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ACSM Guidelines: Chapter 3 Pre-Exercise Evaluations ACSM Manual: Chapter 3 Risk Factor Assessments
Purpose
The extent of medical evaluations necessary before exercise testing depends of the assessment of risk. For many persons, especially those with CAD or other cardiovascular disorders, the exercise test and accompanying physical examination are critical to the development of safe and effective exercise programs. Not all persons warrant extensive testing
Purpose
In the clinical setting, pre-exercise test evaluations usually include:
Medical history (ACSM Guidelines, Box 3.1, P. 42) Physical examination (ACSM Guidelines, Box 3.2, P. 43) Laboratory tests (ACSM Guidelines, Box 3.3, P. 44) (Next slide)
We will focus on the blood lipid profile laboratory test
Laboratory Tests
Laboratory Tests
Blood Tests
Fasted (at least 12 hours) blood test results are relevant to determining risk of:
Hypercholesterolemia (cholesterol) Prediabetes (glucose)
Two options
1) Refer to local laboratory for testing 2) Purchase instrumentation to perform tests
Phlebotomythe practice of withdrawing blood from a blood vessel into a blood collection tube Insertion of needle into vein (larger-volume sample)
Requires professional training
Ratios
TC/HDL: Desirable < 4.5 males, < 4.0 females LDL/HDL: Average Risk 3.6 males, 3.2 females
Triglycerides
HDL cholesterol level is strongly and inversely associated with the risk for CAD
There is growing evidence for a strong association between elevated triglyceride levels and CAD risk
Lifestyle modification, including physical activity, weight reduction, a DASH eating plan, and moderate alcohol consumption are the cornerstones of antihypertensive therapy. Most patients who require drug therapy, require two or more antihypertensive meds to achieve the goal BP.
Phase 3:
An appropriate BP cuff should be used Center the bladder over the brachial artery and secure the appropriate BP cuff snugly at the level of the heart Locate the brachial artery pulse in the antecubital fossa and place the stethoscope bell over the artery
Release pressure 2 to 3 mmHg per heartbeat or 2 to 5 mmHg per second to the fifth Korotkoff sound Deflate the cuff rapidly to zero after DBP is obtained Record the SBP and DBP (fourth and fifth Korotkoff sounds if they are significantly different) Wait at least 1 full minute and repeat Values should be within 5 mm Hg of each other; if not, repeat
Heart Rate
Heart rate can be measured by:
Palpation Auscultation Telemetry (HR monitors/watches) Electrocardiography (ECG, EKG)
Correct
Incorrect