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Professional Standards and Health Screening

• Readings – CSEP-PATH – B1 - Ask– B2 – Assess (51-56)– D1 – Professional Standards– D2 – Basic Legal Considerations– D3 – Reputation and Marketing (Read on own)

• Resources - ACSM Resource Manual 6th ed (American College of Sports Medicine)– Ch 10– Ch 18 (p 284-290)– Ch 19 (p 297-304)– Ch 51

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Outline - Health Screening• Professional Standards and Credentials• Safety and Legal Considerations• Role Of Appraiser• Goals of Health Screening

– Health Screening Forms • details and limitations

– Overview of Risk Factors• Physical Screening Tests

– Resting Blood Pressure and Heart Rate– BMI

Professional Standards and Credentials

• CSEP – Canadian Society for Exercise Physiology– Certified Personal Trainer– Certified Exercise Physiologist*

• ACSM – American College of Sports Medicine– Certified Personal Trainer– Health Fitness Specialist*– Clinical Exercise Physiologist*– Comparison of CSEP and ACSM certifications– * Require 4 year university degree in Kinesiology

• BCRPA – BC Recreation and Parks Association• BCAK – BC Association of Kinesiologists• Certification at any level allows you to practice within

the limitations of your training and qualifications3

CSEP Code of Conduct• Certified members have the responsibility of:

– Enhancing public understanding of the exercise profession– Building their professional reputation on the basis of merit of

services offered and performed– Not competing unfairly with others or competing primarily on

the basis of fees without due consideration of other factors; and

– Maintaining a special obligation to demonstrate understanding, professionalism and technical expertise to apprentice members under their supervision

• Professionalism, competence, confidentiality, factual marketing, clear record keeping (log book)

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Safety and Legal Concerns• The main concern of a fitness program is that it be conducted safely

for everyone permitted to participate in the program.• screen and exclude those individuals who should not be exercising

prior to checking with a physician.• ensure that the program is designed so those individuals cleared for

exercise are able to perform their exercise in a safe manner.• regular check of the equipment and facilities and periodic reviews of

the procedures used by the staff in classes and during testing.– A written record of maintenance and safety checks should be kept. “If it isn’t

written down….it wasn’t done”.– Written records showing when the review, training, and practice were carried out

• A written emergency procedure should be established and staff members trained to carry out the procedure.– Local emergency services to be used should be contacted to help establish the

procedures, and comprehend and agree with the procedures that are to be followed.

• Fortunately, the same kinds of things done to make the program safe also help protect the program legally.

Basic Legal Considerations• Nature of injury associated with physical activity

– Inherent risks – injuries can occur despite no fault being attributable – risk inseparable from activity

– Ordinary negligence – failure to meet standard of care– Gross negligence – deliberate or reckless conduct –

professional does not take steps to correct risk– Product defect/liability – manufacturer at fault due to defect

in design, manufacture or inadequate warnings• Liability exposure

– Injury is attributable to actions of exercise professional– Improper instruction or supervision or failure to respond with

appropriately emergency procedures• Inadequate staff training• Improper pre exercise health screening• Inappropriate exercise prescription• Equipment / facility maintenance• Improper execution or development of an emergency action plan

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Basic Legal Considerations• Negligence

– “Failure to do something that a reasonable / prudent professional would have done, or it can be doing something that a reasonable/prudent professional would not have done”

– To establish negligence the following will be examined.• what was the standard of care? Was it breached?• Did the breach cause the harm?• What damages will the defendant owe if negligence is proven?

• Standard of Care– Provide ‘reasonably safe’ programs and services for clients.

• Risk management and mitigation– Conduct consistent with CSEP ‘ standard of care’ as

documented in CSEP’s• Certification procedures – liability insurance – 3 million (BCAK)• Code of conduct• Scope of practice • CSEP-PATH procedures

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Informed Consent:

• Voluntary acknowledgement of purpose, procedures, and assumption of known (informed) dangers/risk(s) – Although getting the participant's consent

does not prevent legal actions or protect against negligence, it does indicate that the program is concerned with the participant and has acted in good faith. This may be enough for legal protection.

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Waivers:

• Voluntary abandonment of a right to file a lawsuit. Waives all claims to damage including negligence.– Waivers are becoming more common and are

better written. It is possible for some waivers to stand up even if the program (person) was negligent. I believe this is rather worrying from an ethical viewpoint, but spending the money up front to get a well-written legal waiver drawn up does make good fiscal sense.

