or syncope after exercise

may be due to blood pooling in extremities

factors to consider with dizziness or syncope

•Hydration

•Medications (related to the heart)

•Blood pressure

•Heart Rate

•Level of exertion

Edema

Swelling cause by too much fluid trapped in the body’s tissues

characteristics of edema

generally occurs in the abdominal area and limbs, leading to a noticeable increase in size and discomfort.

factors to consider with edema

•Sudden change in weight > 2kg in 1-3

days

•Decrease in exercise tolerance

When to send someone to the hospital for edema

When it as accompanied by

•Dyspnea

•Irregular heartbeat

•Chest pain

•Fatigue

•Severe pain in affected leg(s) affecting ability to walk

Orthopnea

Dyspnea occurring at rest when laying

down, Relieved by sitting upright or standing

Paroxysmal Nocturnal Dyspnea

•Dyspnea beginning 2-5 hrs after sleep

•Relieved by sitting upright or standing

factors to consider for both orthopnea or paroxysmal nocturnal dyspnea

• Sudden change in weight > 2kg in 1-3

days

• May be accompanied by fatigue

• How many pillows do they sleep with

at night

Intermittent claudication

Pain in the lower extremities brought on with exercise

Characteristics of intermittent claudication

• Brought on with exercise (i.e., stairs, hills)

•Disappears within 1-2 minutes of rest

•Doesn’t occur with sitting or standing

•Described as cramping

•Reproducible from day to day

•Doesn’t relieve with stretching

When to send an individual to a family doctor for intermittent claudication

•New symptom and not previously

diagnosed

•Unable to determine if its muscular

When to send an individual to the hospital for intermittent claudication

•Unable to determine if its muscular

•Pain doesn’t go away with rest and

affects ability to walk

Arrhythmias (irregular heartbeat)

A problem with the rate or rhythm

palpations

unpleasant awareness of forceful rapid heartbeat

tachycardia

Fast heart rate > 100 bpm

bradycardia

Slow heart rate < 60 bpm

factors to consider when suspecting arrythmias

•What’s their normal resting heart rate ?

•What is their training status?

•Do they have a pre-existing heart condition?

•Medications (for the heart)

•May be induced by

• various cardiac rhythms

• anxiety

• anemia

• fever

when do you send someone to hospital for Arrhythmias

•Resting HR > 120 bpm

•Resting HR < 40 bpm

Accompanied by;

•Chest Pain

•Dyspnea

•Irregular heartbeat

•Syncope / Presyncope

•Fatigue / Weakness

•Edema

•Confusion / Drowsiness

Know Heart Murmur

May be indication of valvular disease or cardiovascular disease

what part of exercise prescription can ACSM’s Pre-participation Screening help prescribe

desired exercise intensity

categorizing exercise intensity

Light, moderate, vigorous

Light intensity

• 30 to 40% HRR or V02R

• 2 to < 3 METs

• RPE 9-11

• An intensity that causes slight ↑ in

HR and breathing

Moderate intensity

• 40 to < 60% HRR or VO2R

• 3 to < 6 METs

• RPE 12-13

• an intensity that causes noticeable

↑ in HR and breathing

Vigorous- Intensity

• > 60% HRR or VO2R

• > 6 METs

• RPE > 14

• An intensity that causes

substantial ↑ in HR and

breathing

ACSM CVD Risk Stratification

A guideline that categorizes individuals into different risk levels for cardiovascular disease based on health history, current health status, and lifestyle factors. This stratification helps determine appropriate exercise recommendations and pre-screening procedures.

non modifiable risk stratification factors

age and family history

Age as a risk stratification

• Men > 45 years; Women > 55 years

Family history as a risk stratification

• Myocardial Infarction, coronary revascularization,

or sudden death.

• 1st degree relative; male < 55 year; female < 65

years

modifiable risk stratification factors

Physical inactivity, BMI, BP, lipids, Blood glucose, cigarette smoke

Smoking cigarettes as a risk stratification

Current, quite within 6 months or exposed to

environmental smoke

Physical inactivity as a risk stratification

Not meeting > 150 min/week of mod-

vig intensity physical activity

BMI as a risk stratification

BMI > 30 or waist girth > 102 cm (40

in) men, >88cm (35 in) women

BP as a risk stratification

> 130 mmHg systolic, > 80 mmHg

diastolic based on average of 2

readings on 2 separate occasions, or

on antihypertensive medication

Lipids as a risk stratification

LDL > 3.37 mmol•L-1;

HDL < 1.04 mmol•L-1 in men;

HDL < 1.30 mmol•L-1 in women;

on lipid lowering medication

blood glucose as risk stratification

 HbA1C > 5.7%;

or on medication

What is the one negative risk factor

having high HDL cholesterol > 1.55 mmol •L-1

What is considered low risk

Asymptomatic and who have < 2 (i.e., 1 or 0) CVD risk factors

What is considered moderate risk

Asymptomatic and who have > 2 risk factors

what is considered high risk

Individuals with one or more signs/symptoms or know

cardiovascular, pulmonary, or metabolic disease