Chapter 11
Screening and Risk Stratification
Name:__________________________________________
1. Why is it important to screen clients?
a. _____________________________________________________________________________________
_____________________________________________________________________________________
b. _____________________________________________________________________________________
_____________________________________________________________________________________
c. _____________________________________________________________________________________
_____________________________________________________________________________________
2. Exercise usually only provokes ____________________ events only in clients with ____________________
heart disease. Exercise typically does not____________________ cardiac events in clients with
____________________ cardiovascular systems.
3. What risk factors and/or symptoms should personal trainers consider screening for?
A. ___________________________________
B. ___________________________________
C. ___________________________________
D. ___________________________________
4. What should a client screening identify?
a. _____________________________________________________________________________________
_____________________________________________________________________________________
b. _____________________________________________________________________________________
_____________________________________________________________________________________
c. _____________________________________________________________________________________
_____________________________________________________________________________________
d. _____________________________________________________________________________________
_____________________________________________________________________________________
e. _____________________________________________________________________________________
_____________________________________________________________________________________
5. What are the three phases of the screening process, and what happens in each phase?
a. _____________________________________________________________________________________
i. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
b. _____________________________________________________________________________________
i. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
c. _____________________________________________________________________________________
i. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6. What are the eight steps of the screening process?
a. _____________________________________________________________________________________
b. _____________________________________________________________________________________
c. _____________________________________________________________________________________
d. _____________________________________________________________________________________
e. _____________________________________________________________________________________
f.
_____________________________________________________________________________________
g. _____________________________________________________________________________________
h. _____________________________________________________________________________________
7. The ACSM risk classification process is used to ____________________ clients who should undergo a
____________________ examination and ____________________ ____________________ before
beginning a____________________ or ____________________ exercise program. Medical clearances (if
necessary) should be obtained after the personal trainer has conducted both the ____________________
____________________ and a thorough ____________________ -____________________ interview with the
client.
8. What are the two self-guided questionnaires that can be used with clients?
a. _____________________________________________________________________________________
b. _____________________________________________________________________________________
9. When working with clients transitioning out of ____________________ ____________________ , physical
therapy or another ____________________ ____________________ ____________________ , a written
medical clearance is recommended, even if the physician referred them to a personal trainer.
10. Explain the difference between a positive and negative risk factor for atherosclerotic cardiovascular disease:
Positive Risk Factor:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Negative Risk Factor:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
11. What are the positive risk factors for Cardiovascular Disease?
A. ___________________________________
B. ___________________________________
C. ___________________________________
D. ___________________________________
E. ___________________________________
F. ___________________________________
G. ___________________________________
H. ___________________________________
12. What is a negative risk factor for atherosclerotic cardiovascular disease?
___________________________________________________________________________________________
___________________________________________________________________________________________
Atherosclerotic Cardiovascular Disease (CVD) Risk Factors and Defining Criteria
Matching; I recommend making flashcards for the following definitions
13.
_______
Low density lipoprotein cholesterol >130 mg*dL or high
density lipoprotein cholesterol <40 mg*dL or on lipidlowering medication. If total serum cholesterol is all
that is available use >200 mg*Dl
14.
_______
>60mg*dL Negative risk factors, removes 1 risk factor.
15.
_______
Impaired fasting glucose >100mg*dL and <125 mg*dL;
or impaired glucose tolerance >140 mg*dL and <199
mg*dL confirmed by measurements on at least 2
separate occasions
16.
_______
Men > 45 years; women >55 years
17.
_______
Body mass index >30 kg/m2 or waist girth 120 cm (40
in) for men and >88 cm (35 in for women
18.
_______
Myocardial infarction, coronary revascularization or
sudden death before 55 years in father or other male
first-degree relative, or before 65 years in mother or
other female first-degree relative
19.
20.
21.
_______
_______
_______
Not participating in at least 30 minutes of moderate
intensity physical activity on at least 3 days a week for
at least 3 months
Current cigarette smoker or those who quite within the
previous 6 months or exposure to environmental
tobacco smoke
Systolic blood pressure >140 mmHg and/or diastolic
>90mmHg, confirmed by measurements on at least 2
separate occasions, or on anti-hypertensive medication
A. Age
B. Cigarette smoking
C. Dyslipidemia
D. Family History
E. High Density lipoprotein
cholesterol
F. Hypertension
G. Obesity
H. Prediabetes
I.
