Health Appraisal and Fitness Testing

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• Health Appraisal and Fitness Testing
• Physical Fitness is the ability to carry out
  everyday tasks without undue fatigue and with
  energy left over to enjoy leisure time activities
  and meet unforeseen emergencies.
• 2 types of physical fitness
• Health Related
• Sport Skill Related

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• Why the heck do we test??
• Baseline information
• Use for goal setting and/or modification of
  goals
• Documentation of results (you are producing the
  change that you say you are going to produce)

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• Pretest Considerations
• Health Screening
• a. Safety
• b. Risk factor identification
• c. Exercise prescription and Programming
• Types
• General screening for participation in
  self-directed exercise (PAR-Q)
• Screening for fitness assessment and exercise
  prescription (personal medical history, current
  medical status, medications, family history,
  lifestyle considerations

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• Administration
• a. Timing administer screening tool BEFORE
  testing know contraindications to exercise
  testing and referral to other health care
  providers

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• Health Screening and Risk Stratification
• The Preparticipation Screen.What you need to
  know
• Need to have an initial screening tool for
  participants to help you to identify risk factors
  and/or symptoms for various chronic diseases
  (such as cardiovascular, pulmonary, metabolic)

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Things to consider when you choose your health
screens

• Is it valid?
• Is it cost-effective?
• Is it time efficient?
• Is it appropriate for my clients or facilitys
  target population?

• Minimum standard for moderate-intensity exercise
  programs is the PAR-Q (revised 1994)

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PAR-Q The Physical Activity Readiness
Questionnaire

• Designed to identify the small number of adults
  for whom physical activity might be inappropriate
• Identifies those who should receive medical
  advise concerning the most suitable type of
  activity
• QUALIFIED STAFF should interpret PAR-Q results
• All results should be documented and saved
• Understand that many sedentary people can safely
  begin a moderate intensity physical activity
  program without need for extensive medical
  screening

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CAD Risk Factor Thresholds for Use with ACSMs
Risk Stratification The Exercise Scientists
Safety Net

• POSITIVE RISK FACTORS
• Family History (MI or sudden death before 55 in
  father or other 1degree relative (brother or son)
  or before 65 in mother or other 1 degree relative
  (sister or daughter)
• Cigarette smoking (current smoker or quit within
  previous 6 months)
• Hypertension (SBP greater or equal to 140 mmHg
  or diastolic greater or equal to 90 mmHg or on
  antihypertensive meds)
• Hypercholestrolemia (TC greater than 200 mg/dL
  or HDL less than 35 mg/dL or on lipid lower meds)
• Impaired fasting glucose (fasting glucose
  greater than or equal to 110mg/dL confirmed on at
  least 2 separate occasions)
• Obesity (BMI gt 30 kg/m2 or waist girth of
  greater than 100 cm)
• Sedentary Lifestyle (does not meet minimal PA
  recommendation)
• NEGATIVE RISK FACTOR High serum HDL-C level
  greater than 60 mg/dL

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Family History Your first line of defense

• History goes beyond risk factors such as
  cigarette smoking, excess weight, nutritional
  factors and physical inactivity
• Gives you a look at the GENETIC predisposition
  to your clients potential development of coronary
  artery disease (CAD)
• Family history should identify any FIRST DEGREE
  RELATIVES (parents, siblings and children)
• Risk of having an MI are high when a first
  degree relative has an MI or suddenly dies before
  55 for men (father, brother or son) and before 65
  for women (mother, sister, daughter)

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Cigarette Smoking One of our best established
risk factor

• Adverse health impact of smoking is in the areas
  of cardiovascular disease and lung cancer
• Increases ones chances for sudden death
  (defined as death within 1 hour in an apparently
  clinically stable or asymptomatic person) and
  development of CAD risk increases 5 times in 1
  pack per day smokers
• Includes current smokers and those who quit
  within the previous 6 months
• Elevates HR, BP, breathing rates, increases
  susceptibility to arrhythmias, blood clots,
  coronary spasms and atheroscleroisis

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Hypertension Why we watch pressures

• Associated with stroke, heart failure, and MI
• If possible, monitor BP with each visit
• Use standards for BP classifications
• Exercise training and dietary modifications are
  an important part of medical management of
  hypertension
• Systolic pressure of greater than or equal to
  140 mmHg or Diastolic pressure greater than or
  equal to 90 mmHg
• Must confirm on at least 2 separate occasions or
  client is currently taking antihypertensive
  medications
• Classifications ACSM 6th edition Table 3-1 (pg
  41)

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Hypercholestrolemia Where the Blood Fat is At!!

