Prescreening ä To optimize safety ä To permit the development of a sound and effective exercise prescription

PrescreeningPrescreening

To optimize safetyTo optimize safety To permit the development of a sound and To permit the development of a sound and

effective exercise prescription.effective exercise prescription.


Before assessing your client’s physical Before assessing your client’s physical fitness profile, you should classify the fitness profile, you should classify the individual’s health status and lifestyle.individual’s health status and lifestyle.


You will use information from the initial You will use information from the initial health and lifestyle evaluations to screen health and lifestyle evaluations to screen clients for physical fitness testing.clients for physical fitness testing.


The purpose of the pre-participation health The purpose of the pre-participation health screening include:screening include:

Identification and exclusion of individuals Identification and exclusion of individuals with medical contraindications to exercise.with medical contraindications to exercise.


Identification of individuals with disease Identification of individuals with disease symptoms and risk factors for disease symptoms and risk factors for disease development who should receive medical development who should receive medical evaluation before starting an exercise evaluation before starting an exercise program.program.


Identification of persons with clinically Identification of persons with clinically significant disease considerations who significant disease considerations who should participate in a medically supervised should participate in a medically supervised exercise program.exercise program.


Identification of individuals with other Identification of individuals with other special needs.special needs.


It is essential that health screening It is essential that health screening procedures be valid, cost effective, and time procedures be valid, cost effective, and time efficient.efficient.


The The PAR-QPAR-Q has been recommended as a has been recommended as a minimal standard for entry into low-to-minimal standard for entry into low-to-moderate intensity exercise programs.moderate intensity exercise programs.


The PAR-Q was designed to identify the The PAR-Q was designed to identify the small number of adults for whom physical small number of adults for whom physical activity might be inappropriate or those activity might be inappropriate or those who should have medical advice concerning who should have medical advice concerning the most suitable types of activity.the most suitable types of activity.


Prescreening may be composed of:Prescreening may be composed of: Medical historyMedical history Risk stratificationRisk stratification Medical clearanceMedical clearance


Lifestyle evaluationLifestyle evaluation Informed consentInformed consent Exercise testingExercise testing

Medical HistoryMedical History

You should require your clients to complete You should require your clients to complete a comprehensive medical history a comprehensive medical history questionnaire that includes questions questionnaire that includes questions concerning personal and family health concerning personal and family health history.history.


Use the questionnaire to:Use the questionnaire to: Examine the client’s record of personal Examine the client’s record of personal

illnesses, surgeries, and operations.illnesses, surgeries, and operations.


Assess previous medical diagnoses and Assess previous medical diagnoses and signs and symptoms of disease that have signs and symptoms of disease that have occurred within the past year or are occurred within the past year or are currently present.currently present.


Analyze your client’s family history of Analyze your client’s family history of diabetes, heart disease, stroke and diabetes, heart disease, stroke and hypertension.hypertension.


Also, when reviewing the medical history, Also, when reviewing the medical history, you should carefully focus on conditions you should carefully focus on conditions that require medical referral.that require medical referral.


If any of these conditions are noted, refer If any of these conditions are noted, refer your client to a physician for a physical your client to a physician for a physical examination and medical clearance prior to examination and medical clearance prior to exercise testing or starting an exercise exercise testing or starting an exercise program.program.


It is also important to note the types of It is also important to note the types of medication being used by the client.medication being used by the client.


Drugs such as digitalis, beta-blockers, Drugs such as digitalis, beta-blockers, diuretics, vasodilators, bronchodilators, and diuretics, vasodilators, bronchodilators, and insulin may alter the individual’s heart rate insulin may alter the individual’s heart rate blood pressure, ECG, and exercise capacity.blood pressure, ECG, and exercise capacity.


If your client reports a medical condition or If your client reports a medical condition or drug that is unfamiliar to you, be certain to drug that is unfamiliar to you, be certain to consult medical references or a physician to consult medical references or a physician to obtain more information before conducting obtain more information before conducting any exercise tests or allowing the client to any exercise tests or allowing the client to participate in an exercise program.participate in an exercise program.

Medical ClearanceMedical Clearance

Your prospective exercise program Your prospective exercise program participants should obtain a physical participants should obtain a physical examination and a signed medical clearance examination and a signed medical clearance from a physician, especially if they are:from a physician, especially if they are:


Men >40 years of age with two or more Men >40 years of age with two or more major coronary risk factors.major coronary risk factors.


