ExSc Testing & Rx: Lecture 1: Pre-Participation Screening

Dose-Response

More physical activity → lower risk of disease and death

Health Benefits that Improve with More Activity

• All-cause mortality

• Cardiovascular health

• Metabolic health

• Energy balance

• Musculoskeletal health

• Reduced cancer risk

• Mental health

• Overall well-being

Risks of Physical Activity & Exercise

• Musculoskeletal injury

• Sudden cardiac death

• Cardiac events during exercise

Hypertrophic Cardiomyopathy

Heart muscle is abnormally thick → heart has trouble pumping blood → can cause dangerous heart rhythms

Coronary Artery Abnormalities

Heart blood vessels are formed incorrectly → reduced blood flow to the heart, especially during exercise

Aortic Stenosis

Aortic valve is narrowed → heart must work harder to pump blood → less blood leaves the heart

3 Overarching Goals of Preparticipation Screening

1. Identify who needs medical clearance before starting or increasing intensity 

2. Identify people who may benefit from medically supervised exercise

3. Identify conditions that require temporary exclusion from exercise

Conditions Requiring Temporary Exclusion from Exercise

1. Cardiovascular disease: heart attack, heart failure, stroke, high blood pressure

2. Metabolic disease: diabetes, obesity, thyroid issues

3. Renal disease: chronic kidney disease, kidney failure

Cardiovascular Disease

Heart attack, heart failure, stroke, high blood pressure

Metabolic Disease

Diabetes, obesity, thyroid issues

Renal Disease

Chronic kidney disease, kidney failure

Major Signs/Symptoms of Cardiovascular, Metabolic & Renal Disease

• Pain/discomfort in chest, neck, jaw, arms, etc

• Dyspnea

• Dizziness or syncope

• Orthopnea

• Paroxysmal nocturnal dyspnea

• Edema

• Palpitations

• Intermittent claudication

• Heart murmur

• Unusual fatigue

Pain/Discomfort in Chest, Neck, Jaw, Arms, etc.

• Indicates possible myocardial ischemia (heart muscle not getting enough blood → pain or pressure)

• Triggered by:

  • Exercise

  • Excitement or stress

  • Cold weather 

  • After meals

Dyspnea

• Shortness of breath

• May indicate left ventricular dysfunction or chronic obstructive pulmonary disease

Dizziness or Syncope

• Fainting

• Suggests heart can’t increase output properly

Orthopnea

• Difficulty breathy while lying flat

• Relieved by sitting up

• Indicates left ventricular dysfunction

Paroxysmal Nocturnal Dyspnea

Sudden shortness of breath at night that wakes a person from sleep

Edema

• Swelling caused by excess fluid trapped in your body’s tissue

• Lymphatic system is affected

Different Kinds of Edema

• Bilateral ankle edema

• Unilateral ankle edema

• Generalized edema

Bilateral Ankle Edema

Swelling in both ankles caused by fluid buildup; common in heart, kidney, liver problems, or venous issues

Unilateral Ankle Edema

Swelling that occurs in only one ankle, often caused by injury, infection, blood clot (DVT), or localized venous/lymphatic obstruction, rather than a systemic issue

Generalized Edema

• When excess fluid builds up throughout the body’s tissues, causing widespread swelling rather than being limited to one area

• Can be caused by heart, liver, or kidney problems, malnutrition, or certain medications

Palpitations

• Feel your heart beating irregularly, too fast, too hard, or skipping

• They can be caused by stress, anxiety, caffeine, medications, or underlying heart conditions

Arteriovenous Fistula

• Abnormal connection between an artery and a vein, often created surgically for hemodialysis

• It allows blood to flow directly from the artery into the vein, making the vein stronger and easier to access for dialysis

Thyrotoxicosis

• Condition caused by having too much thyroid hormone in the body

• Symptoms like rapid heartbeat, weight loss, anxiety, and heat intolerance

Anemia

• Condition in which the blood has a lower-than-normal number of red blood cells or hemoglobin

• Reduced oxygen delivery to the body’s tissues, causing fatigue, weakness, and pale skin

Fever

• Body temperature higher than normal

• Usually Due to infection or illness

Intermittent Claudication

• Pain, cramping, or weakness in the legs that occurs during exercise or walking due to reduced blood flow (usually from peripheral artery disease)

• Need to rest 1-2 mins

Heart Murmur

• Valvular or cardiovasular disease

• Unusual sound heard during a heartbeat, often a whooshing or swishing

• Caused by turbulent blood flow through the heart valves.

Unusual Fatigue

• Persistent or excessive tiredness that is not relieved by rest and is greater than normal for a person’s activity level

• Signaling an underlying medical condition.

Steps in Preparticipation Health Screening

• Definition: Process to ensure it’s safe to start or increase exercise.

• Step 1: Determine need for medical clearance using the ACSM algorithm (by professional or self-guided)

• Step 2: Obtain clearance if needed (may include ECG, stress test, imaging, based on provider judgment)

ACSM Preparticipation Screening Algorithm

• Identifies individuals at risk for exercise-related cardiovascular events during aerobic exercise (limited evidence for resistance training)

• Purpose: Helps decide if medical clearance is needed, with guidance from a qualified exercise or health professional

• Tools used:

  • Exercise Pre-participation Questionnaire: Current activity and exercise habits

  • Health History Questionnaire: Past and current medical conditions

How ACSM Screening Algorithm Works

• Step 1: Current Exercise Status

• Step 2: Identify Known Diseases

• Step 3: Determine Medical Clearance

• Step 4: Desired Exercise Intensity

• After Classification: Participants fall into 6 categories

  • If clearance needed: refer to physician (ECG, stress test, echo, imaging)

Regular Exerciser

• Have a history of performing planned, structured physical activity 

• ≥30 min, ≥3 days/week, for past 3 months 

• Moderate intensity

Self-Guided Screening Tools

• Evidence-based questionnaires that reduce barriers to exercise and unnecessary medical referrals

  • PAR-Q+

  • ePARmed-X+

• Benefits:

  • Only ~1% need further medical screening

  • Reduces unnecessary doctor visits

  • Valid for 12 months

PAR-Q+

• 7 general health questions

• Follow-up if “yes”

• Tailors recommendations based on medical history & symptoms

ePARmed-X+

• Online interactive tool

• Determines readiness for increased activity & fitness approval

• Supplements PAR-Q+

• Includes physician follow-up form