Screening and risk stratification Because the many people

過濾與危險分類 Screening and risk stratification • Because the many people with undiagnosed heart disease are particularly at risk, screening clients is critical to insure safety. • 因許多人有未被診斷出來的心臟病, 運動 時特別危險, 因此需要過濾確保安全.

Screening and risk stratification • Before performing exercise testing on clients, and before enrolling them into an exercise program, you should evaluate the clients to determine their level of risk and to decide if it is reasonably safe to proceed. • 未參與運動測驗和未參與運動前, 需要評估參與 者的危險程, 度 再決定運動進行是否安全.

ACSM’s Risk Levels 危險分類 三類 • Low-risk: young, with no more than 1 coronary disease risk factor, and without symptoms or known disease. 低危險 • Moderate-risk: Older; or with 2 or more coronary disease risk factors. 中危險 • High-risk: with 1 or more symptoms of cardiopulmonary disease; or with known cardiovascular, pulmonary, or metabolic disease. 高危險

Exercise screening questionnaire using ACSM Criteria • 美國運動醫學會標準的過慮問卷 • Risk factors 危險因素 (2 or more place individual as moderate risk)兩個以上危險 因素為中危險

問卷 • __1, have any of your parents, brothers, or sisters had a heart attack, bypass surgery, angioplasty, or sudden death prior to the age of 55 (male relatives) or 65 (female relatives). First degree relative. • 您的ㄧ等親, 雙親, 兄弟姐妹是否有心臟 病, 動脈繞道手術, 血管整形或猝死? (男 性親戚 55歲前 女性親戚 65歲前)

Risk factors • __2. Have you smoked cigarettes in the past 6 months? 最近六個月有抽菸嗎? • __3. What is your usual blood pressure (大 於 140/90)? Do you take blood pressure medication? 您的血壓過高嗎? (大於或等於 140/90 mm. Hg) 服用高血壓藥物嗎?

Risk factors • __4. What is your LDL低密度脂蛋白 cholesterol? If you don’t know your LDL, What is your total cholesterol膽固醇? What is your HDL高密度脂蛋白cholesterol? 血脂肪, 膽固醇, 高低密度脂蛋白膽固醇?

• [either LDL> 130 (use total cholesterol > 200 if LDL not known) or HDL < 35 is a risk. Note: HDL > 60 is a ‘negative’ risk factor. or taking lipid-lowering medication. • 危險因素: 低密度脂蛋白高於 130 • 膽固醇> 200 HDL < 35 或服藥 • 高密度脂蛋白> 60 為負的危險因素 可減一 個危險因素

Risk factors • __5. What is your fasting glucose (>=110)? 空腹血糖 • __6. What is your height and weight(BMI>= 30)? Also, what is your waist girth (> 100 cm)? 身高體重BMI多少

• __7. Do you get at least 30 minutes of moderate physical activity most days of the week (or its equivalent)? • 每星期有好幾天有從事三十分鐘適度運動嗎 ?

Risk factors • Positive正: family history家庭遺傳; cigarette smoking抽菸‘; hypertension高血 壓; hypercholesterolemia高血膽固醇; impaired fasting glucose空腹血糖過高; obesity肥胖; sedentary lifestyle靜態生活方 式. • Negative負: High serum HDL cholesterol. 高的高密度脂蛋白

Symptoms (1 or more places individual at high risk) 症狀 • __1. Do you ever have pain or discomfort in your chest or surrounding areas (I. e. , ischemia) 胸部附近不舒服? • __2. Do you ever feel faint or dizzy (other than when sitting up rapidly)? 會頭昏? • __3. Do you find it difficult to breathe when you are lying down or sleeping? 躺著 或睡覺呼吸困難?

Symptoms • __4. Do your ankles ever become swollen (other than after a long period of standing)? 踝部腫脹? • __5. Do you ever have heart palpitations, or an unusual period of rapid heart rate? • 心悸 或有時心跳過快嗎?

• __6. Do you ever experience pain in your legs (I. e. , intermittent claudication)? • 腳部會痛嗎? 間歇性跛足?

