Physical Activity Screening

• Preparticipation physical activity (PA) screening helps ensure that the risks of increased PA do not outweigh the benefits.
• American College of Sports Medicine (ACSM) recommendations are constantly changing based on new research.

Importance of Preparticipation Screening

• Screening identifies at-risk individuals.
• Screening focuses on demographic and health-related information.
• Barriers to PA and exercise should not be created.
• Identifies those with contraindications to PA participation, where contraindications are clinical characteristics that make PA unsafe.
• Identifies those who should receive a formal evaluation and clearance from a physician.
• Helps identify who should participate in a medically supervised PA program.
• Screening identifies those with other/significant health or medical concerns, such as unstable angina.

History of PA Preparticipation Screening

• The ACSM and the AHA put forth the two most widely recognized guidelines.
• Guidelines are recommendations, it is the exercise professional- Clinical Exercise Physiologist's (EP-C) responsibility to devise a screening plan that best meets the needs of their clients and environment.

Levels of Screening

• ACSM recommends screenings for everyone about to initiate a physical activity (PA) program.
• Two primary screening levels include:
• Self-guided, with the use of the Physical Activity Readiness Questionnaire (PAR-Q+).
• Professionally supervised.
• These levels aren't mutually exclusive.
• Self-guided efforts may lead one to seek an EP-C for professional guidance.

Self-Guided Screening

• Minimum starting point for anyone who wishes to increase their level of PA.
• PAR-Q+ is a comprehensive assessment of a client's medical and health history.
• PAR-Q+ is a newly revised version of the original PAR-Q.
• ePARmed-X+Physician Clearance Follow-Up Questionnaire is an extension of the PAR-Q+ and used when PAR-Q+ responses suggest further medical clearance is needed.
• PAR-Q+ and ePARmed-X+Physician Clearance Follow-Up Questionnaire are both new and need ongoing evaluation and validation.

Professional Supervised Screening

• Used with interaction with an exercise professional.
• Supervised screening should follow self-guided processes.
• The EP-C can be involved at lower levels of risk.
• More advanced professionals should evaluate higher risk individuals.
• Includes a health history questionnaire, it represents comprehensive eval of health and medical history.
• A medical examination/clearance is an aspect of professional supervised screening.
• It should be led by a physician or qualified professional.
• It is particularly recommended for clients at high risk.

Professional PA Screening Process

• Altered significantly since the recent release of the most recent ACSM guidelines.
• Focuses on PA participation rather than exercise testing.
• Important areas of consideration:
• PA History: A weekly routine of PA looked at over a span of at least 3 months.
• Known Cardiovascular, Metabolic, or Renal Disease (CMR).
• Any major Signs & Symptoms Suggestive of CMR.

PA History

• Performing PA represents lower risk when compared to a sedentary lifestyle.
• Current PA is defined as occurring over the last 3 months.
• Minimum of 3 days a week, for 30+ minutes at a moderate intensity (40-60% HR reserve or VO2max; RPE of 12 - 13).

Known CV, Metabolic, or Renal Disease (CMR)

• These diseases are the most relevant to screening.
• Heart attack, surgery, catheterization, or angioplasty.
• Pacemaker/implantable cardiac defibrillator/rhythm disturbance.
• Heart valve disease, failure, or transplantation.
• Congenital heart disease.
• Type 1 or 2 diabetes mellitus.
• Renal disease.

Major Signs & Symptoms Suggestive of CVD

• Pain or discomfort indicative of myocardial ischemia.
• Dyspnea is the "shortness of breath.
• Syncope or fainting, or dizziness during exercise.
• Orthopnea or paroxysmal nocturnal dyspnea, difficulty breathing while lying down or asleep.
• Ankle edema not due to injury.
• Heart palpitations or tachycardia.
• Intermittent claudication is severe calf pain when walking.
• Heart murmurs.
• Unusual fatigue or shortness of breath during light exertion or normal activities.

Risk Stratification

• ACSM guidelines no longer require CVD risk factor assessment but are advisable.
• New guidelines shift risk factor assessment away from risk stratification and towards use aimed at disease prevention and management.
• Additional value is provided by risk factor assessment, when utilized to provide education to clients and patients for lifestyle modification
• The goal of this is to provide screening recommendations for participants.
• Exercise caution, use best judgment, and refer a client for medical evaluation and clearance when one is in doubt.

Review of Risk Factors For Atherosclerotic CVD

• Risk factors are age, family history, smoking status, sedentary lifestyle, obesity, hypertension, dyslipidemia, diabetes and elevated HDL-C (negative risk factor).
• Age: ≥45 men; ≥55 women.
• Smoking Status; Do you smoke (w/in last 6 months) or exposed to 2nd hand smoke?
• Sedentary Lifestyle; not meeting 30 minutes 3x/wk.
• Obesity; BMI > 30 or waist circumference > 40 inches in men and 35 inches for women.
• Hypertension; > 130 mm Hg or > 80 mm Hg.
• Dyslipidemia; LDL-C ≥ 130 mg/dL.
• Elevated HDL-C (negative risk factor); ≥ 60 mg/dL.
• Risk for future CVD is determined by risk factors.
• Low Risk: 0 or 1 CVD risk factor.
• Increased Risk: 2 or more CVD risk factors.
• Only 1 positive risk factor is assigned per risk area.
• The presence of elevated HDL-C offsets one positive risk factor (negative risk factor)

Contraindications to Exercise Testing

• A clinical characteristic that may increase the risk associated with participation in PA.
• Evaluating risk identifies characteristics that make PA and exercise testing risky.
• Absolute: risks > benefits of exercise
• Relative: risks < benefits of exercise

Absolute Contraindications to Exercise Testing

• Acute myocardial infarction within 2 days.
• Ongoing unstable angina.
• Uncontrolled cardiac arrhythmia with hemodynamic compromise.
• Active endocarditis.
• Symptomatic severe aortic stenosis.
• Decompensated heart failure.
• Acute pulmonary embolism, pulmonary infarction, or deep venous thrombosis.
• Acute myocarditis or pericarditis.
• Acute aortic dissection.
• Physical disability that precludes safe and adequate testing.

Relative Contraindications to Exercise Testing

• Known obstructive left main coronary artery stenosis.
• Moderate to severe aortic stenosis with uncertain relationship to symptoms.
• Tachyarrhythmias with uncontrolled ventricular rates.
• Acquired advanced or complete heart block.
• Recent stroke or transient ischemia attack.
• Mental impairment with limited ability to cooperate.
• Resting hypertension with systolic >200 mm Hg or diastolic >110 mm Hg.
• Uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism.

Pitfalls

• The greatest pitfall is the potential to overlook some risk which leads to an adverse event.
• The EP-C can minimize risk by obtaining as MUCH information as possible related to the client or patient.
• Risk of events must be balanced, with healthy PA behaviors needing to be adopted.
• One approach is for the EP-C to strongly advocate for a PA program that initiates at lower intensities and progresses over time.

This quiz assesses knowledge of pre-participation physical activity screening, its goals, and the role of Exercise Professionals (EP-C). It covers contraindications, appropriate actions during exercise, and staying updated with guidelines like ACSM. The importance of avoiding barriers to physical activity is also addressed.