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ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3

ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3. Pretest Clinical Evaluation David Arnall, Ph.D., P.T., FACSM, ES. What is Necessary ?. Medical History Medical diagnosis Previous medical history Hx of presenting symptoms Recent illnesses, hospitalizations, etc.

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ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3

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  1. ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3 Pretest Clinical Evaluation David Arnall, Ph.D., P.T., FACSM, ES

  2. What is Necessary ? • Medical History • Medical diagnosis • Previous medical history • Hx of presenting symptoms • Recent illnesses, hospitalizations, etc. • Orthopedic problems • Medication history

  3. Review of habits - tobacco use, ETOH, caffeine use, illicit drugs • Exercise history • Work history • Family history of sudden death, stroke, metabolic disease, COPD, and presence of cardiac problems

  4. Components Of ThePhysical Exam • Body weight • BP - rest, supine, sitting, standing • Heart & lung auscultation • Palpation of pulses • Palpation of BLE’s for edema & staining • Inspection for xanthomas • Neurological tests - balance, cognition, etc.

  5. Recommended Lab Tests • Total serum cholesterol and HDL • Fasting triglycerides • Fasting blood glucose • EKG, PFT, Chest X-Ray • Complete panel & blood count • Thyroid function

  6. What are the Desirable Lipoprotein Values ? • Cholesterol : < 200 mg/dl • HDL : > 35 mg/dl • LDL : < 130 mg/dl • Triglycerides : < 200 mg/dl

  7. Some Important Blood Values • RBC : •  4.5 - 6.5 x 1012/L •  3.9 - 5.6 x 1012/L • Hematocrit : •  40% - 52% :  36% - 48% • Hemaglobin : •  14 - 17 g/dl :  11 - 15 g/dl

  8. WBC : 4 - 11 x 109/L • Platelets : 150 - 450 x 109/L • Fasting Glucose : 60 -110 mg/dl • Blood Urea Nitrogen : 4 - 24 mg/dl • Creatinine : 0.3 - 1.4 mg/dl

  9. Contraindications To Exercise • Absolute Contraindications • Unstable angina • Uncontrolled dysrhythmias • Recent EKG changes & cardiac events • Acute myocarditis/pericarditis

  10. Acute pulmonary embolism/infarction • Severe aortic stenosis • Dissecting aneurysm • Acute infections

  11. Contraindications To Exercise • Relative Contraindications • Left main coronary stenosis • Severe hypertension (>200/110) • Tachycardias/bradycardias • Uncontrolled metabolic disease • High-degree AV blocks

  12. Chronic infectious diseases • Cardiomyopathy & outflow obstructions • Stenotic valve disease • ventricular aneurysm

  13. Informed Consent • Purpose & benefits of the testing • Risks associated with the test • A statement indicating that the patient can ask questions • A statement saying the patient can stop the test whenever they want • Emergency equipment is available

  14. Patient Preparation For Testing • Refrain from food & alcohol before test • Patient should be well rested • Patient wears loose fitting clothing • Patient should have a family member to take them home

  15. Patient may need to alter current medication use if this effects the test (antianginal drugs alter EKG responses) • Patient may need to continue their medications to guarantee consistent outcomes (beta-blockers) • Patient should bring all of their medications to the test site

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