• Abnormal blood lipid levels are know to be the
  basis of the atheroscleroisis process
• Total cholesterol and HDL levels should be
  measured in all adults 20 years of age and older
• People with abnormal lipid levels are encouraged
  to modify diet to reduce, in particular, intake
  of saturated fat and cholesterol and participate
  in a regular exercise regiment
• CHOL of greater than 200 mg/dL, HDL of less than
  35 mg/dL, LDL-C more than 130 mg/dL (in place of
  T-CHOL) OR on lipid lowering medication(s)
• If Triglyceride levels available, you can
  evaluate them using Table 3-4 (pg 47)

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Impaired Fasting Glucose Risks of Diabetes

• Fasting blood glucose of greater than or equal
  to 110 mg/dL confirmed on at least 2 separate
  occasions
• Increased risk of Diabetes Mellitus
• Increases your risk of CAD, peripheral vascular
  disease and congestive heart failure

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Obesity An American Epidemic

• An independent risk factor for the development
  of CAD
• Predecessor to type II diabetes
• Body Mass Index (BMI) of greater than or equal
  to 30 kg/m2 or waist measurement of greater than
  100 cm
• Professional opinions vary regarding the most
  appropriate markers and thresholds for obesity so
  you should use clinical judgment when evaluating
  this risk factor
• As a definition, obesity is a surplus of adipose
  tissue containing fat stored in trglyceride form,
  resulting from excessive energy intake relative
  to energy expenditure
• OVERWEIGHT does not always reflect obesity
  (i.e. an athlete can weigh more than ideal
  weight but be very lean)

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Sedentary Lifestyle Confessions of the Clicker
Commando

• Person not participating in a regular exercise
  program or meeting the minimal physical activity
  recommendations from the U.S. Surgeon Generals
  report (accumulating 30 minutes or more of
  moderate physical activity on most days of the
  week)
• Previous exercise history of exercise
  experiences, orthopedic injuries with exercise
  and reason for noncompliance should be considered
• Get off the couch and get into motion!!!

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Negative Risk Factor Protection of HDL-C

• Serum high density lipoprotein of greater than
  60 mg/dL
• 2 ways to increase genetics and physical
  activity
• Pharmacologically, individuals who take ERT have
  higher HDL-C levels

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• Major Signs or Symptoms Suggestive of
  Cardiovascular and Pulmonary Disease
• Pain, discomfort (or other anginal equivalent)
  in the chest, neck, jaw, or arms or other area
  that my be due to ischemia
• Shortness of breath at rest or with mild
  exertion
• Dizziness or syncope
• Ankle edema
• Palpitations or tachycardia
• Intermittent claudication
• Known heart murmur
• Unusual fatigue or shortness of breath with
  usual activities
• BOX 2-1, pg 25

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A. Pain, discomfort (or other anginal equivalent)
in the chest, neck, jaw, or arms or other area
that my be due to ischemia

• Character constricting, squeezing, burning,
  heaviness, heavy Feeling
• Location substernal, across chest in both
  arms, shoulders in neck, cheeks, teeth tingling
  fingers between scapulas
• Provoking factors exercise, excitement, stress,
  cold weather, after eating

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• B. Shortness of Breath at rest or with exertion
• Dyspnea (abnormally uncomfortable awareness of
  breathing) commonly occurs during strenuous
  exertion in health, well-trained persons and
  during moderate exertion in healthy, untrained
  persons
• ABNORMAL when is occurs at a level of exertion
  that is not expected to give symptoms
• shows presence of COPD or left ventricular
  dysfunction

