Preparticipation Health Screening

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in this chapter we will focus on pre-participation physical activity screening guidelines

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so we are going to go through some of the steps that help us to determine if exercise or maybe exercise testing

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is safe for our client we have to make sure that we do no harm um before we move on

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i will tell you a little bit about the the picture that you see here this was one of the studies that i was

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involved in in our human performance lab we had a multitude of treadmills set up as you

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can see and these men are running on the treadmill for three hours straight at i

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believe it was 75 percent of their maximum capacity and we were measuring

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different immune parameters we were looking at the the difference between

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the half of the group who received gatorade the half of the group who received

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placebo which is a flavored water that tasted like gatorade but it wasn't

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we were working with a psychology department so they were monitoring things such as mood pre and

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post three-hour run another thing that we did in this study and this was another way to look at

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immune system function is that we did muscle biopsies so we took a muscle biopsy in the the front

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of the leg and in the the quadricep and what we wanted to do

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was to take a small piece of muscle out of the quadricep uh pre and post three hour run to see

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how some of the again immune parameters were responding to the gatorade or the placebo so it's where you

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you get kind of this long syringe it goes into the little incision that's made

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and a little kind of like a little knife cuts off a small piece of the the muscle

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it's sucked into a syringe and then it can go through a series of analyses

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which we'll talk about more throughout the semester but that was pretty cool um and there was a

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screen over on the side of the the room where the guys were able to watch a movie and i think i told you about the

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movie a brother where art doubt every group of guys got to watch the same movie for weeks and months so

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i know that movie by heart okay so let's go ahead and get into this chapter and we are going to

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again talk about some of the testing concepts so we'll start with vigorous exercise

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sessions and how they can potentially trigger fatal heart attacks and those at

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high risk for heart disease six out of one hundred thousand middle-aged men

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died during or after exercise each year and just to give you an idea before we

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get into this a little deeper a lot of these people tend to be sedentary men

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so you see this happening more in men than women but not just men over the age of 35

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who already had heart disease or were at high risk for it and then they just started exercising

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and they exercised too hard for their fitness level and something happened such as a heart

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attack or a fatal heart attack this is pretty worrisome when we think

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about the screening that we do to get new members enrolled into a health fitness facility

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the efforts to screen these folks who are buying memberships to these uh wellness

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centers and the ymcas the efforts to screen are limited and they're inconsistent so that means that

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we're not doing a great deal of screening in every place and the screenings that we are doing are

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inconsistent so everybody's doing something a bit different and is it sufficient is the question

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according to the american heart association one-third of all americans have some form of

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cardiovascular disease so when we think about that and we think about the millions of people joining

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gems that's another obvious worry that we have the the forms of cardiovascular disease

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obviously that would include something like high blood pressure which can be very dangerous if a person starts to do

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something like weight lifting if they have uncontrolled high blood pressure that can be quite dangerous

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so one way to to think about this whole concept is in snow shoveling and i think we've

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all heard at least on the news about deaths caused by snow shoveling

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so if we think about it this way when we snow shovel it's putting a very

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heavy sudden stress on our heart without simultaneously boosting oxygen

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supply to the heart muscle when we jog when we ride our bike we involve many

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muscle groups the heart rate the breathing start to increase gradually and then that muscle action releases

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chemicals that cause our blood vessels to dilate so as a result more oxygen can reach the working

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muscles our blood pressure actually may start to drop a bit but during snow

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shoveling during weight lifting weight training our body doesn't do that again it's that

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heavy sudden stress on our heart without that simultaneous boosting of oxygen supply to the heart

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muscle so another thing that we have to think about is that in the cold

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weather our blood vessels start to constrict to help us reserve some heat and then all of a

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sudden we see higher blood pressure values because of that constriction of the blood vessels

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so that's another thing that we have to to consider in a 1993

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study in the new england journal of medicine they looked at 1228 heart attack victims

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and i thought this was super interesting they found out that out of shape people increased their

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risk of a heart attack by a hundred fold when they shoveled snow and regular

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exercisers so people who are exercising on a regular basis doubled the risk that's pretty

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interesting when you think about it that way and then in another study that was published in 1995 in the journal of american medical

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association found that the cardiovascular exertion of shoveling snow

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was equivalent to that of a maximal effort on a treadmill for a sedentary man

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for sedentary men so that is very very interesting we have to be careful when we're doing

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activities like this especially if we're seeing a person um who is just on the couch

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they all of a sudden go outside and start doing an activity that they're not used to doing they're

