chapter 3 Health Appraisal

Evaluating Health Status Categories M edical history review R isk factor assessment and stratification P rescribed medications L evel of physical activity E stablish if physician consent is necessary A dminister fitness tests and evaluate results S et up exercise prescription E valuate progress with follow-up test

Preparticipation Questionnaire Concerns PAR-Q versus HSQ –A PAR-Q is appropriate when individuals want to engage exclusively in light- to moderate-intensity exercise activities (see form 3.2). –An HSQ allows fitness professionals to identify medical contraindications to exercise, risk factors, and lifestyle behaviors that may affect an individual’s ability to exercise safely (see form 3.1). (continued)

Preparticipation Questionnaire Concerns (continued) Both questionnaires contain personal health information which is protected by the Health Insurance Portability and Accountability Act (HIPAA) of This information should be shared only with other health professionals who will be working with the participant and should be discussed in a private setting. Fitness test results are also considered personal health information. (continued)

Preparticipation Questionnaire Concerns (continued) The fitness professional should ask additional questions relevant to the participant’s medical history while reviewing the HSQ. Pertinent responses should be documented on the HSQ.

Medical History Review The AHA and ACSM recommend that individuals who mark any of the statements in the medical history section of the HSQ should consult a physician before pursuing a regular exercise program. Fitness professionals should always use their professional experience and academic knowledge to assist them in making decisions on physician consent.

Risk Factor Identification The AHA and ACSM recommend that individuals who mark two or more statements in the assessing risk factor section of the HSQ should consult a physician before pursuing a regular exercise program. Risk factor thresholds are listed in table 3.1. Each risk factor does not cause an equal increase in the risk of a coronary event.

© American College of Sports Medicine ACSM's Guidelines for Exercise Testing and Prescription, 7th edition. All rights reserved.

ACSM Risk Stratification: Counting Risk Factors ACSM Guidelines Required 1. 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). 2. Cigarette smoking (current cigarette smoker or those who quit within the previous 6 months). 3. Hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg, confirmed on at least 2 separate occasions, or on antihypertensive medication).

4. Hypercholesterolemia (Dislipidemia) (serum cholesterol of >200 mg/dl or HDL cholesterol of 130 mg/dl rather than the total cholesterol of >200 mg/dl). If HDL cholesterol is >60 mg/dl, subtract one risk factor from the sum of positive risk factors (negative risk factor

5. Impaired fasting glucose (fasting blood glucose of ≥100 mg/dl, confirmed by measurements on at least 2 separate occasions). 6. Obesity (body mass index of ≥30 kg/m 2, or waist girth of >102 cm for men and >88 cm for women). 7. Sedentary lifestyle (persons not participating in a regular exercise program or meeting the minimal physical activity recommendations from the U.S. Surgeon General’s report— accumulating 30 minutes or more of moderate physical activity on most days of the week).

Risk Factor Stratification Use health status, symptoms, and risk factors to classify participants as low, moderate, or high risk. Low-risk participants include men < 45 yr and women < 55 yr who are asymptomatic and meet no more than one risk factor threshold from table 3.1. Moderate-risk participants include men 45 yr and older and women 55 yr and older or people who meet the threshold for two or more risk factors from table 3.1. (continued)

Risk Factor Stratification (continued) High-risk participants include individuals who have known cardiovascular (e.g., cardiac, peripheral vascular, or cerebrovascular), pulmonary (e.g., chronic obstructive pulmonary diseases), or metabolic (e.g., type 1 and type 2 diabetes) disease or who show signs or symptoms suggestive of these diseases. Individuals classified as low risk are permitted to begin an exercise program of vigorous intensity (e.g., >60% VO 2 R or HRR). (continued).

© American College of Sports Medicine ACSM's Guidelines for Exercise Testing and Prescription, 7th edition. All rights reserved.

Risk Factor Stratification (continued) Individuals classified as moderate risk can begin moderate-intensity exercise (e.g., <60% VO 2 R or HRR). Most facilities offer vigorous physical activity but cannot supervise moderate-risk participants during each visit. Fitness facilities may want to require all individuals classified as moderate risk to obtain physician consent before exercising regularly. Individuals classified as moderate or high risk should obtain physician consent before they begin a vigorous exercise program (e.g., >60% VO 2 R or HRR)...

HRR method of exercise prescription PMHR: 220- AGE PMHR: =200 RHR: 60 HRR: PMHR –RHR or = X0.50X

Question Bob=25 yoa PMHR=220-25=195 Measured Max HR: 193 Measured: RHR=63 What is his HRR? = 130

Prescribed Medications Fitness professionals should be able to identify medications commonly prescribed for high blood pressure, cholesterol, and blood sugar (see appendix D). Medications that will change a participant’s response to physical activity (e.g., beta- blockers) should also be acknowledged.

Present Level of Physical Activity The frequency, intensity, duration, and type of physical activity the participant performs should be documented and discussed. The fitness professional should inquire if exercising causes any unusual physiological responses.

Fitness Testing Common measurements obtained at rest include the following: –Heart rate –Blood pressure –Percent body fat –Waist circumference –Low-back flexibility Common measurements obtained while the participant is exercising include the following: –Heart rate –Blood pressure –Rating of perceived exertion –VO 2 max.

Exercise Prescription An appropriate exercise prescription should be designed in consideration of the following: Individual’s health status Fitness test results Personal goals

Evaluating Progress Fitness tests should be periodically repeated and an HSQ should be readministered to monitor the participant’s contemporary health status. A follow-up fitness test may be conducted 3 mo after the participant has been exercising regularly, with biannual testing thereafter. End of Lecture