KIN 485 HON Ch. 2

Globally, _____ of adults are physically inactive

31.1%

Note specific questions from the participant on the form along with the

responses provided

responsibilities of the participant:

Accuracy in health/lifestyle/medication reporting prior to testing and prompt reporting of S/S during evaluation

Sudden Cardiac Death among Young Individuals Death rates are higher in

African American male athletes and basketball players specifically

skill (performance) related

Agility, balance, coordination, power, reaction time, and speed

Atherosclerotic CVD Risk Factors age:

Men 45 years; Women 55 years

exercise participation

Performing planned, structured physical activity at least 75-150 min/wk. at moderate- to- vigorous intensity for at least the last 3 months

medical history and cardiovascular disease risk factor assessment

cardiovascular disease, metabolic disease, renal disease

physical inactivity

a global pandemic that has been identified as one of the four leading contributors to premature mortality

physical fitness

a set of attributes or characteristics individuals have or achieve that relates to their ability to perform physical activity (relative)

exercise

a type of physical activity consisting of planned, structured, and repetitive bodily movement done to improve or maintain any component of physical fitness

The IC should be verbally described, and the individual be given every chance to

ask questions before signing

Shortness of breath (Dyspnea)

at rest of with mild exertion

signatures:

both patient and physician signs

Prolonged periods of sitting or sedentary behavior are associated with

deleterious health consequences independent of PA levels.

Regardless, high levels of sedentary behavior can be

detrimental to ones health

Although resistance training is growing in popularity, current evidence is insufficient regarding CV complications during resistance training to warrant

formal prescreening recommendations.

vigorous intensity exercise

greater than or equal to 60% HRR (heart rate reserve) or VO2R, an intensity that causes substantial increases in HR and breathing

The recommendations are intended to reduce or remove barriers to adopting and maintaining

habitual PA or exercise.

Although the benefits of regular PA are well established, participation in exercise is associated with an increased risk for

musculoskeletal injury (MSI) and cardiovascular complications such as sudden cardiac death (SCD) and acute myocardial infarction (AMI).

The ACSM preparticipation and pre-exercise screening emphasize the

public health message of PA for all.

Medical history and CV risk factor analysis are not part of the preparticipation health screening procedures for the purpose of

reducing acute risk

Exercise Preparticipation Health Screening Recommendations are not a

replacement for sound clinical judgment and decisions about referrals to a health care provider for medical clearance

The IC should ensure that individuals know and understand the purpose(s) and risks associated with

screening, assessment, and the exercise program.

If the presence or absence of a CVD risk factor is not disclosed or is not available,

that CVD risk factor should be counted as a risk factor.

Pain or discomfort in the chest, neck, jaw, arms or other areas (angina)

that may result from ischemia (cardinal manifestation of cardiac disease)

MSI is the most common exercise-related complication and is often associated with exercise intensity,

the nature of the activity, preexisting conditions, and musculoskeletal anomalies

medical clearance

Self-guided screenings can be an acceptable substitute for this method.

Ankle edema

bilateral edema predictive of heart failure

Palpitations or tachycardia

unpleasant awareness of forceful or rapid beating of the heart

Obtaining informed consent (IC) from individuals is an important ethical and legal consideration and should be completed prior to

(a) the collection of any personal and confidential information (b) any form of fitness testing (c) exercise participation

Dizziness or syncope

(loss of consciousness)

Quantification of leisure time PA has grown and utilizes a variety of methodologies

- Self-report methods: NHANES, BRFSS, etc. - Objective methods: pedometers, accelerometers, etc.

Preparticipation health screening before initiating PA or an exercise program is a two-stage process:

1. The need for medical clearance before initiating or progressing exercise programming is determined using the ACSM screening algorithm 2. If indicated during screening, medical clearance should be sought from an appropriate health care provider.

light intensity exercise

30-39% HRR (heart rate reserve) or VO2R, an intensity that causes slight increases in HR and breathing

Self-report NHANES data indicate

4.7 h · d−1 of sitting time.

moderate intensity exercise

40-59% HRR (heart rate reserve) or VO2R, an intensity that causes noticeable increases in HR and breathing

In the US: ______ of adults meet aerobic activity guidelines. ______ meet muscle strengthening guidelines. _______ meet both the aerobic and muscle strengthening guidelines.

50.9%, 30.4%, 20.5%

Objectively measured accelerometer data indicate

8.0 h · d−1 sitting time.

Atherosclerotic CVD Risk Factors Body Mass Index/Waist Circumference-

Body Mass Index (BMI) 30 kg/m2OR waist girth > 102 cm (40 in) for men or > 88 cm (38 in) for women

The ACSM preparticipation screening algorithm is designed to identify individuals at risk for

CV complications during or immediately after aerobic exercise

Cardiovascular (CV) Disease

Cardiac, Peripheral Vascular or Cerebrovascular Disease, Heart Attack (myocardial Infarction), Stroke, CABG, Stent, etc.

health related

Cardiorespiratory, muscle endurance, muscle strength, flexibility and body composition

American College of Sports Medicine Preparticipation Screening Preparticipation Screening Algorithm Components:

Classifying individuals who do (Yes) or do not (No) currently participate in regular exercise Identifying individuals with known CV, metabolic, or renal diseases or those with signs or symptoms suggestive of cardiac, peripheral vascular, or cerebrovascular disease, Types 1 and 2 diabetes mellitus (DM), and renal disease Identifying desired exercise intensity

benefits to be expected:

Concept of beneficence

use of medical records:

Confidentiality will be observed but data may be used for research purposes

Atherosclerotic CVD Risk Factors cigarette smoking

Current cigarette smoker or those who quit within the previous 6 months or exposure to environmental tobacco smoke (i.e. secondhand)

Orthopnea

Dyspnea at rest in the recumbent position which is resolved promptly by sitting upright or standing

purpose and explanation:

Exactly what you are going to do and how you are going to do it.

