Ex Rx test 1

ACSM certifications- specialty

- exercise is medicine credential -certified cancer exercise trainer -certified inclusive fitness strainer -physical activity in public health specialist

Who can write prescriptions

-M.D. and D.O. -some nurse practitioners -licensed registered dietitians -others

Public health perspective for current recommendations

ACSM, CDC, and NIH documented that dose-response relationship between PA and health (some activity is better than none)

American heart association (1992)

Made physical inactivity a major risk factor for CVD

What do we mean by "trained exercise physiologist" 3

Maintenance of appropriate scientifically based continuing education

Rx

Means prescription -late Latin verb "to take" or "take this"

Age +1

Men 45 years or older Women's 55 years or older

Risks of cardiac events during cardiac rehabilitation

Mortality rate appears to be 6 times higher when individuals exercise in facilities without the ability o successfully manage cardiac arrest

ACSM EIM credential 2

Most health care professionals have little or no training in exercise science (why referral is important)

ACSM EIM credential 3

Physician recommendation often limited to "get more exercise" (lacking a specific exercise prescription)

Exercise

Planned, structured movement

CDC-ACSM recommendation (1995)

"Every US adult should accumulate 30 minutes of moderate- intensity physical activity on most, preferably all, days of the week"

ACSM EIM credential 4

*** exercise professionals "bridge the gap" of exercise as medicine

US physical inactivity

-50.9% of adults meet aerobic activity guidelines -30.4% meet muscle strengthening guidelines -20.5% meet both

Surgeon general's report (1996)

-60% adults do not meet recommendations -25% not active at all

Resources regarding PA participation

-ACSM -Participation community better challenge -Canadian association of cardiovascular prevention and rehabilitation (CACPR) -World health organization -health link BC

Professional organizations and certifications

-American council of exercise (ACE) -American college of sports medicine (ACSM)

Basic principles and guidelines

-Calibrate all equipment -minimize individual anxiety -provide a comfortable seat/examination table -familiar with the emergency response

What about aerobic activity?

-Recommend either 150 minutes per week of moderate activity, 75 minutes of vigorous activity or combination of both for adults -Moderate = can carry on a conversation Vigorous = can not carry on a conversation -perform your activity in "bouts" that are at least 10 minutes long

Sudden cardiac death among young individuals

-absolute annual risk of exercise related death young competitive US athletes: —- one per ~62000 men and one per ~523000 women -death rates also appear to be higher in African American male athletes and basketball player specifically

***Absolute contraindications for exercise testing (more severe)

-acute MI within 2 days -ongoing unstable angina -uncontrollled cardiac arrhythmia and hemodynamic compromise -active endocarditis -Symptomatic sever aortic stenosis -decompensated heart failure -acute pulmonary embolism, pulmonary infarction, or deep venous thrombosis -acute myocarditis or pericarditis -acute aortic dissection -physical disability that precludes safe and adequate testing

Getting started

-beginners should start with aerobic activity -work toward the 150/75 minutes -increase strength training with time at a safe pace -make it fit your schedule Make it FUN

Exercise related cardiac events in adults

-exercise does not provoke cardiovascular events in healthy individuals -risk is related to absence or presence of occult CVD, exercise intensity, age, and PA -SCD occurs every 1.5 million episodes of vigorous physical exertion in men and every 36.5 million of moderate to vigorous exertion in women

Prevention of exercise related cardiac events

-health care professionals -physical active individuals -high school and college athletes -athletes with CVD history -heath care facilities -making adjustments

Pre participation health screening

-identify people at risk for adverse exercise related CV events + who should receive medical clearance before initiating a moderate to vigorous intensity exercise program or increasing program + clinically significant disease who may benefit from participating + medical conditions that may require exclusion from exercise programs

Stage 2 pre participation health screening

-if indicated during screening, medical clearance should be sought from an appropriate health care provider — determined by clinical judgement and discretion of health care provider

Appropriate component medical history

-if person does not know their data in a particular category = marked as risk factor +1

Additional recommendations

-if warranted, a preliminary exam should be performed by a physician -laboratory tests: fasting serum oral cholesterol, fasting plasma glucose, Holter monitoring, cardiac ECG, chest reading Ralphs, 12-lead ECG, pulmonary function, and oximetry

