Risks Associated with Physical
Activity
• While regular physical activity increases the
risk of both musculoskeletal injury and lifethreatening cardiovascular events such as
cardiac arrest, the incidence is low.
– The risk is even lower in those who are
habitually active.
Risks Associated with Physical
Activity
• In general, the risk is lowest among healthy
young adults and non-smoking women,
greater for those with CAD risk factors, and
highest for those with established cardiac
disease.
Risks Associated with Physical
Activity
• The overall absolute risk in the general
population is low especially when weighed
against the health benefits of exercise.
Risks Associated with Physical
Activity
• To further reduce the risks of physical
activity, proper prescreening must occur.
Prescreening
Prescreening
• A necessity prior to any fitness assessment
or participation in any activity program
– Identifies those at risk
– Defines goals and objectives
– Provides starting FITS
– Provides a baseline for measuring
progression
Prescreening
Objectives:
• Optimize safety during exercise testing and
participation.
• Permit the development of a sound and
effective exercise prescription.
Prescreening
The purpose of the pre-participation health
screening include:
• Identification and exclusion of individuals
with medical contraindications to exercise.
Prescreening
• Identification of individuals with disease
symptoms and risk factors for disease
development who should receive medical
evaluation before starting an exercise
program.
Prescreening
• Identification of persons with clinically
significant disease considerations who
should participate in a medically supervised
exercise program.
Prescreening
• Use information from the initial health and
lifestyle evaluations to screen clients for
physical fitness testing and for program
development.
Prescreening
• Identification of individuals with other
special needs.
Prescreening
• It is essential that health screening
procedures be valid, cost effective, and time
efficient.
Prescreening
Prescreening may be composed of:
• Informed consent
• Medical clearance
• Risk stratification
Prescreening
• Medical history
• Lifestyle evaluation
• Exercise testing
Informed Consent
• Prior to conducting any physical fitness
tests or developing any exercise program,
you should see that each participant signs an
informed consent.
Informed Consent
• This form explains the purpose and nature
of each physical fitness test and/or program,
any inherent risks in the testing and/or
program, and the expected benefits of the
tests and/or program.
Informed Consent
• It also ensures your clients’ results will
remain confidential and their participation is
voluntary.
Informed Consent
• If your client is underage (<18 years), a
parent or guardian must also sign the
informed consent.
– Minor gives assent
– Legal guardian gives consent
Informed Consent
• All consent forms should be approved by
your institutional review board or legal
counsel.
Prescreening
• Before assessing your client’s physical
fitness profile, you should classify the
individual’s health status and lifestyle.
Health Status
• Illness or disease?
• Injury?
• Medications and supplements?
Activity Status
• Currently active or inactive?
• Likes and dislikes?
• Obstacles?
Health Status
• PAR-Q
– Physical Activity Readiness
Questionnaire
• The PAR-Q has been recommended as a
minimal standard for entry into low-tomoderate intensity exercise programs.
Health Status
• The PAR-Q was designed to identify the
small number of adults for whom physical
activity might be inappropriate or those who
should have medical advice concerning the
most suitable types of activity.
Medical History
• Your clients should complete a
comprehensive medical history
questionnaire, including personal and
family health history.
Medical History
Use the questionnaire to:
• Examine the client’s record of personal
illnesses, surgeries, and operations.
Medical History
• Assess previous medical diagnoses and
signs and symptoms of disease that have
occurred within the past year or are
currently present.
Medical History
• Analyze your client’s family history of
– diabetes,
– heart disease,
– stroke
– and hypertension.
Medical History
• Focus on conditions that require medical
referral.
Medical History
• If any of these conditions are noted, refer
your client to a physician for a physical
examination and medical clearance prior to
exercise testing or starting an exercise
program.
Medical History
Present Symptoms:
• Dyspnea or shortness of breath
• Angina or chest pain
• Leg cramps or claudication
• Musculoskeletal problems or limitations
• Medications
Medical History
Past History:
• Diseases
• Injuries
• Surgeries
• Lab tests
Medical History
• It is important to note the types of
medication being used by the client.
