ACSM RISK STRATIFICATION
WHY IS IT IMPORTANT TO SCREEN
CLIENTS?
Exercise can increase the risk of sudden
cardiac death and heart attack
Cardiovascular events usually only
occur in clients with preexisting
conditions
Many clients are unaware of their risk
WHY IS IT IMPORTANT TO SCREEN
CLIENTS?
Exercise usually only provokes
cardiovascular events only in clients
with pre-existing heart disease.
Exercise typically does not provoke
cardiac events in clients with normal
cardiovascular systems.
WHAT RISK FACTORS AND/OR SYMPTOMS
SHOULD PERSONAL TRAINERS CONSIDER
SCREENING FOR?
Cardiovascular Disease
Hypertension, High Cholesterol, Past
Heart Attack, Stroke etc.
Metabolic Disease
Diabetes, Kidney Diseases etc.
Pulmonary Disease
Asthma, COPD (common in smokers) etc.
Conditions aggravated by exercise
Exercise Induced Asthma, Arthritis etc.
WHAT SHOULD A SCREENING
IDENTIFY?
Clients with medical contraindications to
exercise
At-risk clients who need a medical exam
first
Clients who need a medically supervised
exercise program
Clients with other special needs
Identify the personal trainer best suited for
the client
THREE PHASES OF THE SCREENING
PROCESS
Risk Classification
Determine if client is at risk for a cardiovascular,
metabolic or pulmonary condition
Health-History Evaluation and Related
Assessments
Complete resting measurements – heart rate,
blood pressure etc.
Medical Clearance or Referral
Determine if doctor must be seen before starting
an exercise program
EIGHT STEPS OF THE SCREENING
PROCESS
 1. Determine the number of risk factors and number of signs and symptoms (based
on tables 11.1 and 11.2)
 2. Determine whether the client is at low, moderate or high risk (based on figure
11.5)
 3. Determine whether a medical evaluation or exercise testing is necessary (based on
figure 11.6)
 4. Conduct a health-history evaluation
 5. Obtain a medical clearance if necessary
 6. Complete an informed consent
 7. Conduct appropriate assessments
 8. Refer the client to a physician or other health care provider if necessary
ACSM RISK CLASSIFICATION
 The ACSM risk classification process is used to identify
clients who should undergo a medical examination and
exercise testing before beginning a moderate or vigorous
exercise program.
 Medical clearances (if necessary) should be obtained after
the personal trainer has conducted both the risk
classification and a thorough health-history interview with
the client.
WHAT ARE THE TWO SELF-GUIDED
QUESTIONNAIRES THAT CAN BE USED WITH
CLIENTS?
 Physical Activity Readiness Questionnaire (PAR-Q) Figure
11.1
 AHA/ACSM Health/Fitness Facility Pre-Participation
Screening Questionnaire Figure 11.2
MEDICAL CLEARANCE
When working with clients transitioning out
of cardiopulmonary rehabilitation, physical
therapy or another medically supervised
program, a written medical clearance is
recommended, even if the physician referred
them to a personal trainer.
EXPLAIN THE DIFFERENCE BETWEEN A POSITIVE
AND NEGATIVE RISK FACTOR FOR
ATHEROSCLEROTIC CARDIOVASCULAR DISEASE:
A positive risk factor is linked to increased
likelihood of cardiovascular disease. The more
positive risk factors present the greater the
chances of cardiovascular disease. The presence
of 2 or more risk factors warrants medical
clearance prior to exercise.
A negative risk factor helps prevent the risk of
cardiovascular disease and subtracts 1 risk factor
from the sum of the risk factors.
POSITIVE RISK FACTORS FOR CARDIOVASCULAR
DISEASE – SEE TABLE 11.1 FOR MORE IN-DEPTH
INFORMATION
Age
Family History
Cigarette Smoking
Sedentary Lifestyle
Obesity
Hypertension
Dyslipidemia
Pre-Diabetes
WHAT IS A NEGATIVE RISK FACTOR FOR
CARDIOVASCULAR DISEASE?
