Risks Associated with Physical Activity

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Risks Associated with Physical Activity

• While regular physical activity increases the
  risk of both musculoskeletal injury and
  life-threatening cardiovascular events such as
  cardiac arrest, the incidence is low.
• The risk is even lower in those who are
  habitually active.

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Risks Associated with Physical Activity

• In general, the risk is lowest among healthy
  young adults and non-smoking women, greater for
  those with CAD risk factors, and highest for
  those with established cardiac disease.

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Risks Associated with Physical Activity

• The overall absolute risk in the general
  population is low especially when weighed against
  the health benefits of exercise.

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Risks Associated with Physical Activity

• To further reduce the risks of physical activity,
  proper prescreening must occur.

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Prescreening
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Prescreening

• A necessity prior to any fitness assessment or
  participation in any activity program
• Identifies those at risk
• Defines goals and objectives
• Provides starting FITS
• Provides a baseline for measuring progression

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Prescreening

• Objectives
• Optimize safety during exercise testing and
  participation.
• Permit the development of a sound and effective
  exercise prescription.

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Prescreening

• The purpose of the pre-participation health
  screening include
• Identification and exclusion of individuals with
  medical contraindications to exercise.

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Prescreening

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

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Prescreening

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

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Prescreening

• Use information from the initial health and
  lifestyle evaluations to screen clients for
  physical fitness testing and for program
  development.

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Prescreening

• Identification of individuals with other special
  needs.

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Prescreening

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

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Prescreening

• Prescreening may be composed of
• Informed consent
• Medical clearance
• Risk stratification

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Prescreening

• Medical history
• Lifestyle evaluation
• Exercise testing

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Informed Consent

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

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Informed Consent

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

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Informed Consent

• It also ensures your clients results will remain
  confidential and their participation is voluntary.

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Informed Consent

• If your client is underage (lt18 years), a parent
  or guardian must also sign the informed consent.
• Minor gives assent
• Legal guardian gives consent

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Informed Consent

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

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Prescreening

• Before assessing your clients physical fitness
  profile, you should classify the individuals
  health status and lifestyle.

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Health Status

• Illness or disease?
• Injury?
• Medications and supplements?

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Activity Status

• Currently active or inactive?
• Likes and dislikes?
• Obstacles?

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Health Status

• PAR-Q
• Physical Activity Readiness Questionnaire
• The PAR-Q has been recommended as a minimal
  standard for entry into low-to-moderate intensity
  exercise programs.

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Health Status

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

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Medical History

• Your clients should complete a comprehensive
  medical history questionnaire, including personal
  and family health history.

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Medical History

• Use the questionnaire to
• Examine the clients record of personal
  illnesses, surgeries, and operations.

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Medical History

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

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Medical History

• Analyze your clients family history of
• diabetes,
• heart disease,
• stroke
• and hypertension.

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Medical History

• Focus on conditions that require medical referral.

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Medical History

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

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Medical History

• Present Symptoms
• Dyspnea or shortness of breath
• Angina or chest pain
• Leg cramps or claudication
• Musculoskeletal problems or limitations
• Medications

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Medical History

• Past History
• Diseases
• Injuries
• Surgeries
• Lab tests

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Medical History

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

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Medical History

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

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Medical History

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

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Medical Clearance

• Your prospective exercise program participants
  should obtain a physical examination and a signed
  medical clearance from a physician.

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Risk Stratification

• Low Risk
• Asymptomatic lt 1 Risk Factor
• Moderate Risk
• Asymptomatic gt 2 Risk Factor
• High Risk
• Sypmtomatic, or known cardiac, pulmonary, or
  metabolic diseases

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Prior Medical Exam

• Current Medical Exam
• Risk
• Low Moderate High
• Moderate Ex. NN NN Rec
• Vigorous Ex. NN Rec Rec
• NN not necessary Rec Recommended

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Exercise Testing

• Physician Supervision
• Risk
• Low Moderate High
• Submax test NN NN Rec
• Max test NN NN Rec
• NN not necessary Rec Recommended

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Risk Stratification

• See ACSMs Guidelines for risk factors
• See ACSMs Guideline for signs and symptoms
• See ACSMs Guidelines for risk stratification

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Lifestyle Evaluation

• A well-rounded physical fitness program requires
  that you obtain information about the clients
  living habits.

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Lifestyle Evaluation

• The lifestyle assessment provides useful
  information regarding the individuals risk
  factor profile.

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Lifestyle Assessment

• Alcohol and caffeine intake
• Smoking
• Nutritional intake - eating patterns
• Physical activity patterns and interests
• Sleeping habits

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Lifestyle Assessment

• Occupational stress level
• Mental status - family lifestyle

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Lifestyle Evaluation

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

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Lifestyle Evaluation

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

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Physical Examination

• Blood pressure
• Heart or lung sounds
• Orthopedic problems

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Laboratory Tests (Ideal s)

• Triglycerides (lt200 mg per dl)
• Total cholesterol (lt200 mg per dl)
• LDL-C (lt130 mg per dl)
• HDL-C (gt40 mg per dl)

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Laboratory Tests (Ideal s)

• TC/HDL-C ratio (lt3.5)
• Blood glucose (60-114 mg per dl)
• Hemoglobin (13.5-17.5 mg per dl for men
  11.5-15.5 mg per dl for women)
• Potassium (3.5-5.5 meq per dl)

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Laboratory Tests (Ideal s)

• Blood urea nitrogen (4-24 mg per dl)
• Creatinine (0.3-1.4 mg per dl)
• Iron (40-190 mg per dl for men 35-180 mg for
  women)
• Calcium (8.5-10.5 mg per dl)

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Physical Fitness Evaluation

• CV fitness (HR, BP, VO2MAX)
• Body composition (BF)
• Musculoskeletal fitness (muscle and bone
  strength)
• Flexibility
• Neuromuscular tension/stress

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Fitness Assessment

• Fitness assessment is discussed elsewhere (KNR
  309)
• Very important in
• program design

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Risks of Exercise Testing.

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

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Risks of Exercise Testing.

• The risk of death during or immediately after an
  exercise test is lt 0.01.
• 1 out of 10,000
• The risk of MI during or immediately after an
  exercise tests is lt 0.04.
• 4 out of 10,000

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Risks of Exercise Testing.

• The risk of a complication requiring
  hospitalization (including MIs) is approximately
  0.1.
• 1 out of 1,000

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Risks of Exercise Testing.

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

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Risks of Exercise Testing.

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

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Risks of Exercise Testing.

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

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Risks of Exercise Testing.

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