Sedentary lifestyle
Matching; I recommend making flashcards for the following definitions
22.
_______
Temporary or short lived symptoms
23.
_______
Any condition that renders some particular movement,
activity or treatment improper or undesirable
24.
_______
Programs that are recommended for patients with
major cardiac impairment or adverse signs or
symptoms (i.e., those at increased risk for future
cardiovascular events).
25.
_______
An episode in which some of the hearts blood supply is
severely cut off or restricted, causing the heart muscle
to suffer and die from a lack of oxygen. Commonly
known as a heart attack
26.
_______
A person showing no signs or symptoms
27.
_______
A general term for any disease of the heart, blood
vessels or circulation
28.
_______
An unexpected death due to cardiac causes that occurs
in a short time period (generally within 1 hour of
symptom onset) in a person with known or
unknown cardiac disease.
29.
30.
31.
_______
_______
_______
Self-administered health questionnaire. Focuses in the
symptoms of heart disease and potential
musculoskeletal problems that should be evaluated
prior to participation in an exercise program. If a client
checks yes then refer to physician.
Any disease or disorder that disrupts normal
metabolism – the process of converting food to energy
on the cellular level
Any condition that affects the blood vessels along the
route between the heart and lungs.
32.
_______
Sudden onset of disease
33.
_______
Includes history, symptoms and risk factor to direct
clients to either participate in an exercise program or
contact their health care provider before participation.
A. Acute
B. AHA/ACSM Health/Fitness
Facility Pre-Participation
Screening Questionnaire
C. Asymptomatic
D. Cardiovascular Disease
E. Contraindication
F. Medically supervised
exercise program
G. Metabolic Disease
H. Myocardial Infarction
I.
Physical Activity Readiness
Questionnaire (PAR-Q)
J.
Pulmonary Disease
K. Sudden Cardiac Death
L. Transient
34. Identify the major signs or symptoms suggestive of cardiovascular, pulmonary or metabolic disease:
a. _____________________________________________________________________________________
b. _____________________________________________________________________________________
c. _____________________________________________________________________________________
d. _____________________________________________________________________________________
e. _____________________________________________________________________________________
f.
_____________________________________________________________________________________
g. _____________________________________________________________________________________
h. _____________________________________________________________________________________
i.
_____________________________________________________________________________________
35. What does ischemic mean?
___________________________________________________________________________________________
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36. When chest pain and discomfort occurs, what key features indicate an ischemic origin? (could indicate future
heart attack - considered more urgent in nature)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
37. When chest pain and discomfort occurs, what key features indicate against an ischemic origin? (not likely a
predictor of a heart attack, still a concern, but not as urgent)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Major signs or symptoms suggestive of cardiovascular, pulmonary or metabolic disease
Matching; I recommend making flashcards for the following definitions
38.
39.
40.
41.
42.
43.
_______
_______
_______
_______
_______
_______
An extra or unusual sound heard during a heartbeat.
May indicate valvular or other cardiovascular disease.
A. Angina Pectoris
Disease of the heart valves in which the opening of the
aortic valve is narrowed.
B. Ankle edema
Chest pain caused by an inadequate supply of oxygen
and decreased blood flow to the heart muscle.
Symptoms may include pain or discomfort, heaviness,
tightness, pressure or burning, numbness, aching and
tingling in the chest, back, neck, throat, jaw or arms
Condition where the heart muscle become thick,
common cause of sudden cardiac arrest in young
people.
C. Aortic Stenosis
D. Dyspnea
An abnormally uncomfortable awareness of breathing,
can be a sign on chronic obstructive pulmonary disease
E. Heart murmur
Swelling of the ankles. Bilateral edema is a sign of
heart failure. Unilateral ankle edema is usually caused
by a blood clot in a vein.
F. Hypertrophic
Cardiomyopathy
Matching; I recommend making flashcards for the following definitions
44.
45.
46.
47.
_______
_______
_______
_______
Dyspnea that begins 2 to 5 hours after the onset of
sleep, relieved by sitting on the edge of the bed or
getting out of bed.
Unpleasant awareness of the forceful or rapid beating
of the heart. Often result from anxiety.
