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Exercise Preparticipation and Health Screening Protocol (Content

Here are the key steps in self-guided screening using the PAR-Q+: 1. The client completes the PAR-Q+ questionnaire independently. 2. The PAR-Q+ identifies individuals who need to consult a health care provider prior to being physically active or continuing their exercise program. 3. For individuals cleared to be physically active without restrictions based on the PAR-Q+, the self-guided screening is complete. They may begin light-moderate intensity physical activity. 4. Anyone answering "yes" to one or more questions on the PAR-Q+ should seek medical evaluation and receive physician's clearance before engaging in physical activity. Ciències de l’Activitat Física i

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0% found this document useful (0 votes)
44 views36 pages

Exercise Preparticipation and Health Screening Protocol (Content

Here are the key steps in self-guided screening using the PAR-Q+: 1. The client completes the PAR-Q+ questionnaire independently. 2. The PAR-Q+ identifies individuals who need to consult a health care provider prior to being physically active or continuing their exercise program. 3. For individuals cleared to be physically active without restrictions based on the PAR-Q+, the self-guided screening is complete. They may begin light-moderate intensity physical activity. 4. Anyone answering "yes" to one or more questions on the PAR-Q+ should seek medical evaluation and receive physician's clearance before engaging in physical activity. Ciències de l’Activitat Física i

Uploaded by

Andreu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Exercise Pre-participation and

health-screening protocol

Ciències de l’Activitat Física i Esport Facultat d’Educació


Why do we have to do this pre-participation
health-screening?

It is a guidance to identify individuals who may be at risk for


serious acute exercise-related cardiovascular events including
sudden cardiac death and myocardial infarction.

If we identify an individual may be at risk, we are going to refer


him/her to a health care provider to recommend medical
clearance on the basis of his/her clinical judgment.

ACSM scientific roundtable, 2015

Ciències de l’Activitat Física i esport Facultat d’Educació


What does the evidence tell about the
risk of cardiac events when people
practice physical activity?

Let’s see…

Ciències de l’Activitat Física i esport Facultat d’Educació


Which is the absolute risk of a cardiac event?
Although the relative risks of sudden cardiac death (SCD) and acute myocardial infarction
(AMI) are higher during sudden vigorous physical exertion versus those at rest, the
absolute risk of these events is very low.

This studies suggest that SCD occurs every 1.5


million episodes of vigorous physical exertion in
men and every 36.5 million hours of moderate-
to-vigorous exertion in women .

Researchers studied more than 10 million


marathon and half marathon runners and
identified an overall cardiac arrest incidence
rate of one per 184,000 runners and an SCD
incidence rate of one per 256,000 runners,
which translate to 0.20 cardiac arrests and
0.14 SCD per 100,000 estimated runner-
hours.

Collectively, these studies illustrate the rarity of CVD events during exercise and
suggest that exercise is safe for most people.
ACSM GETP 9, 1982; Siscovick, 1984; AHA Scientific Statement Circulation 2007
Ciències de l’Activitat Física i esport Facultat d’Educació
Are there difference between physically inactive and active
individuals regarding myocardial infarction and sudden cardiac
death?

The evidence says: Physically inactive individuals are at greater total risk
for acute cardiac events than their physically active counterparts.
Dahabreh IJ, 2011
Ciències de l’Activitat Física i esport Facultat d’Educació
Which is the relative risk of acute myocardial infarction (AMI)
during or immediately following vigorous intensity PA in
sedentary and physically active individuals?

The Onset Study showed that the risk of


AMI during vigorous intensity exercise
was almost twice that at rest even for
individuals who exercised vigorously for
1h on 5 or more days per week.
However, this study also showed that the
risk of AMI for habitually inactive
individuals was 50 times higher than
that for the most physically active
individuals. Regular exercise reduces the
24h risk of CVD events by approximately
50%, meaning that the regular exercisers
relative risk is significantly lower during
both vigorous-intensity exercise and over
the remainder of the day, highlighting the
clearnet benefit of regular physical
activity.

ACSM Roundtable Consensus statement, 2015


Ciències de l’Activitat Física i esport Facultat d’Educació
Are exercise-related cardiovascular events often preceded by
warning signs and symptoms?

Individuals who experience exercise-related cardiovascular complications


during or soon after exercise often have warning signs and symptoms in the
days and weeks before the event.

Thompson et al., (2007)

Ciències de l’Activitat Física i esport Facultat d’Educació


More evidence

Ciències de l’Activitat Física i esport Facultat d’Educació


Ciències de l’Activitat Física i esport Facultat d’Educació
To sum up, the evidence suggest…

The risk of exercise is highest among inactive individuals


and those with known or occult CVD who perform
unaccustomed vigorous-intensity physical activity.