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sedentary they haven't been exercising maybe they're over the age of 35 or not

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and they have risk factors such as being obese they're not exercising they're not eating healthy

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and then they work or they exercise beyond their capabilities

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so let's think about this for a minute um the difference between the deaths that we see in

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older individuals so we said over the age of 35 and then the deaths that we see in

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younger folks such as competitive athletes about 12 to 20 athletes does suddenly

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each year from congenital heart defect so notice that the cause is different so

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the deaths that we see and the younger people who are trained who are athletes for example

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the cause is different on the previous slide we said that the person was sedentary that they had risk factors

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for heart disease they were older potentially here we have a younger athlete who's very

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trained and very fit the cause of death is normally congenital heart defects when we see

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this type of thing happening about a third of these cases are caused by a congenital heart defect

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called hypertrophic cardiomyopathy which is just real simply put a

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thickening of the heart's main pumping muscle the risk for exercise related death in

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high school and college athletes is one per 133 thousand men

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and one per 769 thousand women most states are going to require a

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regular physical once every one to two years for athletes the cost for more sensitive tests that

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pick up things like these congenital heart defects are more expensive

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they require things like two dimensional two-dimensional echocardiograms that would detect heart defects

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and they can range from anywhere to like 400 to 2 000 per screening

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so it's not something obviously that we can do with every athlete at appalachian state or every high school athlete or

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every athlete out there we cannot feasibly do that economically so the american heart

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association developed a 12 item screening tool for cardiovascular disease among athletes

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and it's just basically a short medical health questionnaire that that you as an athlete may have done with an athletic

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trainer or a coach maybe not even knowing that you've done it but it asks questions such as personal

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history family history physical examinations and any positive response on that 12

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item screening tool will prompt further cardiovascular testing so it's possible that

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the types of tests that we talked about earlier may be done but again just to note the differences

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in deaths in a younger group of like an athletic population versus an

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older group of a more sedentary population who who exercise harder than they should

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based on fitness levels so make sure that you know the difference between the two of those

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in order for us to protect ourselves as much as we can when we're working in a fitness facility

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of some sort is once a very important step that we always have to do is to get an

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informed consent signed and we've all signed consent forms before it's a procedure for obtaining a

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client's signed consent to in this situation of fitness centers testing and exercise programs

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we'll look at some examples later of informed consents and some of the things that you'll see

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in a consent form and if you're writing your own one day we're going to need to include things such as a general

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statement of the background of the program a fair explanation of the procedures to

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be followed so what will that person be doing any risk and benefits that will be

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associated with those behaviors so an example of the risk if

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we think about the risks that are associated with something such as a maximal test on a treadmill obviously

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we've seen that one potential risk is the risk of a heart a sudden cardiac

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event happening so that would be a risk that would need to be included if a person is doing the underwater

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weighing test there is a risk of drowning in the underwater wayne tank so very eloquently worded in a conform

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informed consent we see those types of things when those tests are being done and i'll

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show you an example of the one that i used in the human performance lab which includes statements

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such as those so what are the good things the benefits what are the potential bad

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things that could happen the statement uh that participation is

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free and the person can withdraw at any time or sorry they are free to withdraw at any time

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that the testing may not necessarily be free they are free to withdraw at any time so that means that i cannot make a

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person do the fitness testing if they don't want to if they want to drop out of a study that i'm conducting

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they need to be allowed to do that so they can stop at any time and then lastly an explanation of the

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procedures are to be taken and we need to ensure confidentiality so i will not share

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test results to anyone those are confidential

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the informed consent a lot of times is something that the establishment where you intern where you

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work that is going to be established ready to go the consent forms that we use at asu

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they have to go through something called an irb an institutional review board

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which is made up of various faculty university lawyers community lawyers so

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all of this stuff has to be legally approved we can't just write up a consent form and hand it to someone to

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sign we have to get various approvals and and legal approvals most importantly

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the next thing that we're going to have our clients do when they come into our fitness facility

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is to complete a medical health questionnaire so one thing that i want to point out is

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that you're going to hear a medical health questionnaire worded in many different ways we're going to hear it called the mhq

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medical health questionnaire the health risk appraisal the

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pre-participation health screening all one and the same and it's a procedure where

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we we always obtain some background information on our participants

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we're going to screen the participant and then classify them into certain categories and we're going

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to determine first of all whether or not medical clearance is necessary that's one important thing

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that we need does a person have to have medical clearance prior to being exercise tested with you

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their trainer or to begin exercise with you and then secondly we need to screen participants

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in order to determine the appropriate exercise intensity recommendations so obviously

