chapter 2

1. chapter2 chapter 2 Preliminary Health Screening and Risk Classification Author name here for Edited books

2. Chapter Objectives • Understand the importance of classifying client’s health status and lifestyle • Know the variables evaluated by and focus of the various screening methods • Understand the importance of information obtained from clinical tests and which ones require an MD • Introduce procedures for hemodynamic assessment

3. Preliminary Health Evaluation • Twofold purpose: • Detect the presence of disease • Assess initial disease risk of client

4. Table 2.1

5. PAR-Q • Physical Activity Readiness Questionnaire • 7 questions • Identifies who needs medical clearance before fitness testing and/or exercise program initiation • One single “yes” means that medical clearance is required

6. Medical History Questionnaire • Very detailed queries • Personal medical history • Recent diagnoses and signs and symptoms (S/S) of disease • Family medical history (continued)

7. Medical History Questionnaire (continued) • Allows identification of • risk factors, • absolute and relative contraindications for exercise testing, and • medications.

8. Table 2.2

9. Signs and Symptoms of Disease • Checking for signs and symptoms of cardiovascular, pulmonary, metabolic, and musculoskeletal problems or disorders protects you and the client. • Appendix A.3 of book also helps identify risk factors for CVD. • Medical clearance may be required depending on results of this questionnaire.

10. Lifestyle Evaluation • Helps you develop a well-rounded, individualized exercise program • Rounds out risk factor profile • Identifies lifestyle patterns and habits • Highlights possible challenges to adherence

11. Informed Consent • A legal document (both parties sign) • Explains purpose of and procedure for each assessment • Itemizes possible risks and expected benefits • Ensures confidentiality in terms of data collected • Indicates client participation is voluntary • Allows parental approval (as appropriate)

12. Paperwork’s Done. Now What? • Coronary risk factor analysis: • Does client meet the threshold values for positive CHD risk factors? • Does client meet the threshold value for negative CHD risk factor? • What is the net risk factor count?

13. After Risk Factors Are Assessed • Disease risk classification: • Likelihood of an untoward event during testing or exercise • Who needs medical clearance?

14. Disease Risk Classification • Low risk: Asymptomatic and young and <2 net risk factors for CVD • Moderate risk: Asymptomatic and >1 net risk factor for CVD; applies to both younger and older groups • High risk: Symptomatic or known cardiovascular, pulmonary, or metabolic disease

15. Clinical Tests Physical examination: recommended for moderate- and high-risk clients Blood chemistry profile: allows insight into blood glucose and lipid levels Resting blood pressure: allows insight into pressure the heart is generating or withstanding when filling and emptying at rest Graded exercise test: allows ability to monitor physiologic responses to a stressor

16. Physical Examination • Focus should be S/S of CHD • Should also include assessment: • Weight • Orthopedic issues • Cardiac function (rate, regularity) • Blood pressure (various positions) • Heart, lung, and major artery sounds • Signature authority from MD indicating approval to start or continue

17. Blood Chemistry Profile • If values are out of normal ranges, refer client to their medical provider. • NCEP recommends: • Fasting lipoprotein profile assessment every 5 years • LDL-C goals based on risk category • Refer clients for professional help if they have high or very high LDL-C levels.

18. Table 2.5

19. Table 2.6

20. Resting Blood Pressure • SBP: arterial pressure during systole (ejection, emptying; higher number) • DBP: arterial pressure during diastole (relaxation, filling; lower number) • Pulse pressure:SBP − DBP

21. Table 2.3

22. Graded Exercise Test (GXT) • Helps assess functional aerobic capacity • Beneficial for setting exercise prescriptions • Should be administered by trained, certified personnel • Use risk stratification to determine contraindications, need for MD presence, and level of exertional effort

23. Table 2.7

24. Monitoring Hemodynamic Responses • During GXTs, monitor blood pressure (BP) and heart rate (HR). • Monitor HR and BP before, during, and after GXT. • Additionally, monitor electrical activity of heart (ECG) during maximal exertion GXTs.

25. Blood Pressure Assessment • Select proper cuff size for your client • Minimize sources of error • Follow standard technique • Practice, practice, practice! • Take BP near the end of each GXT stage • Deflate cuff fully between measurements • Wait 30 sec before reassessment

26. Heart Rate Assessment • Like BP assessment, record HR at rest, during exercise, and after exercise. • For exercise and recovery, count for 6- or 10-second interval. • Know when to count starting at 1. • Available methods: • Palpation (with fingertips) • Auscultation(with stethoscope) • Heart rate monitors • Electrocardiogram (ECG)

27. Electrocardiogram • Most informative method for assessing HR • Can assess electrical activity of heart chambers, myocardial ischemia, and acute or previous myocardial injury • A good prep job is a must (continued)

28. Electrocardiogram (continued) • Repeated cardiac cycles as seen on an ECG tracing: • P-wave: atrial depolarization • PR interval: delay of impulse at AV node • QRS complex: ventricular depolarization • ST segment: early ventricular repolarization • T-wave: ventricular repolarization • Monitored through various leads

29. Figure 2.1

30. 12-Lead Electrocardiogram • Bipolar (limb) leads (two electrodes per lead): • Lead I: right arm to left arm • Lead II: right arm to left leg • Lead III: left arm to left leg • Unipolar leads (one electrode per lead): • 6 chest (precordial) leads • 3 augmented leads (uses limb lead electrodes)

31. Figure 2.2

32. Figure 2.3