1. Risks Associated with Physical Activity While regular physical activity increases the risk of both musculoskeletal injury and life- threatening cardiovascular events such as cardiac arrest, the incidence is low. –The risk is even lower in those who are habitually active.

2. 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.

3. Risks Associated with Physical Activity The overall absolute risk in the general population is low especially when weighed against the health benefits of exercise.

4. Risks Associated with Physical Activity To further reduce the risks of physical activity, proper prescreening must occur.

5. Prescreening

6. 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

7. Prescreening Objectives: Optimize safety during exercise testing and participation. Permit the development of a sound and effective exercise prescription.

8. Prescreening The purpose of the pre-participation health screening include: Identification and exclusion of individuals with medical contraindications to exercise.

9. Prescreening Identification of individuals with disease symptoms and risk factors for disease development who should receive medical evaluation before starting an exercise program.

10. Prescreening Identification of persons with clinically significant disease considerations who should participate in a medically supervised exercise program.

11. Prescreening Use information from the initial health and lifestyle evaluations to screen clients for physical fitness testing and for program development.

12. Prescreening Identification of individuals with other special needs.

13. Prescreening It is essential that health screening procedures be valid, cost effective, and time efficient.

14. Prescreening Prescreening may be composed of: Informed consent Medical clearance Risk stratification

15. Prescreening Medical history Lifestyle evaluation Exercise testing

16. Informed Consent Prior to conducting any physical fitness tests or developing any exercise program, you should see that each participant signs an informed consent.

17. 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.

18. Informed Consent It also ensures your clients’ results will remain confidential and their participation is voluntary.

19. 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

20. Informed Consent All consent forms should be approved by your institutional review board or legal counsel.

21. Prescreening Before assessing your client’s physical fitness profile, you should classify the individual’s health status and lifestyle.

22. Health Status Illness or disease? Injury? Medications and supplements?

23. Activity Status Currently active or inactive? Likes and dislikes? Obstacles?

24. Health Status PAR-Q –Physical Activity Readiness Questionnaire The PAR-Q has been recommended as a minimal standard for entry into low-to- moderate intensity exercise programs.

25. 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.

27. Medical History Your clients should complete a comprehensive medical history questionnaire, including personal and family health history.

28. Medical History Use the questionnaire to: Examine the client’s record of personal illnesses, surgeries, and operations.

29. Medical History Assess previous medical diagnoses and signs and symptoms of disease that have occurred within the past year or are currently present.

30. Medical History Analyze your client’s family history of –diabetes, –heart disease, –stroke –and hypertension.

31. Medical History Focus on conditions that require medical referral.

32. 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.

33. Medical History Present Symptoms: Dyspnea or shortness of breath Angina or chest pain Leg cramps or claudication Musculoskeletal problems or limitations Medications

34. Medical History Past History: Diseases Injuries Surgeries Lab tests

35. Medical History It is important to note the types of medication being used by the client.

36. 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.

37. 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.

38. Medical Clearance Your prospective exercise program participants should obtain a physical examination and a signed medical clearance from a physician.

39. Risk Stratification Low Risk –Asymptomatic < 1 Risk Factor Moderate Risk –Asymptomatic > 2 Risk Factor High Risk –Sypmtomatic, or known cardiac, pulmonary, or metabolic diseases

40. Prior Medical Exam Current Medical Exam Risk Low Moderate High Moderate Ex.NNNNRec Vigorous Ex.NNRecRec NN = not necessaryRec = Recommended

41. Exercise Testing Physician Supervision Risk Low Moderate High Submax testNNNNRec Max testNNNNRec NN = not necessaryRec = Recommended

42. Risk Stratification See ACSM’s Guidelines for risk factors See ACSM’s Guideline for signs and symptoms See ACSM’s Guidelines for risk stratification

43. Lifestyle Evaluation A well-rounded physical fitness program requires that you obtain information about the client’s living habits.

44. Lifestyle Evaluation The lifestyle assessment provides useful information regarding the individual’s risk factor profile.

45. Lifestyle Assessment Alcohol and caffeine intake Smoking Nutritional intake - eating patterns Physical activity patterns and interests Sleeping habits

46. Lifestyle Assessment Occupational stress level Mental status - family lifestyle

47. 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.

48. 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.

49. Physical Examination Blood pressure Heart or lung sounds Orthopedic problems

50. 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)

51. 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)

52. Laboratory Tests (Ideal #s) Blood urea nitrogen (4-24 mg per dl) Creatinine (0.3-1.4 mg per dl) Iron (40-190  g per dl for men; 35-180  g for women) Calcium (8.5-10.5 mg per dl)

53. Physical Fitness Evaluation CV fitness (HR, BP, VO 2MAX ) Body composition (%BF) Musculoskeletal fitness (muscle and bone strength) Flexibility Neuromuscular tension/stress

54. Fitness Assessment Fitness assessment is discussed elsewhere (KNR 309) Very important in program design

55. Risks of Exercise Testing. Clinical exercise testing is a relatively safe procedure, although complications may arise.

56. 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

57. Risks of Exercise Testing. The risk of a complication requiring hospitalization (including MIs) is approximately 0.1%. –1 out of 1,000

58. 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.

59. Risks of Exercise Testing. The risks associated with submaximal physical fitness testing appear to be even lower.

60. 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.

61. Risks of Exercise Testing. No set of guidelines for exercise testing and participation can cover all situations.