Chapter 2 Preexercise Evaluation

What does the ACSM no longer recommend?

The ACSM no longer recommends the inclusion of exercise testing for medical clearance

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.

Shortness of breath at rest or with mild exertion

- Dyspnea (defined as an abnormally uncomfortable awareness of breathing) is one of the principal symptoms of cardiac and pulmonary disease. - Abnormal exertional dyspnea suggests the presence of cardiopulmonary disorders; in particular, left ventricular dysfunction or chronic obstructive pulmonary disease.

Palpitations or tachycardia

- Palpitations (defined as an unpleasant awareness of the forceful or rapid beating of the heart) may be induced by various disorders of cardiac rhythm.

Intermittent Claudication

- the pain that occurs in the lower extremities with an inadequate blood supply (usually as a result of atherosclerosis) that is brought on by exercise. - The pain does not occur with standing or sitting, is reproducible from day to day, is more severe when walking upstairs or up a hill,

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

-One of the cardinal manifestations of cardiac disease, in particular, coronary artery disease -Key features favoring an ischemic origin include the following: --Character: constricting, squeezing, burning, "heaviness," or "heavy feeling" --Location: substernal, across midthorax, anteriorly; in one or both arms, shoulders; in neck, cheeks, teeth; in forearms, fingers in interscapular region --Provoking factors: exercise or exertion, excitement, other forms of stress, cold weather, occurrence after meals

What is the recommended sequence of evaluation?

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

Patient is at high risk if any one or more of the following factors are present:

1. Left ventricular ejection fraction <40% 2. Survivor of cardiac arrest or sudden death

What is the two-stage process for pre participation health screening before initiating PA?

1. The need for medical clearance before initiating or progressing exercise programming is determined using the ACSM screening algorithm. - Self-guided screening can be an acceptable substitute for this method 2. If indicated during screening, medical clearance should be sought from an appropriate health care provider - The manner of clearance should be determined by the clinical judgement and discretion of the health care provider

Known Heart Murmur

Although some may be innocent, heart murmurs may indicate valvular or other cardiovascular disease.

Unusual fatigue of shortness of breath with usual activities

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

Orthopnea or paroxysmal nocturnal dyspnea

Orthopnea refers to dyspnea ocuuring at rest in the recumbent position that is relieved promptly by sitting upright or standing.

Dizziness or Syncope

Syncope (defined as a loss of consciousness) is most commonly caused by a reduced perfusion of the brain