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Major Coronary Risk Factors
& Pre-Participation
Guidelines
___________________
As Established by the
American College of S...
What is a Risk Factor ?
An aspect of personal behavior or lifestyle, an
environmental exposure or inherited
characteristic...
The Realm of Risk Factor
Modification
Primary Prevention - intervention prior to the
onset of CAD
Secondary Prevention - i...
1. To identify and exclude individuals with medical contraindications to
exercise.
2. To identify persons with clinically ...
Health Screening Devices
By order of cost and complexity
Self administered health questionnaire
Par Q
Analysis of CAD Risk...
Risk Factors for CAD
American College of Sports Medicine
Positive Risk Factors
Age
Family History
Cigarette Smoking
Hypert...
Risk Factors for CAD
American College of Sports Medicine
Table 2-1 Page 24 in Guidelines or Page 19
in Heyward.
Risk Factors
Count the number of positive risk factors and
subtract the number of negative risk factors
At risk if Coronary Disease is present in
the form of MI or Sudden Death:
Father or Brother (1st degree relative) prior to...
At risk if,
Current use is present.
Residual effects may be manifest even if
smoking has stopped
Removal of Risk (?)Remova...
Resting Blood Pressure > 140/90 mm Hg
confirmed by 2 separate measurements (6th
congress on hypertension)
“systolic>140 or...
Blood Pressure:Blood Pressure:
SystolicSystolic DiastolicDiastolic
OptimalOptimal <120<120 <80<80
NormalNormal 120-129120-...
Risk Factors for CAD
American College of Sports Medicine
Hypercholesterolemia (Positive Risk)
On lipid lowering meds
If Li...
Risk Factors for CAD
American College of Sports Medicine
Hypercholesterolemia (Negative Risk)
Lipoprotein profile must be ...
Risk Factors for CAD
American College of Sports Medicine
Diabetes Mellitus
At Risk if:
diagnosed with DM and conditions be...
Risk Factors
Other risk factors:Other risk factors:
Obesity (AHA) BMI>30 or waist of >100Obesity (AHA) BMI>30 or waist of ...
Risk Factors for CAD
American College of Sports Medicine
Physical Inactivity
At risk if:
A combination of a sedentary job ...
Signs/Symptoms of CAD
Angina
Shortness of breath at rest or with exercise
Dizzy
Nocturnal dyspnea
Edema (ankle)
Tachycardi...

Low Risk (apparently healthy): = 0 -1 Risk Factor and
younger

Moderate Risk:= > 2 Risk Factors OR
older (>45 males; >5...
Pre-Participation Testing GuidelinesPre-Participation Testing Guidelines
American College of Sports MedicineAmerican Colle...
Pre-Participation Testing GuidelinesPre-Participation Testing Guidelines
American College of Sports MedicineAmerican Colle...
Pre-Participation Testing GuidelinesPre-Participation Testing Guidelines
American College of Sports MedicineAmerican Colle...
Risk Factor ReviewRisk Factor Review
Non-ModifiableNon-Modifiable
AgeAge
Male genderMale gender
Family historyFamily histo...
Case Study
A 48-year old female desires to start an exercise
program in your facility. Following an initial
questionnaire ...
Case Study from previous slide
A. Undergo medical exam prior to starting a
vigorous program with a physician available to
...
Case Study
John Smith is 43. His blood pressure is 128/82,
and his cholesterol is 222. He has a very stressful
job and has...
Contraindications to Exercise
Absolute ContraindicationsAbsolute Contraindications
Recent significant change in resting EC...
ContraindicationsContraindications
Uncontrolled atrial arrhythmias (compromisingUncontrolled atrial arrhythmias (compromis...
ContraindicationsContraindications
Acute infectionsAcute infections
Significant emotional stressSignificant emotional stre...
ContraindicationsContraindications
Frequent or complex ventricularFrequent or complex ventricular ectopyectopy
Ventricular...
