Preparticipation Physical Activity Screening Guidelines PDF

Preparticipation Physical Activity Screening Guidelines Chapter 2 Copyright © 2018 American College of Sports Medicine What is the incidence of exercise-related sudden cardiac death in middle aged men? Decision Tree Copyright © 2018 American College of...

Preparticipation Physical Activity Screening Guidelines Chapter 2 Copyright © 2018 American College of Sports Medicine What is the incidence of exercise-related sudden cardiac death in middle aged men? Decision Tree Copyright © 2018 American College of Sports Medicine Why do we need to do a screening?! Preparticipation PA screening helps ensure that the risks of increased PA do not outweigh the benefits There are a lot of different opinions & guidelines on how to screen – ACSM is constantly changing their recommendations with new research being available – We will discuss specifically what an EP-C can do and what is expected Copyright © 2018 American College of Sports Medicine Importance of Preparticipation Screening The screening allows you to identify at-risk individuals Preparticipation screening focuses on demographic and health-related information – REMEMBER we don’t want to create additional barriers to PA & exercise PARQ is updated annually. Copyright © 2018 American College of Sports Medicine Importance of Preparticipation Screening – ID those with contraindications to PA participation. Contraindications = clinical characteristics that make PA unsafe – ID those who should receive a formal evaluation and clearance Who should go talk with a physician – ID those who should participate in a medically supervised PA program. Should a physician watch this person exercise? – ID those with other/significant health or medical concerns Should this person even be thinking about exercise? Do they have unstable angina (absolute vs. relative) Copyright © 2018 American College of Sports Medicine  History of PA Preparticipation Screening The two most widely recognized guidelines are put forth by the ACSM & the AHA Guidelines are only recommendations and the EP-C should devise a screening scheme that best meets the needs of their clients and environments. Copyright © 2018 American College of Sports Medicine  Levels of Screening ACSM recommends screenings for EVERYONE about to initiate a PA program Two primary screening levels – Self-guided; PAR-Q+ Physical Activity Readiness Questionnaire+ – Professionally supervised The two levels are not mutually exclusive because self-guided efforts may often lead an individual to seek out an EP-C for professional guidance Copyright © 2018 American College of Sports Medicine  individual wishing to become more physically Self Guided Screening active without direct input from an exercise professional This approach is suggested as a minimum starting point for anyone who wishes to increase their level of PA comprehensive assessment of a client’s medical and health history PAR-Q+ the PAR-Q+ is updated annually – A newly revised version of the original PAR-Q ePARmed-X+Physician Clearance Follow-Up Questionnaire – An extension of the PAR-Q+ designed for use when PAR-Q+ responses suggest further medical clearance is appropriate Both tools are new and require ongoing evaluation and validation Copyright © 2018 American College of Sports Medicine Professional Supervised Screening interaction with an exercise professional such as an ACSM-EP Supervised screening should follow self-guided process The EP-C can be involved at lower levels of risk More advanced professionals should evaluate higher risk Health History Questionnaire – Represents comprehensive eval of health & medical history Medical Examination/Clearance – Led by a physician or other qualified professionals – Particularly recommended for clients at high risk Copyright © 2018 American College of Sports Medicine Professional PA Screening Process The process has been altered significantly with the release of the most recent ACSM guidelines and now focuses on PA participation rather than exercise testing Important Areas of Consideration (what you really need to be aware of/check for) – PA History Weekly routine of PA over a span of months? – Known Cardiovascular, Metabolic, or Renal Disease (CMR) – Major Signs & Symptoms Suggestive of CMR Copyright © 2018 American College of Sports Medicine Are they currently physically active? What does that mean? 30 min., 3 days/week, past 3 months Copyright © 2018 American College of Sports Medicine PA History Currently perfroming PA represents lower risk when compared to a sedentary lifestyle Current PA defined as occurring over the last 3 months But is what they’ve done the past 3 months enough to count?? They need at least: – Frequency: 3 days/week – Duration: 30+ minutes – Intensity: moderate (40-60% HR reserve or VO2max; RPE of 12 - 13) Copyright © 2018 American College of Sports Medicine Copyright © 2018 American College of Sports Medicine  Known CV, Metabolic, or Renal Disease (CMR) CMR diseases 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 Copyright © 2018 American College of Sports Medicine Copyright © 2018 American College of Sports Medicine Major Signs & Symptoms Suggestive of CVD Pain or discomfort indicative of myocardial ischemia Dyspnea at rest or mild exertion "shortness of breath" (fainting) Syncope or dizziness during exercise difficulty breathing while lying Orthopnea or paroxsymal nocturnal dyspnea down or asleep Ankle edema not due to injury Heart palpitations or tachycardia Intermittent claudication severe calf pain when walking Heart murmurs Unusual fatigue or shortness of breath during light exertion or normal activities Copyright © 2018 American College of Sports Medicine Copyright © 2018 American College of Sports Medicine What To Do Once Risk is Established Information gathered throughout the preparticipation screening process drives decisions related to PA participation PA is most safe when the individual is: Currently physically active, free of CMR disease, and free of signs & symptoms of CMR THINGS CAN STILL HAPPEN! Copyright © 2018 American College of Sports Medicine Copyright © 2018 American College of Sports Medicine Pitfalls of ACSM Preparticipation Screening The greatest pitfall is the potential to overlook risk of some kind that ultimately 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 against concerns that obstacles to starting PA has negative impacts on adoption of healthy PA behaviors One approach to address competing concerns is for the EP-C to strongly advocate for initiation of a PA program that initiates at lower intensities and progresses over time Copyright © 2018 American College of Sports Medicine Recommendations Versus Requirements The goal of this is to provide recommendations on how to screen participants NOT to provide requirements The EP-C should exercise caution and use their best judgment and when in doubt refer a client for medical evaluation and clearance Copyright © 2018 American College of Sports Medicine Contraindications to Exercise Testing a clinical characteristic that may increase the risk associated with the participation in physical activity and/or exercise testing The process of evaluating risk can lead to the identification of characteristics that make PA and exercise testing risky These characteristics are known as contraindications and often revealed only through sophisticated medical testing Categories of Contraindications Absolute: risks > benefits Relative: risks < benefits Copyright © 2018 American College of Sports Medicine  Not okay for PA individuals with these biomarkers should not be allowed to → participate in any form of PA program and/or exercise test Probably okay for PA accepted or allowed into a PA assessment/progra m if the benefits → outweigh the risks to the individual Copyright © 2018 American College of Sports Medicine Repurposing Risk Factor Assessment ACSM guidelines no longer require CVD risk factor assessment but are advisable New guidelines shift risk factor assessment away from use for 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 the purposes of lifestyle modification Copyright © 2018 American College of Sports Medicine Review of Risk Factors For Atherosclerotic CVD Age: ≥45 men; ≥55 women Family History; previous CVD-related issues 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 Diabetes: high fasting glucose Elevated HDL-C (negative risk factor); ≥ 60 mg/dL Copyright © 2018 American College of Sports Medicine Review of Risk Factors For Atherosclerotic CVD 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 – IMPORTANT: – Only 1 positive risk factor is assigned per risk area (when multiple criteria are met) – Presence of elevated HDL-C offsets one positive risk factor (negative risk factor) – In this sense, negative is good and positive is bad Think of positive as getting closer to CVD and negative moving away from CVD Copyright © 2018 American College of Sports Medicine