Pre participation Health Screening

Question 1

Why screen prior to exercise?

Answer 1

To screen potential participants for risk factors and or symptoms of various cardiovascular, pulmonary and metabolic diseases (as well as conditions that may be aggravated by exercise)

Question 2

Screening prior to exercise is done in order to optimize…

Answer 2

Safety during exercise resting

Question 3

Screening prior to exercise aids in development of…

Answer 3

Safe and effective exercise prescription

Question 4

Screening prior to exercise identifies individuals with…

Answer 4

Medical contradictions for exclusion from exercise programs until those conditions have been abated or are under control

Question 5

Screening prior to exercise recognizes persons with…

Answer 5

Clinically significant disease(s) or conditions who should participate in medically supervised exercise program

Question 6

Screening prior to exercise detects individuals at increased risk for disease because of…

Answer 6

Symptoms and/or lack of regular physical activity (should be screened before increasing frequency, intensity, and time)

Question 7

Preliminarily Health Screening Forms

Answer 7

Informed consent, 2014 PAR-Q+, Exercise pre-participation health screening process, Lifestyle evaluation

Question 8

Informed Comsent

Answer 8

Obtaining adequate informed consent from participants before exercise testing and participation in an exercise program is an important ethical and legal consideration

Question 9

Content and extent of consent forms may vary but must:

Answer 9

Gather enough information in the informed consent process to ensure that the participant knows and understands the purposes and risks associated with the test or exercise program

Question 10

How should a consent form be explained?

Answer 10

The consent form should be verbally explained and include a statement indicating that the patient has been given an opportunity to ask questions about the procedure and has sufficient information to give informed consent (Note specific questions from the participant on the form along with the responses provided)

Question 11

What must the consent form indicate?

Answer 11

The consent form must indicate that the participant is free to withdraw from the procedure at any time; if the participant is a minor, a legal guardian or parent must sign the consent form

Question 12

When the exercise test is for purposes other than diagnosis or Ex RX (ex. for experimental purposes)…

Answer 12

This should be indicated during the consent process and reflected on the informed consent form, and applicable policies for the testing of human subjects must be implemented

Question 13

Privacy of Patients Health Info

Answer 13

All reasonable efforts must be made to protect the privacy of the patients health information (ex. medical history, test results) as described in the Health Insurance Portability and Accountability Act (HIPAA) of 1996

Question 14

7 Informed Consents for an Exercise Test

Answer 14

Purpose and Explanation of the Test, Attendant Risks and Discomforts, Responsibility’s of the Participant, Benefits to be Expected, Inquiries, Use of Medical Records, Freedom of Consent

Question 15

Changes to ACSM Guidelines

Answer 15

Does not include risk factor analysis or risk level classification; Makes recommendations for physician clearance rather than specific recommendations for a medical examination or exercise test; Does not automatically refer individuals with pulmonary disease for medical clearance prior to the initiation is an exercise program

Question 16

The new pre- participation health screening process is based on…

Answer 16

1) The individuals current level of structured physical activity (should be 3 days of moderate intensity ex for 30 min for last 3 months); 2) The presence of major signs or symptoms suggestive of CV, metabolic or renal diseases; The desired exercise intensity

Question 17

The relative risk of a CV event is transiently increased during…

Answer 17

Vigorous intensity exercise as compared with rest but, the absolute risk of an exercise- related acute cardiac event is low in healthy asymptomatic individuals

Question 18

Among adults, the risk for activity- associated SCD and AMI is known to be highest among those with…

Answer 18

underlying CVD who perform unaccustomed vigorous PA

Question 19

Insufficient evidence is available to suggest that the present of CVD risk factors without underlying disease confers substantial risk of…

Answer 19

Adverse exercise-related CV events

Question 20

CVD risk factor based exercise preparticipation health screening may be overly…

Answer 20

Conservative; High prevalence of risk factors, generating excessive physician referrals, particularly in older adults should still conduct a CVD risk factor assessment with their patients/clients as part of the pre-exercise evaluation

Question 21

*Major Signs or Symptoms Suggestive of Cardiovascular, Metabolic and Renal Diseases

