Chapter 2 Exercise Pre-participation Health Screening

Review Client A: MaleAge: 52Height: 5'8" (1.73 m)Weight: 180 (81.65 kg)Health History:Past cigarette smoker (quit 3 months ago), father suffered from mild stroke at age 54, current exercise pattern involves three 20-minute walks per week. However, he wants to train for a full marathon 6 months down the road.How many risks factor does this client have?

4

Which of the following individuals has a cardiovascular disease risk factor?

A client with a blood pressure of 138/92 mm Hg

Known heart murmur

Although some may be innocent, heart murmurs may indicate valvular or other cardiovascular disease. From an exercise safety standpoint it is especially important to exclude hypertrophic cardiomyopathy and aortic stenosis as underlying causes

Unusual fatigue or shortness of breath with usual activities

Although there may be benign origins for these symptoms, they also may signal the onset of or change in the status of CVD or metabolic disease

Ankle edema

Bilateral ankle edema that is most evident at night is a characteristic sign of heart failure or bilateral chronic venous insufficiency. Unilateral edema of a limb often results from venous thrombosis or lymphatic blockage in the limb. Generalized edema occurs in persons with the nephrotic syndrome, severe heart failure, or hepatic cirrhosis.

Pain; discomfort in the chest, jaw, arms, or other areas that may result from myocardial ischemia

Cardinal manifestation of cardiac disease; particular Coronary Artery Disease CAD ø favoring an ischemic origin ~Character: Constricting, squeezing, burning, "heaviness", or "heavy feeling" ~Location: substernal, across midthorax, anteriorly in one o r both arms shoulfdders; neck, cheeks, teeth; forearms, ~Provoking factors: excitement, exercise/exertion, cold weather, post meals, other forms of stress ø against an ischemic origin ~Character: dull ache, knifelike, sharp, stabbing, jabs, aggravated by respirarion ~Location: left submammary area; left hemithorax ~Provoking factors: after exercise; provoked by specific body motion

Which of the following is a definition of moderate risk?

Individuals who do not have signs/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease, but have two or more (i.e., >2) risk CVD factors

Table 2.1

Major Signs or Symptoms Suggestive of Cardiovascular, Pulmonary, or Metabolic Disease

Client A: MaleAge: 52Height: 5'8" (1.73 m)Weight: 180 (81.65 kg)Health History:Past cigarette smoker (quit 3 months ago), father suffered from mild stroke at age 54, current exercise pattern involves three 20-minute walks per week. However, he wants to train for a full marathon 6 months down the road.Based on the health information, what is the risk category of this client?

Medium Risk

Risk stratification of cardiac patients (patients with known disease) includes lowest risk, moderate risk, and high risk according to the AACVPR. Which of the following places a patient into the moderate-risk category?

Mild to moderate level of silent ischemia during exercise testing or recovery (ST-segment depression <2 mm from baseline)

Orthopnea or paroxysmal nocturnal dyspnea

Orthopnea refers to dyspnea occurring at rest in the recumbent position that is relieved promptly by sitting upright or standing. Paroxysmal nocturnal dyspnea refers to dyspnea, beginning usually 2-5 hours after the onset of sleep, which may be relieved by sitting on the side of the bed or getting out of bed. Both are symptoms of left ventricular dysfunction.

Which of the following is a symptom of coronary artery disease?

Pain or discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may result from ischemia

Intermittent Claudication

Pain that occurs in the lower extremities with an inadequate blood supply that is brought on my exercise. Patient w diabetes are at increased risk for this condition

Palpitations or tachycardia

Palpitations (defined as an unpleasant awareness of the forceful or rapid beating of the heart) may be induced by various disorders or cardiac rhythm. These include: tachycardia, bradycardia of sudden onset, ectopic beats, compensatory pauses, and accentuated stroke volume resulting from valvular regurgitation. Palpitations also often result from any anxiety states and high cardiac output states, such as anemia, fever, etc.

Client A: MaleAge: 52Height: 5'8" (1.73 m)Weight: 180 (81.65 kg)Health History:Past cigarette smoker (quit 3 months ago), father suffered from mild stroke at age 54, current exercise pattern involves three 20-minute walks per week. However, he wants to train for a full marathon 6 months down the road.Based on the information, this client can:

Participate in maximal exercise testing with a physician present.

Which of the following is NOT a purpose of the preparticipation health screening?

Recognition of persons with clinically significant disease(s) or conditions who should participate in a community-based exercise program

Exercise or health/fitness professionals should have a thorough knowledge of all but which of the following when doing a risk stratification?

The pathologic sequencing of the disease

Orthopnea refers to

dyspnea occurring at rest in the recumbent position

Shortness of breath at rest or w mild exertion

~Dyspnea (abnormally uncomfortable awareness of breathing) is one of the principal symptoms of cardiac and pulmonary disease. ~Commonly occurs during strenuous exertion in healthy well-trained individuals during moderate exertion in healthy UNtrained individuals. ~Regard as abnormal when it occurs at a level of exertion that is not expected to evoke this symptom. ~Suggests the presence of cardiopulmonary disorders; in particular, left ventricular dysfunction or chronic obstructive pulmonary disease.

Dizziness or syncope

~Syncope (loss of consciousness) most commonly caused by a reduced perfusion of the brain ~Dizziness & syncope DURING exercise may result from cardiac disorders that prevent the normal rise (or an actual fall) in cardiac output. ~Cardiac disorders include: severe coronary artery disease, aortic stenosis, malignant ventricular dysrhythmias, hypertrophic cardiomyopathy