Preparticipation Health Screening Chapter 2 ACSM Guidelines for

Pre-participation Health Screening Chapter 2 ACSM Guidelines for Exercise Testing and Prescription, Ninth Edition Kayla Dressler, MS ACSM-RCEP

Pre-Participation Screening � What are we screening for? Signs and symptoms suggestive of cardiovascular, pulmonary and metabolic diseases (Table 2. 1) � Risk factors for CVD � Other health conditions (pregnancy, arthritis, etc. ) � � Why do we screen for this? Optimize safety during the exercise test � Aid in the development of a safe and effective Ex. Rx � Identify individuals with medical contraindications to participating in an exercise program � Identify those who should be exercising in a medically supervised exercise program � Detect those who need medical clearance prior to beginning an exercise program � ACSM GETP 9, Chapter 2; Riebe et. al

Who should have a medical exam and or GXT before exercise? (ACSM GETP, 9 th Edition) � Less emphasis on the need for medical evaluation in healthy asymptomatic individuals (ACSM GETP, page 28) � Rationale, page 20 � Lack of consensus among organizations in preparticipation screening recommendations prior to vigorous exercise � ACSM: High Risk – medical exam and exercise test before participation in any type of exercise program; Moderate Risk – medical exam before participation in a vigorous exercise program (page 28)

How do we classify individuals? � Risk classification is based on: � Presence or absence of CVD risk factors (Table 2. 2) � BP Classifications (Table 3. 1, page 46) � LDL, HDL, Total Cholesterol (Table 3. 2, page 46) � Known cardiovascular, pulmonary, and/or metabolic disease (page 26, Figure 2. 3) � Major signs or symptoms suggestive of cardiovascular, pulmonary and/or metabolic disease (page 21, Table 2. 1) � PEP: Health History Questionnaire & Informed Consent

Risk Classification � Low, Moderate, High (Figure 2. 4, page 28) � Case studies (Box 2. 1, page 29)

Modifiable vs. Non-modifiable � Modifiable Risk Factors* � Non-modifiable Risk Factors

New Pre-participation Guidelines (ACSM GETP, 10 th Edition) � Rationale: � Absolute risk of SCD and AMI is low and often proceeded by signs or symptoms � Questionable whether risk factors truly predict the risk of SCD or AMI during exercise � Benefits of exercise outweigh risks for most people � Excessive referrals � New � Do Guidelines – for medical clearance I still need to know the risk factors and their criteria?

Pre-Participating Health Screening Tools � Self-Guided Methods (minimum) � PAR-Q (page 24) � AHA/ACSM Health/Fitness Facility Pre-participation Screening Questionnaire (page 25) � PEP: Informed Consent & HHQ � Purpose: Flag those who need physician's approval or a clinical exercise test before beginning a PA program