ACSM chapter 2

Classification / significance of ankle edema for cardiovascular, metabolic, and renal disease

- bilateral ankle edema is most evident at night is a characteristic of heart failure *is also a characteristic of bilateral chronic venous insufficiency -Unilateral edema of a limb often results from 1.) venous thrombosis or 2.) lymphatic blockage of a limb

During preparticipation health screening ___________ should be considered a CVD risk factor and not a ____________ disease

- hypertension - not a Cardiac disease

If someone describes recent periods of noticeable breathlessness - which is an occurrence of nonspecific CVD symptoms - what are some additional questions to ask to clarify the vague or ambiguous response?

-What were you doing during those periods of breathlessness ? -Were you more breathless than you would have expected for this activity?

What things can be known or defined as high cardiac output states?

-anemia -fever -thyrotoxicosis -arteriovenous fistula -idiopathic hyperkinetic heart syndrome

Anasarca occurs in individuals with what three things?

1. Nephrotic syndrome 2. Severe heart failure 3. Hepatic cirrhosis

What are the nine signs of of cardiovascular metabolic and renal disease?

1. Pain ( in the chest, arms, jaw, or other areas that may result from myocardial ischemia) 2. Shortness of breath at rest (or with mild excertion) 3. Diszziness / syncope 4.Orthopnea 5. Ankle edema 6. Palpitations or tachycardia 7. Intermittent Clasidication 8. Known heart mumor 9. Unusual fatigue

What are the characteristics of patients at lowest risk for exercise participation?

1.) Absence of complex ventricular dysrhythmias during exercise testing and recovery 2.) absence of angina or other significant symptoms (shortness of breath, light-headedness, dizziness) 3.) presence of normal hemodynamics during exercise and recovery ( aka normal increases and decreases in heart rate and systolic blood pressure with workloads and recovery 4.) Functional capacity of 7 METS

What individuals may immediately and without medical clearance initiate a light to moderate intensity exercise program?

1.) Healthy individuals who - do not currently exercise -have no history or signs / symptoms of cardio vascular, metabolic, or renal disease 2.) Healthy individuals who - exercise regularly -no signs or symptoms of CV, metabolic, or renal disease ***may continue current volume or intensity or progress without clearance**** 3.) Participants who -exercise regularly -have a known history of cardio vascular, metabolic, or renal disease -do not have any signs or symptoms (clinically stable ) *may continue with moderate intensity* **** if want to progress to vigorous intensity aerobic exercise, medical clearance is recommended****

What is the next classification of individuals on The ACSM Preparticipation screening algorithm?

1.) Identifying those with known Cardio Vascular, metabolic, or renal diseases 2.) Or those with signs and symptoms suggestive of : 1.) cardiac, 2.) peripheral vascular, 3.) cerebrovascular disease 4.) type 1/Type2 Diabetes Mellitus (DM) , 5.) and renal diseases ****participants should be asked during preparticipation health screening if they have ever been diagnosed by a Qualified health care provider****

What individuals should obtain medical clearance to initiate a light to moderate intensity exercise program?

1.) Participants who do not currently exercise -and have a known CV, metabolic, or renal disease - are asymptomatic

What are the characteristics of patients at lowest risk for exercise participation?

1.) Presence of complex ventricular dysrhymias during exercise testing or recovery 2.) absence of angina or other significant symptoms (shortness of breath, light-headedness, dizziness at low levels (<5 METS) 3.) High level of silent ischemia (ST-segment depression >2mm from baseline during exercise testing or recovery 4.) presence of abnormal hemodynamics with exercise testing ( chronotropic incompetence or flat or decreasing systolic blood pressure with increasing workloads) risk recovery (severe post exercise hypotension)

What are the non exercise testing findings for moderate risks

1.) Rest ejection fraction 40%-49%

What participants should seek medical clearance regardless of disease status?

1.) Symptomatic participants who do not currently exercise ***** If signs / symptoms are present with activities of daily living then medical clearance may be urgent***** 2.) Participants who - exercise regularly - have signs / symptoms of Cardio vascular, metabolic, or renal disease (regardless of status) *****should discontinue exercise until clearance is given*****

The need for medical clearance prior to beginning an exercise program is based on

1.) current exercise participation 2.) history of Cardio vascular, metabolic, or renal disease 3.) signs / symptoms suggestive of cardio Vascular, metabolic, or renal disease 4.) desired exercise intensity

What are the characteristics of patients at moderate risk for exercise participation?

