ACSM-EP Domain Study Guide

Pain or discomfort in chest, neck, jaw, arms that may be due to ischemia or lack of blood flow - Characteristics Location Provoking Factors

Characteristics: pain is constricting, squeezing, burning, heaviness, or "heavy feeling" Location: substernal, across midthorax, anteriorly; in one or both arms or shoulders; in neck, cheeks, or teeth; or in forearms, fingers, +/or in the interscapular region Provoking Factors: pain comes on with exercising, excitement, stress, cold weather, or after meals

Negative Risk Factor:

HDL - >60 mg/dL

What does Absolute Contraindication mean?

absolutely not allowed

Bilateral Edema:

common at night

Unusual Fatigue + Shortness of Breath that occurs during Light Exertion or Normal Activity + not during Strenuous Activity:

could be an onset of CVD +/or metabolic

a 22-year recent college graduate is joining a gym. since becoming an accountant 6 months she no longer walks across campus or plays intramural soccer and is concerned about her now sedentary lifestyle. although her BMI is slightly above normal, she reports no significant medical history and no symptoms of diseases even when walking up 3 flights of stairs to her apartment. she would like to begin playing golf.

currently participates in regular exercise: no known CMR: no signs/symptoms: no desired intensity: moderate medical clearance: not needed

a 60 year old women is beginning a professionally lead walking program. 2 years ago she had a drug eluding stent placed in her left anterior descending coronary artery after a routine exercise stress test revealed significant ST-segment depression. she completed a brief cardiac rehabilitation program in the 2 months following the procedure but has been inactive since. she reports no signs./symptoms and take a cholesterol lowering statin and platelet medications as directed by her cardiologist

currently participates in regular exercise: no known CMR: yes signs/symptoms: no desired intensity: moderate medical clearance: needed

a 35-year old business consultant is in town for 2 weeks and seeking a temporary membership at a fitness club she and her friends have been training for a long distance charity bike ride for the last 16 weeks she is unable to travel with her bike and she does not want to lose her fitness. she reports no current symptoms of CMR and has no medical history except hyperlipidemia for which she takes HMG-COA reductase inhibitor statin daily.

currently participates in regular exercise: yes known CMR: no signs/symptoms: no desired intensity: vigorous medical clearance: not needed-

a 40 year old former collegiate swimmer turned lifelong triathlete requests assistance with run training. his only significant medical history is a series of overuse injuries to his shoulders and achilles. in recent weeks, he notes his workouts are unusually difficult and constricting in his chest with exertion, something he attributes to deficiencies in core strength upon further questioning he explains that the chest constriction is improved with rest and that he often feels dizzy during recovery.

currently participates in regular exercise: yes known CMR: no signs/symptoms: yes desired intensity: vigorous medical clearance: needed

a 50 year old non-smoking male was recently invited by colleagues to participate in a 10k trail run. he reports currently walking 40 min M, W, F something he has "done for years" his goal is to run the entire race without stopping and he is seeking training services. he reports having what he has had a mild heart attack at 45 years old. completed cardiac rehabilitation and has no problems since. he takes a statin and angiotensin converting enzyme (ACE) inhibitor and aspirin daily. during the last visit with his cardiologist which took place 2 years ago, no changes in medical condition.

currently participates in regular exercise: yes known CMR: yes signs/symptoms: no desired intensity: vigorous medical clearance: needed

Paroxysmal Nocturnal Dyspnea:

difficulty breathing while asleep

What does Relative Contraindication mean?

do the benefits outweigh the risks

Preparticipation Health Screening:

dynamic process in that it may vary in its scope and components depending on the clients needs from a medical/health standpoint, as well as the presence and signs/symptoms suggestive of CMR diseases, and their physical activity program goals 1. individuals current PA level 2. the presence of signs/symptoms and/or known CVD, metabolic, or renal disease 3. the desired exercise intensity

Syncope:

fainting, dizziness, poor blood flow - sudden decrease in venous return + consequent reduction in blood flow to the brain

Palpitations:

occurs from anxiety states + high cardiac output states, such as anemia, fever, thyrotoxicosis, ateriovenous fistula, + idiopathic hyperkinetic heart syndrome

Generalized Edema(Anasarca):

occurs in individuals with the nephrotic syndrome, severe heart failure, or hepatic cirrhosis

ePARmed-X+:

physician clearance follow-up questionnaire - if you answer yes to any of the questions on the PAR-Q+ used so if physician can use to refer individuals to a professionally supervise physical activity program and make recommendations for that program 3 sections: 1. background information regarding the PAR-Q+ and ePARmed-X+ clearance process 2. a brief history and demographic information regarding the participant 3. the physician's recommendations regarding the participant becoming more physically active

