Exercise Science Health Screening Health Screening Why Determines

Exercise Science Health Screening

Health Screening … Why? – Determines Activity Readiness – Identifies Risk – Identifies contraindications – Identifies personal health history – Helps Identify Goals – Assists in the Prescription of Exercise – Fulfills Legal and Professional Obligations – Networking

Health Screening … What? – Physical Activity Readiness – Demographics – Risk Appraisal – Medical History – Lifestyle History – Exercise History – Goals/Wants/Needs

Health Screening Primary Risk Factors for Coronary Heart Disease § Smoking § Hypertension § Hyperlipidemia (240 mg/dl) § Obesity § Family History (prior to age 55) § Diabetes

Health Screening Secondary Risk Factors for Coronary Heart Disease § Sedentary Lifestyle § Stress § Gender § Race § Diet

Health Screening Physical Activity Readiness Questionnaire PAR-Q n n n n n For most people physical activity should not pose any problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is your best guide in answering these few questions. Please read them carefully and check the yes or no opposite the question if it applies to you. YES NO Has your doctor ever said you have heart trouble? Do you frequently have pains in your heart and chest? Do you often feel faint or have spells of severe dizziness? Has a doctor ever said your blood pressure was too high? Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise? Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to? Are you over age 65 and not accustomed to vigorous exercise? If you answered YES to one or more questions. . . n if you have not recently done so, consult with your personal physician by telephone or in person before increasing your physical activity and/or taking a fitness test. If you answered NO to all questions. . . n If you answered PAR-Q accurately, you have reasonable assurance of your present suitability for an exercise test.

Health Screening DIXIE COLLEGE FITNESS CENTER Medical Questionnaire & Informed Consent Social Security Number _______ Date _______ / _______ Last Name _________________ First Name _____________ Address _______________________________________ Street City State Zip Home Phone _______________ Business Phone _____________ Birthdate ______/______ Sex (Male/ Female) _______ Course ____ Section _______ Resting Blood Pressure______/______ Resting Heart Rate_______ Height______ Weight___________________________________________ Emergency Contact Information Name ______________________ Relationship ____________ Phone Number _______________________________________________________ Participant Status ______ Student ______ Full Time ______ Part Time ______ Dixie College Employee ______ Dixie Center Employee __________________________________________

Health Screening yes _____ no _____ _____ _____ _____ _____ Health Risk Appraisal 1. Has a doctor ever said you have a heart condition and recommended a medically supervised physical activity program? 2. Do you have chest pains brought on by physical activity? 3. Have you developed chest pains within the last month? 4. Do you tend to lose consciousness or fall over as a result of dizziness? 5. Have you been diagnosed with hypertension (high blood pressure), Systolic BP of 160 mm. Hg or greater, or a Diastolic BP of 90 mm. Hg or greater on at least two (2) separate occasions? 6. Has a doctor ever recommended medication for your blood pressure or heart condition? 7. Do you have a serum cholesterol level of 240 mg/dl or greater? 8. Do you have Diabetes Mellitus? (Persons with insulin-dependent diabetes mellitus -IDDM- who are over 30 or have had IDDM for more that 15 years and persons with noninsulin-dependent diabetes mellitus who are over the age of 35. ) 9. Do you Smoke? If yes, how many packs/day _________ 10. Do you have a bone or joint problem that could be aggravated by the proposed physical activity? _____ 11. Do you have a family history of Coronary or other Atherosclerotic disease in parents, grandparents, siblings at or before the age of 55? _____ 12. Are you over the age of 65 and not accustomed to vigorous activity? _____ 13. Are you aware, through your own experience or a doctors advice of any other physical reason against your exercising without medical supervision? If “yes”, explain: ___________________________________________________________ Instructor’s Comments: _____________________________________________________________________________________

Health Screening n n n n n n n Medical & Lifestyle Questionnaire yes no _____ 1. Do you have Asthma? Medication: ____________ 2. Weight gain in the past 10 years? How many pounds? _________ 3. Weight at age; 20 _______; 30 _______; 40 _______; 50_______; 60 _______? _____ 4. Do you have a history of Chronic Low Back pain? _____ 5. Have you had a recent surgery? Please Specify _____________ 6. Have you had a physical from your physician in the past year? If not how long has it been? ______________ 7. Are you pregnant? Number of months along? ______________ 8. Circle your correct activity level: a. Little or No exercise weekly. b. Light, 10 -20 minutes 1 to 2 times/week. c. Moderate, 10 -20 minutes 3 to 5 times/week. d. High, 20 -30 minutes 3 to 5 times/week. e. Vigorous 30+ minutes 5 to 7 times/week. _____ 9. Estimate your current stress level: a. Unhurried, generally happy, rarely tense or anxious. b. Ambitious, generally relaxed, tense 1 -3 times/week. c. Feel tense maybe twice daily, sometimes hard driving. d. Quite tense, usually rushed, hard driving, competitive. e. Extremely tense, always rushed and hard driving. _____ 10. Do you currently take any medications? Please list all: ___________________________________________________________