High Density Lipoprotein Cholesterol greater than
60 mg/dL
MATCHING- ANSWERS GIVEN AT END OF PPT
13
Low density lipoprotein cholesterol >130 mg*dL or high density lipoprotein
cholesterol <40 mg*dL or on lipid-lowering medication. If total serum
cholesterol is all that is available use >200 mg*dL
A.
Age
14
>60mg*dL Negative risk factors, removes 1 risk factor.
B. Cigarette
Smoking
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
C. Dyslipidemia
16
Men > 45 years; women >55 years
D. Family History
17
Body mass index >30 kg/m2 or waist girth 120 cm (40 in) for men and >88 cm
(35 in for women
E. High Density
Lipoprotein
Cholesterol
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
F. Hypertension
19
Not participating in at least 30 minutes of moderate intensity physical activity
on at least 3 days a week for at least 3 months
G. Obesity
20
Current cigarette smoker or those who quite within the previous 6 months or
exposure to environmental tobacco smoke
H. Prediabetes
21
Systolic blood pressure >140 mmHg and/or diastolic >90mmHg, confirmed by
measurements on at least 2 separate occasions, or on anti-hypertensive
medication
I. Sedentary
Lifestyle
MATCHING- ANSWERS GIVEN AT END OF PPT
22
Temporary or short lived symptoms
23
Any condition that renders some particular movement, activity or treatment improper or
undesirable
24
26
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).
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
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.
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
25
29
30
31
32
33
Any condition that affects the blood vessels along the route between the heart and
lungs.
Sudden onset of disease
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 PreParticipation 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
IDENTIFY THE MAJOR SIGNS OR SYMPTOMS
SUGGESTIVE OF CARDIOVASCULAR, PULMONARY
OR METABOLIC DISEASE
 Pain discomfort in the chest, neck, jaw or arms or other areas that
may result from ischemia
 Shortness of breath at rest or with mild exertion
 Dizziness or syncope (passing out)
 Orthopnea or paroxysmal nocturnal dyspnea
 Ankle edema
 Palpitations or tachycardia
 Intermittent Claudication
 Known heart murmur
 Unusual fatigue or shortness of breath with usual activities
WHAT DOES ISCHEMIC MEAN?
What happens when your heart doesn’t get
enough oxygen.
Usually happens because of a shortage of blood
and oxygen to the heart muscle.
It is usually caused by a narrowing or blockage
of one or more coronary arteries.
WHEN CHEST PAIN AND DISCOMFORT OCCURS,
WHAT KEY FEATURES INDICATE AN ISCHEMIC
ORIGIN?
Characterized by a constricting, squeezing,
burning heaviness or heavy feeling
Located in sub sternal, across mid-thorax,
anteriorly in one or both arms, shoulders, neck,
cheeks, teeth, forearms, fingers and interscapular
region
Provoked by exercise or exertion, excitement or
other forms of stress, cold weather and
occurrence after meals
WHEN CHEST PAIN AND DISCOMFORT OCCURS,
WHAT KEY FEATURES INDICATE THAT IT IS NOT AN
ISCHEMIC ORIGIN?
Characterized by a dull ache, knifelike, sharp
stabbing and jabs aggravated by respiration
Located in left sub mammary area; in the left
hemithorax
Provoked by completion of exercise and provoked
by a specific body motion
MATCHING- ANSWERS GIVEN AT END OF PPT
38
An extra or unusual sound heard during a heartbeat. May indicate valvular or other cardiovascular
disease.
39
Disease of the heart valves in which the opening of the aortic valve is narrowed.
40
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
A. Angina Pectoris
B. Ankle edema
C. Aortic Stenosis
41
Condition where the heart muscle become thick, common cause of sudden cardiac arrest in young
people.
D. Dyspnea
42
An abnormally uncomfortable awareness of breathing, can be a sign on chronic obstructive
pulmonary disease
E. Heart murmur
43
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- ANSWERS GIVEN AT END OF PPT
44
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.
45
Unpleasant awareness of the forceful or rapid beating of the heart. Often result from anxiety.
