Chapter 2-3
Health Appraisal
Pre-Assessment Screening & Risk Factor Assessments
Informed Consent
•First step in HRPF assessment and must precede
the health risk appraisal where exchange of
private information and exercise is involved.
•Informed Consent is a process of documentation
that attests to the fact that clear communications
have taken place between the individual who is
desiring the assessment and the professional
administering them.
Essential Steps of the Informed Consent
~Explain the purpose of the assessments
~Describe the procedures to be used
~Describe the risks and discomforts associated with the
assessments.
~Describe the benefits obtained from the assessments
~Describe alternatives (if applicable)
~Describe the responsibilities required of the client
~Encourage the client to ask questions at any time
~Explain how data will be handled (confidentiality)
~Explain that the client can withdraw his or her consent and stop
the assessment process at any time.
Box 21, page 12
Pre-assessment Screening – Step 2
• Always obtain a medical
history or pre-exercise
health risk appraisal on
each participant.
• Stratify individuals
according to their
disease risk.
• Refer high-risk
individuals to a
healthcare provider for
medical evaluation and
a graded exercise test.
Rationale for Screening
• Identify those with medical
contraindication (see box 2.2 p. 15).
• Identify those who should receive medical
evaluation by MD prior to testing.
• Identify those who should perform HRPF
assessments administered by professional
in clinical setting.
• Identify those with other health
risk/medical concerns.
Rationale for pre-testing and
screening
• Risk of both cardiovascular and musculoskeletal injuries
are associated with exercise.
• The risks increase with the intensity of the exercise.
• The risks increases also in those individuals with known
or previous injuries/diseases.
• Therefore, it is crucial to know the medical history of
individuals perform Health-Related Physical Fitness
Testing
• Physical fitness testing is useful for the following:
– Identifying adverse S/S or conditions that might
compromise well-being during exercise.
– Provides an opportunity for individuals to be educated and
motivated to adopt more healthful lifestyles
– Helps in establishing goals to progress toward, and to
evaluate progress.
Pre-participation
Health Screening
• All facilities that offer exercise
equipment or services should
conduct pre-participation health
screening of all new members
and/or prospective users,
regardless of age.
• Conduct pre-participation health
screening using one or more of
several different instruments:
– Comprehensive health history
questionnaire (p. 17-18).
– Physical Activity Readiness
Questionnaire (PAR-Q).
– ACSM Risk Stratification Guidelines
Types of Screening Instruments
•
A comprehensive medical/health
questionnaire should include:
– Medical diagnosis
– Previous physical exam findings
– History of symptoms
– Recent illness, hospitalization,
new medical diagnosis or
surgical procedures
– Orthopedic problems
– Medication use and drug
allergies
– Lifestyle habits
– Exercise and work history
– Family history of disease
•
The PAR-Q is preferred when
testing large numbers of
individuals in a short period of
time in a basic fitness
assessment. Participants are
directed to contact their physician
if they answer “yes” to one or
more questions.
•
The ACSM has low, moderate,
and high risk strata based on the
presence (or absence) of different
risk factors. See page 21 (ACSM)
ACSM Risk Stratification: Counting Risk Factors
Table 2.1, pp. 19
1. Age: Men >= 45, Women >= 55
2. Family history: (MI, coronary revascularization, or sudden death
before 55 yrs in father or other male first-degree relative, or before
65 yrs in mother or other female first degree relative).
3. Cigarette smoking: (current cigarette smoker or those who quit
within the previous 6 months).
4. Sedentary lifestyle: (persons not participating in at least 30
minutes of moderate physical activity (40%-60% VO2) on at least
3 days of the week for at least 3 months.
5. Obesity: Body mass index of >30 kg/m2, or waist
girth of >102 cm – (40 in. men and >88 cm – (35 in.
women).
6. Hypertension: (SBP 140 >mm Hg or DBP >90 mm
Hg, confirmed on at least 2 separate occasions, or on
antihypertensive medication).