ACSM Roundtable Consensus statement, 2015


Ciències de l’Activitat Física i esport Facultat d’Educació
So, before designing and implementing a
physical exercise program, we must identify…
1. People with absolute contraindications that need to be
excluded from physical activity practice.

2. People with diagnosed diseases and/or high


risk of having them.

3. People who need to pass a medical clearance or


assessment before starting PA practice.

The goal is to optimize security while participating in a PA


program.
ACSM, 2000
Ciències de l’Activitat Física i esport Facultat d’Educació
The following table indicates the risk
factors that may lead an atherosclerotic
cardiovascular disease.

Therefore, we should check if our client


has risk factors before starting the
physical exercise program. That is why,
we should try to know the following
information:
• Age, family history, cigarette
consumption, physical inactivity,
weight/height, blood pressure,
cholesterol levels and glucose
levels.

In the table, next to each risk factor,


there are the defining criteria with the
cut points to establish if there is or not
a risk factor.

(ACSM’s, 2017)
When can we say that someone has optimal,
low, high or very high cholesterol (LDL, HDL,
Triglycerides, total)?

When can we say that someone has


prehypertension, hypertension (stage 1)
and hypertension (stage 2)?
(ACSM’s, 2017)
Activity 1 - In class
How many positive risk factors does this person have? Read and fill out the
table.
Man, age 45yr, nonsmoker. Height= 182.9 cm, weight= 76.4kg, BMI= 22.8 kg·m-2.
RHR= 64 beats ·min-1, resting BP= 124/78 mm Hg. Total colesterol= 187 mg·dL-1
(4.84 mmol· L-1), LDL-C= 103mg · L-1 (2.67 mmol·L-1), HDL-C= 39mg·dL-1 (1.01
mmol· L-1), FBG= 88 mg·dL-1 (4.84 mmol·L-1). Recreationally competitive runner,
runs 4-7 d· wk-1, completes one to two marathons and numerous other road
races every year. No medications other than over-the-counter ibuprofen as
needed. Father died at age 51 yr of a heart attack; mother died at age 81 yr of
cancer.
CVD risk factors
Age YES /NO Obesity YES /NO
Family history YES /NO Hypertension YES /NO
Cigarette smoking YES /NO Dyslipidemia YES /NO
Physical inactivity YES /NO Diabetes YES /NO
Negative risk factor: HDL-C ≥60mg · dL-1 YES /NO
Number of CVD risk factors:
Ciències de l’Activitat Física i esport Facultat d’Educació
Is my client/user able to practicing
physical exercise?

In which PA intensity can he/she start?

Let’s see how to carry out the screening

Ciències de l’Activitat Física i esport Facultat d’Educació


Levels of screening
1. Self-Guided Screening (the client or user can do it by
him/herself) using :
• Physical Activity Readiness Questionnaire + (PAR-Q+)

2. Professionally Supervised Screening (done by a professional)


using :
• Health History Questionnaire
• Pre-participation Physical Activity Screening Process
• Medical Examination/Clearance

Ciències de l’Activitat Física i esport Facultat d’Educació


1. Self-Guided Screening

 Minimum requirement to start an exercise program in order to


identify those persons who may require additional screening
prior to becoming more physically active.
Must answer:
- Physical Activity Readiness Questionnaire for Everyone (PAR-
Q+).
- The Electronic Physical Activity Readiness Medical Examination
(ePARmed-X+).

PAR-Q+ Online | The New PAR-Q+ and ePARmed-X+: OFFICIAL WEBSITE (eparmedx.com)

Ciències de l’Activitat Física i esport Facultat d’Educació


1. Self-Guided Screening
What does these questionnaires allow to know about?

Physical Activity Readiness Questionnaire for Everyone (PAR-Q+).


The PAR-Q+ will tell you whether it is necessary for you to seek further advice before
becoming more physically active or engaging in a fitness appraisal. PAR-Q + can be
used by people between 15 to 69 years-old. Over 69 years-old, and not used to being
very active, please check with the doctor.

The Electronic Physical Activity Readiness Medical Examination


(ePARmed-X+).
The ePARmed-X+ supplements the paper and online versions of the PAR-Q+. At the
end of this process, you will have several options:
- You may be able to do any physical activity you want as long as you start slowly
and build up gradually.
- You may need to restrict your physical activities to those that are safe for you.
- You may be advised to consult a doctor, another health care practitioner who is
licensed to diagnose, or a qualified exercise professional about the types of
physical activities that are appropriate for you.
Ciències de l’Activitat Física i esport Facultat d’Educació
This is the
questionnaire.
(You have a copy on
Virtual campus,
specifically in the folder
of this topic).

Let’s see how it is


structured and
what type of
information ask
for.
Does the person
have any kind of
the following
health problems?