Musculoskeletal Risk FactorsMusculoskeletal Risk Factors
Tables 57.1 & 57.2 Resource ManualTables 57.1 & 57.2 Resource Man...
Musculoskeletal Risk FactorsMusculoskeletal Risk Factors
Previous injuryPrevious injury
Previous physical activityPrevious...
Musculoskeletal Risk FactorsMusculoskeletal Risk Factors
Extrinsic FactorsExtrinsic Factors
Excessive load on the bodyExce...
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American College of Sports Medicine

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American College of Sports Medicine

  1. 1. Major Coronary Risk Factors & Pre-Participation Guidelines ___________________ As Established by the American College of Sports Medicine
  2. 2. What is a Risk Factor ? An aspect of personal behavior or lifestyle, an environmental exposure or inherited characteristic, which, on the basis of epidemiological evidence, is known to be associated with health-related conditions considered to be important to prevent.
  3. 3. The Realm of Risk Factor Modification Primary Prevention - intervention prior to the onset of CAD Secondary Prevention - intervention after the onset of CAD
  4. 4. 1. To identify and exclude individuals with medical contraindications to exercise. 2. To identify persons with clinically significant disease conditions who should be referred to a medically supervised exercise program. 3. To identify individuals with disease symptoms and risk factors for disease development who should receive further medical evaluation before starting an exercise program. 4. To identify persons with special needs for safe exercise participation (e.g., elderly persons, pregnant women). The Purposes forThe Purposes for Pre-Participation Health ScreeningsPre-Participation Health Screenings Review of ACSM GuidelinesReview of ACSM Guidelines
  5. 5. Health Screening Devices By order of cost and complexity Self administered health questionnaire Par Q Analysis of CAD Risk Profile Physical exam by a physician Basic diagnostic Exercise Testing (GXT) Advanced diagnostic exercise testing (Nuclear stress, Stress Echo, Pharmacological Stress)
  6. 6. Risk Factors for CAD American College of Sports Medicine Positive Risk Factors Age Family History Cigarette Smoking Hypertension Hypercholesterolemia Diabetes Mellitus Sedentary Lifestyle/Activity Negative Risk Factors High Serum HDL Cholesterol
  7. 7. Risk Factors for CAD American College of Sports Medicine Table 2-1 Page 24 in Guidelines or Page 19 in Heyward.
  8. 8. Risk Factors Count the number of positive risk factors and subtract the number of negative risk factors
  9. 9. At risk if Coronary Disease is present in the form of MI or Sudden Death: Father or Brother (1st degree relative) prior to the age of 55. Mother or Sister (1st degree relative) prior to the age of 65. Family HistoryFamily History Risk Factors for CAD American College of Sports Medicine
  10. 10. At risk if, Current use is present. Residual effects may be manifest even if smoking has stopped Removal of Risk (?)Removal of Risk (?) Cessation for > 2-6 monthsCessation for > 2-6 months Risk Factors for CAD American College of Sports Medicine Cigarette/Cigar Smoking
  11. 11. Resting Blood Pressure > 140/90 mm Hg confirmed by 2 separate measurements (6th congress on hypertension) “systolic>140 or diastolic >90” Current Prescription for Blood Pressure Medicine (for hypertensive diagnosis) Risk Factors for CAD American College of Sports Medicine Blood Pressure
  12. 12. Blood Pressure:Blood Pressure: SystolicSystolic DiastolicDiastolic OptimalOptimal <120<120 <80<80 NormalNormal 120-129120-129 80-8480-84 High NormalHigh Normal 130-139130-139 85-8985-89 Hypertension:Hypertension: Stage 1Stage 1 140-159140-159 90-9990-99 Stage 2Stage 2 160-179160-179 100-109100-109 Stage 3Stage 3 >>180180 >>110110
  13. 13. Risk Factors for CAD American College of Sports Medicine Hypercholesterolemia (Positive Risk) On lipid lowering meds If Lipoprotein profile is not available at risk with Total Cholesterol > 200 mg/dL If Lipoprotein profile is available at risk with HDL cholesterol < 35 mg/dL LDL>130
