1. 2 Preliminary Health Screening and Risk Classification chapter 2
Author name here for Edited books

2. 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

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

4. Table 2.1

5. 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

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

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

8. Table 2.2

9. 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.

10. 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

11. 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)

12. 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?

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

14. 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

15. 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

16. 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

17. 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.

18. Table 2.5

19. Table 2.6

20. 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

21. Table 2.3

22. 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

23. Table 2.7

24. 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.

25. 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

26. 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)

27. 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)

28. 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

29. Figure 2.1

30. 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)

31. Figure 2.2

32. Figure 2.3