2 Preliminary Health Screening and Risk Classification chapter 2 Author name here for Edited books

Chapter Objectives Understand the importance of classifying client’s health status and lifestyle Know the variables evaluated by and focus of the various screening methods Understand the importance of information obtained from clinical tests and which ones require an MD Introduce procedures for hemodynamic assessment

Preliminary Health Evaluation Twofold purpose: Detect the presence of disease Assess initial disease risk of client

Table 2.1

PAR-Q Physical Activity Readiness Questionnaire 7 questions Identifies who needs medical clearance before fitness testing and/or exercise program initiation One single “yes” means that medical clearance is required

Medical History Questionnaire Very detailed queries Personal medical history Recent diagnoses and signs and symptoms (S/S) of disease Family medical history (continued)

Medical History Questionnaire (continued) Allows identification of risk factors, absolute and relative contraindications for exercise testing, and medications.

Table 2.2

Signs and Symptoms of Disease Checking for signs and symptoms of cardiovascular, pulmonary, metabolic, and musculoskeletal problems or disorders protects you and the client. Appendix A.3 of book also helps identify risk factors for CVD. Medical clearance may be required depending on results of this questionnaire.

Lifestyle Evaluation Helps you develop a well-rounded, individualized exercise program Rounds out risk factor profile Identifies lifestyle patterns and habits Highlights possible challenges to adherence

Informed Consent A legal document (both parties sign) Explains purpose of and procedure for each assessment Itemizes possible risks and expected benefits Ensures confidentiality in terms of data collected Indicates client participation is voluntary Allows parental approval (as appropriate)

Paperwork’s Done. Now What? Coronary risk factor analysis: Does client meet the threshold values for positive CHD risk factors? Does client meet the threshold value for negative CHD risk factor? What is the net risk factor count?

After Risk Factors Are Assessed Disease risk classification: Likelihood of an untoward event during testing or exercise Who needs medical clearance?

Disease Risk Classification Low risk: Asymptomatic and young and <2 net risk factors for CVD Moderate risk: Asymptomatic and >1 net risk factor for CVD; applies to both younger and older groups High risk: Symptomatic or known cardiovascular, pulmonary, or metabolic disease

Clinical Tests Physical examination: recommended for moderate- and high-risk clients Blood chemistry profile: allows insight into blood glucose and lipid levels Resting blood pressure: allows insight into pressure the heart is generating or withstanding when filling and emptying at rest Graded exercise test: allows ability to monitor physiologic responses to a stressor

Physical Examination Focus should be S/S of CHD Should also include assessment: Weight Orthopedic issues Cardiac function (rate, regularity) Blood pressure (various positions) Heart, lung, and major artery sounds Signature authority from MD indicating approval to start or continue

Blood Chemistry Profile If values are out of normal ranges, refer client to their medical provider. NCEP recommends: Fasting lipoprotein profile assessment every 5 years LDL-C goals based on risk category Refer clients for professional help if they have high or very high LDL-C levels.

Table 2.5

Table 2.6

Resting Blood Pressure SBP: arterial pressure during systole (ejection, emptying; higher number) DBP: arterial pressure during diastole (relaxation, filling; lower number) Pulse pressure: SBP − DBP

Table 2.3

Graded Exercise Test (GXT) Helps assess functional aerobic capacity Beneficial for setting exercise prescriptions Should be administered by trained, certified personnel Use risk stratification to determine contraindications, need for MD presence, and level of exertional effort

Table 2.7

Monitoring Hemodynamic Responses During GXTs, monitor blood pressure (BP) and heart rate (HR). Monitor HR and BP before, during, and after GXT. Additionally, monitor electrical activity of heart (ECG) during maximal exertion GXTs.

Blood Pressure Assessment Select proper cuff size for your client Minimize sources of error Follow standard technique Practice, practice, practice! Take BP near the end of each GXT stage Deflate cuff fully between measurements Wait 30 sec before reassessment

Heart Rate Assessment Like BP assessment, record HR at rest, during exercise, and after exercise. For exercise and recovery, count for 6- or 10-second interval. Know when to count starting at 1. Available methods: Palpation (with fingertips) Auscultation(with stethoscope) Heart rate monitors Electrocardiogram (ECG)

Electrocardiogram Most informative method for assessing HR Can assess electrical activity of heart chambers, myocardial ischemia, and acute or previous myocardial injury A good prep job is a must (continued)

Electrocardiogram (continued) Repeated cardiac cycles as seen on an ECG tracing: P-wave: atrial depolarization PR interval: delay of impulse at AV node QRS complex: ventricular depolarization ST segment: early ventricular repolarization T-wave: ventricular repolarization Monitored through various leads

Figure 2.1

12-Lead Electrocardiogram Bipolar (limb) leads (two electrodes per lead): Lead I: right arm to left arm Lead II: right arm to left leg Lead III: left arm to left leg Unipolar leads (one electrode per lead): 6 chest (precordial) leads 3 augmented leads (uses limb lead electrodes)

Figure 2.2

Figure 2.3