46
47
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
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
CARDIOVASCULAR
 Coronary artery disease: Major form of cardiovascular
disease; results when the coronary arteries are
narrowed by deposits of fibrous and fatty tissue
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
CARDIOVASCULAR
 Peripheral Vascular disease: Affects 20% of
Americans over 65. Caused by atherosclerosis
(hardening of the arteries) that cause decreased blood
flow to the legs.
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
CARDIOVASCULAR
 Cerebrovascular disease: Group of brain dysfunctions
related to disease of the blood vessels supplying the
brain. Hypertension is the most common cause as it
damages blood vessel linings making them more narrow
and stiff. Can lead to stroke.
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
PULMONARY
Chronic Obstructive Pulmonary Disease (COPD):
Condition of chronically poor airflow to the lungs that
worsens over time. Cigarette smoking is the leading
cause of COPD.
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
PULMONARY
Asthma: Chronic lung disease that inflames and narrows
the airways. Causes recurring periods of wheezing, chest
tightness, shortness of breath and coughing.
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
PULMONARY
Interstitial lung disease: Thickening of the interstitium of
the lungs which affects the ability to breathe and get
oxygen into the blood stream. Can be caused by
inflammation, scarring or extra fluid within the lungs.
Fluid that is
pressing on the
lung. Notice
the difference
in size between
the two lungs
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
PULMONARY
Cystic Fibrosis: Inherited disease characterized by the
buildup of thick, sticky mucus that can damage many of
the body’s organs.
The average
life expectancy
for someone
with cystic
fibrosis is only
37 years.
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
METABOLIC
Diabetes Mellitus: Disease where a person has high
blood sugar either because the pancreas does not produce
enough insulin (Type 1) or because cells do not respond to
the insulin that is produced (Type 2)
Born with the condition
Type 2- Develops over time
IDENTIFY AND DEFINE KNOWN CARDIOVASCULAR,
PULMONARY AND METABOLIC DISEASES:
METABOLIC
Renal Disease: Occurs when the kidneys fail to
adequately filter waste products from the blood
RISK LEVELS
Risk classification becomes progressively more
important as disease prevalence increases. Clients
can be classified into low, moderate or high risk
levels. The risk level is used to determine who
should be cleared by their physician prior to
participation.
WHAT DETERMINES IS A CLIENT IS LOW,
MODERATE OR HIGH RISK?
LOW
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.
WHAT DETERMINES IS A CLIENT IS LOW,
MODERATE OR HIGH RISK?
MODERATE
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.
WHAT DETERMINES IS A CLIENT IS LOW,
MODERATE OR HIGH RISK?
HIGH
Known cardiovascular, pulmonary, metabolic disease, OR
major signs or symptoms of suggestive of cardiovascular,
pulmonary or metabolic disease, cardiovascular disease
risk factors.
MATCHING- ANSWERS GIVEN AT END OF PPT
44
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.
45
Known cardiovascular, pulmonary, metabolic disease, OR major signs or symptoms of suggestive
of cardiovascular, pulmonary or metabolic disease, cardiovascular disease risk factors.
46
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.
A. Low Risk
B. Moderate Risk
C. High Risk
QUESTION 57
The personal trainer must remember that no set guidelines
for exercise testing and participation can cover all
situations.
Exercise testing recommendations reflect the notion that the
risk of cardiovascular events increase as a function of
increasing physical activity intensity.
What this means- whenever you participate in some form of
exercise there is always the risk of having a heart attack. As a
Personal Trainer it is your responsibility to reduce the likelihood
of a heart attack occurring. This is a form of Risk Management.
QUESTION 58
Exercise testing can be submaximal or maximal.
Submaximal exercise testing does not require all-out effort,
gives an estimated maximal oxygen uptake.
Maximal testing tests how hard the heart works during
exercise and helps find the upper limits of the
cardiovascular system.
Most personal trainers will need to refer clients for maximal
testing due to the cost of equipment.
The fitness assessments we perform in class (1 mile walk, 1.5
mile run, Queens College) are all submaximal tests.
QUESTION 59
Medical supervision of exercise tests varies from physiciansupervised tests to situations in which no physician may be
present.