Symptoms • __7. Has a physician ever said you have a heart murmur? (has he/she said it is OK, and safe for you to exercise? ) • 心有雜音? 運動安全嗎? • __8. Do you feel unusually fatigued or find it difficult to breathe with usual activities? 從事一般活動感覺疲憊或者呼吸困難嗎?

others • __1. How old are you? (men >= 55 are at • moderate risk. ) 你幾歲? __2. Do you have any of the following diseases: 有下列疾病嗎? heart disease, chronic obstructive pulmonary disease (emphysema or chronic bronchitis), asthma, diabetes mellitus, thyroid disorder, renal disease, or liver disease等疾病? (yes to any disease places individual at high risk)

others • __3. Do you have any bone or joint problems, such as arthritis or a past injury, that might get worse with exercise? (exercise testing may need to be delayed or modified運動測驗需要延期或修正). 有 骨或關節問題? 運動會惡化?

其他 • __4. Do you have a cold or flu, or any other infection? 感冒或其他感染? (exercise testing must be delayed. 運動測驗需要延期 )

others • __5. Are you pregnant? 懷孕嗎? (exercise testing may need to be delayed or modified). • __6. Do you have any other problem that might make it difficult for you to do strenuous exercise? 有參與激烈運動會有 困難的症狀?

Interpretation 解說 • Low risk (young, and no more than 1 risk factor): can do maximal testing or enter a vigorous exercise program. 低危險 可做最大運動 測驗 或者參與激烈運動 • Moderate risk (older, or 2 or more risk factor): can do submaximal testing or enter a moderate exercise program. • 可以做非最大運動測驗 或者從事適度的運動計畫

• High risk (one or more symptoms or disease) can do no testing without physician presence; can enter no program without physician clearance. • 沒有醫師在場, 不能從事運動測驗. • 沒有醫師的同意, 不能參加運動.

ACSM recommendations for (A) current medical examination and exercise testing prior to participation and (B) physician supervision of exercise tests • • • low risk A. Moderate exercise not necessary Vigorous exercise not necessary 從事中度與激烈運動前不需進一步健康檢查 B. Sub-maximal test not necessary Maximal test not necessary 中度運動表示 3 -6 METs. 激烈運動表示 6 METs以上 not necessary表示運動參與或測驗時不需醫師在場

ACSM recommendations for (A) current medical examination and exercise testing prior to participation and (B) physician supervision of exercise tests • • • Moderate risk 中危險 A. Moderate exercise not necessary Vigorous exercise recommended 從事中度運動前不需健康檢查, 但激烈運動要 B. Sub-maximal test not necessary Maximal test recommended 中度運動表示 3 -6 METs. 激烈運動表示 6 METs以上 not necessary表示運動參與或測驗時不需醫師在場 recommended 建議醫師在場

ACSM recommendations for (A) current medical examination and exercise testing prior to participation and (B) physician supervision of exercise tests • High risk 高危險 • A. Moderate exercise recommended • Vigorous exercise recommended • B. Sub-maximal test recommended • Maximal test recommended • 中度運動表示 3 -6 METs. • 激烈運動表示 6 METs以上 • recommended表示運動參與前建議要健康檢查或 測驗時建議醫師在場

Back-saver sit and reach • Flexibility • 要有12 inch高木箱與 測量木尺, 木尺與木箱 接處點為 9 inch.

如何鼓勵以提升體適能 • 過去大部分檢測認同體適 能的表現(結果)而非過程. A more appropriate method is to use recognition programs based on participating regularly in physical activity (the process) as this is more likely to track into adulthood.

Thanks for your attention! • The purpose of life is to • serve and to show compassion and the will to help others. --Albert Schweitzer. • 以運動保健專業 來幫助別人更健 康更快樂更成長

參考文獻 • 教育部體適能網站 • ACSM’s Resource Manual for Guidelines for • • Exercise Testing and Prescription, 5 th edition, 2006. Lippincott Williams & Wilkins. The Cooper Institute, FITNESSgram ACTIVITYgram, 4 th edition, Human Kinetic, 2007. Swain, David P and Leutzoltz, Brian C. Exercise Prescription, Human kinetic, 2002.