ACSM[042-082]

>>>>>>>>>>>>>
3
CHAPTER
Pre-Exercise Evaluations
This chapter contains information related to pre-exercise testing procedures and
serves as a bridge between the risk stratification concepts presented in Chapter 2,
the fitness assessment (Chapter 4), and/or clinical exercise testing concepts
(Chapters 5 and 6). Although each of the chapter elements (e.g., medical history,
physical examination, identification of exercise contraindications, informedconsent
procedures) relate to health/fitness and clinical exercise settings, the lowerrisk
population typically encountered in the health and fitness setting generally
justifies a less sophisticated approach to the pre-exercise test procedures. Therefore,
abbreviated versions of the medical history and physical examination procedures
described within this chapter are reasonable within the health and fitness
setting.
The extent of medical evaluation necessary before exercise testing depends
on the assessment of risk as determined from the procedures outlined in Chapters
1 and 2. For many persons, especially those with atherosclerotic cardiovascular
disease (CVD) and other cardiovascular disorders, the exercise test and
accompanying physical examination are critical to the development of a safe
and effective exercise program. In today’s healthcare environment, not all persons
warrant extensive testing; however, it is important to work with healthcare
providers in understanding the importance of the baseline exercise evaluation.
This evaluation provides greater assurance of exercise safety by identifying
residual myocardial ischemia, significant dysrhythmias, and the effect of certain
medical therapies.
A comprehensive pre-exercise test evaluation in the clinical setting generally
includes a medical history, physical examination, and laboratory tests. The goal
of this chapter is not to be totally inclusive or to supplant more specific references
on each subject, but rather to provide a concise set of guidelines for the
pre-exercise test participant assessment.
MEDICAL HISTORY, PHYSICAL EXAMINATION,
AND LABORATORY TESTS
The pre-exercise test medical history should be thorough and include both past
and current information. Appropriate components of the medical history are presented
in Box 3.1. A preliminary physical examination should be performed by a
physician or other qualified personnel before exercise testing moderate- and
42