Exercise testing exam 1
Why is physical activity super important in a health history questionnaire?
Because it helps determine whether an individual needs to be medically cleared and helps to better guide exercise prescription
Why are medications important in a health history questionnaire form?
Different medications have different side effects on exercise, including prescribed, OTC, and supplements
Current signs or symptoms suggestive of disease is crucial in a health history questionnaire because
It tells us if someone needs to be medically cleared before exercise because these symptoms will put patients at risk
angina pectoris characters (cardiac origin) to identify high risk signs and symptoms
The patient may feel - crushing - heavy - tightness - vice-like - often accompanied by profuse sweating
Health habits such as smoking, caffeine, diet, and mental health are important in a health history questionnaire because
These can be risk factors for CVD and mental health can affect our health due to things like stress
pain in the chest=
angina pectoris
coronary artery disease (CAD)
arteriosclerosis or atherosclerosis of the blood vessels in the heart
In a informed consent allow the participant the opportunity to
ask questions
In informed consents age of majority=
considered an adult and responsible for actions in the legal sense
Syncope is a high risk symptom that includes
dizziness of fainting at rest or during exercise - repetitively - @ rest or during mild exertion
unreasonable breathlessness is a high risk sign and symptom and includes
dyspnea, orthopnea, paroxysmal nocturnal dyspnea
signs and symptoms are things people
experience and display
What is the fourth step of a pre participation screening?
identify current or desired exercise intensity
What is the third step of a pre participation screening?
identify high risk medical conditions - yes or no questions, it only takes one yes for them to seek medical clearance in order to exercise
Overweight individuals with what waist circumferences and BMI have a high risk for disease
- Men: BMI 25-29.9, waist circumferences >102 cm - Women: BMI 25-29.9, waist circumferences >88 cm
Obesity class I individuals with what waist circumferences and BMI have a very high risk for disease
- Men: BMI 30-34.9, waist circumferences > 102 cm - women: BMI 30-34.9, waist circumferences > 88 cm
Obesity class I individuals with what waist circumferences and BMI have a high risk for disease
- Men: BMI 30-34.9, waist circumferences less than or equal to 102 cm - women: BMI 30-34.9, waist circumferences less than or equal to 88 cm
Obesity class II individuals with what waist circumferences and BMI have a very high risk for disease
- Men: BMI 35-39.9, waist circumference less than or equal to 102 cm or >102 cm - Women: BMI 35-39.9, waist circumference less than or equal to 88 cm or > 88cm
Dyslipidemia or Hyperlipidemia
- any abnormal lipid levels - contributes to fatty deposits on the inner walls of blood vessels and around major organs - increased risk of CVD
Family history positive risk factor for CVD
- myocardial infarction - coronary revascularization - sudden death - before 55 yr in father or other male that is a first degree relative or before 65 yr in mother of other female that is a first degree relative
ongoing heart murmur is a high risk symptom that includes
- not uncommon as an infant so it needs to be current
Professional is demonstrated by
- how would you want your family member to be treated as a client or patient? - Always introduce yourself and your position (will allow the participant to open up) - Explain the assessment or exercise program components in simple but accurate terms while maintaining professional language (so it is easier for the pt to understand) - Allow opportunity for questions - explain the results to the individual you assessed when applicable
purpose of CVD risk factor assessment
- identify areas for health fitness education - identify areas for lifestyle and behavior modifications to help reduce modifiable risk factors
What is the second step of a pre participation screening?
- identifying their current activity level (algorithm splits at no)
Exercise testing guidelines: minimize subject stress and anxiety
- important because stress can cause physiological factors that influence HR - Do not rush - Be confident - Provide privacy
Blood pressure
- indirect measurement of heart blood discharge and filling pressures (pumping and filling efficiency of the heart) - top # = systolic - bottom # = diastolic
In a pre-exercise evaluation, what is the first thing you obtain?