1.) mild to moderate level of silent ischemia during exercise testing or recovery (ST-segment depression less than 2mm from baseline) 2.) absence of angina or other significant symptoms (shortness of breath, light-headedness, dizziness at high levels (>7 METS) 3.) Functional Capacity less than 5 METS

The "Progressive Transitional Phase" will help with

1.) minimize the risk of musculoskeletal injury 2.) allow sedentary individuals to improve their cardiorespiratory fitness without large spikes in CV risk during vigorous intensity

What are the non exercise testing findings for highest risks

1.) rest ejection fraction <40% 2.) history of cardiac arrest or sudden death 3.) complex dysthymia at rest 4.) complicated myocardial infraction or revascularization procedure 5.). Presence of signs or symptoms of postevent / postprocedure myocardial ischemia 6.) Presence of clinical depression

What are the non exercise testing findings for lowest risks

1.) resting ejection fraction greater than 50% 2.) uncomplicated myocardial infarction or revascularization procedure 3.) absence of complicated ventricular dysththmias at rest 4.) absence of congestive heart failure 5.) absence of signs / symptoms of postevent /. Post procedure myocardial ischemia 6.) absence of clinical depression

What are the different ways medical clearance can vary from provider to provider?

1.) verbal consultations 2.) resting or stress electrocardiogram 3.) echocardiogram 4.) computed tomography ( used for the assessment of coronary artery calcium) 5.) nuclear medicine imaging studies 6.) angiography

More specifically, abnormal exertion all dyspnea suggests dysfunction in what part of the body? (When referring to major signs and symptoms of cardiovascular metabolic and renal disease? Two dysfunctions )

1.Left ventricular dysfunction 2. Chronic obstructive pulmonary disease

What is considered to be light to moderate intensity?

2-3 Metabolic Equivalents (METS)

Pre-participation health screening before beginning an exercise program should be distinguished / differentiated from what?

A periodic medicinal examination (which should be encouraged as part of routine health maintenance)

What is Dyspnea?

Abnormally uncomfortable awareness of breathing

Vigorous intensity exercise is more likely to trigger _________________ in comparison to light / moderate intensity in selected individuals

Acute cardio vascular events

The associated risk with vigorous exercise is migrated by

Adopting a progressive transitional phase (two to three months) while the duration and intensity are gradually increased

Who provides guideline recommendations for participants / patients with known CVD?

American Association of Cardiovascular and Pulmonary Rehabilitation AACVPR

Generalized edema is known as __________ Generalized edema is ________

Anasarca Swelling

Palpitations often result from what?

Anxiety High cardiac output states (hyperkinetic)

Why do healthy individuals experience dizziness after exercise?

As a result of a reduction in venous return to the heart

Intermittent claudication occurs with an inadequate blood supply usually as a result of what?

Atherosclerosis (the build up of fats, cholesterol, and other substances in the artery walls)

Why is the type of medical clearance left to the discretion and clinical judgment of the provider?

Because there is no single universal recommended screening test - type of procedures conducted during clearance may vary widely from provider to provider

Classification / significance of Orthopnea and / or paraoxysmal nocturnal dyspnea for cardiovascular, metabolic, and renal disease

Both are symptoms of left ventricular dysfunction *nocturnal dyspnea may occur in in individuals with chronic obstructive pulmonary disease. (Difference is that relief is given followed by a bowel movement)

What does the The ACSM Preparticipation screening algorithm begin with? - Why does it begin with this?

By classifying individuals who do or do not exercise - better identify those unaccustomed to regular physical exertion ( these individuals may place disproportionate demands on the cardio vascular system and increase their risk for complications)

What else can the PAR-Q+ be used for?

Can be used for 1.) self guided exercise pre-participation health screening tool 2.) supplemental tool for professionals - who may want additional tools beyond the algorithm

When using the algorithm, exercise professionals should monitor participates for _________ which may alter

Changes which may alter their categorization and recommendations Participants who initially declare no signs or symptoms of disease may develop signs / symptoms only after beginning an exercise program *** this would necessitate more aggressive screening recommendations

What are the key features favoring an ischemic origin Character? Location? Provoking factors?

Character : constricting, squeezing, burning, heavy feeling Location : substernal (below the sternum), across midthorax, anteriorly, in one of both arms, shoulders, in neck, cheeks, teeth, in forearms, fingers in interscapular region Provoking factors : exercise or excretion, excitement, stress, after meals

What are the key features against an ischemic origin? Character? Location? Provoking factors?

Character: dull ache, knife like, sharp, stabbing, aggravated by respiration Location : in left submammary area, left hemithorax Provoking factors : after completion of exercise or specific body motion

The manner of clearance for exercise should be given / determined by

Clinical judgment and discretion of health care provider

The AACVPR guidelines do not consider __________ such as ___________. These may require what?

Comorbidities such as Type 2 Diabetes, morbid obesity, severe pulmonary disease, debilitating neurological and orthopedic conditions These all may require modification of the recommendations

Why does The ACSM Preparticipation screening algorithm only clued aerobic exercise?