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• C. Dizziness or syncope
• Syncope (defined as a loss of consciousness) is
  caused by a lack of blood to the brain
• Dizziness during exercise may result from a rise
  or fall in cardiac output
• Life threatening conditions from CAD,
  cardiomyopathy, heart arrhythmia
• Dizziness or syncope after exercise should be
  investigated although it may occur in health
  adults

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D. Orthopnea and paroxysmal nocturnal dyspnea

• Orthopnea dyspnea occurring at rest in the
  recumbent position that is relived promptly by
  sitting upright or standing
• Paroxysmal Nocturnal Dyspnea refers to dyspnea,
  beginning usually 2-5 hours after you fall
  asleep, which is relieved by sitting on the side
  of the bed or getting out of bed
• BAD STUFF Left ventricular failure (HEART
  FAILURE)

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E. Ankle Edema

• Bilateral ankle edema (swelling) that is most
  evident at night heart failure and venous
  return problems
• Unilateral swelling of a limb often results from
  a venous thrombosis (blood clot) or lymphatic
  blockage
• Sign of venous return insufficiency

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F. Palpitations or tachycardia

• Palpitations unpleasant awareness of the
  forceful or rapid beating of the heart
• Tachycardia fast heart rate at rest over 100
  bpm
• Palpitations result from anxiety, high cardiac
  output, anemia, fever

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G. Claudication

• Intermittent claudication pain that occurs in
  a muscle with an inadequate blood supply (usually
  as a result of atherosclerosis) that is stressed
  by exercise
• No pain with standing or sitting
• Can reproduce the pain day to day is more
  severe when walking upstairs or up a hill
• Disappears in 1-2- minutes after stopping
  exercise
• CAD prevalent Diabetics are at increase risk
  for this condition

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H. Known heart murmurs

• Although some may be innocent, heart murmurs may
  indicate valve disease or other CV disease
• From an exercise safety standpoint, it is
  important to have this investigated further
• Unchecked, this can cause exertion-related
  sudden cardiac death

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Initial ACSM Risk Stratification Low risk
younger individuals (men less than 45 and women
less than 55) who are asymptomatic and meet no
more than 1 risk factor Moderate risk older
adults (men greater than or equal to 45 and women
greater than or equal to 55) OR those who meet
the threshold for 2 or more risk factors High
risk Individuals with one or more
signs/symptoms of cardiovascular and/or
pulmonary disease OR known cardiovascular
(cardiac, peripheral vascular or CV disease),
pulmonary (COPD, asthma, interstitial lung
disease or CF) or metabolic disease (diabetes
types 1 and 2, thyroid disease, renal or liver
disease)
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ACSM Recommendations for (A) Current Medical
Examination and Exercise Testing Prior to
Participation and (B) Physician Supervision of
Exercise Tests Pg 27, Table 2-2
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• Exercise Testing What order??
• Resting measurements (HR, BP, blood chemistry)
• Body composition
• Cardiorespiratory fitness
• Muscular fitness (when assessing on same day as
  CR fitness, use this order)
• Flexibility (flexibility is most appropriately
  assessed when the body is fully warmed)

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• OK Client..here is what you need to do!!
• Appropriate, comfortable, loose-fitting clothing
• Adequately hydrated
• Avoid alcohol, tobacco, caffeine and food for
  approximately 3 hours before testing
• Avoid strenuous exercise or physical activity on
  the day of the test
• Adequate sleep the night prior to the assessment
  is suggested

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• Testingthe fun begins!!
• Resting data (HR, BP)
• Body Composition (skinfolds, WHR, BMI,
  hydrostatic weighing, NIR, BIA, MRI, DEXA)
• Cardiorespiratory Fitness (submaximal vs.
  maximal Rockport Walk Test treadmill and
  bicycle ergometers)
• Muscular Strength and Endurance (Leg and Arm
  press and hand grip dynamometer push-ups and
  crunches)
• Flexibility (sit and reach box YMCA test)

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LAB TIME!! Next class meeting Like this stuff??
Do I have a class for you!!