EXS 145 Guidelines for Exercise Testing & Prescription

Transcription

1 EXS 145 Guidelines for Exercise Testing & Prescription Andrew Weiler M.Ed MCCD Adjunct Faculty CGCC Employee Wellness Coordinator SRPMIC Employee Wellness Coordinator Pot & Window LLC

2 Today How to aid in development of safe exercise prescription/testing? Absolute & Relative Contraindications CAD Risk Factor Thresholds ACSM Risk Stratification Categories Exercise Testing: Risk & Supervision AHA Risk Stratification Criteria

3 Today Blood Pressure Lab 1 See one Do one Teach one

4 How to aid in development of safe exercise prescription/testing? Identify and exclude individuals with medical contraindications to exercise Identify increased risk due to: Age Symptoms Risk factors Clinically significant disease

5 How to aid in development of safe exercise prescription/testing? Why? Send for medical evaluation Possibly including exercise testing Refer to medically supervised programs Identify special needs Educate/council

6 How to aid in development of safe exercise prescription/testing? Especially screen for: Cardiovascular diseases (name a few?) Pulmonary diseases Metabolic diseases Conditions aggravated by exercise: Pregnancy Orthopedic injury Arthritis Hypertension

7 Screening Don t lose your clients (Two ways) They are inconvenienced by screening Died because you didn t screen them.

8 Professionally qualified exercise staff refers to appropriately trained individuals who possess academic training, practical & clinical knowledge, skills & abilities commensurate with the credentials defined in Appendix D.

9 The professionally guided preparticipation screening process involves: the review of more detailed health/medical history information and specific risk stratification, and detailed recommendations for physical activity/exercise, medical examination, exercise testing, and physician supervision.

10 Absolute & Relative Contraindications Table 2-2, Box 3-5 Relative: Significantly increased risk for injury with exercise Risks benefits carefully considered Absolute: Very high risk Benefit > risk is unlikely Who makes that call? Personal trainer: Don t exercise either!

11 Major Signs/Symptoms Suggestive of Cardiovascular, Pulmonary, and Metabolic Disease p26-27

12 Do you see why this is a reference tool? Major Signs/Symptoms Suggestive of Cardiovascular, Pulmonary, and Metabolic Disease p26-27

13 Known Cardiovascular, Pulmonary, and Metabolic Disease An individual has known cardiovascular, pulmonary, and/or metabolic disease if a physician has diagnosed one of the following conditions: Cardiovascular disease (CVD): cardiac, peripheral artery (PAD), or cerebrovascular disease Pulmonary disease: chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, or cystic fibrosis Metabolic disease: diabetes mellitus (type 1 or type 2), thyroid disorders, and renal or liver disease

14 CAD Risk Factor Thresholds for use With ACSM Stratification Table 2-1 Family History: MI, coronary revascularization or sudden death in: Male first-degree relative <55 y.o. Female first-degree relative <65 y.o. Cigarette smoking: Smoker in last 6 months

15 CAD Risk Factor Thresholds for use With ACSM Stratification Table 2-1 Hypertension SBP >140 mmhg DBP >90 mmhg Anti-hypertensive medication Measurements on > two separate occasions Sedentary Lifestyle >3 months F: < 3 days I: < Moderate 40-60%VO 2 R D:< 30 minutes

16 CAD Risk Factor Thresholds for use With ACSM Stratification Table 2-1 Dyslipidemia LDL >130 mg/dl Total Chol > 200 mg/dl Some say only as substitute for LDL HDL < 40 mg/dl Negative Risk Factor: HDL> 60 mg/dl Controversy: removes dyslipidemia or any RF?

17 CAD Risk Factor Thresholds for use With ACSM Stratification Table 2-1 Prediabetes (impaired fasting glucose): FPG> 100 mg/dl <126 mg/dl Confirmed on > 2 separate occasions IGT on OGTT Obesity: BMI > 30 kg/m 2 Waist girth: > 102 cm men > 88 cm women Waist/Hip > 0.95 men, > 0.86 women

18 Undisclosed or Unavailable CVD Risk Factor Information Health/fitness and exercise professionals and clinicians are encouraged to adopt a conservative approach to CVD risk factor identification for the purposes of risk stratification, especially when: risk factor information is missing, and/or the criteria for identifying the presence or absence of a specific risk factor cannot be determined or is not available.