Obstruction of blood vessels which causes inadequate
blood flow and leads to insufficient oxygen supply to an
organ, tissue or body part
A heart rate that exceeds the normal range. Resting
heart rate >100 bpm.
48.
_______
Dyspnea that occurs at rest in a reclined position that is
relieved by sitting upright or standing.
49.
_______
Painful cramping in the leg or hip that occurs when
walking or exercising and typically disappears when the
person stops the activity.
50.
_______
Loss of consciousness, caused by reduced blood flow to
the brain.
A. Intermittent Claudication
B. Ischemia
C. Orthopnea
D. Palpitations
E. Paroxysmal nocturnal
dyspnea
F. Syncope
G. Tachycardia
51. Identify and define known cardiovascular, pulmonary and metabolic diseases:
a. Cardiovascular:
i. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
ii. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
iii. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
b. Pulmonary:
i. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
ii. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
iii. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
iv. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
c. Metabolic:
i. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
ii. ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
52. Risk classification becomes progressively more important as ____________________ prevalence
____________________. Clients can be classified into ____________________, ____________________or
____________________ risk levels. The ____________________ ____________________is used to determine
who should be cleared by their ____________________ prior to participation.
53. What determines if a client is considered low, moderate or high risk?
a. Low:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
b. Moderate:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
c. High:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Matching; I recommend making flashcards for the following definitions
54.
_______
No known cardiovascular, pulmonary, metabolic
disease, no major signs or symptoms of suggestive of
cardiovascular, pulmonary or metabolic disease, less
than 2 cardiovascular disease risk factors.
A. Low Risk
55.
_______
Known cardiovascular, pulmonary, metabolic disease,
OR major signs or symptoms of suggestive of
cardiovascular, pulmonary or metabolic disease,
cardiovascular disease risk factors.
B. Moderate Risk
56.
_______
No known cardiovascular, pulmonary, metabolic
disease, no major signs or symptoms of suggestive of
cardiovascular, pulmonary or metabolic disease, 2 or
more cardiovascular disease risk factors.
C. High Risk
57. The personal trainer must remember that no set ____________________ for exercise testing and participation
can cover all____________________. Exercise testing recommendations reflect the notion that the risk of
____________________ events increase as a function of increasing physical activity ____________________.
58. Exercise testing can be submaximal or maximal. ____________________ exercise testing does not require allout effort, gives an ____________________ maximal oxygen uptake. Maximal testing tests how hard the
____________________ works during exercise and helps find the ____________________
____________________ of the cardiovascular system. Most personal trainers will need to refer clients for
____________________ testing due to the cost of equipment.
59. Medical supervision of exercise tests varies from ____________________ -____________________ tests to
situations in which ____________________ ____________________ may be present. The degree of physician
supervision may differ, depending on local ____________________ and ____________________, the client’s
____________________ ____________________ and the ____________________ of the staff conducting the
test. In all situations in which exercise testing is being performed site ____________________ should at least be
certified at a level of ____________________ ____________________ ____________________.
60. ____________________ exercise intensity is any exercise that is 40 to 60% of VO2R 3-6 METs and defined as an
intensity that causes ____________________ increases in heart rate and breathing. ____________________
exercise intensity is any exercise that is > 60% of VO2R, >6 METs and defined as an intensity that causes
____________________ increases in heart rate and breathing.
Refer to table 11.6 to answer the following questions
61. For the following risk factors indicate if a medical exam, exercise test or physician supervised exercise test
should be completed prior to exercise.
a. Low Risk
i. Medical Exam recommended before exercise?
1. _______ Moderate Exercise
2. _______ Vigorous Exercise
ii. Exercise test recommended before exercise?
1. _______ Moderate Exercise
2. _______ Vigorous Exercise
iii. Medically supervised exercise test recommended before exercise?
1. _______ Submax
2. _______ Max
b. Moderate Risk
i. Medical Exam recommended before exercise?
1. _______ Moderate Exercise
2. _______ Vigorous Exercise
ii. Exercise test recommended before exercise?
1. _______ Moderate Exercise
2. _______ Vigorous Exercise
iii. Medically supervised exercise test recommended before exercise?
1. _______ Moderate Exercise
2. _______ Vigorous Exercise
c. High Risk
i. Medical Exam recommended before exercise?
1. _______ Moderate Exercise
2. _______ Vigorous Exercise
ii. Exercise test recommended before exercise?