  14. 14. Risk Factors for CAD American College of Sports Medicine Hypercholesterolemia (Negative Risk) Lipoprotein profile must be available. Subtract one risk factor if HDL cholesterol is > 60 mg/dL
  15. 15. Risk Factors for CAD American College of Sports Medicine Diabetes Mellitus At Risk if: diagnosed with DM and conditions below are unmet (fasting glucose is >110 mg/dl on two occasions) Classified as Known Disease: diagnosed with Type 1 for more than 15 years or diagnosed with Type 1 & age > 30 or diagnosed with Type 2 and age > 35
  16. 16. Risk Factors Other risk factors:Other risk factors: Obesity (AHA) BMI>30 or waist of >100Obesity (AHA) BMI>30 or waist of >100 cm for men and >88 for womencm for men and >88 for women Use your best judgement due to the controversyUse your best judgement due to the controversy
  17. 17. Risk Factors for CAD American College of Sports Medicine Physical Inactivity At risk if: A combination of a sedentary job involving sitting a large part of the day The absence of regular exercise or a recreational pursuit (accumulating 30 min or more of moderate physical activity most days of the week)
  18. 18. Signs/Symptoms of CAD Angina Shortness of breath at rest or with exercise Dizzy Nocturnal dyspnea Edema (ankle) Tachycardia or palpations Heart murmur Unusual fatigue Claudicating (limping)
  19. 19.  Low Risk (apparently healthy): = 0 -1 Risk Factor and younger  Moderate Risk:= > 2 Risk Factors OR older (>45 males; >55 female)  High Risk= Current diagnosis of Cardiac, Pulmonary, Metabolic disease (known disease) or > 1 Sign/Symptom of CAD Pre-Participation Screening GuidelinesPre-Participation Screening Guidelines American College of Sports MedicineAmerican College of Sports Medicine ACSM Risk Stratification CategoriesACSM Risk Stratification Categories
  20. 20. Pre-Participation Testing GuidelinesPre-Participation Testing Guidelines American College of Sports MedicineAmerican College of Sports Medicine Pre-participation testing is recommended for: – Low Risk Mod Risk High Risk Mod NA NA Rec Vig NA Rec Rec Physician Present at Exercise Tests Sub NA NA Rec Max NA Rec Rec
  21. 21. Pre-Participation Testing GuidelinesPre-Participation Testing Guidelines American College of Sports MedicineAmerican College of Sports Medicine Moderate IntensityModerate Intensity Exertional level of = 40-60% of maximal oxygen consumption Exertional level = 3-6 METS Brisk walking 3-4 mph (may be hard for some) An exertional level that allows for sustained exercise for 45 minutes or more (non-competitive, well within the individuals capacity)
  22. 22. Pre-Participation Testing GuidelinesPre-Participation Testing Guidelines American College of Sports MedicineAmerican College of Sports Medicine VigorousVigorous Exertional level > 60% of maximal oxygen consumption Exertional level > 6 METS an effort great enough to cause fatigue within 20 minutes
  23. 23. Risk Factor ReviewRisk Factor Review Non-ModifiableNon-Modifiable AgeAge Male genderMale gender Family historyFamily history ModifiableModifiable Cigarette smokingCigarette smoking HypertensionHypertension Poor cholesterol profilePoor cholesterol profile (High TC, LDL, Low HDL)(High TC, LDL, Low HDL) DiabetesDiabetes Physical InactivityPhysical Inactivity
  24. 24. Case Study A 48-year old female desires to start an exercise program in your facility. Following an initial questionnaire and interview you find that she has no personal history of heart disease, but her father died following a heart attack at the age of 60. In addition, she has a resting BP of 145/85. Her total cholesterol is 220 with an HDL of 69. She is not obese. She currently walks 30 minutes 4 times per week, but does not strength train. According to ACSM this person is at low risk, at moderate risk, at high risk, or none of the above.
