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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
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
slide3
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
slide8
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
slide10
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
slide12
Chronic infectious diseases
  • Cardiomyopathy & outflow obstructions
  • Stenotic valve disease
  • ventricular aneurysm
slide13
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
slide15
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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