The degree of physician supervision may differ, depending
on local policies and circumstances, the client’s health
status and the experience of the staff conducting the test.
In all situations in which exercise testing is being performed
site personnel should at least be certified at a level of basic
life support.
Medically supervised exercise tests typically occur in cardiac
rehabilitation facilities.
WHAT IS THE DIFFERENCE BETWEEN
MODERATE AND VIGOROUS EXERCISE?
Moderate exercise intensity
is any exercise that is 40 to
60% of VO2R 3-6 METs
and defined as an intensity
that causes noticeable
increases in heart rate and
breathing.
Vigorous exercise intensity
is any exercise that is >
60% of VO2R, >6 METs
and defined as an intensity
that causes substantial
increases in heart rate and
breathing.
USE THIS TABLE TO COMPLETE QUESTION 60
Low Risk
Medical exam recommended before exercise?
_____ Moderate
_____ Vigorous
Exercise Test recommended before exercise?
_____ Moderate
_____ Vigorous
Medically supervised exercise test
recommended before exercise?
_____ Submax
_____ Max
USE THIS TABLE TO COMPLETE QUESTION 60
Moderate Risk
Medical exam recommended before exercise?
_____ Moderate
_____ Vigorous
Exercise Test recommended before exercise?
_____ Moderate
_____ Vigorous
Medically supervised exercise test
recommended before exercise?
_____ Submax
_____ Max
USE THIS TABLE TO COMPLETE QUESTION 60
High Risk
Medical exam recommended before exercise?
_____ Moderate
_____ Vigorous
Exercise Test recommended before exercise?
_____ Moderate
_____ Vigorous
Medically supervised exercise test
recommended before exercise?
_____ Submax
_____ Max
EXPLAIN WHY THE FOLLOWING IS RECOMMENDED
TO BE INCLUDED IN A HEALTH-HISTORY
EVALUATION: MEDICAL HISTORY
Includes current and previous medical conditions, injuries,
surgical procedures and therapies can all influence an
exercise plan. Include dates and thoroughly discuss all
conditions listed.
EXPLAIN WHY THE FOLLOWING IS RECOMMENDED
TO BE INCLUDED IN A HEALTH-HISTORY
EVALUATION: MEDICATIONS
Some medications will affect heart rate and blood
pressure response to exercise. Client’s need to report any
changes in medication. Beta blockers, diuretics and
calcium channel blockers are medications to particularly
be aware of.
EXPLAIN WHY THE FOLLOWING IS RECOMMENDED
TO BE INCLUDED IN A HEALTH-HISTORY
EVALUATION: EXERCISE HISTORY
A client’s experience with exercise is important to allow
the trainer to know if an advanced protocol is appropriate,
attitude towards working out is important to know as it
may alter the type of exercises selected.
EXPLAIN WHY THE FOLLOWING IS RECOMMENDED
TO BE INCLUDED IN A HEALTH-HISTORY
EVALUATION: NUTRITION
Dietary intake is directly related to weight and body
composition. It will also affect potential for disease,
mood and energy level.
DOCUMENTATION
Documentation is an important part of risk management.
Personal trainers should keep accurate records of client
responses to testing and training, changes in reported
health status and how these changes are communicated to
appropriate health care providers.
Client health information should be updated regularly.
Records may be maintained either in paper or electronic
form and should be stored in a safe place to maintain client
confidentiality.
No rule for amount of time files must be kept, usually 3-5
years.
EXPLAIN THE DIFFERENCE BETWEEN OBTAINING
MEDICAL CLEARANCES TO EXERCISE AND
OBTAINING PHYSICIAN INPUT:
When seeking medical clearance the personal trainer will
not allow the client to exercise until the physician
approves to do so.
When seeking physician input the personal trainer
typically proceeds with training, but may make
modifications and incorporates recommendations
provided by the physician
WHEN A CLIENT SHOULD BE REFERRED FOR
MEDICAL CLEARANCE:
Per ACSM risk stratification process
When client has significant or recent health status
change not evaluated by physician
WHAT IS HIPAA?
