1. 1 Screening and Testing

2. 2 75,000 / year Heart attack during / after exercise Sedentary Had heart disease With high Risk Exercise too hard Congenital cardiovascular disease 50% incidence cardiovascular problems during exercise *Medical screening *Risk factors identified *Exercise prescription individually ACSM 1992

3. 3 Exercise program Health promotion Medical screening & evaluation procedures before SAFE *Medical history *Coronary heart disease analysis * Physical fitness assessment Cardiovascular fitness Body composition Muscular strength /endurance Flexibility *ACSM classification categories *Medical/Health status questionnaire *Medical evaluation *Graded Exercise Test *Risk factors analysis *Informed consent *Physical fitness tests

4. 4 Primary and Secondary Risk Factors for Heart Disease

5. 5

6. 6 ACSM Recommendation for (A) Medical Examination and Exercise Testing Prior Participation (B) Physician Supervision of Exercise Tests

7. 7

8. 8 In general, most individuals except people with known serious diseases Moderate exercise 40-60% VO2 max without medical evaluation or exercise test Whenever people are in doubt about their own personal safety while exercising Medical evaluation I recommended Exercise test is not recommended as a routine screening procedure in adults who have no evidence of heart disease

9. 9 Moderate exercise 40-60% of VO2max without medical evaluation or exercise test Apparently healthy individual *Exercise program proceeds gradually *Be alter the development of signs / symptoms Vigorous exercise > 60% of VO2max M > 40 F > 50 Medical examination Maximal Exercise Test with physician supervision Distinction between between moderate and vigorous untrained 15 min 60 min *Sudden death during exercise high intensity is a significant risk

10. 10 Who needs Maximal Graded Exercise Test 2 or more major coronary risk factors and / or symptoms are at increased risk Maximal GXT Prior to vigorous exercise Useful to establish an effective and safe exercise program Submaximal testing up to 75% of VO2max Less valuable information

11. 11 Health status information Informed consent Goals / interests Make decision about appropriate physical activity Code in ACSM Health Status Questionnaire *emergency information *major health problem *special attention required Help to identify

12. 12 Making Decisions Based on Health Status Denial of request for entry to fitness program and/or immediate referral for medical attention Medically supervised exercise Exercise carefully prescribed and supervised by an exercise leader Vigorous-intensity exercise Any unsupersived physical activity Admission Educational information workshop professional help

13. 13 Guidelines for Determining Necessary Supervision Medical Referral Conditions for medical referral or supervised programs are guidelines to be used with other information the individual in making a decision concerning safe and appropriate physical activity. Individuals with medical conditions or characteristics, symptoms, behaviors, or test scores that place them at a high risk for major health problems should have medical clearance before increasing their level of physical activity

14. 14 Supervised program Individuals with moderate risk of major health problems or conditions that require special attention or emergency procedures may be directed to physical activities under supervision by a qualified instructor or medical personnel. Unsupervised program People without any of the problems coded under MC, SEP, or RF in the HSQ can participate in an unsupervised program and be admitted to any of the fitness activities offered by a fitness center. If they have not been active in the past few months, it is recommended that they begin with moderate-intensity activities; but they will be able to progress quickly to other activities of interest and greater intensity.

15. 15 Education Individuals who have moderate risk of CHD, conditions that might be affected by exercise, or borderline fitness scores should receive education about their problems and know what to do in emergencies. Changes in health/fitness status Changes in exercise program Examples: unusual fatigue leg pain chest pain… drug- alcohol- psychological.. Excessive heat sunburn population...