L4 - Pre-exercise Health Screening

• Risk of Exercise - Increased risk for musculoskeletal injury

  • Walking & moderate intensity PA have low risk
  • Increase risk with jogging, running, competitive sports, contact sports
  • High intensity increase risk, nature of activity, pre-existing conditions
  • Risk is inversely related to physical fitness
  • Fitter you are less at risk
  • Methods to reduce include stretching, warm up & cool down → no studies confirm these are effective, still do them
• Risk of Exercise - Increased risk of cardiovascular (CV) complications:

  • Sudden cardiac death or heart attack (MI)
  • Not common
  • Very low risk in healthy individuals performing moderate PA
  • Risk increases with vigorous PA
  • Higher risk in middle aged & older adults than younger individuals
  • Higher risk in most sedentary individuals performing unaccustomed or infrequent exercise
  • Acute increase risk in CVD patients performing vigorous activity
• Why screen pre-exercise:

  • Benefits outweigh the risks
  • Some individuals may have an unacceptably high acute risk
  • So high that they should not exercise, or start very slowly
  • Belong to clinical
  • Atherosclerotic arterial disease
  • Main cause of heart attacks with exercise
  • Plaque, narrows BV
  • Vigorous exercise increases blood flow, blood vessels can’t keep up - heart attack
• The relationship between habitual frequency of vigorous PA & the relative risk of myocardial infarction

  • 50x higher risk of heart attack for inactive person compared to active
  • Can reduce risk
• Purpose of pre-exercise health screening is to:

  • Assess clients readiness to exercise
  • Identify high-risk clients who need clearance from their doctor in order to participate
  • Maximise the benefits of exercise participation for the client
  • Protect the fitness professional & organisation from litigation
• Risk of PA:

  • Regular exercisers have a risk of dying during rest of about 1 in every 20 million hours
  • Sedentary people have a risk of dying during rest of 1 in ever 5.5 million hours
  • 3.6-fold increase
• Risk of PA:

  • Moderate exercise increase the chance 4-fold) of dying to about 1 in every 5 million hours on average (for ‘low risk’ people)
  • Most intense exercise increases the risk of adverse effects events to about 20-fold
• Risk of PA:

  • Since humans are ‘at rest’ for a large part of the day (relative to undertaking vigorous ex.) then the long-term benefits for regular exercisers are clear
  • Reduce chance of dying at rest
• Commonly used screening algorithms & questionnaires:

  • ACSM Screening Algorithm
  • Physical Activity Readiness Questionnaire (PAR-Q)
  • Adult Pre-exercise Screening System (APSS)
• ACSM Screening Algorithm:

  • If need medical clearance (prior to exercise)
  • If someone is PA & say no clearance not necessary
  • If active & know have CVD, then medical clearance may not be necessary → because they know what signs to look out for & what they can/can’t do = can do moderate PA
  • Medical clearance needed if know CVD but don’t exercise
  • No signs of CVD don’t need medical clearance
• PAR-Q:

  • If answer yes, may need to get medical clearance but also use some common sense/ask more questions
  • Medical clearance → for people not PA & show signs of cardiovascular disease (CVD)
• PAR-Q+:

  • Targeted on specific diseases
  • More questions, if have known medical condition
• Adult Pre-exercise Screening System (APSS):

  • Added diabetes & asthma; as are hugely prevalent in NZ & Aussie
  • If using PAR-Q don’t need this
• Exercise Intensity Guidelines:

  • If answered no to all, look at how active they have been in past, start low if been sedentary
  • More someone been PA higher intensity can start ExRx
• Adult Pre-exercise Screening System (APSS):

  • Look at identifiable risks, that increase risk of cardiac faint
  • Age = risk factor, together with sex
  • If may >45 yrs males or >55 yrs females get a point for a risk factor
  • Other risk factors
  • Smoking
  • Sedentary
  • Obesity
  • High BP, cholesterol, blood sugar
  • Higher number of risk factor = higher risk & more appropriate to get medical clearance
  • Medical & other problems
• Blood Pressures

  • Systolic (SBP): contraction phase
  • Pressure of heart contracting
  • Diastolic (DBP): filling phase
  • Often measured in brachial artery
• BP classification:

  • Often climb or fall together (SBP & DBP)
  • High BP both will be elevated
  • Endothelial cells damaged can cause Atherosclerotic arterial disease
  • Avoid exercise if: SBP >200 mm Hg at rest &/or DBP >110 mm Hg at rest
  • Come with massive risk during exercise
• Prehypertension:

  • Every mL over can be a sign of prehypertension & increase risk of HR
  • If consistent can be dangerous
  • Don’t need medical clearance for that
• Resting BP technique:

  • Client is seated with arm at heart level
  • Select proper cuff size
  • While wrapping the cuff: tell the client it is supposed to be firm & not painful
  • Wrap cuff firmly around the upper arm
  • Ensure the microphone is over the brachial artery
  • To get accurate reading
  • Ensure the client remains silent to ensure no noise with the microphone
• Automated BP Devices:

  • Automated devices eliminate technician bias
  • Arm devices are more accurate than wrist or finger devices
  • Validity varies based on device
  • Automated devices have not all been validated for use during exercise!!
  • Have to do manually
  • But does create technician bias
  • We want safety over accuracy
• Hypertension Phenomena:

  • White coat hypertension
  • Masked hypertension
  • Cuff hypertension
• White coat hypertension:

  • Individual becomes hypertensive when a health professional measures BP
  • When tell people going to take BP, BP goes up
  • Take a break & do it again in another minute
  • More common in women
  • BP 5x more likely to be elevated when doctor uses manual measure compared with automated device
• Masked hypertension:

  • Elevated BP outside of physician’s office, but normal in the office
  • Not common
  • More common in men & those with BMI’s >25 kg/m2 (obesity)
• Cuff hypertension:

  • Use of incorrect cuff size (most fit normal)
  • Cuff too small = overestimation of BP
• Resting Heart Rate:

  • <60 bpm = bradycardia (slow HR) - eg athletes
  • 60 to 100 bpm = normal
  • >100 bpm = tachycardia (fast HR)
  • Need to be careful may put at risk
• Resting Heart Rate:

  • Rest individual for 5-10 minutes in a supine or seated position prior to measurement
  • Fluctuates (stress, time of day, eating)
  • Lower in supine (lying) position that sitting or standing
  • Ideal in lying position
  • Often, but not always, indicative of cardiorespiratory fitness
  • Average resting HR in women in 7-10 bpm higher than men
  • If fit or have smartwatch can ask them what their RHR normally is
• HR Palpation Technique:

  • Use tips of index & middle fingers
  • Apply light pressure
  • Start stopwatch with pulse beat; 1st beat is 0
  • Duration
  • Rest: 30-60 sec (bpm for 30 sec x 2)
  • Exercise: 10 sec (x6)
• HR Palpation Techniques:

  • Palpation
  • Brachial artery
  • Carotid artery
  • Radial artery
  • Temporal artery