- informed consent which will allow you to determine medical history > CVD risk factor assessment > preparticipation screening
Smoking positive risk factor for CVD
- just living with someone who smokes (secondhand smoke) is just as risky - specific to tobacco smoke - current cigarette smokers or those who quit within the previous 6 months or exposure to environmental tobacco smoke
Respiratory assessments abnormal findings at rest
- labored breathing (working hard to breathe) - use of accessory muscles of breathing (sternocleidomastoid, intercostals, scalene) - snoring or wheezing heard with inspiration or expiration - may indicate heart failure or pulmonary disease * recommend seeking medical clearance before exercise
Identifying past medical conditions in a health history questionnaire allows us to determine
- limitations and participation in exercise
diabetes high-risk medical conditions
- mellitus - type 1 or type 2
HDL positive CVD risk factor
- men: <40 mg/dL - women: <50 mg/dL - or on lipid-lowering medication
Age positive risk factors for CVD
- men: greater than or equal to 45 - women: greater than or equal to 55
importance of age in informed consents
- minors require guardian consent for legal documents (guardian has to sign and date them) - 18 years old in all states except: > Alabama and Nebraska= 19 > Mississippi= 21
What is the purpose of pre-participation screenings?
- Help qualified exercise and health-care professionals identify individuals who should seek medical clearance prior to starting a moderate-vigorous exercise program - 1st thing we need to figure out: are the sedentary or not? - more sedentary > higher risk of AMI (acute myocardial infarction)
Overweight individuals with what waist circumferences and BMI have an increased risk for disease
- Men: BMI 25-29.9, waist circumference less than or equal to 102 cm - women: BMI 25-29.9, waist circumference less than or equal to 88cm
Modifiable risk factors for CVD
* it only takes one; we can do something to reduce these factors - high blood fats - high blood pressure - physical inactivity - smoking - stress - high blood sugar obesity
Nonmodifiable risk factors for CVD
*Cant change, it only takes one - Age - gender - genetic factors/family history - sex
Physical activity readiness questionnaire (PAR-Q+)
- AHA/ACSM self-screening tool - supplement to health history questionnaire - limitations include ~ reading level: needs to be 5th grade reading level ~ primary language: designed for the English language
bilateral ankle swelling is a high risk symptom that includes
- AKA edema - it is crucial to ask when and how long - in both ankles - swelling stays 2-3 hours after elevation (not relieved)
Body mass index (BMI)/ waist circumference positive risk factor for CVD
- BMI: greater than or equal to 30 kg/m - waist girth men: > 102 cm (40 in) - waist girth women: > 88 cm (35 in)
blood pressure positive risk factor for CVD
- CVD risk not in pre-participation screening - systolic BP > or equal to 130 mmHg and/or diastolic BP > or equal to 80 mmHg - based on an average of 2 or more readings obtained on 2 or more occasions - or on hypertension medication
Heart sounds and rate
- apical pulse= HR - should be compared to pulse rate - normal rate: 60-100 bpm at rest - Tachycardia: greater than or equal to 101 bpm - bradycardia: less than or equal to 59 bpm > highly trained (very fit) can normally have this HR @ rest - Normal sounds= S1 (lub, closing of atrioventricular (mitral and tricuspid) valve) and S2 (dub, closing of semilunar valves (aortic and pulmonary)) - any additional sounds= murmur > individual should seek medical clearance before exercise
Cerebral vascular disease
- arteriosclerosis or atherosclerosis of the blood vessels in the brain - a stroke can result from this - dizziness or fainting spells (syncope) is a symptom we screen fo for this disease
peripheral vascular disease (PVD) peripheral arterial disease
- arteriosclerosis or atherosclerosis of the blood vessels in the extremities - for PVD, we screen for the symptom of intermittent claudication
In an informed consent benefits and risk must be verbally explained in order to help the participant
- be aware - interprets the benefits and risks correctly
Why do we care about stress as a CVD risk factor?