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these medical health questionnaires are used to meet individual needs i'm not going to take a person who's

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never exercised before and put them on a high intensity workout program so that's not something

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that would be safe for that person to do so a big big reason that we need to do these pre-participation health

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screenings again the the points that are included

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in a medical health questionnaire we'll look at several different examples of these one we may see things such as medical

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diagnoses previous physical exam findings that your doctor has discovered

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during exams history of symptoms recent illnesses hospitalization

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surgeries that a person may have had any orthopedic problems medication use

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and drug allergies lifestyle habits such as eating habits

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exercise history and then lastly you may see questions on family history so we've all

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again filled out medical health questionnaires we will look at several different kinds

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and the really nice thing i think about the medical health questionnaires is that unless we're needing something overly

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specific maybe for a study that we're doing there are a ton of medical health questionnaires out there

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that are available for you to use so this is not something that you usually have to come up with on your own

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one of those questionnaires here is one called par q plus par q and u

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it stands for physical activity readiness questionnaire and this

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particular questionnaire it's used for those people who want to exercise typically in a pretty low intensity low

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to moderate exercise so just like a nice walking program and it has seven questions you can take

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a look at some of the examples here but has your doctor ever said that you had a heart condition or high blood pressure

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yes or no have you ever been diagnosed with another chronic medical condition other

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than heart disease or high blood pressure are you currently taking prescribed medications

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so if a person were to answer yes to any one of those seven questions

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it is recommended that they go to a doctor before starting an exercise program such as walking

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if they answer no to all seven of the questions we could probably start them on a pretty

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nice walking program to get them started with exercise so this would be a type of medical

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health questionnaire that you would use in a maybe like a health fair

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setting where you're trying to get a a bunch of people through very quickly make a fast determination

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can they start a walking program several days per week or not but obviously it's not a great medical

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health questionnaire for anything above walking if we're going to do anything of a higher intensity

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we need to be asking more questions and using a different type of medical health questionnaire

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the questionnaire that that is going to ask every question imaginable is one called a comprehensive

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medical health questionnaire and that is one that we used again in our community testing program

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in the human performance lab that's the type of questionnaire we need in a setting

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where there's no medical doctor present we don't have the equipment we need in

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case something bad should happen so we need to do a super thorough evaluation of that person before we

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begin to exercise test them is it safe to do it or not and if it's not

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we either need to get a medical doctor to our facility to be there while the test is done

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or we need to send them to their doctor for further evaluation and that is that's something that i did

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quite a bit in the human performance lab i was able to get our medical doctor for

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the university to our lab when needed and they would watch the test while we

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did it just to make sure that everything was going okay and if if something went wrong we had somebody there who was who

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was trained ready to help us

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so now we're going to talk about the pre-participation health screenings and

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how we do that today the the purpose of the pre-participation

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health screening process again is to identify individuals who may be at elevated risk for exercise

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related sudden cardiac death or they may be at elevated risk for an acute myocardial

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infarction and myocardial infarction means heart attack so is that person at risk of

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having some type of health related event while we're exercising with them

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while they're doing an exercise test or they're engaging in a program that we've prescribed and if that person is at high risk they

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mean they may need to be referred to a healthcare provider for medical clearance prior based on

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that doctor's clinical judgment so the one thing on the slide that i

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wanted to point out this is a really great article if you want to read on

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risk stratification and how the process has changed quite a bit over the past several years the way that

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we used to do pre-participation health screening was through a process called risk factor

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profiling so basically this is where we would take a medical health questionnaire and we

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would count the number of risk factors that a person had so maybe they were older

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check that's one risk factor maybe they were obese and then we would say okay check that's a second risk factor maybe

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they had a family history of heart disease check that was a risk factor so we would actually count the number of

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risk factors a person had and again that was called risk factor profiling

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we don't do that any longer this changed fairly recently and the reason for that is that we

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started to see that it was causing excessive physician referrals so we were saying if a person

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has over x number of risk factors they need to go to their doctor and get clearance before working out with me

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their personal trainer so it was causing too many doctor referrals

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possibly creating a barrier to exercise participation so in order to kind of back that up all

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of the research that's been done has shown that there is evidence that exercise is safe for most people

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and it has many health and fitness benefits so how are we going to have a person become

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healthier if we're keeping them from exercising so we can improve some of

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these risk factors by just getting somebody for example in a really nice walking program

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another thing that we were seeing through the research is that most exercise related cardiovascular events

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are often preceded by warning signs and symptoms so we have time to call 9-1-1