Comprehensive health fitness evaluation includes

-informed consent, exercise pre participation health screening, and pre exercise evaluation -resting measurements -circumference measurements and body composition analysis -measurement of CRF -measurement of muscular fitness -measurement of flexibility

Relative contraindications

-known obstructive left main coronary artery stenosis -moderate to severe aortic stenosis with uncertain relationship to symptoms -tachyarrhythmias with uncontrolled ventricular rates -acquired advanced or complete hear block -recent stroke or transient ischemia attack -mental impairment with limited ability to cooperate -resting hypertension with systolic greater than 200 mmHg or diastolic greater than 110 mmHg -uncorrected medical conditions

Pre participation health screening pt 2

-low risk of SCD and AMI during light to moderate exercise -greater risk of SCD and AMI with vigorous exercise — reduce risk with mitigated progressive transitional phase

Risks associated with PA and exercise

-musculoskeletal injury (MSI) is the most common exercise related complications -sudden cardiac death and acute myocardial infarction are associated with vigorous intensity exercise

Principles of writing medicinal and dietary prescriptions

-must have sound knowledge of evidence and mechanism behind usage of specific drug (medicinal) or reasoning suggesting certain foods/supplements; how it might help and potential side effects -knowledge on appropriate dosing -must come from evidence-based scientific research *** 1/5000 drugs actually make it to the people

Basic principles and guidelines

-no exact EX RX for fitness testing -obtain resting measurements -allow sufficient time for HR and BP to return to baseline -medications should be noted ****- general rule of thumb is that a test should not affect any subsequent test

What do we know about physical activity?

-protect your joints, prevent falls and injuries, and reduce risk of disease. -more important than weight loss -limiting your sedentary time to less s than 6-8 hours a day

Purposes of health related physical fitness testing

-provide baseline data for health status relative to standards and age and sex matched norms -how to treat clients -follow up data allow short and long term evaluation of progress -motivation for individuals by establishing fitness goals

Medical and CV screening

-provides information for designing individualized exercise programs to lower or reduce known health risks -may uncover a need for other health or medical referrals

HR measurement

-pulse palpitation -auscultation -HR monitor -ECG

What about strength training?

-recommend that you do muscle strength training two times per week to increase bone strength and muscular fitness -adults should perform 8-12 reps that work large muscle groups -do not require gym (at home body weight)

Stage 1 pre participation health screening

-the need for medical clearance before initiating or progressing exercise programming is determined using ACSM screening algorithm —-will accept self guided screenings

Who should be able to write EX Rx

-trained exercise physiologists

General physical activity classifications

-very light *** light *** moderate *** vigorous -near maximal to maximal -cardio, max HR, flexibility, muscular strength etc

Recommended sequence of evaluation

1. Informed consent 2. Exercise pre participation health screening 3. Health history 4. CV risk factor analysis

Transitional phase

2-3 months Begin with light to moderate intensity (2-3 METS) Gradually increase intensity overtime (3-5 METS)

Appropriate room temp

68 F and 72 F (20 C and 22 C); humidity less than 60% with adequate airflow

Physical inactivity

A global pandemic that has been identified as one of the four leading contributors to premature mortality -globally 31.1% of adults are physical inactive

Recommendation

A suggestion or proposal as to the best course of action, especially one put forward an authoritative body

Prescription

An instruction written by a medical practitioner that authorizes a patient to be provided a medicine or treatment

Sedentary behavior

Any behavior characterized by any activity that burns only 1.5 Mets

What do we mean by "trained exercise physiologist" 2

Appropriate field training (internship) with experienced practitioner- not unlike "medical residency"

What do we mean by "trained exercise physiologist" 1

At least an undergraduate degree in exercise science/related field (kinesiology)

LDL

Bad cholesterol

US physical activity guidelines (2008)

Based on review of research since 1996 surgeon general's report

Physical activity

Bodily movement that results in calories burned

Obesity +1

Body mass index greater than or equal to 30 kg/m^2 OR waist girth greater than 102 cm (40 in) for men and greater than 88 cm (35 in) for women

Why exercise prescription and not "workout plans"

By virtue of how we generically perceive the term 'prescription', it is reasonable to assume that the public accept sand has much confidence in the treatment

Comprehensive health fitness evaluation

Can usually be completed in one session

ACSM certifications - clinical

Certified clinical exercise physiologist

ASCM certifications-fitness

Certified group exercise instructor -certified personal trainer -certified exercise physiologist