Women >50 years of age with two or more Women >50 years of age with two or more major coronary risk factors.major coronary risk factors.


Individuals of any age with known Individuals of any age with known cardiovascular, pulmonary, or metabolic cardiovascular, pulmonary, or metabolic disease.disease.

Lifestyle EvaluationLifestyle Evaluation

Planning a well-rounded physical fitness Planning a well-rounded physical fitness program for an individual requires that you program for an individual requires that you obtain information about the client’s living obtain information about the client’s living habits.habits.


The lifestyle assessment provides useful The lifestyle assessment provides useful information regarding the individual’s risk information regarding the individual’s risk factor profile.factor profile.


Factors such as smoking, lack of physical Factors such as smoking, lack of physical activity, and diets high in saturated fats or activity, and diets high in saturated fats or cholesterol increase the risk of CAD cholesterol increase the risk of CAD atherosclerosis, and hypertension.atherosclerosis, and hypertension.


Additionally the lifestyle evaluation should Additionally the lifestyle evaluation should gather information on drug and alcohol use, gather information on drug and alcohol use, physical activity level and psychological physical activity level and psychological stress levels of the individual.stress levels of the individual.


These factors can be used to pinpoint These factors can be used to pinpoint patterns and habits that need modification patterns and habits that need modification and to assess the likelihood of the client’s and to assess the likelihood of the client’s adherence to the exercise program.adherence to the exercise program.

Risk StratificationRisk Stratification

See ACSM’s Guidelines for risk factors - p. See ACSM’s Guidelines for risk factors - p. 18.18.

See ACSM’s Guidelines for risk See ACSM’s Guidelines for risk stratification - p. 19.stratification - p. 19.

Informed ConsentInformed Consent

Prior to conducting any physical fitness Prior to conducting any physical fitness tests or exercise programs, you should see tests or exercise programs, you should see that each participant signs an informed that each participant signs an informed consent.consent.


This form explains the purpose and nature This form explains the purpose and nature of each physical fitness test, any inherent of each physical fitness test, any inherent risks in the testing, and the expected risks in the testing, and the expected benefits of the tests.benefits of the tests.


The informed consent also ensures your The informed consent also ensures your clients that the results will remain clients that the results will remain confidential, and that their participation is confidential, and that their participation is strictly voluntary.strictly voluntary.


If your client is underage (<18 years), a If your client is underage (<18 years), a parent or guardian must also sign the parent or guardian must also sign the informed consent.informed consent.


All consent forms should be approved by All consent forms should be approved by your institutional review board or legal your institutional review board or legal counsel.counsel.

Risks of Exercise Testing.Risks of Exercise Testing.

Clinical exercise testing is a relatively safe Clinical exercise testing is a relatively safe procedure, although complications may procedure, although complications may arise.arise.


The risk of death during or immediately The risk of death during or immediately after an exercise test is after an exercise test is << 0.01%. 0.01%.

The risk of MI during or immediately after The risk of MI during or immediately after an exercise tests is an exercise tests is << 0.04%. 0.04%.


The risk of a complication requiring The risk of a complication requiring hospitalization (including MIs) is hospitalization (including MIs) is approximately 0.1%.approximately 0.1%.


The data do suggest that the rate of The data do suggest that the rate of complications during exercise testing is complications during exercise testing is higher in populations undergoing diagnostic higher in populations undergoing diagnostic testing, compared with persons being tested testing, compared with persons being tested as part of a preventive medical examination.as part of a preventive medical examination.


The risks associated with submaximal The risks associated with submaximal physical fitness testing appear to be even physical fitness testing appear to be even lower.lower.


Submaximal physical fitness testing appears Submaximal physical fitness testing appears to have an extremely low risk when to have an extremely low risk when accompanied by appropriate pretest accompanied by appropriate pretest screening such as the PAR-Q and can be screening such as the PAR-Q and can be administered safely by qualified personnel administered safely by qualified personnel in non-medical settings.in non-medical settings.


No set of guidelines for exercise testing and No set of guidelines for exercise testing and participation can cover all situations.participation can cover all situations.

Documents

Prescreening ä To optimize safety ä To permit the development of a sound and effective exercise prescription