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Kin 187 > Health Screening and Risk Factor Analysis > Flashcards

Health Screening and Risk Factor Analysis Flashcards

1
Q

What were the old guide lines for Exercise preparticipation Health Screening (7 steps)

A
  1. Determine readiness
  2. Identify signs and symptoms of disease
  3. Coronary/atherosclerotic cardiovascular risk factor analysis
  4. Disease risk classification
  5. Medical History
  6. Lifestyle history
  7. Informed Consent
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2
Q

What are the new guidelines for Exercise Preparticipation Health Screening (6 steps)

A
  1. The individuals current level of structured PA
  2. The presence of major signs and symptoms suggestive of CV metabolic or renal diseases
  3. Desired exercise intensity
  4. Medical history
  5. Lifestyle history
  6. Informed consent
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3
Q

What is the purpose of health screening

A

There is risk inherent in any exercise program or exercise test

Detailed knowledge of your clients background and medical status allows you to prescribe exercise more effectively

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4
Q

What is step 1 (PARQ)

What is the purpose of it

What type of method is it

What does it involve

A

Determine readiness of activity

Purpose: To determine clients readiness for physical activity

Self guided method

7 questions
Identifies who needs medical clearance before fitness testing or exercise program initiation
One single yes means that medical clearance is required
No means you are ready to be physically active

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5
Q

What is step 2

What is the purpose of it

What is the definition

A

Identify signs and symptoms of disease

To identify those in need of medical clearance

Disease definition
Any established cardiovascular pulmonary or metabolic disease or symptom thereof

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6
Q

What are known diseases for CVD

A

Cardiac, peripheral artery (PAD)

Cerebrovascular disease (stroke)

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7
Q

What are known diseases for pulmonary

A

Chronic obstructive pulmonary disease (COPD)

Asthma

Interstitial lung disease

Cystic fibrosis

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8
Q

What are known diseases for metabolic

A

Diabetes

Thyroid disorders

Renal or liver disease

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9
Q

Is hypertension considered a known established cardiovascular disease

A

No

This is a risk factor that may or soon cause the previous disease - it is not a disease

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10
Q

Is obesity a disease

A

No

It is a risk factor

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11
Q

What are the major signs or symptoms suggestive of cardiovascular metabolic and renal disease

A

Pain/discomfort in chest, neck, jaw, arms or other areas that may result from ischemia

Shortness of breath

Dizziness or syncope

Orthopnea or paroxysmal nocturnal dyspnea

Ankle edema

Palpitations or tachycardia

Intermittent claudication

Known heart murmur

Unusual fatigue or dyspnea

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12
Q

The pain symptom has a ischemic origin if

Character:
Location:
Provoking factors:

A

Character: Constricting, squeezing, burning, heaviness

Location: Substernal, across midthorax, anteriorly in one or both arms, in neck, cheek, teeth, forearms, fingers, interscapular region

Provoking factors: Exercise or exertion, excitement, other forms of stress, cold weather, occurence after meals

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13
Q

What is ischemia

A

Lack of blood flow

Cells dying and causing pain

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14
Q

Dyspnea symptoms signs:

Classification/significance:

A

Shortness of breath at rest or with mild exertion

  1. An abnormally uncomfortable awareness of breathing
  2. One of the principal symptoms of cardiac and pulmonary disease
  3. During strenuous exertion in health well trained individuals
  4. During moderate exertion in healthy untrained individuals
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15
Q

What does dyspnea suggest the presence of

A

Left ventricular dysfunction

Chronic obstructive pulmonary disease

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16
Q

What is dyspnea

A

Shortness of breath

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17
Q

Syncope signs/symptoms

Classifications/significance:

A

Dizziness or feeling faint

  1. Loss of consciousness
  2. Caused by reduced perfusion of the brain
  3. Result from cardiac disorders during exercise that prevent the normal rise or fall in cardiac output
  4. May occur in healthy individuals as a result of a reduction in venous return to the heart
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18
Q

What are the ways to increase venous return

A

Skeletal pump
Respiratory pump
Contractility of the veins - vasoconstriction

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19
Q

Orthopnea signs/symptoms

Classification/significance

Symptoms of:

A

Orthopnea or paroxysmal nocturnal dyspnea

  1. Orthopnea - dyspnea occuring at rest in the recumbent position
  2. Paroxysmal nocturnal dyspnea - dyspnea beginning usually 2-5 hr after the onset of sleep

Symptoms of:
Left ventricular dysfunction
Sometimes COPD

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20
Q

Ankle edema:

Classification/significance:

A

Flow limited

  1. Bilateral ankle edema at night - sign of heart failure or bilateral chronic venous insufficiency
  2. Unilateral edema - from venous thrombosis or lymphatic blockage
  3. General edema - nephrotic syndrome, severe heart failure or hepatic cirrhosis
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21
Q

Bilateral ankle edema at night is a sign of

A

Heart failure or bilateral chronic venous insufficiency

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22
Q

Unilateral edema comes from

A

Venous thrombosis

Lymphatic blockage

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23
Q

General edema is a sign of

A

Nephrotic syndrome

Severe Heart Failure

Nepatic cirrhosis

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24
Q

Classification/significance of Palpitations and tachycardia

What is it often a result from:

A
  1. Palpitations - unpleasant awareness of forceful or rapid beating of the heart
  2. Tachycardia, bradycardia of sudden onset

Result from anxiety state or high cardiac output state

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25
Q

Intermittent claudication classification/significance

Also known as:

Often due to:

A

The pain that occurs in a muscle with an inadequate blood supply that is stressed by exercise

Cramping

Due to:
Atherosclerosis
Coronary artery disease

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26
Q

Classification/significance of heart murmur

A

Valvular or other cardiovasuclar disease

  1. hypertropic cardiomyopathy
  2. aortic stenosis
  3. Cause of exertion-related sudden cardiac death
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27
Q

What are the ACSM preparticipation algorithm components (4)

A

Classify individuals who do or do not regularly exercise

Identify individuals with known CV, metabolic or renal diseases

Identify individuals with signs/symptoms suggestive of cardiac peripheral vascular, type 1/2 diabetes and renal disease

Identify desired exercise intensity

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28
Q

Someone who does not regularly exercise and has No CV, metabolic or renal disease AND no signs or symptoms requires…

A

No medical clearance

Light to moderate exercise

May progress to vigorous intensity exercise

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29
Q

Someone who does not regularly exercise and has known CV, metbolic or renal AND Asymptomatic requires…

A

Medical clearance

After medical clearance, light to moderate

May progress as tolerated

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30
Q

Someone who does not regularly exercise and has known CV, metbolic or renal AND has signs/symptoms requires…

A

Medical clearance

After medical clearance, light to moderate

May progress as tolerated

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31
Q

What are the 3 steps of diagnosing

A
  1. Does the person physically exercise
  2. Medical History
  3. Have sign or symptoms
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32
Q

Exercise professionals working with patients with known CVD in exercise based cardiac rehabilitation and medical fitness setting are advised to…

A

Use more in depth risk stratification procedures

33
Q

Risk stratifications for patients with CV disease is broken down into…

A

Lowest risk
Moderate risk
Highest risk

34
Q

What are the characteristics of patients at lowest risk for exercise participation WITH EXERCISE TESTING

A

Absence of complex ventricular dysrhythmias during exercise testing and recovery

Absence of angina or other significant symptoms

Presence of normal hemodynamics during exercise testing and recovery

Functional capacity is >= 7 metabolic equivalents (mets)

35
Q

What are the characteristics of patients at lowest risk for exercise participation WITH NON EXERCISE TESTING

A

Resting ejection fraction >= 50%

Uncomplicated myocardial infarction or revascularisation procedure

Absence of:

  1. Complicated ventricular dysrthmias at rest
  2. Congestive heart failure
  3. Signs or symptoms of post event/post procedure ischemia
  4. Clinical depression
36
Q

What are the characteristics of patients at Moderate Risk for exercise participation WITH EXERCISE TESTING

A

Presence of angina or other significant symptoms - shortness of breath, light headedness/dizziness orcuring only at high levels of exertion (>= 7 mets)

