ACSM Preparticipation Screening

Physical Activity and Risk

Introduction

  • Discussion of the ACSM's preparticipation and screening algorithm.

  • No complex mathematics involved except for simple addition.

ACSM Preparticipation Screening Algorithm

  • Physically Active Individuals

    • No Cardiovascular, Metabolic, or Renal Disease:

    • If asymptomatic, continue their current exercise regimen.

    • With Signs/Symptoms of Cardiovascular, Metabolic, or Renal Disease:

    • Discontinue exercise and seek medical clearance.

    • Example: A regular exerciser reports calf pain after 20 minutes on the treadmill, which suggests possible peripheral artery disease (PAD).

  • Individuals Not Currently Active

    • No Signs/Symptoms:

    • Begin with light to moderate physical activity and progress as tolerated.

    • Known Cardiovascular, Metabolic, or Renal Disease:

    • Asymptomatic individuals should seek medical clearance.

    • With Signs/Symptoms of Cardiovascular, Metabolic, or Renal Disease:

    • Should also obtain medical clearance before starting exercise.

Medical Clearance Considerations

  • Asymptomatic Individuals with CMR Disease:

    • Use judgment regarding the necessity for medical clearance based on individual circumstance.

    • Important Questions to Ask:

    • Has a physician recommended exercise?

    • Have they ever been advised against exercising?

    • Are there specific exercises to be avoided or special conditions affecting exercise?

  • Emphasis on avoiding loss of motivation due to unnecessary delays in beginning exercise.

  • Recommendation to start with light exercise and gradually increase intensity.

Exercise Guidelines Based on Assessment

  • Intensity Considerations:

    • For individuals on medications that affect heart rate, use Rate of Perceived Exertion (RPE) instead of traditional heart rate monitoring.

Case Studies for Application

  • Case 1: Frodo

    • Not currently active, desires to train for hiking, reports no symptoms.

    • Suggested: Start light to moderate exercise according to the algorithm for non-physically active.

  • Case 2: Gandalf

    • Active 6–7 days a week, asymptomatic.

    • Suggested: Continue current activities or increase intensity as desired.

  • Case 3: Sam Wise

    • Not currently active, reports shortness of breath and chest pain when exerting.

    • Suggested: Obtain medical clearance before engaging in exercise due to concerning symptoms.

Contraindications to Exercise

  • Definitions:

    • Contraindications: Characteristics complicating the safety of physical activity and exercise testing

    • Two Categories:

    • Absolute Contraindications: Risks outweigh potential benefits (e.g., ongoing unstable angina).

    • Relative Contraindications: Benefits may outweigh risks, requiring careful consideration of specific circumstances.

  • Shift from a focus on risk factors to disease prevention and management per ACSM guidelines.

Cardiometabolic Disease Risk Factors

  • Risk stratification categorized by the number of risk factors.

    • Low Risk: 0-1 risk factor

    • Increased Risk: 2 or more risk factors

  • Important Note: Only one positive risk factor is assigned per risk area, regardless of how many criteria are met.

    • Example:

    • If a patient has a blood pressure of 144/88, it counts as one positive risk factor under the hypertension category.

  • Negative risk factors (e.g., elevated HDL) can offset positive counts.

Positive Risk Factor Categories

  1. Age

    • Men: Risk factor starts at age 45.

    • Women: Risk factor starts at age 55.

  2. Family History

    • Relevant for first-degree relatives (parents, siblings).

  3. Smoking Status

    • Includes consideration for vaping (not traditionally included in ACSM classifications).

  4. Sedentary Lifestyle

    • Not meeting minimum physical activity thresholds.

  5. Obesity

    • Evaluated via Body Mass Index (BMI) or waist circumference.

  6. Hypertension

    • Evaluated via systolic and diastolic blood pressure.

  7. Dyslipidemia

    • High cholesterol and triglycerides considered.

  8. Diabetes

    • Evaluated through blood glucose and HbA1c tests.

  9. Negative Risk Factor:

    • Elevated HDL (60 mg/dL or higher) counts as a single negative risk factor.

Case Studies for Risk Factor Evaluation

  • Case A: 55-year-old active man with LDL 120 and HDL 61.

    • Risk factors assessed, resulting in zero overall.

  • Case B: 53-year-old inactive man.

    • Age factor, physical inactivity, and low HDL, leading to three positive risk factors total.

  • Case C: 45-year-old physically active woman with LDL 120 and HDL 61.

    • No positive risk factors, resulting in zero.

  • Case D: Another 45-year-old inactive woman with LDL 120 and HDL 41.

    • Physical inactivity results in one positive risk factor.

Conclusion

  • Importance of understanding contraindications, risk factors, and guidelines for exercise prescription in relation to cardiovascular health.

  • Continued education and consideration for lifestyle changes are encouraged in all exercise programs.