7. Dyslipidemia: LDL chloesterol > 130 or HDL <40 or
on lipid- lowering medication. If total cholesterol is all
that is available use >200 mg/dl
8. Prediabetes: Impaired fasting blood glucose = >100
mg/dl and <125 mg/dl, (confirmed by measurements on
at least 2 separate occasions).
Negative Risk Factor
• HDL - > 60 mg/dl
• For individuals having
high HDL, one positive
CVD risk factor is
subtracted from the sum
of positive risk factors.
ACSM: Check for these major signs or symptoms
(Table 2.2, p. 20 ACSM)
• 1. Pain, discomfort (or other anginal
equivalent) in the chest, neck, jaw, arms, or
other areas that may be due to ischemia.
• 2. Shortness of breath at rest or mild exertion.
• 3. Dizziness or syncope.
• 4. Orthopnea (discomfort in breathing which is
brought on or aggravated by lying flat) or
paroxysmal nocturnal dyspnea (acute
difficulty in breathing appearing suddenly at
night, usually waking the patient after an hour
or two of sleep).
• 5. Ankle edema.
ACSM: Check for these major signs or
symptoms (cont)
• 6. Palpitations (forcible or irregular pulsation of the
heart, perceptible to the individual, usually with an
increase in frequency or force, with or without
irregularity in rhythm) or tachycardia (rapid beating
of the heart, typically over 100 beats per minute at
rest).
• 7. Intermittent claudication (a condition caused by
lack of blood flow and oxygen to the leg muscles,
characterized by attacks of lameness and pain,
brought on by walking).
• 8. Known heart murmur.
• 9. Unusual fatigue or shortness of breath with usual
activities.
Using Screening Results for Risk
Stratification
• Once symptom and risk factor screening has been
conducted using questionnaires, the individual
considering exercise testing and prescription should
be stratified according to disease risk. Stratification
according to disease risk is important for several
reasons:
– To identify those in need of referral to a healthcare
provider for more extensive medical evaluation.
– To ensure the safety of exercise testing and participation.
– To determine the appropriate type of exercise test or
program.
ACSM Risk Stratification Levels
Table 2.3 pg. 20
Low risk: asymptomatic and meet no more than
one risk factor threshold).
Moderate risk : asymptomatic and meet the
threshold for two or more risk factors.
High risk: individuals with one or more
signs/symptoms or known cardiovascular,
pulmonary, or metabolic disease including
diabetes mellitus.
ACSM Recommendations for
(A) Current Medical Examination* and Exercise Testing Prior to Participation
and (B) Physician Supervision of Exercise Tests pg. 22
Low Risk
Moderate
Risk
High Risk
Not necessary
Not necessary
Recommended
Not necessary
Recommended
Recommended
B. Submaximal Test Not necessary
Not necessary
Recommended
Not necessary
Not necessary
Recommended
A. Moderate
Exercise**
A. Vigorous
Exercise † †
B. Maximal Test
* Within the past year.
** 3-6 METS; brisk walking; pace that can be sustained for 45 minutes; 40-60% maximal oxygen uptake.
† † >6 METS; substantial cardiorespiratory challenge; >60% maximal oxygen uptake.
‡ Physician should be in close proximity and readily available.
Blood Pressure
• Blood pressure is the force of blood against the
walls of the arteries and veins created by the heart as it
pumps blood to every part of the body.
Expressed in millimeters of mercury (mmHg)
• Systolic BP is the maximum pressure in the arteries
during the contraction (systole) phase
• Diastolic BP is the minimum pressure in the arteries
during the relaxation (diastole) phase of the heart.
Blood Pressure Guidelines
Systolic (mm Hg)
Normal
Pre-hypertensive
Stage I
Stage II
<120
Diastolic (mm Hg)
<80
120-139
140-159
80-89
90-99
>160
>100
Blood Pressure
• See course materials for blood pressure
techniques.
• http://vimeo.com/8068713