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

Functional capacity < 5 mets

37
Q

What are the characteristics of patients at Moderate Risk for exercise participation WITH NON EXERCISE TESTING

A

Rest ejection fraction 40% to 49%

38
Q

What are the characteristics of patients at Highest Risk for exercise participation WITH EXERCISE TESTING

A

Presence of complex ventricular dysrythmias during exercise testing or recovery

Presence of angina or other significant symptoms at low levels of exertion (< 5 METS)

High level of silent ischemia (ST segment depression >= 2mm from baseline)

Presence of abnormal hemodynamics with exercise testing or recovery

39
Q

Presence of abnormal hemodynamics with exercise testing (highest risk) involves

with recovery involves

A

Chronotropic incompetence or flat/decreasing systolic BP with increasing workloads

Severe post exercise hypotension

40
Q

What is post exercise hypotension

A

Dramatic reduction in blood pressure

41
Q

What are the characteristics of patients at Highest Risk for exercise participation WITH NON EXERCISE

A

Rest ejection fraction <40%

History of cardiac arrest or sudden cardiac death

Complex dysrhythmias at rest

Complicated myocardial infarction or revascularisation procedure

Presence of congestive heart failure

Presence of signs or symptoms of postevent/postprocedure ischemia

Presence of clinical depression

42
Q

With the different risk categories what does the person have to have in order to put them in a certain category

A

At least one of the issues to deem them that category

43
Q

Hypertension new report as of 2017 has…

Which are

A

2 stages

stage 1:
SBP 130 - 139 mmHg
OR
DBP 80 - 89 mmHg

Stage 2:
SBP >= 140 mmHg
OR
DBP >= 90 mmHg

44
Q

The new 2017 report states that SBP and DBP are for:

Normal
Elevated
Hypertension 1
Hypertension 2

A

Normal
SBP < 120 mmHg
AND
DBP < 80 mmHg

Elevated
SBP 120 - 129 mmHg
AND
DBP < 80 mmHg

Hypertension 1
SBP 130 - 139 mmHg
OR
DBP 80 - 89 mmHg

Hypertension 2
SBP >= 140 mmHg
OR
DBP >= 90 mmHg

45
Q

What is step 3

A

Preparticipation screening algorithm

Risk factors
Risk stratification for patients with CVD

46
Q

What is a risk factor

A

Sign, symptom or characteristic that increases or decreases the chance of developing a disease

47
Q

What is a positive risk factor

What is a negative risk factor

A

Increase risk of disease

Decrease risk of disease

48
Q

What is step 4

A

Medical history

49
Q

What does medical history involve

A

Medical diagnosis

Previous physical examination findings

History of symptoms

Recent illness, hospitalisation, new medical diagnoses, surgical procedures

Orthopedic problems

Medication use including supplement including supplements and drug allergies

Other habits like caffeine alcohol tobacco or drugs

Exercise history

Work history

Family history

50
Q

What is step 5

A

Lifestyle evaluation

51
Q

What is involved with lifestyle evaluation

A

What physical activity are they doing

Other lifestyle behaviours and habits
e.g. smoking, diet and alcohol

52
Q

What is step 6

A

Informed consent

53
Q

What is the purpose of informed consent

What questions should they ask

A

To explain the risks and benefits of the assessment and to obtain permission for participation

What is the risk?
What is a benefit?
When to terminate the testing?

54
Q

You don’t participate in regular exercise. And, you don’t have any known CV, metabolic or renal disease AND no signs or symptoms suggestive of these diseases. Following ACSM preparticipation screening algorithm, your recommended exercise intensity is moderate to vigorous level

A

False

55
Q

Clint has a coronary artery disease, and he had an exercise testing at the cardiac rehab. The testing result indicates that he had 1.5mm of ST segment depression during exercise testing. He is at _______ based on risk stratification criteria

A

Moderate risk

56
Q

Having dyspnea typically suggests the presence of ____

A

Left ventricular dysfunction

57
Q

If your patient has unilateral edema, it indicates that he/she may have lymphatic blockage

A

True

58
Q

________ is shortness of breath at rest in the recumbent position and is suggestive of cardiovascular disease

A

Orthopnea

59
Q

Dona is a 54 years old woman and her father had a heart attack when he was 45 years old. Her risk factor for family history is ______