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get help get somebody there to help us if we see these warning signs

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and then again i just mentioned the cardiovascular risks that are associated with exercise are going to lessen

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more and more as people become physically fit so we don't want to hinder them from not

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beginning an exercise program we don't want to create a barrier um

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people when we refer folks to the doctor or when we make appropriate referrals to

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another person a lot of individuals tend not to follow up on those referrals so they go to

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melanie maybe me they come to me to work out with them and put them on a nice exercise program

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and they're paying me to do so but then all of a sudden i say nope you have to go to your doctor and get a physical

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first and a lot of people just were not following through so it was creating this huge huge barrier

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the new guidelines which we're going to cover next reduce the possibility of some of those unnecessary barriers to

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adopting and maintaining a regular exercise program so let's take a look at some of the the

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things that we're going to look at today when we do a pre-participation screening

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once the medical health questionnaire is completed we can proceed to screening and i just on i will come back to this

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table in a minute but the first thing that i want us to look at are these three things at the top pre-participation is going to

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be based on three factors number one no particular order

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is the individual's current level of physical activity so we're going to say do you participate in regular exercise

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yes or no if the person says yes we're going to go this way if the

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person says no we're going to go this way on this flowchart the next thing that we're going to look

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at is the presence of signs and symptoms so how does the person have any sign or

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symptom of disease and and or do they have

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any known disease so k-n-o-w-n-k-n-o-w-m

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um i was making sure i was spelling that correctly so do they have any known disease

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and then lastly um do they uh or or what can we determine their exercise

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intensity to be light moderate or vigorous so those are the three factors

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the individual's current level of activity signs symptoms or diagnose disease

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and then lastly exercise intensity

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so the purpose of the flowchart again is to determine whether or not

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medical clearance is necessary and then to determine appropriate exercise intensity recommendations

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this manual which you'll actually use in an upcoming class after this one but this is a really great

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manual the guidelines for exercise testing and prescription so i do recommend you get this if you're planning on getting

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any of the certifications that we've discussed it it has every thing that you'll

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possibly need to study for those certifications

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the goals of the american college of sports medicine exercise pre-participation health screening is to

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identify individuals who number one should receive medical clearance

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before initiating an exercise program or maybe a person who's wanting to

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increase the intensity of their program so maybe they want to exercise more days per week they want to increase the

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frequency maybe they want to increase the intensity how hard they're working

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and then the volume of their current program how can we make that uh safe for a person to do so we're

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going to identify individuals who need medical clearance before starting or before increasing what they're doing

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currently the screening process is also going to

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help us to identify individuals with clinically significant diseases who may benefit from participating in a

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medically supervised program so for example our cardiac rehab program

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that we have at our wellness center through appalachian regional health care that is a medically supervised exercise

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program those cardiac rehab patients or those pulmonary patients are there with doctors and nurses present

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being supervised in a medically supervised program so maybe the person that that that we're

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working with would be better suited for a program like that and then lastly we want to identify

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individuals with medical conditions that require exclusion from exercise programs so maybe someone

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who just had a heart attack for example that person would need to be excluded from exercise from our exercise

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program until the condition is under better control

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and then just to review a bit more of what we talked about a couple of slides back there is

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substantial evidence that suggests that exercise is safe for most people so most people can go out

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and they can do a walking program a nice low to moderate intensity program

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because of the following we know that exercise related cardiovascular events are often preceded

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by warning signs and symptoms so that is that's good that we're able to

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to know what those signs and symptoms are and we can get help there right away

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we know that cardiovascular risks associated with exercise are going to start to lessen as individuals become

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more physically fit the most common risks are in those

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sedentary individuals who are starting a physical activity program or performing

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an exercise test so this is important we're going to see the highest risk individual

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being that person who has either never exercised before or they have an exercise in a long time

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so that is the group we need to be we need to be careful with everyone but that is the group we need to be super careful

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with our non-exercisers and then just something to throw out

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there pulmonary disease used to be included in the screening process but it has been

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removed because evidence suggests that pulmonary disease does not increase the immediate risk of

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a cardiovascular event happening during our following exercise

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so again going back to that point where we said regular exercise reduces the risk of cardiovascular diseases

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events during vigorous exercise this is a great chart that shows

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the more exercise we do so the more days per week the higher the volume so five

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or more days per week we see the lowest risk of acute myocardial infarction so again

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a heart attack so the more days per week that you're engaging in exercise the lower

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that risk becomes

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there is uh again new evidence informed new evidence-informed model for exercise the

