ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3 Pretest Clinical Evaluation David Arnall, Ph.D., P.T., FACSM, ES

What is Necessary ? l Medical History l Medical diagnosis l Previous medical history l Hx of presenting symptoms l Recent illnesses, hospitalizations, etc. l Orthopedic problems l Medication history

l Review of habits - tobacco use, ETOH, caffeine use, illicit drugs l Exercise history l Work history l Family history of sudden death, stroke, metabolic disease, COPD, and presence of cardiac problems

Components Of The Physical Exam l Body weight l BP - rest, supine, sitting, standing l Heart & lung auscultation l Palpation of pulses l Palpation of BLE’s for edema & staining l Inspection for xanthomas l Neurological tests - balance, cognition, etc.

Recommended Lab Tests l Total serum cholesterol and HDL l Fasting triglycerides l Fasting blood glucose l EKG, PFT, Chest X-Ray l Complete panel & blood count l Thyroid function

What are the Desirable Lipoprotein Values ? l Cholesterol : < 200 mg/dl l HDL : > 35 mg/dl l LDL : < 130 mg/dl l Triglycerides : < 200 mg/dl

Some Important Blood Values l RBC : l  x /L l  x /L l Hematocrit : l  40% - 52% :  36% - 48% l Hemaglobin : l  g/dl :  g/dl

l WBC : x 10 9 /L l Platelets : x 10 9 /L l Fasting Glucose : mg/dl l Blood Urea Nitrogen : mg/dl l Creatinine : mg/dl

Contraindications To Exercise l Absolute Contraindications l Unstable angina l Uncontrolled dysrhythmias l Recent EKG changes & cardiac events l Acute myocarditis/pericarditis

l Acute pulmonary embolism/infarction l Severe aortic stenosis l Dissecting aneurysm l Acute infections

Contraindications To Exercise l Relative Contraindications l Left main coronary stenosis l Severe hypertension (>200/110) l Tachycardias/bradycardias l Uncontrolled metabolic disease l High-degree AV blocks

l Chronic infectious diseases l Cardiomyopathy & outflow obstructions l Stenotic valve disease l ventricular aneurysm

l Informed Consent l Purpose & benefits of the testing l Risks associated with the test l A statement indicating that the patient can ask questions l A statement saying the patient can stop the test whenever they want l Emergency equipment is available

Patient Preparation For Testing l Refrain from food & alcohol before test l Patient should be well rested l Patient wears loose fitting clothing l Patient should have a family member to take them home

l Patient may need to alter current medication use if this effects the test (antianginal drugs alter EKG responses) l Patient may need to continue their medications to guarantee consistent outcomes (beta-blockers) l Patient should bring all of their medications to the test site