Health Insurance Portability and Accountability Act of
1996.
Requires the US department of health and human services
to establish national standards for electronic health care
information to facilitate efficient and secure exchange of
private health data.
Provides federal protection and gives patient’s rights with
respect to personal health information.
QUESTION 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 scope of practice.
Referral may take place at any time – during the physical
assessment process, once exercise training has begun or
even several months into training.
QUESTION 68
Potential problems may be discovered while conducting
physical assessments.
The Personal Trainer must DECIDE whether or not to refer the
client to a health care provider for a more IN-DEPTH
assessment.
Personal trainers should err on the side of caution.
If in DOUBT the Personal Trainer should REFER the client to
an appropriate physician or specialist.
QUESTION 69
Personal trainers are responsible to continually reevaluate
the health status of their clients through either formal (direct
questions, written or physical assessments) or informal
(casual conversation or observation) means.
QUESTION 69 CONT.
The onset of NEW signs and symptoms, AGGRAVATION of
existing medical conditions, or occurrences of INJURY may
warrant stopping or MODIFYING exercise training until after
further consultation with the physician.
Recognizing these situations and communicating EFFECTIVELY
with the health care team will maximize the SAFETY of
clients, increase their probability of successfully REACHING
established health and fitness goals, and raise the STATURE
of the Personal Trainer in the eyes of the medical community.
This is why it is important to have a list of professionals to
refer your client to.
QUESTION 70
Serious joint injuries or those that do not resolve
quickly should at a minimum prompt a
recommendation to follow up with a health care
professional and modification of training techniques
to protect or minimize strain 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 scope of practice.
QUESTION 71
Personal trainers should encouraged injured clients
to use the RICE method until their client can get an
appointment with their physician.
WHAT DOES RICE STAND FOR?
YOU SHOULD KNOW THIS 
WHEN REFERRING A CLIENT FOR CONSULTATION
WHAT INFORMATION SHOULD BE SENT TO THE
PHYSICIAN?
Heart Rate
Blood pressure
Observed signs and symptoms
Was the client sweating, short of breath etc.
Accurate description of the situation
WHAT CAN A PERSONAL TRAINER DO TO MAKE
COMMUNICATION WITH HEALTH CARE PROVIDERS
MORE EFFICIENT
 Always include information that clearly identifies the
client, including his or her full name, age, sex, and date
of birth
 Be clear and to the point as to the purpose of the
communication
 Set a response date
WHAT CAN A PERSONAL TRAINER DO TO MAKE
COMMUNICATION WITH HEALTH CARE PROVIDERS
MORE EFFICIENT
 If something needs to be turned around quickly, write
“URGENT” in big letters at the top of the form
 Provide options that can be checked off easily
 Allow room for additional comments
WHAT CAN A PERSONAL TRAINER DO TO MAKE
COMMUNICATION WITH HEALTH CARE PROVIDERS
MORE EFFICIENT
 Faxing or emailing is typically more effective and
quicker than the mail system
 Call the office staff and notify them that a fax or email
that needs attention is on the way
 If requesting a release or personal medical information,
then automatically include a Release of Medical
Information form signed by your client
 Doctors offices will not release information unless they are given
permision by your client
INFORMED CONSENT
Generally written
document that
conveys health/fitness
information to the
client to achieve an
understanding
regarding his/her
participation options.
INFORMED CONSENT FOR THE FITNESS
ASSESSMENT ENSURES THAT THE CLIENT:
 Has full knowledge of the tests to be performed
 Understands the relevant risks associated with those test
 Know about alternative procedures
 Understands the benefits associated with the
assessments
INFORMED CONSENT FOR THE FITNESS
ASSESSMENT ENSURES THAT THE CLIENT:
 Has been provided an opportunity for inquiry
 Gives consent voluntarily, not under any duress or fact
inaccuracy
 Is of legal age and mentally competent
EXPLAIN WHY WRITTEN CONSENT IS PREFERRED
OVER VERBAL OR IMPLIED CONSENT:
Written consent is an effective risk management practice.