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pre-participation health screening that we looked at that flow chart then we're getting ready to come back to that right

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now involves three major factors so let's define these a little bit further we said that one

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aspect of pre-participation health screening is the individual's current level of physical activity

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so we're going to define that as this you are an exerciser a regular exerciser

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if you engage in at least 30 minutes of moderate intensity exercise

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on at least three days per week and you've been doing that for the past three months

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so at least 30 minutes of moderate intensity exercise at least three days per week and you've

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been doing that for the past three months so that is who we will define as a

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regular exerciser do you exercise yes or no if it's anything less than 30

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minutes three days a week for the past three months that will be no but if they are doing

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that 30 minutes of moderate intensity three days a week for the past three months yes we're going to say they are a

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regular exerciser another factor one of the three that

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we're going to look at in pre-participation health screening is the presence of signs and symptoms

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and or known cardiovascular metabolic or renal diseases

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so let's look at metabolic first metabolic disease would include somebody with

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diabetes type 1 or type 2 diabetes so that is a metabolic disease

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renal disease is a disease of the kidneys so anyone with metabolic or renal

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disease is a a disease that we need to be aware of when we're doing pre-participation

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health screening cardiovascular disease again if we break up that word

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cardiovascular that is any disease of the heart or its vessels our vascular our vessels

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our vascular system so that would include things such as heart attack

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a person who's had heart surgery cardiac catheterization which we'll talk about this a little bit

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later too but this basically is cardiac catheterization coronary

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angioplasty this is where we uh see plaque build up in a person's arteries

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and maybe a balloon is inserted through the femoral artery

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on a a device where the balloon is inflated and deflated it's on a catheter and it's

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inflated and deflated inside the vessel and the point is to try to break up the plaque buildup

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in the vessel so that is angioplasty the person has atherosclerosis or

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plaque buildup in the vessel and that angioplasty procedure is trying to get rid of some or all of

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that plaque buildup another cardiovascular disease would be

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somebody with a pacemaker a heart valve disease somebody with heart failure heart transplantation all of these

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are considered signs and symptoms of disease and then number three desired exercise

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intensity is our third factor in pre-participation health screening so again that is defined as low

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intensity exercise moderate intensity or vigorous intensity or we might hear that called high

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so low moderate high low moderate vigorous

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now let's define some of the signs and symptoms we said that if a person has certain

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signs and symptoms that that would be one of the factors that we look at in pre-participation exercise training

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the first one would be defined as pain or discomfort in the chest

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neck jaw arms or other areas that may be due to ischemia so first of all if we look at

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the the very beginning of this this uh sign or symptom

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pain discomfort in the chest neck jaw arms that is every symptom that we hear of

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for a potential heart attack correct um also we see here anginal equivalent

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angina means um chest pain so if the person has pain or discomfort

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in the chest the neck the jaw the arms that is a definite sign of a heart attack

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so that would be a sign that we need to be aware of and signs of a heart attack or

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when that happens due to a heart attack it's often due to ischemia and ischemia means that

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again there's plaque buildup there's some type of blockage in the vessel to where the blood cannot

35:07

get through as efficiently as it should so we may be cutting the blood supply off to the

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heart and when that happens for too long the heart muscle begins to die um

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this signer this sign could potentially be a sign of someone who's eaten too much

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too so we see a lot of people who better safe than sorry which is great

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they go to the hospital and they have this checked out and they just over indulge they ate a little bit too much

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but we have to to be very aware of the signs and symptoms that we're seeing

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in the folks that we're exercising with and always veer on the side of caution if a person has pain in the chest neck

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jaw arms we we need to call 9-1-1 and get help

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another sign or symptom would be shortness of breath at rest or during mild exertion so this

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means that the person is doing something very easy something that they've done quite often

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and they can't breathe well so that is a definite concern another sign or symptom is dizziness or

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syncope syncope means loss of consciousness so dizziness or syncope

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and we don't know why it's happening the person hasn't been drinking too much nothing alcohol related this means

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that the person has dizziness or they have lost consciousness and we don't know why what is going on

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that is a definite sign or symptom of a heart problem orthopenia

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or you may also hear a nocturnal dyspnea orthopenia is discomfort in breathing

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which is brought on or aggravated by laying flat so maybe lying like like in the

36:56

the bed nocturnal dyspnea this is usually a sign of heart failure

37:02

and you sometimes hear this called cardiac asthma and what happens it occurs with the

37:07

fluid buildup and the lungs that enter the alveoli and we've all remember from biology class

