1

Screening and Testing

2

75,000 / yearHeart attackduring / after exercise

Sedentary Had heart diseaseWith high Risk

Exercisetoo hard

Congenitalcardiovasculardisease

50% incidencecardiovascular problemsduring exercise

*Medical screening*Risk factors identified*Exercise prescription individually

ACSM 1992

3

Exercise program

Health promotionMedical

screening & evaluationprocedures

before

SAFE

*Medical history*Coronary heart disease analysis* Physical fitness assessment

Cardiovascular fitnessBody compositionMuscular strength /enduranceFlexibility

*ACSM classification categories*Medical/Health status questionnaire*Medical evaluation*Graded Exercise Test*Risk factors analysis*Informed consent *Physical fitness tests

4

Primary and Secondary Risk Factors for

Heart Disease

5

6

ACSM Recommendation for(A) Medical Examination and Exercise Testing Prior Participation

(B) Physician Supervision of Exercise Tests

7

8

In general, most individualsexcept people with knownserious diseases

Moderate exercise40-60% VO2 maxwithout medical evaluationor exercise test

Whenever people are in doubtabout their own personal safetywhile exercising

Medical evaluation I recommended

Exercise test is not recommended as a routine screeningprocedure in adults who have no evidence of heart disease

9

Moderate exercise40-60% of VO2max

without medical evaluationor exercise test

Apparently healthyindividual

*Exercise program proceeds gradually*Be alter the development of signs / symptoms

Vigorous exercise> 60% of VO2max

M > 40 F > 50Medical examinationMaximal Exercise Test with physiciansupervision

Distinction between between moderate and vigorous

untrained

15 min60 min*Sudden death during exercise

high intensity is a significant risk

10

Who needs Maximal Graded Exercise Test

2 or moremajor coronary risk factors

and / orsymptoms

are at increased risk

MaximalGXT

Prior tovigorous exercise

Useful to establishan effective and safeexercise program

Submaximal testingup to 75% of VO2max

Less valuable information

11

Health status information

Informed consent

Goals / interests

Make decision aboutappropriate

physical activity

Code in ACSM Health Status Questionnaire

*emergency information*major health problem*special attention required

Help to identify

12

Making Decisions Based on Health Status

Denial of request for entry to fitness programand/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 informationworkshopprofessional help

13

Guidelines for Determining Necessary Supervision

Medical ReferralConditions for medical referral or supervised programs areguidelines to be used with other information the individual inmaking 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 majorhealth problems should have medical clearance before increasingtheir level of physical activity

14

Supervised programIndividuals with moderate risk of major health problems or conditions that require special attention or emergencyprocedures may be directed to physical activities undersupervision by a qualified instructor or medical personnel.

Unsupervised programPeople without any of the problems coded under MC, SEP, or RFin the HSQ can participate in an unsupervised program and beadmitted to any of the fitness activities offered by a fitness center.If they have not been active in the past few months, it isrecommended that they begin with moderate-intensity activities;but they will be able to progress quickly to other activities ofinterest and greater intensity.

15

EducationIndividuals who have moderate risk of CHD, conditions thatmight be affected by exercise, or borderline fitness scoresshould receive education about their problems and know what to do in emergencies.

Changes in health/fitness status

Changes in exercise program

Examples:unusual fatigueleg pain chest pain…

drug- alcohol-psychological..

Excessive heatsunburnpopulation...