Atherosclerotic CVD Risk Factors bloods glucose

Fasting plasma glucose ≥ 100 mg/dL, OR2 h plasma glucose from OGTT ≥ 140 mg/dL, OR HbA1C ≥ 5.7%

inquiries:

You must give the client an opportunity to address questions

Atherosclerotic CVD Risk Factors negative risk factor

High Density Lipoprotein Cholesterol (HDL-C) - HDL-C 60 mg/dL

Attendant Risks and Discomforts:

Identify risks and discomforts, ensure that you have done everything to lower the risk and have emergency procedures in place

Prior to engaging in physical activity or structured exercise programs:

Informed consent Exercise preparticipation health screening, Health history Cardiovascular (CV) risk factor analysis

Atherosclerotic CVD Risk Factors lipids

LDL-C 130 mg/dL, OR HDL-C < 40 mg/dL in men or < 50 in women, OR Currently on lipid-lowering medication, OR TC 200 mg/dL if only result available

Atherosclerotic CVD Risk Factors family history:

Myocardial infarction, coronary revascularization or sudden death before 55 years of age in father or other male first degree relative or before 65 years of age in mother or other female first degree relative

Atherosclerotic CVD Risk Factors physical inactivity

Not meeting the minimum threshold of 500-1,000 MET-min of moderate-to-vigorous physical activity or 75-50 min/wk. of moderate-to-vigorous intensity physical activity

Paroxysmal nocturnal dyspnea

PND and Orthopnea are symptoms of left ventricular dysfunction

Atherosclerotic CVD Risk Factors blood pressure

SBP 130 mmHg and/or DBP 80 mmHg , based on an average of 2 readings obtained on 2 occasions, or on antihypertensive medication

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

That decision is left to the qualified health care provider.

medical clearance should be sought from an appropriate health care provider

The manner of clearance should be determined by the clinical judgment and discretion of the health care provider.

freedom of consent:

This is a voluntary process which means they can withdraw at any time

metabolic disease

Type 1 or Type 2 Diabetes Mellitus

renal disease

Undefined by ACSM

Major Signs or Symptoms Suggestive of Cardiovascular, Metabolic, and Renal Disease

Unusual fatigue or shortness of breath with usual activities

Care needs to be taken to interpret signs or symptoms within context of individuals recent history:

What were you doing during these periods? Were you more breathless than you would have expected for this activity? Compared to recent similar activities, were you more fatigued following the activity?

Identify individuals who are at risk for adverse exercise-related CV events:

a) who should receive medical clearance before initiating a moderate to vigorous intensity exercise program or increasing the intensity of their current program b) with clinically significant disease(s) who may benefit from participating in a medically supervised exercise program c) with medical conditions that may require exclusion from exercise programs until those conditions are abated or better controlled

These recommendations also acknowledge that vigorous exercise is associated with a small but measurable acute risk of

activity-associated SCD and AMI and those with with underlying CVD who perform unaccustomed vigorous PA are at highest risk.

This recommendation better aligns with evidence that exercise testing is a poor predictor of

acute cardiac events in asymptomatic individuals.

The preparticipation health screening identifies those who are at risk for

adverse exercise-related CV events and which individuals should be referred for medical clearance.

CVD risk factor assessment information for the development of an individuals Ex Rx, lifestyle modification, and

an opportunity for one-on-one education about CVD risk reduction.

physical activity

any bodily movement produced by the contraction of skeletal muscles that results in a substantial increase in caloric requirements over resting energy expenditure

Medical and CV screening may also uncover a need for other

health or medical referrals

Individuals with Pulmonary disease are not automatically referred for medical clearance because pulmonary disease does not

increase the risk of nonfatal or fatal CV complications

SCD and AMI are associated with vigorous intensity and are much less common than MSI but

may lead to long-term morbidity and mortality.

Highest risk is associated with activities that are weight-bearing or involve repetitive motion:

jogging, walking, cycling, weightlifting, etc.

Although the content and extent of consent forms may vary, enough information must be present in the informed consent process to ensure that the participant

knows and understands the purposes and risks associated with the test or exercise program in health/fitness or clinical settings.

However, medical and CV screening provides valuable information for designing individualized exercise programs to

lower or reduce known health risks.

Known heart murmur

may indicate hypertrophic cardiomyopathy which is the leading cause of sudden cardiac death

For individuals having HDL-C ≥ to 60 mg/dL,

one CVD risk factor is subtracted from the sum of positive CVD risk factors

Intermittent claudication

pain that occurs in the lower extremities due to inadequate blood flow during activity

Insufficient evidence is available to suggest that the presence of CVD risk factors without

underlying disease confers substantial risk of adverse exercise-related CV events.