Answer 21

Pain (discomfort or other angina equivalent) in the chest, neck, jaw, arms, or other areas that may result from ischemia; Shortness of breath at rest or with mild exertion; Dizziness or Syncope; Orthopnea or Paroxysmal Nocturnal Dyspnea; Ankle Edema, Palpitations or Tachycardia; Intermittent Claudication, Known Heart Murmur, Unusual fatigue or shortness of breath with usual activities

Question 22

Pre-participation health screening before initiation PA or an exercise program stage 1

Answer 22

The need for medical clearance before initiation or progressing exercise programming is determined using the updated and revised ACSM screening algorithm (In the absence of professional assistance, interested individuals may use self-guided methods)

Question 23

Pre-participation health screening before initiation PA or an exercise program stage 2

Answer 23

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

Question 24

Self- Guided Methods

Answer 24

Pre-participation health screening by self-reported medical history or health risk appraisal should be done for all individuals wishing to initiate a physical activity program (This self-guided method can be easily accomplished by using the Par-Q+)

Question 25

The ACSM Pre-Participation Screening Algorithm

Answer 25

New instrument designed to identify participants at risk for CV complications during or immediately after aerobic exercise

Question 26

Although resistance training is growing in popularity, current evidence is...

Answer 26

insufficient regarding CV complications during resistance training to warrant formal prescreenimg recommendations (CV complications during resistance training, this risk cannot currently be determined but appears to be low)

Question 27

American College of Sports Medicine Preparticipation Screening Algorithm Components

Answer 27

1) Classifying individuals who do or do not currently participate in regular exercise; 2) Identifying individuals with known CV, metabolic, or renal diseases or those with signs or symptoms suggestive of cardiac, peripheral vascular, or cerebrovascular disease, Type 1 and Type 2 diabetes mellitus (DM), and renal disease; 3) Identifying desired exercise intensity

Question 28

Exercise professionals working with patients with known CVD in exercise-based cardiac rehabilitation and medical fitness settings are advised to...

Answer 28

Use more in-depth risk stratification procedures

Question 29

Characteristics of patients at lowest risk for exercise participation (all characteristics listed must be present for patients to remain at lowest risk)

Answer 29

Absence of complex ventricular dysrhythmias during exercise testing and recovery, Absence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness, during exercise testing and recovery), Presence of normal hemodynamics during exercise testing and recovery (i.e., appropriate increases and decreases in heart rate and systolic blood pressure with increasing workloads and recovery), Functional capacity ≥7 metabolic equivalents (METs)

Question 30

LOWEST RISK (cont.) Nonexercise Testing Findings

Answer 30

Resting ejection fraction ≥50%, Uncomplicated myocardial infarction or revascularization procedure, Absence of complicated ventricular dysrhythmias at rest, Absence of congestive heart failure, Absence of signs or symptoms of postevent/postprocedure ischemia, Absence of clinical depression

Question 31

Characteristics of patients at moderate risk for exercise participation (any one or combination of these findings places a patient at moderate risk)

Answer 31

Presence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness occurring only at high levels of exertion [≥7 METs]), Mild to moderate level of silent ischemia during exercise testing or recovery (ST-segment depression <2 mm from baseline), Functional capacity <5 METs

Question 32

MODERATE RISK Nonexercise Testing Findings

Answer 32

Rest ejection fraction 40% to 49%

Question 33

Characteristics of patients at high risk for exercise participation (any one or combination of these findings places a patient at high risk)

Answer 33

Presence of complex ventricular dysrhythmias during exercise testing or recovery, Presence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness at low levels of exertion [<5 METs] or during recovery), High level of silent ischemia (ST-segment depression ≥2 mm from baseline) during exercise testing or recovery, Presence of abnormal hemodynamics with exercise testing (i.e. chronotropic incompetence or flat or decreasing systolic BP with increasing workloads) or recovery (i.e., severe postexercise hypotension)

Question 34

HIGHEST RISK Nonexercise Testing Findings

Answer 34

Rest ejection fraction <40%, History of cardiac arrest or sudden death, Complex dysrhythmias at rest, Complicated myocardial infarction or revascularization procedure, Presence of congestive heart failure, Presence of signs or symptoms of postevent/postprocedure ischemia, Presence of clinical depression