Health Screening n _____ 1. n _____ 2. n n n _____ 3. _____ 4. _____ 5. n n _____ 6. _____ 7. n _____ 8. n n n _____ 9. _____ 10. _____ 11. Goals Lose Weight (reduce body fat) How many pounds? ________. Weight Gain How many pounds? ________. Firm Up - Tone Muscles Increase Muscular Strength Improve Athletic Performance How? ______________. Lower Blood Pressure / Heart Rate Lower Blood Sugar Levels Level now? ___________. Lower Cholesterol Level now? ___________. Reduce Stress Leisure / Social Activity Maintain Current Fitness

Health Screening Informed Consent & Release Form General Statement of Program Objectives & Procedures: I _____________, understand that this physical fitness program may include exercises to build the cardiorespiratory system (heart & lungs), the musculoskeletal system (muscle endurance, strength, and flexibility) and to improve body composition. The exercises may include aerobic activities (treadmill walking/running, rowing, cycling, or stairclimbing, etc. ), calisthenics and/or strength training (variable resistance machines, or free weights) to assist in improving overall health and fitness levels. Potential Risks: I understand that the reaction of the heart, & vascular system, lungs and muscular system to the aforementioned exercises cannot always be predicted with specific accuracy. I am also aware of risks that may occur while engaged in said exercises such as; abnormalities in blood pressure and heart rate, ineffective functioning’s of the heart, in rare instances heart attack and stroke, muscular sprains, strains, muscular pain, and possible broken bones.

Health Screening Potential Benefits: I also understand that a program of regular exercise for the heart, lungs, muscles, and joints has many associated benefits. These may include; a decrease in body fat, improvement in blood lipid profile, decrease in blood pressure and resting heart rate, increases in muscular strength, endurance, bone density and overall joint stability, as well as improvements in ones psychological function and a decrease risk of coronary heart disease. Acknowledgement: I further acknowledge the existence & purpose of certain rules and procedures concerning the use of the equipment, facilities and activities of the Fitness Center. I agree to abide by those rules and procedures and shall make every effort to ensure that the equipment and facilities are kept in a safe and useable condition. Release: Having read the foregoing information, I acknowledge my understanding of the risks, benefits and rules set forth above and knowingly agree to assume full responsibility for the same.

Health Screening Physician Release Form Dear Physician Your patient_______________, is registered for the Fitness Center course at Dixie College in which they will be asked to participate in a cardiorespiratory and/or musculoskeletal exercise program. Through our initial screening process (we follow the American College of Sports Medicine Guidelines) your patient has come to our attention as an individual at Higher Risk and requires a medical release prior to beginning their exercise program. Please check the following activities which you feel your patient can participate in safely with your consent. We have a well qualified staff supervising the Fitness Center at all times so programs can be individualized

Health Screening Exercises (cardiorespiratory & muscular strengthening) ______ Rowing ______ Stationary Bikes (Lifecycles-upright & recumbent- & Schwinn Air Dynes) ______ Stairclimbers (Stairmaster 4000 pt, 4400 pt and Crossrobics 1650 LE) ______ Treadmills (Lifestride 9500) ______ Variable Resistance Strength Machines (Cybex) ______ Free Weights ______ Calisthenics Exercises ______ All of The Above Please list below any limitations or medical considerations in which we should be aware of: ______ No Limitations ______ Limitations: If you have any questions or comments, please contact me at

Health Screening Common Conditions Trainers May Encounter – Respiratory § Asthma, COPD – Musculoskeletal § Tendon/Ligament conditions § Arthritis § Back conditions – Metabolic § Diabetes § Hypoglycemia – Other § § Pregnancy Hernia Illness/Infection Etc.

Health Screening Common Types of Medications – Antihypertensives: decrease contraction force of the heart – Beta Blockers: decreases RHR and Ex. Hr by blocking catecholamines – Calcium Channel Blockers: Vasodialates arteries & decrease contraction force of the heart – Diuretics: increase kidney function, lowers blood volume – Bronchodilators: relaxes bronchi passages – Cold Medication: decrease blood flow to the upper respiratory vessels to reduce inflammation