Adult Pre Participation Screening and Exercise Prescription Practicum
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1 Adult Pre Participation Screening and Exercise Prescription Practicum Objectives of this exercise: To administer pre participation screening and risk stratification for clients To write an appropriate exercise prescription and recommendations for exercise supervision Name of Client: Gender: Age: This stage is a self-administered questionnaire 1) Has your doctor ever said that you have a heart/lung condition, stroke or diabetes and that you should only do physical activity recommended by a doctor? 2) Do you feel pain in your chest when you do physical activity? 3) In the past month, have you had chest pain when you were not doing physical activity? 4) Do you lose your balance because of dizziness or do you ever lose consciousness? 5) Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? 6) Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? 7) Do you know of any other reason why you should not do physical activity? IF YOU ANSWERED to any of the 7 questions, please seek guidance from your doctor or appropriate allied health professional prior to undertaking physical activity/exercise IF YOU ANSWERED to all of the 7 questions, and you have no other concerns about your health, you may proceed to initiate physical activity/exercise
2 Evaluate for major symptoms/signs of CVS and presence of metabolic and pulmonary disease. (Appendix 1) Proceed to estimate the number of risk factors Age: Gender: Criteria 45yrs Males or 55yrs Females +1 risk factor Risk Factors Family History of heart disease ( stroke, heart attack) Relative Age Relative Age Father Mother Brother Sister Son Daughter If male < 55yrs = +1 risk factor If female < 65yrs = +1 risk factor Maximum of 1 risk factor for this question Cigarette Smoking Yes/ No If yes, (smoke regularly or given up within the past 6 months) = +1 risk factor Physical Activity Level Sedentary Light Moderate Vigorous Frequency per week Minutes per week If physical activity level< 150 min/ week = +1 risk factor If physical activity level 150 min/ week = -1 risk factor (vigorous physical activity/ exercise weighted x 2)
3 Height : Weight: BMI = Weight (kg) / Height (m) 2 Abdominal Circumference: BMI = BMI 27.5 kg/m 2 = +1 risk factor Waist 90 cm for men and 80 cm for women = +1 risk factor Blood Pressure /or on Medication (postpone exercise if BP SBP 200 mm Hg or DBP 110 mm Hg ) Hyperlipidaemia or on medication Total Cholesterol levels LDL levels HDL levels BP 140 mm Hg systolic or 90 mm Hg diastolic on 2 occasions or on medication = +1 risk factor On medication = +1 risk factors If not on medication: Total cholesterol 5.20 mmol/l = +1 risk factor HDL cholesterol 1.6 mmol/l = -1 risk factor HDL cholesterol < 1.00 mmol/l = +1 risk factor LDL cholesterol 3.40 mmol/l = +1 risk factor Maximum 1 risk factor Pre diabetes (fasting glucose) Fasting glucose 6.1 mmol = +1 risk factor TOTAL RISK FACTOR
4 Presence of Major Symptoms and Signs: Yes No Presence of CVD, Pulmonary or Metabolic Disease Yes No (Refer to Appendix 1) Risk level: (Refer to Appendix 2) Low Risk Moderate Risk High Risk Remarks: Need for further exercise medical clearance? Yes No Remarks: Client may initiate exercise Up to vigorous intensity Up to moderate intensity Exercise is withheld pending medical clearance
5 Appendix 1: List of Major signs and symptoms List of CVD, Pulmonary and Metabolic Disease Pain or 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 oedema Palpitation Intermittent claudication Known heart murmur Unusual fatigue or shortness of breath with usual activities 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, renal or liver disease Reference source: ACSM s Resource Manual for Guidelines for Exercise Testing and Prescription Sixth Edition
