4. American College of Sports Medicine, American Heart Association. Exercise and acute cardiovascular events: placing the risks into perspective.

Transcription

1 4. American College of Sports Medicine, American Heart Association. Exercise and acute cardiovascular events: placing the risks into perspective. Med Sci Sports Exerc. 2007;39(5):

2 Prevention of Exercise-Related Cardiac Events Health care professionals should know the pathologic conditions associated with exerciserelated events so that physically active children and adults can be appropriately evaluated. Physically active individuals should know the nature of cardiac prodromal symptoms and seek prompt medical care if such symptoms develop (see Table 2.1).

3 Prevention of Exercise-Related Cardiac Events (cont.) High school and college athletes should undergo preparticipation screening by qualified professionals. Athletes with known cardiac conditions or a family history should be evaluated prior to competition using established guidelines.

4 Prevention of Exercise-Related Cardiac Events (cont.) Health care facilities should ensure that their staffs are trained in managing cardiac emergencies, have a specified plan, and have appropriate resuscitation equipment (see Appendix B). Physically active individuals should modify their exercise program in response to variations in their exercise capacity, habitual activity level, and the environment (Chapters 6 and 8).

5 Chapter 2 Exercise Preparticipation Health Screening

6 Introduction Compared to previous editions of the Guidelines, the present version of Chapter 2: Does not include risk factor analysis or risk level classification Makes recommendations for physician clearance rather than specific recommendations for a medical examination or exercise test. Does not automatically refer individuals with pulmonary disease for medical clearance prior to the initiation of an exercise program

7 Introduction (cont.) The new preparticipation health screening process is based on 1. The individual's current level of structured physical activity 2. The presence of major signs or symptoms suggestive of CV, metabolic, or renal diseases (Table 2.1) 3. The desired exercise intensity

8 Table 2.1 Major Signs or Symptoms Suggestive of Cardiovascular, Metabolic and Renal Disease Pain; discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may result from ischemia Shortness of breath at rest or with mild exertion Dizziness or syncope Orthopnea or paroxysmal nocturnal dyspnea Ankle edema Palpitations or tachycardia Intermittent claudication Known heart murmur Unusual fatigue or shortness of breath with usual activities

9 Introduction (cont.) This updated preparticipation process is based on the outcomes of a scientific roundtable sponsored by the American College of Sports Medicine (ACSM) in 2014 The relative risk of a CV event is transiently increased during vigorous intensity exercise as compared with rest but that the absolute risk of an exercise-related acute cardiac event is low in healthy asymptomatic individuals (Figure 1.2) Among adults, the risk for activity-associated SCD and AMI is known to be highest among those with underlying CVD who perform unaccustomed vigorous PA

10 Introduction (cont.) Insufficient evidence is available to suggest that the presence of CVD risk factors without underlying disease confers substantial risk of adverse exercise-related CV events CVD risk factor based exercise preparticipation health screening may be overly conservative due to the high prevalence of risk factors and may generate excessive physician referrals, particularly in older adults Exercise professionals are encouraged to complete a CVD risk factor assessment with their patients/clients as part of the preexercise evaluation (see Chapter 3)

11 Preparticipation Health Screening Preparticipation health screening before initiating PA or an exercise program is a two-stage process: 1. The need for medical clearance before initiating or progressing exercise programming is determined using the updated and revised ACSM screening algorithm (see Figure 2.2) a) In the absence of professional assistance, interested individuals may use self-guided methods 2. If indicated during screening (see Figure 2.2), medical clearance should be sought from an appropriate health care provider a) The manner of clearance should be determined by the clinical judgment and discretion of the health care provider

12 Self-Guided Methods Preparticipation health screening by self-reported medical history or health risk appraisal should be done for all individuals wishing to initiate a physical activity program. This self-guided method can be easily accomplished by using the PAR-Q+ (see Figure 2.1)

13 FIGURE 2.1. The Physical Activity Readiness Questionnaire + (PAR-Q+). Reprinted with permission from the PAR-Q+ Collaboration and the authors of the PAR-Q+ ( 3 ). (continued)

14 FIGURE 2.1. The Physical Activity Readiness Questionnaire + (PAR-Q+). Reprinted with permission from the PAR-Q+ Collaboration and the authors of the PAR-Q+ ( 3 ). (continued)

15 FIGURE 2.1. The Physical Activity Readiness Questionnaire + (PAR-Q+). Reprinted with permission from the PAR-Q+ Collaboration and the authors of the PAR-Q+ ( 3 ). (continued)

16 FIGURE 2.1. The Physical Activity Readiness Questionnaire + (PAR-Q+). Reprinted with permission from the PAR-Q+ Collaboration and the authors of the PAR-Q+ ( 3 ). (continued)

17 American College of Sports Medicine Preparticipation Screening Algorithm The ACSM preparticipation screening algorithm (Figure 2.2) is a new instrument designed to identify participants at risk for CV complications during or immediately after aerobic exercise Although resistance training is growing in popularity, current evidence is insufficient regarding CV complications during resistance training to warrant formal prescreening recommendations CV complications during resistance training, this risk cannot currently be determined but appears to be low

18 American College of Sports Medicine Preparticipation Screening Algorithm (cont.) Algorithm components Classifying individuals who do or do not currently participate in regular exercise Identifying individuals with known CV, metabolic, or renal diseases or those with signs or symptoms suggestive of cardiac, peripheral vascular, or cerebrovascular disease, Types 1 and 2 diabetes mellitus (DM), and renal disease Identifying desired exercise intensity

19 Figure 2.2. The American College of Sports Medicine preparticipation screening algorithm. ACSM, American College of Sports Medicine; HR, heart rate; HRR, heart rate reserve; METs, metabolic equivalents; RPE, rating of perceived exertion; O 2 R, oxygen uptake reserve. Used with permission from ( 25 ). (continued)

20 Figure 2.2. The American College of Sports Medicine preparticipation screening algorithm. ACSM, American College of Sports Medicine; HR, heart rate; HRR, heart rate reserve; METs, metabolic equivalents; RPE, rating of perceived exertion; O 2 R, oxygen uptake reserve. Used with permission from ( 25 ). (continued)

21 Figure 2.3. Exercise preparticipation health screening questionnaire for exercise professionals. Used with permission from (18).

22 Risk Stratification for Patients in cardiac Rehabilitation and Medical Fitness Facilities Exercise professionals working with patients with known CVD in exercise-based cardiac rehabilitation and medical fitness settings are advised to use more in-depth risk stratification procedures Risk stratification criteria from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) are presented in Box 2.2

23 Box 2.2 American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Risk Stratification Criteria for Patients with Cardiovascular Disease Characteristics of patients at lowest risk for exercise participation (all characteristics LOWEST RISK listed must be present for patients to remain at lowest risk) Absence of complex ventricular dysrhythmias during exercise testing and recovery Absence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness, during exercise testing and recovery) Presence of normal hemodynamics during exercise testing and recovery (i.e., appropriate increases and decreases in heart rate and systolic blood pressure with increasing workloads and recovery) Functional capacity 7 metabolic equivalents (METs)