ACSM[042-082]

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CHAPTER 2 Preparticipation Health Screening and Risk Stratification 21Assess your health status by marking all true statementsHistoryYou have had:_____ a heart attack_____ heart surgery_____ cardiac catheterization_____ coronary angioplasty (PTCA)_____ pacemaker/implantable cardiacdefibrillator/rhythm disturbance_____ heart valve disease_____ heart failure_____ heart transplantation_____ congenital heart diseaseSymptoms_____ You experience chest discomfort with exertion_____ You experience unreasonable breathlessness_____ You experience dizziness, fainting, or blackouts_____ You take heart medications.If you marked any of these statements in this section, consultyour physician or other appropriate health care providerbefore engaging in exercise. You may need to use a facilitywith a medically qualified staff.Other health issues_____ You have diabetes_____ You have asthma or other lung disease_____ You have burning or cramping sensation in yourlower legs when walking short distances_____ You have musculoskeletal problems that limityour physical activity_____ You have concerns about the safety of exercise_____ You take prescription medications_____ You are pregnantCardiovascular risk factors_____ You are a man older than 45 years_____ You are a woman older than 55 years, have had ahysterectomy, or are postmenopausal_____ You smoke, or quit smoking within the previous 6 months_____ Your blood pressure is 140/90 mm Hg_____ You do not know your blood pressure_____ You take blood pressure medication_____ Your blood cholesterol level is 200 mg/dL_____ You do not know your cholesterol level_____ You have a close blood relative who had aheart attack or heart surgery before age55 (father or brother) or age65 (mother or sister)_____ You are physically inactive (i.e., you get30 minutes of physical activity on atleast 3 days per week)_____ You are 20 pounds overweight_____ None of the aboveIf you marked two or more of the statements in this sectionyou should consult your physician or other appropriatehealth care provider before engaging in exercise. You mightbenefit from using a facility with a professionally qualifiedexercise staff a to guide your exercise program.You should be able to exercise safely without consulting yourphysician or other appropriate health care provider in aself-guided program or almost any facility that meets yourexercise program needs.a Professionally qualified exercise staff refers to appropriately trained individuals who possess academic training, practical and clinical knowledge,skills, and abilities commensurate with the credentials defined in Appendix D.FIGURE 2.2. AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire(Modified from American College of Sports Medicine Position Stand and American HeartAssociation. Recommendations for cardiovascular screening, staffing, and emergencypolicies at health/fitness facilities. Med Sci Sports Exerc. 1998;30(6):1009–18.)
22 GUIDELINES FOR EXERCISE TESTING • www.acsm.orgactivity regimens conducted at low (40% oxygen update reserve V . O 2 R) tomoderate (40%–60% V . O 2 R) exercise intensity, little additional assessment isneeded beyond the ACSM/AHA Questionnaires (1), provided that one adheres toall medical clearance recommendations contained within the form. Such regimensshould incorporate the physical activity recommendations from the U.S.Surgeon General (6,23). A specific self-guided exercise regimen suitable for previouslysedentary individuals may be found in the ACSM Fitness Book (6).PROFESSIONALLY GUIDED SCREENING FOR PHYSICAL ACTIVITYProfessionally guided implies that the health fitness/clinical assessment is conductedby—and the exercise program is designed and supervised by—appropriately trainedpersonnel who possess academic training and practical/clinical knowledge, skills,and abilities commensurate with the credentials defined in Appendix D.Self-guided surveys are effective in identifying individuals who would benefitfrom medical consultation before participation in an exercise program (1). A moreadvanced process administered by professionally trained personnel provides greaterdetail regarding CVD risk factors and signs/symptoms and identifies a broader scopeof chronic diseases and/or conditions that need special consideration before engagingin an exercise program. The professionally guided preparticipation screeningprocess involves (a) the review of more detailed health/medical history informationand specific risk stratification, and (b) detailed recommendations for physical activity/exercise,medical examination, exercise testing, and physician supervision.Many health/fitness and clinical exercise program facilities use a more elaboratehealth/medical history questionnaire designed to provide additional detailsregarding selected health/fitness habits and medical history, such as theAHA/ACSM Questionnaire (1) (Fig. 2.2). This questionnaire may be used as abasic instrument for this process, but additional information needs to beobtained related to specific CVD risk factors.RISK STRATIFICATIONAppropriate recommendations for medical examination, physical activity/exercise,exercise testing, and physician supervision are made based on a risk stratificationprocess that assigns participants into one of three risk categories: (a) low, (b) moderate,or (c) high risk (Table 2.1). The process by which individuals are assignedto one of these risk categories is called risk stratification and is based on:• The presence or absence of known cardiovascular, pulmonary, and/or metabolicdisease• The presence or absence of signs or symptoms suggestive of cardiovascular,pulmonary, and/or metabolic disease• The presence or absence of CVD risk factorsLow risk: Individuals classified as low risk are those who do not havesigns/symptoms of or have diagnosed cardiovascular, pulmonary, and/ormetabolic disease and have no more than one (i.e., 1) CVD risk factor. Therisk of an acute cardiovascular event in this population is low, and a physical
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