Medical History
• Drugs such as digitalis, beta-blockers,
diuretics, vasodilators, bronchodilators, and
insulin may alter the individual’s heart rate
blood pressure, ECG, and exercise capacity.
Medical History
• If your client reports a medical condition or
drug that is unfamiliar to you, be certain to
consult a physician to obtain more
information before conducting any exercise
tests or allowing the client to participate in
an exercise program.
Medical Clearance
• Your prospective exercise program
participants should obtain a physical
examination and a signed medical clearance
from a physician.
New 2016 ACSM Guidelines
• See pdf files
Lifestyle Evaluation
• A well-rounded physical fitness program
requires that you obtain information about
the client’s living habits.
Lifestyle Evaluation
• The lifestyle assessment provides useful
information regarding the individual’s risk
factor profile.
Lifestyle Assessment
•
•
•
•
•
Alcohol and caffeine intake
Smoking
Nutritional intake - eating patterns
Physical activity patterns and interests
Sleeping habits
Lifestyle Assessment
• Occupational stress level
• Mental status - family lifestyle
Lifestyle Evaluation
• These factors can be used to pinpoint
patterns and habits that need modification
and to assess the likelihood of the client’s
adherence to the exercise program.
Lifestyle Evaluation
• Factors such as
• smoking,
• lack of physical activity,
• and diets high in saturated fats or
cholesterol
• increase the risk of CAD atherosclerosis,
and hypertension.
Physical Examination
• Blood pressure
• Heart or lung sounds
• Orthopedic problems
Laboratory Tests (Ideal #s)
•
•
•
•
Triglycerides (<200 mg per dl)
Total cholesterol (<200 mg per dl)
LDL-C (<130 mg per dl)
HDL-C (>40 mg per dl)
Laboratory Tests (Ideal #s)
• TC/HDL-C ratio (<3.5)
• Blood glucose (60-114 mg per dl)
• Hemoglobin (13.5-17.5 mg per dl for men;
11.5-15.5 mg per dl for women)
• Potassium (3.5-5.5 meq per dl)
Laboratory Tests (Ideal #s)
• Blood urea nitrogen (4-24 mg per dl)
• Creatinine (0.3-1.4 mg per dl)
• Iron (40-190 mg per dl for men; 35-180 mg
for women)
• Calcium (8.5-10.5 mg per dl)
Physical Fitness Evaluation
• CV fitness (HR, BP, VO2MAX)
• Body composition (%BF)
• Musculoskeletal fitness (muscle and bone
strength)
• Flexibility
• Neuromuscular tension/stress
Fitness Assessment
• Fitness assessment is discussed elsewhere
(KNR 309)
• Very important in
program design
Risks of Exercise Testing.
• Clinical exercise testing is a relatively safe
procedure, although complications may
arise.
Risks of Exercise Testing.
• The risk of death during or immediately
after an exercise test is < 0.01%.
– 1 out of 10,000
• The risk of MI during or immediately after
an exercise tests is < 0.04%.
– 4 out of 10,000
Risks of Exercise Testing.
• The risk of a complication requiring
hospitalization (including MIs) is
approximately 0.1%.
– 1 out of 1,000
Risks of Exercise Testing.
• The data suggest that the rate of
complications during exercise testing is
higher in populations undergoing diagnostic
testing, compared with persons being tested
as part of a preventive medical examination.
Risks of Exercise Testing.
• The risks associated with submaximal
physical fitness testing appear to be even
lower.
Risks of Exercise Testing.
• Submaximal physical fitness testing appears
to have an extremely low risk when
accompanied by appropriate pretest
screening such as the PAR-Q and can be
administered safely by qualified personnel
in non-medical settings.
Risks of Exercise Testing.
• No set of guidelines for exercise testing and
participation can cover all situations.