Preparticipation Physical Activity Guidelines

Preparticipation Physical Activity Screening Guidelines

• These guidelines are provided by the American College of Sports Medicine (ACSM)
• The guidelines aim to help ensure that the risks of increased physical activity (PA) do not outweigh the benefits
• There are numerous opinions and guidelines on how to screen individuals effectively
• The ACSM recommendations are continuously updated with new research
• Evaluation of the individual's current physical activity status plays a crucial role.

Exercise-Related Sudden Cardiac Death in Middle-Aged Men

• Incidence data of exercise-related sudden cardiac death in middle-aged men is discussed.

Screening Algorithm

• A flowchart, showing screening steps, is included.
• The process involves a physical activity history to determine if the individual has a cardiac-related condition (CMR or symptoms [S/S])
• It includes decision-making criteria (Yes/No) regarding further medical clearance (MC).
• Detailed guidelines to determine required medical clearance (MC), including whether medical supervision is needed.

Purpose of Preparticipation Screening

• Identifying individuals at risk is a primary goal
• Screening helps determine if PA is safe for the individual involved
• Focuses on demographic and health-related information for proper evaluation
• Aim is to avoid creating obstacles to PA and exercise

Importance of Preparticipation Screening

• Identifying those with contraindications to participation to ensure participation safety

• Identifying those requiring a formal evaluation and clearance by a physician

• Determining when a medically supervised PA program is necessary

• Assessing those with health concerns for suitability for exercise

• Determining if unstable angina is present (relative/absolute)

History of PA Pre-participation Screening

• Guidelines and recommendations are set by the ACSM and the American Heart Association (AHA)
• The screening process should meet individual and environment-specific needs

Levels of Screening

• ACSM recommends two levels: self-guided and professionally supervised screening; these are not mutually exclusive
• Self-guided methods include questionnaires (PAR-Q+) and the Physical Activity Readiness Questionnaire (PAR-Q) to identify those needing evaluation
• Professionally supervised methods include a comprehensive health history questionnaire, medical examination/clearance to assess high-risk individuals.

Self-Guided Screening

• PAR-Q+ is a newly revised version of the original PAR-Q.
• ePARmed-X+ Physician Clearance Follow-up Questionnaire is an extension to the PAR-Q+ used when further medical clearance is needed

Professionally Supervised Screening

• The screening process involves following a self-guided process, ensuring a comprehensive evaluation of the individual
• The EP-C (exercise professional) can assess lower risk individuals and referral for higher risk
• A medical examination and clearance is necessary for higher risk individuals

Professional PA Screening Process

• The process is centered on recent ACSM guidelines, with current focus on PA participation instead of exercise testing
• Key criteria to assess include the patient's PA History, known cardiovascular, metabolic, or renal disease (CMR) and major signs and symptoms suggestive of CMR.

PA History

• Current PA is a much lower risk factor compared to sedentary lifestyle.
• Assessing PA over the last 3 months to determine current level of activity
• At least 3 days per week of activity is required with intensity lasting 30+ minutes, at moderate intensity (40-60% HR reserve or VO2max; RPE of 12–13)

Known CV, Metabolic, or Renal Disease (CMR)

• Specific CMR diseases like heart attack, heart valve disease, implantable devices are assessed.
• Type 1 or 2 diabetes mellitus and renal disease are also key criteria

CMR Disease Screening

• Symptoms and conditions suggestive of CMR disease

Major Signs & Symptoms Suggestive of CVD

• A list of specific symptoms or indicators of cardiovascular disease

What to Do Once Risk is Established

• Information gathered during screening guides PA participation decisions
• Individuals should remain physically active, without CMR disease and symptoms.

Pitfalls of ACSM Preparticipation Screening

• The need to avoid overlooking potential risks during the screening process
• Obtaining as much information related to the client as possible
• Balancing risk with the importance of adopting healthy PA behaviors

Recommendations Versus Requirements

• Providing recommendations on screening, rather than rigid requirements
• Exercise caution and refer clients for medical evaluation and clearance when required

Contraindications to Exercise Testing

• Identifying characteristics known as contraindications (conditions or test results that increase risk during PA)
• Categorized as absolute and relative

Absolute and Relative Contraindications

• Clear distinctions of risks and benefits associated with the presence of particular disease states (absolute risk outweighing benefits). Sub-classifying the risk of some medical conditions as either absolute (risk outweighing benefit) or relative (risks outweighing benefits)

Repurposing Risk Factor Assessment

• Newer guidelines move away from using CVD risk factors for stratification risk, aiming towards disease prevention and management instead
• Risk factor assessment can provide valuable education, aiming toward lifestyle modification.

Review of Risk Factors For Atherosclerotic CVD

• Age, family history, smoking status, sedentary lifestyle, obesity, hypertension, dyslipidemia, diabetes, and elevated HDL-C are risk factors assessed
• One positive risk factor per categorized risk area is sufficient to establish increased risk.