A

Positive Present

60
Q

According to the new report from American Heart Association, Stage 1 hypertension is determined if

A

SBP is between 130 and 139 mmHg or DBP is between 80 and 90 mmHg

61
Q

If your client’s HDL level is 45 mg/dL, his risk factor for dyslipidemia is absent neutral

A

True

62
Q

Your client’s body weight is 220 lbs and height is 5’9’’. What is his body mass index

A

33 kg/m^2

63
Q

You forgot to record your client’s weight and height on the file, but recorded information on gender and waist circumference. Can you identify your client’s risk factor for obesity

A

Yes

64
Q

Your client’s body weight is 220 lbs and height is 5’9’’. How does the BMI classify the level of obesity

A

Obese Class 1

65
Q

What is graded exercise test recognised for

A

Detection of CAD in people with CHEST PAIN syndromes or potentially equivalent symptoms

Evaluation of the anatomic and functional severity of CAD

Prediction of CV event and all cause death

Evaluation of physical capacity and effect tolerance

Evaluation of exercise related symptoms

Assessment of chronotropic competence, arryhthmias and response to implanted device therapy

Assessment of the response to medical interventions

66
Q

CDD4 recommendations for evaluation of physical functions states that patients at a minimum should be able to:

A

6 or 8m gait > 0.6m/s

8 sit to stand repetitions in 30 secs

8 arm curls with a 4kg mass

Ascending a flight of 10 steps in under 30s

Chair sit and reach to the toes on both sides

67
Q

What are the recommendations for activity when Test Not Available for aerobic training

A

Activities in the range of 2 to 4 METs

Exercise HR = resting HR +20 contraction/min

RPE no higher than 11 to 14

Start slow, go slow, and be alert for symptoms

68
Q

What are the recommendations for activity when Test Not Available for strength training

A

2 sets of 30s of sit-to-stand repetitions

2 sets of 8 arm curls with 4kg mass

10 step ups 2 times

Chair sit and reach 2 times, holding for 30 secs

69
Q

Intensity of physical activity and breathing for:

Light
Moderate
Vigorous
High

A

Light = 1.5-3 METs
Barely detectable increased depth

Moderate = 3-6 METs
Can pass the talk test

Vigorous = 6-9 METs
Cant pass the talk test

High = > 9 METs
Heavy breathing

70
Q

What is Step 1 of the essential steps for exercise programming

A

Step 1: Assess current health status (history of the disease, current symptoms and physical and cardiovascular restrictions and treatments)

71
Q

What is Step 2 of the essential steps for exercise programming

A

Step 2: Assess current level of physical activity

72
Q

What is Step 3 of the essential steps for exercise programming

A

Identify exertional symptoms that limit physical activity

73
Q

What is Step 4 of the essential steps for exercise

A

Evaluate physical function and performance

Mildly impaired to normal = >=6 METs
Moderately impaired, low functioning = 4-5 METs
Severely impaired, very low functioning = 3-4 Mets
Needs aid, debilitated = <=3 METs

74
Q

What is Step 5 of the essential steps for exercise programming

A

Select recommended physical performance assessments

75
Q

What are the commonly used tests of physical functioning

A 
Walking test
Gait speed test
Core and lower extremity functional test
Chair to stand test
Timed up and go test
Arm curl test
76
Q

Someone who regularly exercises, has no CV, metabolic or renal disease AND no signs or symptoms what is required

A

Medical clearance not necessary

Continue moderate or vigorous intensity exercise

May progress following ACSM guidelines

77
Q

Someone who regularly exercises, has known CV, metabolic or renal disease AND Asymptomatic

A

Medical clearance for moderate intensity exercise not necessary

Medical clearance (within the last 12 months if no chance in signs/symptoms) recommended before engaging in vigorous intensity exercise

Continue with moderate intensity exercise

Following medical clearance may progress as tolerated

78
Q

Someone who regularly exercises, has signs or symptoms regardless of disease status is required

A

Discontinue exercise and seek medical clearance

May return to exercise following medical clearance

Progress as tolerated

Kin 187 (21 decks)

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