He/she can do PA.


End of the
questionnaire

Attention!
He/she has to answer the
following questions.

(See the next slides)


After the 10 questions, check if there is ‘YES’ in any question.
And…
NO to all of
the
questions

The person can start doing physical activity gradually,


getting advise from a qualified exercise professional

YES to one
or more
questions

The person should complete the ePARmed-X+ and visit a


qualified exercise professional before becoming more
physically active or engaging in a fitness appraisal.
IMPORTANT!

The client/user has to fill out and sign the participant declaration
Pre-participation health screening model

How do we know if our client/user needs medical clearance?

In case of non medical clearance needed, how do we know what


type of PA intensity he/she may do?

Appling the model for exercise pre-participation


health-screening.

ACSM Roundtable Consensus statement, 2015


Ciències de l’Activitat Física i esport Facultat d’Educació
Pre-participation health screening model
The model for exercise pre-participation health screening is based
on three factors:
• The individual’s current level of physical activity
• Presence of signs or symptoms and/or known cardiovascular,
metabolic, or renal disease
• Recommended exercise intensity

To apply the model, we need the information about our


client/user.
How?

ACSM Round table Consensus statement, 2015


Ciències de l’Activitat Física i esport Facultat d’Educació
By using this questionnaire,
called “Exercise Pre-
participation Health
Screening Questionnaire for
Exercise Professionals”

This questionnaire ask for:

- Symptoms
- Current Physical Activity
- Past and present medical
conditions

(You have a copy on Virtual


campus, specifically in the
folder of this topic).
Pre-participation health screening model

When you have the information about:


• The individual’s current level of physical activity
• Presence of signs or symptoms and/or known
cardiovascular, metabolic, or renal disease

Let’s apply the model

ACSM Round table Consensus statement, 2015


Ciències de l’Activitat Física i esport Facultat d’Educació
Follow the conceptual map according to your user’s answers.

Ciències de l’Activitat Física i esport Facultat d’Educació


To watch in more detail…

When your client/user participates in regular exercise

Ciències de l’Activitat Física i esport Facultat d’Educació


To watch in more detail…

When your client/user NO participates in regular exercise

Ciències de l’Activitat Física i esport Facultat d’Educació


Activity in class

Make pairs. Adopt the role of exercise professional and perform the
pre-participation health screening protocol to your partner.

• PAR-Q+
• Exercise Pre-participation Health Screening Questionnaire for
Exercise Professionals

Then, what does Pre-participation health screening model say about the
situation of your partner?

Ciències de l’Activitat Física i esport Facultat d’Educació


Pre-participation health screening
recommendations

• Recommend that exercise professionals consult with health care


providers when there are questions about individuals with
known disease or signs and symptoms suggestive of disease, or
any other concern about an individual’s ability to safely
participate in an exercise program.

• Recommend routine exercise testing before initiating a vigorous


intensity, physical activity program only for individuals at high
risk of exercise- related complications.

ACSM Roundtable Consensus statement, 2015


Ciències de l’Activitat Física i esport Facultat d’Educació
Value of pre-participation health screening (I)

• Strongly support the public health message that all people


should adopt a physically active lifestyle

• Reduce the emphasis on the need for medical evaluation in


healthy, asymptomatic persons

• Emphasize identifying those with known disease because they


are at greatest risk for an exercise-related cardiac event

• Simple exercise pre-participation health screening process


ACSM Roundtable Consensus statement, 2015
Ciències de l’Activitat Física i esport Facultat d’Educació
Value of pre-participation health screening (II)

• Recognize that the hazards of exercise-related cardiovascular


events may more likely be reduced by careful attention to a
safe and effective exercise prescription that:
– Addresses FITT-VP (frequency ,intensity, time, type, volume,
progression) that incorporates a progressive transitional phase during
which exercise duration and intensity are gradually increased
– Advocates appropriate warm-up and cool-down
– Promotes education of warning signs/symptoms
– Encourages sedentary people to engage in regular, brisk walking to
move them out of the least physically fit, least physically active cohort
– Counsels physically inactive individuals to avoid unaccustomed
vigorous intensity physical activity.

ACSM Croundtable Consensus statement, 2015


Ciències de l’Activitat Física i esport Facultat d’Educació
Activity 2
Read the article “New preparticipation health screening
recommendation“ (Magal and Riebe, 2016). And answer the questions.

Activity 3
Obtain the following information from your real case study.
- Socio-demographic and ecological data.

Perform the pre-participation health screening protocol to your real


case study.
• PAR-Q+
• Exercise Pre-participation Health Screening Questionnaire for
Exercise Professionals

Then, what does Pre-participation health screening model say about the
situation of your real case study?
Ciències de l’Activitat Física i esport Facultat d’Educació

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