Health History Questionnaire:

professionally supervised screening establishes his/her medical/health risks for participation in a physical activity program assesses a clients: 1. family history of CMR disease 2. personal history of various diseases/illnesses 3. surgical history 4. past/present health behaviors/habits 5. current use of various drugs/medications 6. specific history of various signs/symptoms suggestive of CMR disease among other things 7. tailor the HHQ to the clients needs

Tachycardia:

rapid beating or fluttering of the heart

Intermittent Claudication:

severe calf pain when walking -lack of oxygenated blood flow to working muscles similar in origin to chest pain Characteristics - 1. more severe when walking upstairs/uphill 2. often describes as a cramp 3. disappears within 1-2 min after exercises 4. coronary artery disease + type 1/2 diabetes more common

Dyspnea:

shortness of breath moderate/severe - stair climbing (normal) mild/rest - indicates CVD or pulmonary

Ankle Edema/Swelling not due to injury:

suggestive of heart failure, blood clot, insufficiently of the veins, or a lymph system blockage

Orthopnea:

trouble breathing while lying down - poor ventricular function - usually relieved by sitting-up/standing

Heart murmurs:

unusual sounds caused by blood flowing throuhg the heart 1. may indicate valvular or other CVD's 2. exclude hypertrophic cardiomyopathy + aortic stenosis as underlying causes 3. unless previously diagnosed and determined to be safe, all heart murmurs should be evaluated by a physician

Unilateral Edema:

venous thrombosis or lymphatic blockage

Positive Risk Factors:

1. Age - men >45; women >55 2. Family History - men > 55; women >65 3. Cigarette Smoking - current or quit <6 months 4. Sedentary Lifestyle - 30 min/3 days/week <3 months 5. Obesity - BMI >30 kg/m²; men >102cm(40in); women >88cm(35in) 6. Hypertension - >140/90 mmHg 7. Dyslipidemia - LDL >130 mg/dL; HDL <40 mg/dL; Total >200 mg/dL 8. Prediabetes - Fasting Glucose >126 mg/dL

Absolute Contraindications to Exercise:

1. acute myocardial infarction within 2 days 2. ongoing unstable angina 3. uncontrolled cardiac arrhythmia's with hemodynamic compromise 4. active endocarditis 5. symptomatic severe aortic stenosis 6. decompensated heart failure 7. acute pulmonary embolism, pulmonary infarction, or deep venous thrombosis 8. acute myocarditis or pericarditis 9. acute aortic dissection 10. physical disability that precludes safe + adequate testing

Known CVD, Metabolic, and Renal Diseases:

1. heart attack 2. heart surgery 3. pacemaker 4. heart valve disease 5. heart failure 6. heart transplant 7. congenital heart disease 8. T1DM and T2DM 9. renal disease

Why is it important to screen clients?

1. identify medical contraindications 2. identify those who need medical clearance 3. identify those who need medical supervision 4. identify those with health/medical concerns

Relative Contraindications to Exercise:

1. known obstructive left main coronary artery stenosis 2. moderate to severe aortic stenosis with uncertain relationship to symptoms 3. tachyarrtithymias with uncontrolled ventricular rates 4. acquired advanced or complete heart block 5. recent stroke or transient ischemia attack 6. mental impairment with limited ability to cooperate 7. mental impairment with limited ability to cooperate 8. resting hypertension with systolic >200 mmHg or diastolic >110 mmHg 9. uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, + hyperthyroidism

9 signs/symptoms of CMR:

1. pain or discomfort in chest, neck, jaw, arms that may be due to ischemia or lack of blood flow 2. dyspnea 3. syncope 4. orthopnea 5. ankle edema/swelling not due to injury 6. palpations + tachycardia 7. intermittent claudication 8. heart murmurs 9. unusual fatigue + shortness of breath that occurs during light exertion or normal activity + not during strenuous activity

What are the two approaches to preparticipation physical activity screening?

1. self-guided screening - performed by the individual wishing to become more physically active without direct input from an exercise professional 2. professionally supervised screening - interaction with an exercise professional

Physical Activity Readiness Questionnaire+ (PARQ+):

7 yes/no questions 1. has your doctor ever said that you have a heart condition? or high blood pressure? 2. do you feel pain in your chest at rest, during your daily activities of living, or when you do physical activity? 3. do you lose balance because of dizziness or have you lost consciousness in the last 12 months? 4. have you ever been diagnosed with prescribed medications for chronic medical condition? 5. are you currently taking prescribed medications for a chronic medical condition 6. do you currently have(or have within the past 12 months) a bone, joint, or soft tissue(muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? 7. has your doctor ever said that you should only do medically supervised physical activity? if you answered no to all questions you are ready to engage in PA - if answered no to any questions answer follow up questions and if answered yes to any of those, seek medical clearance

Low-Risk for Risk Factors:

<1 risks

Moderate-Risk for Risk Factors:

>2 risks