ACSM screening algorithm

Classifying individuals who do or do not currently participate in regular exercise -identifying individuals with known CV, metallic or renal diseases or those with signs or symptoms of cardiac peripher vascular, or cerebrovascular diseases, diabetes mellitus, and renal disease -identifying exercise intensity

Informed consent

Completed prior to: -collection of any personal and confidential information -any form of fitness testing -exercise participation + should ensure that individuals know and understand purpose and risk +be verbally described and the individual should be given chance to ask questions before signing

Cigarette smoking +1

Current smoker, or have quit less than 6 months or is exposed to environmental smoke

Exercise testing and risk of cardiac events

Data indicate that in a mixed population the risk of exercise testing is low, ~ six cardiac events per 10000 symptom limited maximum tests

Exercise is medicine

Decrease blood pressure by 50%

Exercise is medicine

Decrease depression as effective as behavioral therapy

Exercise is medicine

Decrease heart disease by 40%

What is the problem with certified personal trainers?

Easy to apply to become a trainer -lots of websites do not require credentials or extensive knowledge to apply

Test organization

Ensure all necessary documents are available in the individual's file and available for thee test administration

IFG

Fasting

HDL

Good cholesterol

HDL -1

Greater than or equal to 60 mg/dl

PA guidelines advisory committee report

Health benefits can be obtained by: -performing a moderate amount of PA on most if not all days of the week -maintain a regular program of PA that is longer in duration, of greater intensity, or both -aerobic activity occur in less than 10 min bouts

Cardiorespiratory endurance

Health related fitness -ability to supply oxygen to organs

Body composition

Health related fitness -relative amount of fat mass and fat free mass

Muscular endurance

Health related fitness -to continue to perform without fatigue

Flexibility

Health related fitness -ROM. At a particular joint

Muscular strength

Health related fitness -one repetition maximum increases weight

Family history +1

Heart attack, 'Bypass surgery', or sudden death before the age of 55 years for father/brother OR before 65 years for mother/sister

Pre diabetes +1

IFG greater than or equal to 100 mg/dl or OGTT greater than or equal to 140 and less than or equal to 199 mg/dl confirmed by two different measurements

Identifying and controlling CVD risk factors

Important objective of overall CVD prevention and management -provides information on individual, ex Rx, and lifestyle modifications

Dyslipidemia +1

LDL greater or equal to 130 mg/dl, or HDL men less than 40 mg/dl and women less than 50 mg/dl l, or taking medicine or TC greater than 200 mg/dl

Risks of cardiac events during cardiac rehabilitation

Lower rates, one cardiac arrest per 116906 patient hours, one MI per 219970 patient hours, one fatality per 752365 patient hours, and one major complication per 81670 patient hours

ACSM EIM credential 1

No patient should leave a doctor's office without an assessment of their physical activity -proper prescription of an exercise program -or a referral to a qualified fitness professional

OGTT

Not fasting, oral glucose testing

Medical history

Not part of pre-screening; gives more information to help create treatment

Sedentary lifestyle +1

Not participating in moderate PA at least 3 days/week for 3 months

Self guided method

PAR-Q +

Physical fitness

Relate to ability to perform physical activity

Prescription for health series

Sit less move more

Agility

Skill related fitness -changes body in space

Speed

Skill related fitness -perform movement in short amount of time

Reaction time

Skill related fitness -time between action and reaction to it

Coordination

Skill related fitness -use of senses with body parts to perform acts smoothly

Power

Skill related fitness -rate to perform work P=w/t

Balance

Skill related fitness -stationary and moving equilibrium

Hypertension +1

Systolic blood pressure greater than or equal to 140 mmHg and or diastolic greater than or equal to 90 mmHg OR taking medicine

EIM form

The prescription to who the individual should exercise - includes aerobic and strength training

CVD

There is a 20% to 35% lower risk for CVD, CHD and stroke

Risk stratification for individuals in cardiac rehabilitation and medical fitness facilities

Use more in-depth cardiac risk stratification rehab

Transgender evaluation

—may create a challenge for the exercise professional - many health risk status and norms are based on sex recorded at birth - little evidence to guide decision making -keep testing for years to come to ensure safety and comfortability