37:13

our alveoli are those air sacs that are responsible for o2 and co2 exchange from the blood

37:22

so at night maybe while a person is laying down those alveoli those air stacks start to

37:28

fill up with fluid during the day the fluid buildup is more may be retained and the legs do the

37:34

gravity but while sleeping the body reabsorbs this fluid resulting in an increase of total blood volume and

37:41

the blood pressure leading to pulmonary hypertension so just to kind of sum that up a little

37:48

bit it is a sign or symptom of heart problems and one way that some folks counteract this

37:54

uh not being able to breathe at night is that they will maybe build up some pillows and they

38:00

sleep on several pillows or sleep while sitting up and they can breathe better but really

38:05

they need to go to the doctor and get this checked out this is a big big sign of heart failure and a heart

38:12

problem ankle edema is a swelling of the ankles so that is

38:19

also a sign of heart problems so we need to get to the doctor and get that checked out if it's an unexplained

38:26

ankle swelling heart palpitations uh palpitation is a

38:32

forcible or irregular pulsation of the heart and a lot of times the person can feel it

38:38

usually with an increase in frequency or force so where the person is feeling possibly

38:45

an irregularity and rhythm or tachycardia meaning that there's a

38:51

really rapid beating of the heart and typically tachycardia is defined as over 100 beats

38:57

per minute at rest that's a really high heart rate at rest so the person again needs to see the

39:02

doctor this is a sign or a symptom of heart problems intermittent

39:08

claudication you also might hear this called peripheral artery disease

39:14

is a hardening of the arteries in our our legs for example so it's where a

39:20

person has a clot that's in the legs and

39:26

they feel it more when they're exercising so for example if a person is walking uphill

39:31

or they're walking upstairs there's a huge demand for oxygen in that working muscle in the calves for example

39:38

and the oxygen the fuel that that muscle needs can't get there because it's uh there's a blockage

39:45

because of plaque that is intermittent claudication or peripheral artery disease

39:52

and it can be quite dangerous if the plaque breaks off and it floats toward the heart or to the brain it can cause a

39:59

heart attack or a stroke so definitely something we wanted to get looked at and again a lot of people to

40:05

help the the legs feel better they'll sit and rest for a minute

40:10

and they lower the oxygen demand the fuel demand on that working muscle and it starts to feel better and they'll

40:16

start back but they do feel it more usually when they're going up a hill or like a flight of stairs

40:22

because the the pain is so great the blood flow the oxygen flow can't do what it needs so again another

40:30

sign or symptom of heart problems potential heart problems a known heart murmur a heart murmur is

40:37

an extra or maybe an unusual sound heard during a heartbeat

40:43

the murmurs can range from very faint to very loud and the the one thing that we want to

40:48

think about here some so some of you may have even been diagnosed with a heart murmur

40:53

there are two types a lot of kids are diagnosed with heart murmurs uh innocent heart murmurs are the

41:00

harmless types of heart murmurs so a lot of people have those but there are abnormal heart murmurs

41:07

which again can lead to heart problems so that we need to to be aware of and then lastly there are nine

41:15

signs and symptoms the last one is unusual fatigue or shortness of breath

41:22

with usual activities so again we are doing something for example that we do all the time

41:28

getting the groceries walking to the mailbox walking to class walking up a flight of stairs taking a

41:35

walk around our neighborhood and just doing something we do every day and then all of a sudden we start to see

41:41

unusual fatigue or shortness of breath doing that and it's not something we've experienced

41:47

before so certainly something we need to get looked at

41:55

so now let's go back to our screening form and i want to go through this in detail with you so that we all

42:02

understand how to do an appropriate pre-participation health screening so again we're going to start here

42:11

and ask our client do you participate in regular exercise and if they tell us that they do we see

42:18

on their medical health questionnaire that they do exercise at a moderate intensity three

42:23

days a week for 30 minutes and they've been doing that for the past three months

42:29

we're going to call them a regular exerciser and if they do not meet all of those

42:34

criteria they will be a non-exerciser so let's pretend that they say no and

42:40

we'll start on this side of the flow chart so the next thing that we're going to do on the medical health questionnaire is

42:47

to look for signs and symptoms of disease so

42:53

the signs and symptoms that we talked about are the the ones that we just listed

42:59

there's nine of them ankylodem edema heart palpitations

43:04

um the heart murmurs all of the ones that we just listed

43:10

intermittent claudication if a person has none of those nine

43:16

signs and symptoms they would obviously fall here but we also

43:22

have to think about the diagnose diseases so have they been diagnosed with

43:28

cardiovascular disease and we went through a list of the different cardiovascular diseases that we're looking for