  25. 25. Case Study from previous slide A. Undergo medical exam prior to starting a vigorous program with a physician available to supervise max exercise B. Undergo medical exam prior to starting a vigorous program but no physician is necessary for max exercise C. No medical exam prior to vigorous program but a physician is necessary for max exercise D. No medical exam prior to vigorous program and no physician is necessary for max exercise.
  26. 26. Case Study John Smith is 43. His blood pressure is 128/82, and his cholesterol is 222. He has a very stressful job and has not exercised in 7 years. John’s 70- year old mother had a heart attack last year. According to ACSM, how many positive risk factors does John have? 5, 4, 3, or 2?
  27. 27. Contraindications to Exercise Absolute ContraindicationsAbsolute Contraindications Recent significant change in resting ECGRecent significant change in resting ECG Severe CAD: Unstable angina and/or acute MISevere CAD: Unstable angina and/or acute MI Acute CHFAcute CHF Uncontrolled ventricular arrhythmia’sUncontrolled ventricular arrhythmia’s
  28. 28. ContraindicationsContraindications Uncontrolled atrial arrhythmias (compromisingUncontrolled atrial arrhythmias (compromising cardiac function)cardiac function) Third degree AV block w/o pacemakerThird degree AV block w/o pacemaker Suspected or known dissecting aneurysmSuspected or known dissecting aneurysm Aortic stenosis (narrowed)Aortic stenosis (narrowed) Myocarditis or pericarditisMyocarditis or pericarditis Thrombophlebitis or intracardiac thrombiThrombophlebitis or intracardiac thrombi Recent systemic or pulmonary embolusRecent systemic or pulmonary embolus
  29. 29. ContraindicationsContraindications Acute infectionsAcute infections Significant emotional stressSignificant emotional stress Relative ContraindicationsRelative Contraindications:: Hypertension: Resting DP > 110 mmHg or resting SPHypertension: Resting DP > 110 mmHg or resting SP > 200mmHg> 200mmHg Moderate valvular diseaseModerate valvular disease Electrolyte abnormalitiesElectrolyte abnormalities Fixed rate pace-makerFixed rate pace-maker
  30. 30. ContraindicationsContraindications Frequent or complex ventricularFrequent or complex ventricular ectopyectopy Ventricular aneurysmVentricular aneurysm Uncontrolled metabolic disease (i.e., diabetes)Uncontrolled metabolic disease (i.e., diabetes) Chronic infectious diseaseChronic infectious disease Neuromuscular, musculoskeletal, or rheumatoidNeuromuscular, musculoskeletal, or rheumatoid disorders exacerbated by exercisedisorders exacerbated by exercise Advanced or complicated pregnancyAdvanced or complicated pregnancy
  31. 31. Musculoskeletal Risk FactorsMusculoskeletal Risk Factors Tables 57.1 & 57.2 Resource ManualTables 57.1 & 57.2 Resource Manual Intrinsic FactorsIntrinsic Factors Bony alignment abnormalitiesBony alignment abnormalities Leg length discrepanciesLeg length discrepancies Muscle weakness and imbalancesMuscle weakness and imbalances Lack of flexibilityLack of flexibility Joint laxityJoint laxity Body compositionBody composition
  32. 32. Musculoskeletal Risk FactorsMusculoskeletal Risk Factors Previous injuryPrevious injury Previous physical activityPrevious physical activity GenderGender Predisposing musculoskeletal diseasePredisposing musculoskeletal disease Warm-up, stretching exercises (???)Warm-up, stretching exercises (???)
  33. 33. Musculoskeletal Risk FactorsMusculoskeletal Risk Factors Extrinsic FactorsExtrinsic Factors Excessive load on the bodyExcessive load on the body Training “errors”Training “errors” Adverse environmental conditionsAdverse environmental conditions Faulty equipment (I.e., worn shoes)Faulty equipment (I.e., worn shoes)

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