- because stress can increase HR - stress can cause SNS to release hormones that can affect the cardiovascular system
Oral Glucose Tolerance Test (OGTT)
- blood glucose test - The patient participates in a sugar challenge (drinks sugar) and comes in after 2 hours to measure plasma glucose values - high CVD risk factor when 2 hr plasma glucose values is greater than or equal to 140 mg/dL
Hemoglobin (Hb)A1C
- blood glucose test - glycated hemoglobin is a form of hemoglobin that is chemically linked to sugar - long-term view of glucose control because RBC's last 120 days - this tests how glycated your hemoglobin is in your RBC (how many glucose molecules are attached to hemoglobin) - high CVD risk factor when HbA1C values are greater than or equal to 5.7%
fasting blood glucose (FBG)
- blood glucose test - single snapshot (the day of) of blood glucose - an acute/short term test of blood glucose - high CVD risk factor when FBG is greater than equal to 100 mg/dL
informed consent must be obtained prior to:
- collection of any confidential or personal information - test administration (before you touch them) - exercise participation
Respiratory assessments (counting respirations)
- count rate for 30s then double = beats per minute - normal resting rate is 12-24 breaths per minute
Purpose of body composition (anthropometric) measurements
- disease risk classification for cardiovascular, metabolic, and renal diseases based on: - area of fat deposition: central adiposity puts one at the highest risk - obesity classification - body fat % - increase awareness about the relationship between obesity and disease (want them to know about the risk of central adiposity) - monitor changes in lean body mass in older adults > Lean body mass begins to decline starting @45-50 especially in sedentary
peripheral pulses
- evaluates quality of peripheral circulation and left ventricular pumping efficiency
Angina pectoris triggers to identify high risk signs and symptoms
- exercise - excitement - New exertion (ex. pain will increase in chest maybe due to lack of oxygen)
waist circumference threshold for increased risk
- fat 2 cm below the belly button is very risky - >102 cm in men - >88 cm in women - better determinate of disease risk versus BMI alone; never use BMI alone to identify disease risk or health status - the more measurements, the greater the validity
Arteriosclerosis
- fatty accumulation within the lumen of the blood vessel, which will impair normal blood flow (can happen to any blood vessel) - cardiovascular disease
High-density lipoprotein (HDL)
- function to transport ingested lipids from the blood into the liver for storage - HDL to low: positive risk factor > not transporting lipids (fats) into the liver to be stored, so more are in the bloodstream - HDL to high: negative risk factor > transporting more lipids (fats) to be stored into the liver, so less is present in the bloodstream - give some protection against CVD because it can be a negative risk factor
LDL positive CVD risk factor
- greater than or equal to 130 mg/DL - or on lipid-lowering medication
Total cholesterol CVD risk factor
- greater than or equal to 200 mg/dL - blood lipid risk associated with CVD
HDL negative CVD risk factor
- greater than or equal to 60 mg/dL - a negative CVD risk factor will take away a positive CVD risk factor, providing protection to the vascular system
athrosclerosis
- hardening of stiffening of arterial walls that occurs with age (arteries lose elasticity and contraction ability) - cardiovascular disease
cardiac high-risk medical conditions
- heart attack - open heart surgery (bypass, valve, etc) - cardiac catheterization with or without angioplasty (stent) - congenital heart disease - heart failure - heart murmur - stroke or cerebrovascular disease - pacemaker or implantable cardiac defibrillator - heart arrhythmia - valve disease (aortic, mitral, etc)
4 Components of ACSM pre-participation screening algorithm
- high-risk physical symptoms: yes or no? - current level of physical activity: yes or no? (criteria has to be met in order to say yes) - high-risk medical conditions: yes or no? (only takes one to answer yes) - desired level of physical activity or exercise: light-vigorous
Exercise test guideline prior to test:
- paperwork complete and/or available (informed consent, pre-participation screening) - equipment calibrated; in good working condition -a ambient air: 68-72 degrees Fahrenheit, below 60% humidity with good airflow because too hot, cold, or humid air changes how we respond to exercise
basic cardiovascular assessment includes evaluating
- peripheral pulses - HR (apical pulse/ lub dub) - blood pressure - respiratory rate
To be physically active they have to meet the criteria on if they exercise regularly which includes
- planned and structured - must be moderate intensity, which is met when there is a noticeable increase in heart and respiratory rate - duration: 3 times a week at least 30 minutes a session for 3 months
Purpose of basic cardiovascular assessment
- provide a baseline measurement for reference - identify any high-risk symptoms and signs that may not have been reported during the pre-participation screening
What is the purpose of a health fitness assessment?
- provide information about fitness and health status - develop and modify exercise prescription - set S.M.A.R.T goals - collect baseline data and track progress toward goals - not required to begin exercise - it is mandatory to get baseline HR and BP before exercise
low-density lipoprotein (LDL)
- provides a quick understanding of how much lipids (fats) are in the blood; carrier for cholesterol - produced by the liver - function to release fats from body tissues into the bloodstream - abnormal LDL levels are associated with CVD; the higher the LDL, the more fats are released into the blood
What is the purpose of Health history in pre-exercise evaluation ?