43:34

do they have metabolic diseases like diabetes or do they have renal diseases disease of the kidneys if they do not

43:42

have any diagnosed disease and they have no signs and symptoms of the disease

43:50

then we can go down the flow chart medical clearance is not necessary so that means that they

43:56

can begin an exercise program without medical clearance and the intensity that they can begin is

44:03

a light to moderate intensity and they may gradually progress to vigorous

44:09

following guidelines that we'll review throughout this class but they would obviously need to start

44:14

light to moderate because this is a non-exerciser this is somebody who has not exercised before

44:20

or they have an exercise in a long time so light to moderate intensity exercise is

44:26

where we go with a non-exerciser and i think a really cool thing about this flow chart

44:31

that you'll need to memorize is this our non-exercise non-exercisers

44:36

always are light to moderate intensities never will we put a a person who is not currently exercising

44:43

on a tougher program than that now one thing that i want to mention

44:49

here is this going back to the top we said that this person has no disease

44:54

no signs and symptoms of disease maybe they haven't been diagnosed

45:00

but they could potentially have signs and symptoms so we're going to see that in future categories so keep that in

45:06

mind just because a person hasn't been diagnosed with a disease doesn't mean that they don't have a

45:12

disease it may mean that they just haven't been to the doctor ever or in a long time so we have to

45:18

to remember that okay so let's start again

45:23

the person does not participate in regular exercise they have been diagnosed with a disease

45:31

so we know that they have either a cardiovascular disease a metabolic disease or and or

45:39

a renal disease but that person is asymptomatic so that this is an

45:45

example of what i was just mentioning this is a person who has no symptoms which means the disease that

45:52

they have is under control they are asymptomatic they do not have any of the nine signs and

45:58

symptoms that we covered on the previous slide for this non-exerciser it is definitely

46:06

recommended that medical clearance be accomplished before they begin exercise

46:13

and the reason they need medical clearance is because they do have a diagnosed disease and they have an exercise ever or in a

46:21

while so we definitely need to go to the doctor get them looked at before they can begin and once

46:28

they re receive medical clearance light to moderate intensity exercise

46:33

is the way to go and again they can gradually progress into more and more exercise but but not not

46:40

right away and then if we go back to the top for our non-exerciser

46:47

let's look at this person what if a person has a sign or a symptom of disease

46:55

if they have any sign or symptom those nine signs and symptoms that we covered

47:00

they all sound pretty bad to me so a person with pain in the chest pain in the the neck

47:07

the jaw shortness of breath dizziness they can't sleep at night because they can't

47:13

breathe all of those things sound pretty serious if they have one or more of those nine signs or

47:19

symptoms they have to go to the doctor it does not matter and nothing else matters it

47:25

doesn't matter if they have disease diagnosed disease they have a sign or a symptom of disease

47:32

that is not under control or has not been diagnosed so they go straight to the doctor and then

47:39

if that person is cleared to exercise again they can begin light to moderate intensities

47:45

so that's another really cool thing about the slow chart and that's easy to remember if a person has a sign or symptom they

47:52

automatically go to the doctor because that means something is is wrong something is not under control

48:02

okay let's start again so is the person a regular exerciser and now yes they are

48:09

so now our client says they're doing three days a week for 30 minutes for the past three months

48:16

and that exercise is at a moderate pace that's at a pace that's that's really great it's recommended for most

48:22

americans so the person is exercising they have

48:27

no diagnosed disease so no known disease and they have no signs and symptoms so

48:33

this is a pretty easy person to determine what to do with them they have no problems that we know of

48:40

they are currently exercising so we know that their body is tolerating exercise pretty well

48:46

and medical clearance is not going to be necessary for that person and they can continue to do

48:52

what they're doing which hopefully is a moderate to vigorous intensity program

49:00

okay now i'm going to skip this middle uh column this is kind of our gray category so

49:05

let's go to this side and this should be an easy one to determine also because we just talked about this

49:12

now we have a regular exerciser who has a sign or a symptom of cardiovascular

49:19

metabolic or renal disease and we said if the person has a sign or symptom of

49:26

any of those diseases regardless of whether or not they've been diagnosed

49:31

they have to go to the doctor even that exerciser so a person who exercises can have a

49:36

disease we know that so any sign or symptom says we need to

49:42

send them to the doctor and something that is really important for us as exercise professionals is this we know

