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ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3. Pretest Clinical Evaluation David Arnall, Ph.D., P.T., FACSM, ES. What is Necessary ?. Medical History Medical diagnosis Previous medical history Hx of presenting symptoms Recent illnesses, hospitalizations, etc.

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ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3

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Acsm s guidelines for exercise testing and prescription chapter 3

ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3

Pretest Clinical Evaluation

David Arnall, Ph.D., P.T., FACSM, ES


What is necessary

What is Necessary ?

  • Medical History

    • Medical diagnosis

    • Previous medical history

    • Hx of presenting symptoms

    • Recent illnesses, hospitalizations, etc.

    • Orthopedic problems

    • Medication history


Acsm s guidelines for exercise testing and prescription chapter 3

  • Review of habits - tobacco use, ETOH, caffeine use, illicit drugs

  • Exercise history

  • Work history

  • Family history of sudden death, stroke, metabolic disease, COPD, and presence of cardiac problems


Components of the physical exam

Components Of ThePhysical Exam

  • Body weight

  • BP - rest, supine, sitting, standing

  • Heart & lung auscultation

  • Palpation of pulses

  • Palpation of BLE’s for edema & staining

  • Inspection for xanthomas

  • Neurological tests - balance, cognition, etc.


Recommended lab tests

Recommended Lab Tests

  • Total serum cholesterol and HDL

  • Fasting triglycerides

  • Fasting blood glucose

  • EKG, PFT, Chest X-Ray

  • Complete panel & blood count

  • Thyroid function


What are the desirable lipoprotein values

What are the Desirable Lipoprotein Values ?

  • Cholesterol : < 200 mg/dl

  • HDL : > 35 mg/dl

  • LDL : < 130 mg/dl

  • Triglycerides : < 200 mg/dl


Some important blood values

Some Important Blood Values

  • RBC :

    •  4.5 - 6.5 x 1012/L

    •  3.9 - 5.6 x 1012/L

  • Hematocrit :

    •  40% - 52% :  36% - 48%

  • Hemaglobin :

    •  14 - 17 g/dl :  11 - 15 g/dl


  • Acsm s guidelines for exercise testing and prescription chapter 3

    • WBC : 4 - 11 x 109/L

    • Platelets : 150 - 450 x 109/L

    • Fasting Glucose : 60 -110 mg/dl

    • Blood Urea Nitrogen : 4 - 24 mg/dl

    • Creatinine : 0.3 - 1.4 mg/dl


    Contraindications to exercise

    Contraindications To Exercise

    • Absolute Contraindications

      • Unstable angina

      • Uncontrolled dysrhythmias

      • Recent EKG changes & cardiac events

      • Acute myocarditis/pericarditis


    Acsm s guidelines for exercise testing and prescription chapter 3

    • Acute pulmonary embolism/infarction

    • Severe aortic stenosis

    • Dissecting aneurysm

    • Acute infections


    Contraindications to exercise1

    Contraindications To Exercise

    • Relative Contraindications

      • Left main coronary stenosis

      • Severe hypertension (>200/110)

      • Tachycardias/bradycardias

      • Uncontrolled metabolic disease

      • High-degree AV blocks


    Acsm s guidelines for exercise testing and prescription chapter 3

    • Chronic infectious diseases

    • Cardiomyopathy & outflow obstructions

    • Stenotic valve disease

    • ventricular aneurysm


    Acsm s guidelines for exercise testing and prescription chapter 3

    • Informed Consent

      • Purpose & benefits of the testing

      • Risks associated with the test

      • A statement indicating that the patient can ask questions

      • A statement saying the patient can stop the test whenever they want

      • Emergency equipment is available


    Patient preparation for testing

    Patient Preparation For Testing

    • Refrain from food & alcohol before test

    • Patient should be well rested

    • Patient wears loose fitting clothing

    • Patient should have a family member to take them home


    Acsm s guidelines for exercise testing and prescription chapter 3

    • Patient may need to alter current medication use if this effects the test (antianginal drugs alter EKG responses)

    • Patient may need to continue their medications to guarantee consistent outcomes (beta-blockers)

    • Patient should bring all of their medications to the test site


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