Topic 2- Screening and Testing

Risks when exercising- middle aged/elderly

Heart attacks (1/3 already have CVD and HTN)

Risks when exercising- youth

Congenital heart defects

4 qualities of an effective screen

1. conducted in all facilities with exercise equipment

2. done regardless of age

3. simple, not intensive

4. interpreted by qualified staff

PAR-Q screen

only intended for light/moderate exercise, NOT vigorous

contact doctor if answer yes to any question

ACSM screen questions

1. do you exercise regularly (3 3 30 rule)

2. medical history

3. desired exercise intensity

4. if no to any of these factors, there is a need for medical clearance

ACSM can be used for vigorous intensity

8 signs/symptoms of CVD when exercising

1. pain/discomfort in chest, neck, jaw, or arms

2. SOB at rest or with mild exertion

3. dizziness/loss of consciousness

4. Ankle edema (swelling)

5. Palpitations

6. Tachycardia (resting HR > 100 bpm)

7. heart murmur

8. fatigue or SOB w/ usual activities

Prescribe someone who:

1) does not regularly exercise

2) has any signs/symptoms of CVD

medical clearance before exercising

Prescribe someone who:

1) does not regularly exercise

2) has CV, metabolic, or renal disease but asymptomatic

medical clearance before exercising

Prescribe someone who:

1) does not regularly exercise

2) has no CV, metabolic, or renal disease and asymptomatic

no medical clearance- but gradually build from light to moderate intensity

Prescribe someone who:

1) does regularly exercise

2) has any signs/symptoms of CVD

stop exercising and see doctor

Prescribe someone who:

1) does regularly exercise

2) has CV, metabolic, or renal disease but asymptomatic

see a doctor every 12 months and, if cleared then exercise permitted

Prescribe someone who:

1) does regularly exercise

2) has no CV, metabolic, or renal disease and asymptomatic

no doctor needed, can exercise regularly

ACSM CVD risk factors- Age

men > 45 yr, women > 55 yr

ACSM CVD risk factors- Family history

heart attack, heart bypass, or sudden death (parent or 1st degree relative before 55 in men, 65 in women)

ACSM CVD risk factors- Cigarette smoking

current smoker or quit in the last 6 months

ACSM CVD risk factors- Hypertension

systolic pressure > 130 or diastolic pressure > 80 or on blood pressure medications

ACSM CVD risk factors- high cholesterol

LDL > 130, HDL< 40 in men, 50 in women, or on cholesterol lowering meds

*if good cholesterol is > 60, subtract 1 point to total risk factor sum

ACSM CVD risk factors- impaired fasting glucose

>100 mg/dl or HbA1C (long term glucose control) > 5.7%

ACSM CVD risk factors- obesity

BMI > 30

ACSM CVD risk factors- sedentary lifestyle

no 3 3 30

AHA screening recommendations- HS, collegiate level

some form of CV screen, personal and family history (CV lesions), completed by a trained healthcare worker, complete history/physical examination

What are you looking for in an AHA history/physical examination?

• elevated BP

• heart murmur

• fam history

• chest pain

• fainting

• SOB w/ fatigue

Marfan’s syndrome symptoms

tall thin stature, long arms/legs, double jointed fingers, curved spine, flat feet/hammer toes, stretch marks, chest bone curved in or out, nearsightedness

Absolute contraindication

symptoms inadvisable to exercise test or exercise (risks outweigh benefits)

Relative contraindication

when the benefits outweigh the risks, so exercise with caution

Test criteria- Validity

accuracy

Test criteria- Reliability

repeatability

Two types of reliability

Intratester- Do I get the same results from day to day?

Intertester- Do I get the same results when tested by different examiners?

Test criteria- Norms

Score comparison

Test criteria- Economy

ease of the test

Order of tests for total fitness program

1. body composition

2. aerobic fitness

3. muscular fitness

Is it better to undertest someone or overtest them?

Undertest! Overtesting can be exhausting

Evaluation test instructions

• complete questionnaire at home

• wear exercise attire

• no eating/drink, tobacco, coffee beforehand

• avoid prior exercise

• good nights sleep

• bring questionnaire

• take meds

• blood analysis- 12 hr fast

Order of fitness tests

1. home questionnaire

2. quiet, resting tests

3. body composition

4. CV fitness

5. musculoskeletal tests

6. immediate feedback/counseling

7. follow up evals after 3-6 mo, 1 year, and yearly after that

Informed consent

knowing consent of an individual or legal rep PRIOR to participation

What does informed consent include?

Background/objectives of the plan, procedures, risks, benefits, answering any questions, feeling free to stop participating or to not answer questions, methods to ensure confidentiality