Determinants of HealthSocial and Economic Environment

Health Services

POPULATION HEALTH

Personal Health PracticesPhysical Environments

Individual Capacity and Coping Skills

Determinants of HealthSocial and Economic Environment

Health Services

POPULATION HEALTH

Personal Health PracticesPhysical Environments

Individual Capacity and Coping Skills

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Wellness Continuum

Figure 1.1

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Role Of Exercise Professional• Assess clients physical activity and lifestyle

habits– CSEP-PATH uses Health Benefit Ratings to assist

in the provision of advice to the client• Design program (along with client) to improve

fitness, coping skills and sense of mastery • Refer clients to other health professionals• Rely on these professionals to provide

information and support for the goals you have assisted the client in developing

• Client Based Approach, part of a team of Professionals

CSEP-PATH Health Benefit Ratings• Excellent - Associated with optimal health benefits

• Very Good - Associated with considerable benefits

• Good - Associated with many health benefits

• Fair - Associated with some benefits, but also some health risks

• Poor- Associated with considerable health risks

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Pre-participation Screening • Most prospective participants are apparently

healthy• Primary safety goal of health screening is to

identify those who should receive further medical evaluation prior to exercise testing or training– identify medical conditions – identify possible contraindicated activities– Is referral to a medically supervised exercise program needed?

• Information gathered can assist in designing an individualized exercise program

• Following screening protocol will fulfill legal and insurance requirements

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Pre-participation Screening • CSEP-PATH guidelines• Forms

– Welcome Letter – Appropriate preparation for first meeting– AAL-Q – Abilities for Active Living – PAR-Q - Physical Activity Readiness

• PARMED X if client fails PAR-Q– Informed Consent form– PASB-Q – Physical Activity and Sedentary Behaviour– LIFESTYLE checklist – SOC-Q – Stages of Change– *BPK 343 adds health history to CPAFLA requirements

• Physical Screening • HR, BP, and observations

• We will also add height, weight and girth measurements in lab this week, to determine BMI and health risk

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Physical Activity Readiness• PAR-Q - developed in BC, used worldwide

– Brief, Self administered• Appraiser can not assist or interpret for client

• Sensitivity - nearly 100%– % with medical contraindications who answer Yes

• Specificity - ~ 80%– % of persons without medical conditions who answer NO

• Limitations – sensitivity and specificity for predicting exercise ECG

abnormalities– Inability to screen out persons with 2 or more major CAD

(Coronary Artery Disease) risk factors– Inability to Identify medications that may affect exercise safety– Inability to Identify pregnancy– Absence of questions that identify adverse health behaviors

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Health History• Limitations of PAR-Q addressed in part by

– Health History form and – CSEP forms– physical screening (resting BP and HR)

• Important to assess risk for CAD and other chronic diseases– PASB –Q, Health History, Lifestyle Checklist, Body

composition, Physical Screening– See slide 21 for ACSM risk factors for CAD

• Several risk factors depend on health behavior– Lifestyle checklist

• Personal History is used to – Clarify risk of CAD events during exercise– Prioritize interventions– Encourage change in lifestyle and reduce disease– Develop or modify exercise program

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Pre-participation Screening • ACSM guidelines

– Minimum required is self administered questionnaire such as PAR-Q

– Does not require medical exam for asymptomatic, apparently healthy men under 45 and women under 55 with fewer than two CAD risk factors (see slides 27 and 28 for details)

• For vigorous exercise above 60% VO2max

– Also, medical exam unnecessary for anyone asymptomatic and apparently healthy to undergo

• moderate exercise at 40-60% VO2max

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Other Considerations

• The properties of drugs must be understood and discussed with a physician– May alter HR / BP; ECG response, exercise capacity

• Link between dietary habits and development of disease

• Past and current exercise behaviours / habits• What do they enjoy?• Type A behaviour?• Eating Disorders?• Age and Exercise Intentions?

– how old is this person and how vigorously does he or she want to exercise?

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Physical Screening Tests

Client may be unaware of a riskfactor!• blood pressure• heart rate• observation

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Blood Pressure indications that fail screening

• CSEP-PATH- systolic > 145- diastolic > 95- On BP medication• ACSM- systolic > 140- diastolic > 90

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Classification Systolic (mmHg) Diastolic (mmHg)

Normal < 120 < 80

Pre Hypertension

120 - 130 80 - 89

Stage 1 140 - 159 90 - 99

Stage 2 > 160 > 100

Risk of CVD, beginning at 115 / 75 mmHg, doubles with each increment of 20 / 10 mmHg

Classification of Blood Pressure for Adults

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Heart Rate indications that fail screening

• CSEP-PATH and ACSMHR > 100 bts/min at rest• ACSM cautions about HR < 60 in an untrained

individual at rest

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Observation indicating failure of screening

• shortness of breath• coughing persistently• pregnant• lower extremity swelling• posture• limp• flexibility and strength?

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