Chapter 3 Testing Concepts

1. Chapter 3Testing Concepts Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

2. Key Issues In Chapter 3 • Always obtain a medical history or pre-exercise health risk appraisal on each participant. • Stratify individuals according to their disease risk. • Refer high-risk individuals to a healthcare provider for medical evaluation and a graded exercise test. Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

3. Preparticipation Health Screening • Conduct preparticipation health screening using one or more of several different instruments: • Comprehensive medical/health questionnaire (Physical Fitness Activity 3.2). • Physical Activity Readiness Questionnaire (PAR-Q) (Figure 3.2). • ACSM/AHA questionnaire (Physical Fitness Activity 3.1). Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

4. ACSM Risk Stratification: Counting Risk Factors • 1. Family history (MI, coronary revascularization, or sudden death before 55 yrs in father or other male first-degree relative, or before 65 yrs in mother or other female first degree relative). • 2. Cigarette smoking (current cigarette smoker or those who quit within the previous 6 months). • 3. Hypertension (sBP $140 mm Hg or dBP $90 mm Hg, confirmed on at least 2 separate occasions, or on antihypertensive medication). • 4. Hypercholesterolemia (serum cholesterol of >200 mg/dl or HDL cholesterol of <35 mg/dl, or on lipid-lowering medication. If LDL cholesterol is available, use >130 mg/dl rather than the total cholesterol of >200 mg/dl). If HDL cholesterol is >60 mg/dl, subtract one risk factor from the sum of positive risk factors (negative risk factor). Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

5. ACSM Risk Stratification: Counting Risk Factors (cont) • 5. Impaired fasting glucose (fasting blood glucose of $110 mg/dl, confirmed by measurements on at least 2 separate occasions). • 6. Obesity (body mass index of $30 kg/m2, or waist girth of >100 cm). • 7. Sedentary lifestyle (persons not participating in a regular exercise program or meeting the minimal physical activity recommendations from the U.S. Surgeon General’s report—accumulating 30 minutes or more of moderate physical activity on most days of the week). Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

6. ACSM: Check for these major signs or symptoms • 1. Pain, discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may be due to ischemia. • 2. Shortness of breath at rest or mild exertion. • 3. Dizziness or syncope. • 4. Orthopnea (discomfort in breathing which is brought on or aggravated by lying flat) or paroxysmal nocturnal dyspnea (acute difficulty in breathing appearing suddenly at night, usually waking the patient after an hour or two of sleep). • 5. Ankle edema. Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

7. ACSM: Check for these major signs or symptoms (cont) • 6. Palpitations (forcible or irregular pulsation of the heart, perceptible to the individual, usually with an increase in frequency or force, with or without irregularity in rhythm) or tachycardia (rapid beating of the heart, typically over 100 beats per minute at rest). • 7. Intermittent claudication (a condition caused by lack of blood flow and oxygen to the leg muscles, characterized by attacks of lameness and pain, brought on by walking). • 8. Known heart murmur. • 9. Unusual fatigue or shortness of breath with usual activities. Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

8. Using Screening Results for Risk Stratification Once symptom and risk factor screening has been conducted using questionnaires, the individual considering exercise testing and prescription should be stratified according to disease risk. Stratification according to disease risk is important for several reasons: ! To identify those in need of referral to a healthcare provider for more extensive medical evaluation. ! To ensure the safety of exercise testing and participation. ! To determine the appropriate type of exercise test or program. Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

9. ACSM Risk Stratification Levels • Low risk (men <45 and women <55 years of age who are asymptomatic and meet no more than one risk factor threshold). • Moderate risk (men $45 and women $55 years of age or those who meet the threshold for two or more risk factors). • High risk (individuals with one or more signs/symptoms or known cardiovascular, pulmonary, or metabolic disease including diabetes mellitus). Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

10. ACSM Recommendations for (A) Current Medical Examination* and Exercise Testing Prior to Participation and (B) Physician Supervision of Exercise Tests * Within the past year. ** 3-6 METS; brisk walking; pace that can be sustained for 45 minutes; 40-60% maximal oxygen uptake. † Not essential, but not viewed as inappropriate. † † >6 METS; substantial cardiorespiratory challenge; >60% maximal oxygen uptake. ‡ Physician should be in close proximity and readily available. Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

11. ACSM/AHA Risk Stratification • ACSM/AHA recommend that participants be classified into one of three risk strata (see text for details). • apparently healthy (class A-1) • persons at increased risk (classes A-2 and A-3) • persons with known cardiovascular disease (classes B, C, and D) Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

12. Cardiovascular Screening of Competitive Athletes • About 12-20 athletes die suddenly each year from congenital heart defects. • About a third of these cases are caused by a congenital heart defect called hypertrophic cardiomyopathy. • The AHA recommends that some form of preparticipation cardiovascular screening for high school and collegiate athletes is justifiable. Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

13. Other Issues Covered in Chapter 3 • Informed consent (see Figures 3.5 and 3.6). • Health/fitness facility standards and guidelines (see Box 1.1, Box 3.4). • Certification (see Box 3.5 and the Sports Medicine Insight). Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

14. Concepts and Purposes in Physical Fitness Testing Test Criteria 1. Validity 2. Reliability 3. Norms 4. Economy • Rationale: • To assess current fitness levels • To identify special needs • To evaluate progress • To motivate and educate Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.

15. Physical Fitness Testing Batteries • Pre-test guidelines (see page 64) • Test session organization (see page 64) • Health-related fitness testing batteries • YMCA • CPAFLA • AAHPERD • FITNESSGRAM • PCPFS President’s Challenge Exercise Testing and Prescription: A Health-Related Approach by Nieman. McGraw-Hill.