ACSM CPT Chapter 11: Preparticipation Physical Activity Screening Guidelines

Chapter Objectives:

  • Know the outcomes and the overall process of the ACSM Preparticipation physical activity screening.
  • Discover the importance of his screening and the issues with it, as well as investigating the tools used like the PAR-Q and health history questionnaire. 
  • Find the course of action for a client when the risk is established.
  • Understand absolute and relative contraindications for exercise testing.

Importance of Preparticipation Physical Activity Screening

  • This involves gathering and analyzing the demographic and health related info on clients. This also includes medical and health assessments like the presence of symptoms and signs that will be used for making decisions on future physical activity.
  • This is why it is important for screening people prior to physical activity programs:
    • Finding people with some kind of medical contraindication for physical activity.
    • Finding people that need evaluation or examination and clearance for activity prior to starting.
    • Finding people that should only be in medically supervised programs.
    • Finding people with medical concerns.

Levels of Screening

  • There are two main approaches to screening for physical activity. One way is done by someone on their own when they wish to increase their physical activity level, and the other is done by some kind of professional.
  • Self-Guided Screening 
    • This is considered to be a minimum or a starting point for someone that wants to start or increase their physical activity.
    • Physical Activity Readiness Questionnaire
      • The health history questionnaire is a comprehensive assessment of someone’s medical and health history. Since this is seen as having too much information, oftentimes we just use a PAR-Q. 
      • The original PAR-Q was seven yes and no questions that are readable and understandable for someone to answer. It essentially screens out clients from participating in exercise that might be too hard for them. 
      • The PAR-Q has since evolved o have seven questions that have changed slightly over the years and is called the PAR-Q+.
    • ePARmed-X + Physician Clearance Follow-Up Questionnaire
      • This was a tool made in Canada for a physician to refer people into professionally done physical activity programs and make some recommendations for that program.
      • This is designed to be used to elaborate on the 7 yes and no questions that are on the PAR-Q. It can also be used for medical clearance for professional screenings.
  • Professionally Supervised Screening
    • Health History Questionnaire
      • This is used to establish medical and health risks for participating in physical activity programs.
      • The minimum categories assessed by the health history questionnaire are:
        • Family history of CMR disease.
        • History of illnesses and diseases like CMR.
        • Surgical histories.
        • Present and past health behaviors and habits.
        • Current use of drugs and medications.
        • Certain histories of signs and symptoms like CMR or others.
    • Medical Examination or Clearance
      • This is led by a physician and may be needed for health and medical status prior to an activity program.
      • This will include some routine lab assessments.
    • Preparticipation Physical Activity Screening Process
      • Physical Activity (or Exercise) History
        • Someone that is currently in a physical activity program is considered a lower risk for some kind of cardiovascular event when exercising than when someone has been sedentary.
        • Someone is considered a current exerciser when they have been regularly active for 3 months. The threshold is lower than the normal. This is 3 days per week of 30 minutes of activity.
      • Known Cardiovascular, Metabolic, and/or Renal Disease
        • The diseases or conditions covered in this are:
          • Heart Attack
          • Hear surgeries
          • Coronary Angioplasties.
          • Catheterization.
          • Heart Valve disease.
          • Heart failure.
          • Pacemaker or cardiac defibrillators.
          • Heart Transplant.
          • Congenital Heart Disease.
          • Type 1 or 2 diabetes.
          • Renal diseases like renal failure.
      • ACSM Major Signs or Symptoms Suggestive of Cardiovascular Disease
        • Discussion of ACSM Signs or Symptoms
          • Pain in the chest, arms, neck, jaw or other area due to ischemia or lacking oxygenated blood flow to tissues like the heart. 
          • Dyspnea: this is a term used to define the shortness of breath someone might have. 
          • Syncope, which is fainting and dizziness that occurs during exercise due to causes like bad blood flow to the brain or not enough cardiac output from cardiac disorders.
          • Orthopnea is breathing that is troubled when someone is lying down. This often occurs when sleeping.
          • Ankle edema is swelling occurring in the ankle and is not due to injury in this category.
          • Palpitations and tachycardia are when there is rapid beating or even fluttering of he heart.
          • Intermittent claudication is when you have severe calf pain when you are walking.
          • Heart murmurs are when there are weird sounds that are caused by the blood flowing incorrectly through the heart.
          • Fatigue that is unusual and hard to explain and shortness of breath from light activity are causes for concern.
      • What To Do Once Risk Is Established?
        • When someone has been assessed for where their risk is with all of these conditions, we must next determine how hard that person can exercise and where they should not go when exercising. Some people will be unable to perform vigorous exercise.
  • American Association of Cardiovascular and Pulmonary Rehabilitation Risk Stratification
    • This uses the low, medium, and high risk categories to identify the level of risk someone is at. 
    • It serves as a bridge for offering services and also programming for the more risky and diseased clients like those that are in clinical exercise programs.
  • Pitfalls of ACSM Preparticipation Physical Activity Screening
    • One of the major pitfalls is overlooking any signs or symptoms of ongoing CVD and then having the client have a cardiac event with you there training them. These are of course very rare scenarios, but there should be a lot of caution to minimize these times.
    • When possible, a moderate risk client should be potentially treated like a high risk client, as it is always better to be safe than sorry.
    • Clients with risks need to be started at low to moderate levels first just to be safe.
  • Recommendations versus Requirements
    • Caution and the use of your best judgement is dire when handling individual clients. Refer a client when you have any doubt about them. 

Contraindications to Exercise Testing 

  • What Does Contraindication Really Mean?
    • Contraindications are clinical characteristics that people may have that will make physical activity and testing of exercising more of a risk than when they didn’t have these clinical characteristics.
  • Absolute versus Relative
    • Absolute is when contraindications are absolute, AKA the person with this biomarker shouldn’t be allowed in any kind of physical activity program. And relative refers to when the contraindications are accepted or allowed in activity.
  • Repurposing Risk Factor Assessment and Management
    • It is no longer mandatory to have this risk assessment in order to determine medical clearance for people wanting to start activity.
  • Review of ACSM Atherosclerotic Cardiovascular Disease (CVD) Risk Factors and Defining Criteria
    • The positive risk factors are:
      • Client age for males is over 45 and over 55 for females.
      • Family history of cardiovascular events like a heart attack, sudden death, or coronary revascularization.
      • The smoking of cigarettes or quitting within 6 months. Also, secondhand smoke on a regular basis is a risk factor.
      • Sedentary lifestyle: which means not participating in regular exercise 30 minutes a day, 3 days a week, for the past 3 months.
      • Obesity which is defined as having a BMI greater than 30 or a man’s waist circumference of 102cm or women’s waist circumference of 88cm. 
      • Hypertension: his is having a blood pressure equal to or greater than 140 / 90 mmHg. 
      • Dyslipidemia is having an LDL cholesterol level greater than or equal to 130, or an HDL less than 40. Also, a total blood cholesterol of 200 or more.
      • Diabetes is when you have a fasting blood glucose of greater than or equal to 126.
    • The only negative risk factor:
      • This is an HDL cholesterol level that is equal to or greater than 60 mmHg.

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