19 Undisclosed or Unavailable CVD Risk Factor Information (cont.) If the presence or absence of a specific risk factor is not disclosed or is unavailable, the risk factor should be counted as a risk factor except for prediabetes. Missing or unknown criteria for prediabetes should be counted as a risk factor in the presence of age( 45 years), particularly for those with a body mass index 25 kg m -2 and for those who are younger, have a body mass index 25 kg m -2, and have additional risk factors for prediabetes.

20 Risk Stratification Table 2-1

21 ACSM Risk Stratification Categories Table 2-1 Low Risk Men < 45, Women <55 y.o. Asymptomatic < 1 CAD RF Moderate risk: Men > 45, Women >55 y.o. Symptomatic (not really but I say yes) > 2 CAD RF

22 ACSM Risk Stratification Categories Table 2-1 High Risk > sign/symptom table 2-3 Known cardiovascular, pulmonary, metabolic disease Look at table 2-3 again: Do you see why the GETP8 is a reference text?

23 More About Risk Stratification Assessing risk becomes more important as prevalence increases Signs/symptoms represents a higherlevel concern for decision making than RFs Low-risk (ACSM) isolated HTN

24 More About Risk Stratification More about HTN Aggravated by exercise Commonly clustered with other risk factors: obesity, DM, CAD, HLP Low-risk (ACSM) isolated HTN < 160/100 mmhg = Moderate I Ex testing not necessary Physician clearance advisable

25 More About Risk Stratification More about HTN Low-risk (ACSM) isolated HTN < 160/100 mmhg = Intense I Ex testing necessary Document hemodynamic response Physician clearance advisable Stage II HTN (documented)>160/100 mmhg Phys clearance & test

26 More About Risk Stratification Individuals stratified to need medical clearance: Benefit from further assessment Benefit from professionally-guided exercise programs

27 Risk Stratification (cont.) Figure 2-3

28 Table 2-1 (p23) & Figure 2.3 (p24) after risk factors & Figure 2.4 (p32) Table 2-1 & Figure 2.3 great for a quiz Funny: need for testing could be looked at as Can I test him/her? Interpreted by qualified professionals Results documented

29 Exercise Testing and Testing Supervision Recommendations Based Upon Risk Category Figure 2-4

30 Atherosclerotic Cardiovascular Disease Risk Factors (cont.) The table of risk factors contains clinically relevant established CVD risk factor criteria that should be considered collectively when making decisions about: the level of medical clearance, the need for exercise testing prior to initiating participation, and the level of supervision for both exercise testing and exercise program participation.

31 Exercise Testing and Participation Recommendations Based Upon Risk Category Once the risk category has been established for an individual as low, medium, or high, appropriate recommendations may be made regarding: the necessity for medical examination and clearance before initiating a physical activity/exercise program or substantially changing the FITT framework of an existing physical activity/exercise program,

32 Exercise Testing and Participation Recommendations Based Upon Risk Category (cont.) the necessity for an exercise test before initiating a physical activity/exercise program or substantially changing the FITT framework of an existing activity program, and the necessity for physician supervision when participating in a maximal or submaximal exercise test.

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34 Exercise Testing: Risk & Supervision Risk of CV events increases with I In all situations where testing is performed: BLS all staff, ACLS at least some staff Whenever possible test should be performed by ACSM certified staff because: These credentials document the KSAs directly related to exercise testing

35 Box 2-2 AHA Risk Stratification Criteria: Class A: Know it, live it, love it A-1 Children, adolescents, Men <45, Women <55 years old No S/S of heart disease No presence of heart disease No major RFs for CVDs A-2 Men >45, Women >55 years old No S/S of heart disease No presence of heart disease <2 major RFs for CVDs

36 Box 2-2 AHA Risk Stratification Criteria: Class A: Know it, live it, love it A-3 Men >45, Women >55 years old No S/S of heart disease No presence of heart disease >2 major RFs for CVDs No restrictions other than basic guidelines ECG & BP monitoring not required No supervision necessary A-2 & A-3 should have medical clearance A-2,3 should have medically-supervised exercise test prior to an I = vigorous exercise training.

37 Box 2-2 AHA Risk Stratification Criteria: Class B: What you need to know: RHR< 100 bpm? Exercise tolerance >6 METs? Normal BP response to graded exercise? Can they monitor their own I? (RPE, Pulse, knows S/S etc.) Physician clearance as stable disease? No to above questions or Class C we don t need to know we won t be working with them

38 Blood Pressure Lab: Keep practicing See one Do one Teach one