49:50

that we have a regular exerciser we need we have to tell them to discontinue

49:55

exercise so discontinue what you're doing seek medical clearance right away

50:02

because you have a sign or symptom of something that is potentially wrong we need to get that taking a look

50:08

at and then again once they've gotten medical clearance they can return to exercise if the

50:15

doctor says that's okay so the exercise intensity that that again the doctor warrants for them okay

50:23

so now our this one is not a complicated category it just has a little

50:29

addition to it that we haven't seen before so now let's look at this middle column we have an exerciser

50:37

who has known disease but is asymptomatic so that means that

50:43

they have been diagnosed with a cardiovascular disease of some sort a

50:48

metabolic disease or a renal disease and those diseases are under control

50:54

though there's no symptoms everything's under control medical clearance for moderate intensity

51:00

exercise is not going to be necessary but if the patient if our client has not

51:08

had a checkup within the last 12 months

51:14

and no change in signs and symptoms it is recommended before beginning vigorous exercise that they go to the

51:20

doctor so depending upon your intensity here it's recommended

51:26

that no clearance is needed or clearance is needed so basically uh another way to kind of think about

51:32

this is that that annual annual checkup that's recommended for all lavas is really important here so if they have

51:39

they've had a regular checkup they've had their diagnosed disease that we know that they have based on this

51:45

column they've had it checked out within the past 12 months they've been doing well

51:51

then vigorous exercise is okay with them but always moderate should be real good for

51:58

this group so a known disease in a regular exerciser who is asymptomatic

52:04

moderate intensity we should be good to go

52:11

okay and then just a couple of last things that i want to follow up on i've been talking about intensity a lot

52:17

and this is something that we're going to look at more throughout this semester in great detail

52:23

but i just wanted to give you an idea today because we've talked about it so much light intensity exercise is

52:30

um the easiest way to remember it is this it's an intensity that causes a slight increase in heart rate of

52:36

breathing so we're going to be breathing a little heavier than we usually do there's slight increase in heart rate

52:42

it's going to be a little tougher to talk on a scale of 6 to 20 we're going to

52:48

talk about a chart called rating of perceived exertion on a scale from 6 to 20

52:54

light intensity would be somewhere between 9 and 11. and mints we'll talk about later this is

53:02

a way to classify intensity of exercise but a good way to think about it too

53:08

remember we've been talking about vo2 max light intensity exercise

53:13

is where you are exercising at about 30 to 40 percent of your maximal capacity so that's a

53:20

nice way to think about light intensity moderate intensity is 40 to 60 percent

53:27

of your maximal capacity and vigorous or high intensity is over 60 percent of your maximal

53:34

capacity so that might be a a nice way to think about light moderate vigorous or low moderate

53:41

high however you want to think about those intensities moderate intensity means that there's a

53:47

more noticeable increase in heart rate and breathing so you're going to be able to talk to your

53:52

workout partner a little bit a sentence or two so you want to be able to do that but you don't

53:58

want to be able to carry on a full conversation with them and then vigorous intensity means it's

54:04

really tough to talk there's a substantial increase in heart rate and breathing

54:11

we've also talked about medical clearance so medical clearance means this is one

54:17

that we have here at asu it's a form that you can have your client take to their

54:22

doctor and it just basically says your patient and you fill in the name here wishes to

54:28

take part in exercise and then the health care provider can make recommendations

54:33

yes it is okay for this person or sorry no it is not okay for this person um

54:40

okay go back sorry yes go back to yes uh i am not aware of any contraindications toward

54:46

pre-participation and uh exercise program so this means that the doctor

54:51

says that there are no problems there are no contraindications toward participation and exercise yes

54:58

that person can go ahead okay now i believe the patient can participate but i urge

55:04

caution because so maybe they have an ankle issue

55:09

so the doctor puts some notes here they can exercise but i would be careful with the ankle because

55:16

the patient should not engage in the following activity so maybe they say that weight training is not going to be

55:22

allowed for this person because they have uncontrolled high blood pressure and we are trying to get the blood

55:28

pressure under control or maybe the doctor says no definitely

55:33

not i recommend the patient not participate in the exercise program above for the following reasons

55:39

and doctors offices have their own medical clearance forms but but again this is something that some

55:44

facilities will provide to the client to to provide to the doctor

55:51

okay that concludes the lecture on pre-participation health screening a really important chapter this is one of

55:57

the most important chapters that we will deal with we have to make sure that exercise is safe for our client

56:04

exercise testing is safe for our client before we can go any further so this is a chapter that i

56:10

would really suggest focusing on pretty strongly and we'll pick up next time with

56:17

the next step in participation screening

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