Current evidence is insufficient regarding cardio vascular complications during resistance training - risk cannot be determined but currently appears to be low

What is the final component in The ACSM Preparticipation screening algorithm?

Desired exercise intensity

When does dyspnea occur in healthy untrained individuals?

During moderate exertion

When does Dyspnea occur in well trained individuals?

During strenuous exertion

Nocturnal dyspnea is

Dyspnea beginning usually 2-5 hours after the onset of sleep

What is orthopnea?

Dyspnea occurring at rest in the recumbent position

Classification / significance of shortness of breath / dyspena for cardiovascular, metabolic, and renal disease

Dyspnea, is a principle symptoms of cardiac and pulmonary disease Is abnormal when it occurs at an unexpected level of excretion to evoke symptoms. Abnormal exertional dyspnea suggests presence of cardiopulmonary disorders

What is the vigorous intensity threshold? What is this threshold commonly associated with?

Greater than 6 METS Commonly associated with triggering of acute CV events in susceptible individuals

Classification / significance of known heart murmur for cardiovascular, metabolic, and renal disease

Heart murmurs indicate 1.) valvular disease 2.) cardiovascular disease *some heart murmurs are innocent*

From an exercise standpoint, what is important to exclude as underlying causes of known heart mumurs? And why?

Important to exclude 1.)hypertrophic cardiomyopathy 2.) aortic stenosis Important to exclude these as underlying issues becuase they are among the more common causes of exertion related sudden cardiac death

Why is it important to determine the desired intensity of a participant during the preparticipation screening?

In certain individuals, vigorous intensity is more likely to trigger acute cardio vascular events in comparison to light to moderate exercise

What population is at an increased risk for intermittent claudication?

Individuals with diabetes are at an increased risk

Classification / significance of Palpitations or Tachycardia for cardiovascular, metabolic, and renal disease

Induced by various disorders of cardiac rhythm -tachycardia -bradycardia of sudden onset -ectopic beats -compensatory pauses -prominent stroke volume which results from valvular regurgitation

Define syncope

Loss of consciousness

In the The ACSM Preparticipation screening algorithm, participants are grouped into _______ of _______ categories

One of six categories

Classification / significance of pain as a sign for cardiovascular, metabolic, and renal disease

One of the primary or major clinical signs of cardiac disease -more particular coronary artery disease

When should excretion intensity be increased

Over time and as long as the individual remains symptom free

Individuals initiating exercise without assistance or are outside of fitness facilities may choose what as a self screening tool?

PAR-Q+

What is a self guided method of pre-participation health screening?

PAR-Q+

Classification / significance of known heart murmur for cardiovascular, metabolic, and renal disease? When does this not occur? When is it more severe? When does it disappear?

Pain that occurs in the lower extremities with an adequate blood supply that is brought on by exercise -Pain does not occur with standing or sitting -Is reproducible from day to day and is more severe when walking uphill or upstairs -disappears within 1-2 min after stopping exercise Is often described as a cramp

To better identify those individuals who may have undiagnosed diseases, participants should be screened for the __________ and ___________

Presence or absence of signs and symptoms of the particular diseases

Syncope is most commonly caused by what?

Reduced perfusion of the brain

Once an individuals disease status has been ascertained where should attention shift to? Why?

Signs and symptoms suggestive of these diseases Attention should shift here because the Cardio Vascular metabolic, and renal diseases of concern for preparticipation health screening may be present but undiagnosed

Nocturnal dyspnea is relieved by

Sitting on the side of the bed Getting out of bed Relieved following a bowel movement

Orthopnea is relieved by?

Sitting upright or standing

Classification / significance of dizziness / syncope for cardiovascular, metabolic, and renal disease

Syncope during exercise may result from cardiac disorders that prevent the normal rise (or fall) of cardiac output

What tool is a new instrument to identify participants at risk for Cardio Vascular Complications During or immediately after aerobic exercise

The ACSM Preparticipation screening algorithm

What is used for exercise professionals to systematically determine a participants need for medical clearance prior to beginning an exercise program?

The ACSM updated Preparticipation health screening algorithm

Classification / significance of unusual fatigue, or shortness of breath with usual activities for cardiovascular, metabolic, and renal disease

This may signal the onset of, or the change in status of cardiovascular or metabolic disease *there may be benign origins*

Who is classified as current exerciser?

Those with a history of the following : 1.) performing planned, structured physical activity 2.) with at least moderate intensity 3.) For at least 30 min 4.) Three or more days a week 5.) Within the past three months

Palpitations defined is

Unpleasant awareness or rapid beating of the heart