- provides information used to identify cardiovascular risk factors (how can we minimize them) and complete the pre-participation screen - helps guide exercise test selection and exercise program design (aka prescription)
intermittent claudication is a high risk symptom that includes
- reproducible lower extremity pain triggered by exercise (buttock, thigh, calf), does not occur with standing or sitting - acluded blood vessels - not at rest with movement - this is not sciatic pain because sciatic pain can be relieved by sitting or sitting
Exercise testing guidelines: multiple test on the same day (test battery)
- resting vitals and anthropometric (height, weight, circumferences > body comp) data first - do not test the same muscle groups repetitively without adequate rest (because they will fatigue) - follow the same test sequence for every session to maintain validity
Respiratory assessments normal findings at rest
- rise and fall of chest wall unlabored (relaxed, breathing is not difficult) - sound of respiration soft or inaudible
dyspnea
- shortness of breath at rest or with mild exertion
peripheral pulses abnormal findings
- significant strength differences = PVD (blood flow is being disturbed) - irregular frequency: arrhythmia (electrical disturbances) * recommended to seek medical clearance before exercise
peripheral pulses normal findings
- strength equal bilaterally: R & L pulse strength should be equal - regular frequency: every 4-5 seconds or less you should feel a pulse
other high risk symptoms include:
- syncope - bilateral ankle swelling - palpitations or tachycardia - intermittent claudication - ongoing heart murmur - unusual fatigue
Resting BP contraindication for exercise testing:
- telling us we should not do exercise - systolic >200 mmHg - diastolic > 110 mmHg - we care about BP before exercise because during exercise BP increases, and the greater the systolic pressure > the greater the stress on the heart
classifying obesity based on BMI
- underweight: BMI < 18.5 - normal: BMI 18.5-24.9 - overweight: BMI 25.0-29.9 - obesity class I: BMI 30-34.9 - obesity class II: BMI 35-39.9 - obesity class III: BMI > or equal to 40
Palpitations or tachycardia is a high-risk system that includes
- unpleasant awareness of a forceful or rapid heartbeat - at rest - important to ask when it happened and what triggered it
calculating BMI
- weight (kg) / height (m^2) - lbs > kg conversion: divide by 2.2 - cm > m conversion: divide by 100 - in > m conversion: multiply inches by 0.0254
normal BMI
18.5-24.9, no additional risk at these BMI levels assigned
underweight BMI
<18.5, no additional risk at these BMI levels assigned
physical inactivity positive risk factor for CVD
Not meeting the minimum threshold of 500-1000 MET-min of moderate to vigorous physical activity for 75-150 min per week of moderate to vigorous intensity physical activity
If a patient is physically active and has a history of high-risk disease, when is the only time they need to seek medical clearance?
if they want to increase their exercise intensity - ex. The patient is physically active but wants to participate in a trail run (considered vigorous) and has a history of a mild heart attack > the patient needs to seek medical clearance to be informed on exercise limitations since they want to increase too vigorous exercise activities
in the ACSM preparticipation screening algorithm, how many physical symptoms does it take for the patient to need medical clearance for exercise?
just one
renal high-risk medical conditions
kidney disease
information in informed consents is
protected and kept private
paroxysmal nocturnal dyspnea
shortness of breath after 2-5 hours of sleep, relieved by sitting up - occurs at night and wakes people out of their sleep - these individuals may sleep in a recliner propped up
orthopnea
shortness of breath when lying down that is relieved by sitting up * this is a classic sign of congestive heart failure and these are individuals that may sleep on a recliner (propped up)
Angina pectoris location to identify high risk signs and symptoms
substernal (under sternum), shoulders, arm, neck/jaw - for women, sometimes the location will include low back pain, hip pain, elbow pain and the character and & trigger would look the same
In blood glucose test, what are we looking for?
the function of how well insulin is working
It is important to explain the pt their responsibilities in an informed consent so
the patient know what they are responsible for and agree to it
What is the 1st step of a pre participation screening?
to identify high risk signs and symptoms
identifying current or desired exercise intensity
uses the Borge scale which informs us on HR response to exercise - light: slight increase in pulse and respiration, RPE 9-11 - moderate: noticeable increase in pulse in respirations, 12-13 - vigorous: a substantial increase in pulse and respirations, RPE > or equal to 14 * ask what kind of physical activity or exercise they're looking to do
When identifying high-risk signs and symptoms, what is important to ask?
what triggers the symptoms and/or describe situations when they occur - it is also essential to ask what relieves them - if patients say yes to one or more symptoms, they need to seek medical clearance before exercise
unusual fatigue
with normal activities like grocery shopping they are having to sit down to rest
In the informed consent it is mentioned the client is able to
withdraw or refuse
If an individual is not physically active and has no history or signs of a high risk medical condition, can they participate in exercise?
yes