6 Appendix 2: Risk Categories HIGH RISK: Individuals classified as high risk are those who have one or more signs/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease MODERATE RISK PATIENTS ( 2 RISK FACTORS): Individuals at moderate risk may participate in aerobic physical activity/exercise at a light or moderate intensity LOW RISK PATIENTS (< 2 RISK FACTORS or Negative PAR Q): Individuals at low risk may participate in aerobic physical activity/exercise up to a vigorous or high intensity Need further medical clearance at a LOW or MODERATE intensity? Need further medical clearance before exercising at VIGOROUS intensity? LOW RISK MODERATE RISK HIGH RISK Recommended Clients may initiate low to moderate exercise pending clearance Supervision required? Often recommended depends on the reason for falling into this category Type of supervision recommended None Professional* Clinical** *Professional supervision = under the supervision of a health/ fitness professional possessing a combination of academic training and certification equivalent to the EIMS Clinical Fitness Professional Level 1 **Clinical supervision = under the direct supervision of a health/ fitness professional possessing a combination of advanced college training and certification equivalent to the ACSM Registered Clinical Exercise Physiologist and Exercise Specialist or EIMS CFP level 2 and 3
7 Appendix 3: Exercise Intensity Guidelines Adapted from ACSM s Exercise is Medicine; A Clinician s Guide to Exercise Prescription by Steven Jonas and Edward Phillips Intensity Category Heart Rate Measure Rate of Perceived Exertion (RPE) Light < 64 % HR max Very light to light RPE 1-2 Moderate % HR max Moderate to somewhat hard RPE 3-4 Description An aerobic activity that does not cause a noticeable change in breathing rate An intensity that can be sustained for at least 60 minutes An aerobic activity that is able to be conducted whilst maintaining a conversation uninterrupted An intensity that may last between 30 and 60 minutes Vigorous >76-90 % HR max Hard RPE 5-6 An aerobic activity in which a conversation generally cannot be maintained uninterrupted An intensity that may last up to about 30 minutes High 90 % HR max Very Hard RPE 7 An intensity that generally cannot be sustained for longer than about 10 minutes
8 Appendix 4: Quantifying Exercise Intensity The following information provides a step by step guide on calculating intensity using the following methods Percentage of Maximal Heart Rate Percentage of Heart Rate Reserve Percentage of Maximal Heart Rate (%HRmax) In order to calculate a target heart rate (THR) based on a percentage of your client s HRmax, you must first either know (from exercise testing) or calculate her HRmax. The simplest way to calculate HRmax is using the formula HRmax = 220 age; however, this method is not the most accurate. A more accurate, but slightly more complicated method is the formula HRmax = (0.67 age) Once the predicted HRmax for your client is established, multiply this number by the percentage of HRmax that you would like your patient to exercise at. The formula for calculating a target heart rate (THR) range using percentage of maximal heart rate (%HR max) is: THR = HRmax desired % Tutorial Question 1 For a 51 year old client to exercise at moderate intensity, calculate the upper and lower range of target heart rate using both HR max estimate formulas. The ACSM suggests that moderate-intensity exercise should be performed at 64% 76% of HRmax Target Heart Rate (THR) = HRmax desired % Using HRmax = 220-age Using HRmax = (0.67 age) HRmax = 220 = HRmax = (0.67 ) = Lower range (64%) = 0.64 = Upper range (76%) = 0.76 = Lower range (64%) = 0.64 = Upper range (76%) = 0.76 =
9 Appendix 4: Quantifying Exercise Intensity Percentage of Heart Rate Reserve (HRR) Using heart rate reserve (HRR) is a more accurate measure of exercise intensity. This method calculates the difference between a patient s maximal and resting heart rate, i.e., heart rate reserve or usable heart rate range, and then multiplies this number by exercise intensity (percentage). In order to use this method, the client s resting and maximal heart rates need to be known or estimated using the calculations above. The formula for calculating a target heart rate (THR) range using heart rate reserve (HRR) is: THR = [(HRmax HR rest) % intensity] + HR rest Tutorial Question 2 A 51 year old client who has a resting heart rate (HR rest) of 78 beats per minute and you would like him to exercise at a moderate intensity (40-60% HRR), then in order to determine his target heart rate (THR), complete the following calculation. HR rest: beats/min HRmax: beats/min (use formula 220- age to determine HRmax) Exercise intensity: - % of HRR THR = [(HRmax HR rest) % intensity] + HR rest Upper range = [( ) ] + = beats per minute Lower range = [( - ) x ] + = beats per minute Reference Source: ACSM s Exercise is Medicine; A Clinician s Guide to Exercise Prescription by Steven Jonas and Edward Phillips
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