Having the consent in writing could be used in court as
documentation that the client was made aware of
activities to be performed and possible side effects (i.e.
injury, even death) of participating in the activity.
MATCHING- ANSWERS GIVEN AT END OF PPT
13
C
Low density lipoprotein cholesterol >130 mg*dL or high density lipoprotein
cholesterol <40 mg*dL or on lipid-lowering medication. If total serum
cholesterol is all that is available use >200 mg*dL
A.
Age
14
E
>60mg*dL Negative risk factors, removes 1 risk factor.
B. Cigarette
Smoking
15
H
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
C. Dyslipidemia
16
A
Men > 45 years; women >55 years
D. Family History
17
G
Body mass index >30 kg/m2 or waist girth 120 cm (40 in) for men and >88 cm
(35 in for women
E. High Density
Lipoprotein
Cholesterol
18
D
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
F. Hypertension
19
I
Not participating in at least 30 minutes of moderate intensity physical activity
on at least 3 days a week for at least 3 months
G. Obesity
20
B
Current cigarette smoker or those who quite within the previous 6 months or
exposure to environmental tobacco smoke
H. Prediabetes
21
f
Systolic blood pressure >140 mmHg and/or diastolic >90mmHg, confirmed by
measurements on at least 2 separate occasions, or on anti-hypertensive
medication
I. Sedentary
Lifestyle
MATCHING- ANSWERS GIVEN AT END OF PPT
22
L
Temporary or short lived symptoms
23
E
Any condition that renders some particular movement, activity or treatment improper or
undesirable
24
F
25
H
26
C
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).
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
A person showing no signs or symptoms
27
D
A general term for any disease of the heart, blood vessels or circulation
28
K
29
I
30
G
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.
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
31
J
32
A
33
B
Any condition that affects the blood vessels along the route between the heart and
lungs.
Sudden onset of disease
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 PreParticipation 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
MATCHING- ANSWERS GIVEN AT END OF PPT
38
E
An extra or unusual sound heard during a heartbeat. May indicate valvular or other cardiovascular
disease.
39
C
Disease of the heart valves in which the opening of the aortic valve is narrowed.
40
A
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
41
F
42
D
43
B
A. Angina Pectoris
B. Ankle edema
C. Aortic Stenosis
Condition where the heart muscle become thick, common cause of sudden cardiac arrest in young
people.
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- ANSWERS GIVEN AT END OF PPT
44
E
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.
45
D
Unpleasant awareness of the forceful or rapid beating of the heart. Often result from anxiety.
46
B
47
G
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
C
Dyspnea that occurs at rest in a reclined position that is relieved by sitting upright or standing.
49
A
Painful cramping in the leg or hip that occurs when walking or exercising and typically disappears
when the person stops the activity.
50
F
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
MATCHING- ANSWERS GIVEN AT END OF PPT
44
A
45
C
46
B
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.
Known cardiovascular, pulmonary, metabolic disease, OR major signs or symptoms of suggestive
of cardiovascular, pulmonary or metabolic disease, cardiovascular disease risk factors.
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.
A. Low Risk
B. Moderate Risk
C. High Risk
USE THIS TABLE TO COMPLETE QUESTION 60
Low Risk
Medical exam recommended before exercise?
No
Moderate
No
Vigorous
Exercise Test recommended before exercise?
No
Moderate
No
Vigorous
Medically supervised exercise test
recommended before exercise?
No
Submax
No
Max
USE THIS TABLE TO COMPLETE QUESTION 60
Moderate Risk
Medical exam recommended before exercise?
No
Moderate
Yes
Vigorous
Exercise Test recommended before exercise?
No
Moderate
No
Vigorous
Medically supervised exercise test
recommended before exercise?
No
Submax
No
Max
USE THIS TABLE TO COMPLETE QUESTION 60
High Risk
Medical exam recommended before exercise?
Yes
Moderate
Yes
Vigorous
Exercise Test recommended before exercise?
Yes
Moderate
Yes
Vigorous
Medically supervised exercise test
recommended before exercise?
Yes
Submax
Yes
Max