1. _______ Moderate Exercise
2. _______ Vigorous Exercise
iii. Medically supervised exercise test recommended before exercise?
1. _______ Moderate Exercise
2. _______ Vigorous Exercise
62. Explain why the following is recommended to be included in a health-history evaluation:
a. Medical History:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
b. Medications:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
c. Exercise History:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
d. Nutrition:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
63. Documentation is an important part of ____________________ ____________________. Personal trainers
should keep accurate records of client responses to ____________________ and ____________________,
changes in reported ____________________ ____________________and how these changes are
communicated to appropriate ____________________ ____________________ ____________________.
Client ____________________ ____________________should be updated regularly. Records may be
maintained either in ____________________ or ____________________ form and should be stored in a safe
place to maintain client ____________________. No rule for amount of time files must be kept, usually
___ - ___ _________________.
64. Explain the difference between obtaining medical clearances to exercise and obtaining physician input:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
65. When should a client be referred for medical clearance?
a. _____________________________________________________________________________________
b. _____________________________________________________________________________________
66. What is HIPAA?
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
67. It is the responsibility of the personal trainer to refer clients to other members of the team when problems or
potential problems arise or are identified that are beyond the personal trainers ____________________ __
____________________. Referral may take place at any time – during the ____________________
____________________process, once ____________________ ____________________has begun or even
____________________ ____________________into training.
68. Potential problems may be discovered while conducting physical assessments. The Personal Trainer must
________________ whether or not to refer the client to a health care provider for a more ___ -_____________
assessment. Personal trainers should err on the side of caution. If in ____________________ the Personal
Trainer should ____________________ the client to an appropriate physician or specialist.
69. Personal trainers are responsible to ________________ ________________ the health status of their clients
through either ________________ (direct questions, written or physical assessments) or ________________
(casual conversation or observation) means. The onset of ____________________ signs and symptoms,
____________________ of existing medical conditions, or occurrences of ____________________ may warrant
stopping or ____________________ exercise training until after further consultation with the physician.
Recognizing these situations and communicating ____________________ with the health care team will
maximize the ____________________of clients, increase their probability of successfully
____________________ established health and fitness goals, and raise the ____________________ of the
Personal Trainer in the eyes of the medical community.
70. Serious ____________________ ____________________or those that do not resolve quickly should at a
minimum prompt a ____________________ to follow up with a health care professional and
____________________of training techniques to protect or ____________________
____________________on the joint. Clients reporting a muscle or joint problem that has been either brought
on or aggravated by exercise should be referred to a health care professional. Personal trainers should be
careful not to move beyond their appropriate ____________________ __ ____________________.
71. Personal trainers should encouraged injured clients to use the ____________________ method until their client
can get an appointment with their physician.
72. What does RICE stand for?
73. When referring a client for consultation what information should be sent to the physician?
A. ___________________________________
B. ___________________________________
C. ___________________________________
D. ___________________________________
74. What can a personal trainer do to make communication with health care providers more efficient?
a. _____________________________________________________________________________________
_____________________________________________________________________________________
b. _____________________________________________________________________________________
_____________________________________________________________________________________
c. _____________________________________________________________________________________
_____________________________________________________________________________________
d. _____________________________________________________________________________________
_____________________________________________________________________________________
e. _____________________________________________________________________________________
_____________________________________________________________________________________
f.
_____________________________________________________________________________________
_____________________________________________________________________________________
g. _____________________________________________________________________________________
_____________________________________________________________________________________
i. ______________________________________________________________________________
______________________________________________________________________________
h. _____________________________________________________________________________________
_____________________________________________________________________________________
75. Define informed consent:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
76. Informed consent for the fitness assessment ensures that the client:
a. _____________________________________________________________________________________
_____________________________________________________________________________________
b. _____________________________________________________________________________________
_____________________________________________________________________________________
c. _____________________________________________________________________________________
_____________________________________________________________________________________
d. _____________________________________________________________________________________
_____________________________________________________________________________________
e. _____________________________________________________________________________________
_____________________________________________________________________________________
f.
_____________________________________________________________________________________
_____________________________________________________________________________________
g. _____________________________________________________________________________________
_____________________________________________________________________________________
77. Explain why written consent is preferred over verbal or implied consent:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
78. What are you still confused or need additional information on?
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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