Objectives of this exercise: To administer pre participation screening and risk stratification for clients To write an appropriate exercise prescription and recommendations for exercise supervision

This stage is a self-administered questionnaire

1) Has your doctor ever said that you have a heart/lung condition,

stroke or diabetes and that you should only do physical activity recommended by a doctor?

YES

NO

2) Do you feel pain in your chest when you do physical activity?

YES NO

3) In the past month, have you had chest pain when you were not doing physical activity?

YES NO

4) Do you lose your balance because of dizziness or do you ever lose consciousness?

YES NO

5) Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?

YES NO

6) Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

YES NO

7) Do you know of any other reason why you should not do physical activity?

YES NO

IF YOU ANSWERED ‘YES’ to any of the 7 questions, please seek guidance from your doctor or

appropriate allied health professional prior to undertaking physical activity/exercise

IF YOU ANSWERED ‘NO’ to all of the 7 questions, and you have no other concerns about your

health, you may proceed to initiate physical activity/exercise

Adult Pre Participation Screening

and Exercise Prescription Practicum

Name of Client: ____________________________________

Gender: ____________________________________

Age: ____________________________________

Evaluate for major symptoms/signs of CVS and presence of metabolic and

pulmonary disease. (Appendix 1) Proceed to estimate the number of risk

factors

Criteria Risk Factors

Age: Gender:

≥ 45yrs Males or ≥ 55yrs Females +1 risk factor

Family History of heart disease ( stroke, heart attack) Relative Age Relative Age ⎕ Father _____ ⎕Mother _____ ⎕ Brother _____ ⎕Sister _____ ⎕ Son _____ ⎕Daughter _____

If male < 55yrs = +1 risk factor

If female < 65yrs = +1 risk factor

Maximum of 1 risk factor for this question

Cigarette Smoking Yes/ No

If yes, (smoke regularly or given up within the past 6 months) = +1 risk factor

Physical Activity Level Sedentary Light Moderate Vigorous ⎕ ⎕ ⎕ ⎕

Frequency per week

Minutes per week

If physical activity level< 150 min/ week = +1 risk factor

If physical activity level

≥ 150 min/ week = -1 risk factor

(vigorous physical activity/ exercise weighted x 2)

Height : Weight: BMI = Weight (kg) / Height (m) 2 Abdominal Circumference:

BMI = ________________

BMI ≥ 27.5 kg/m2 = +1 risk factor

Waist ≥ 90 cm for men and ≥ 80 cm for women = +1 risk factor

Blood Pressure /or on Medication (postpone exercise if BP SBP ≥ 200 mm Hg or DBP ≥ 110 mm Hg )

BP ≥ 140 mm Hg systolic or 90 mm Hg diastolic on 2 occasions or on medication = +1 risk factor

Hyperlipidaemia or on medication Total Cholesterol levels LDL levels HDL levels

On medication = +1 risk factors If not on medication: Total cholesterol ≥ 5.20 mmol/L = +1 risk factor

HDL cholesterol ≥1.6 mmol/L = -1 risk factor

HDL cholesterol < 1.00 mmol/L = +1 risk factor

LDL cholesterol ≥ 3.40 mmol/L = +1 risk factor Maximum 1 risk factor

Pre diabetes (fasting glucose)

Fasting glucose ≥ 6.1 mmol = +1 risk factor

TOTAL RISK FACTOR

Presence of Major Symptoms and Signs: ⎕ Yes ⎕No

Presence of CVD, Pulmonary or Metabolic Disease ⎕ Yes ⎕No

(Refer to Appendix 1)

Risk level: (Refer to Appendix 2)

⎕ Low Risk ⎕ Moderate Risk ⎕High Risk

Remarks: ________________________________________________

Need for further exercise medical clearance? ⎕ Yes ⎕No

Remarks: ________________________________________________

Client may initiate exercise

⎕ Up to vigorous intensity

⎕ Up to moderate intensity

⎕ Exercise is withheld pending medical clearance

Appendix 1: List of Major signs and symptoms

List of CVD, Pulmonary and Metabolic Disease

Pain or discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may result from ischemia

Shortness of breath at rest or with mild exertion

Dizziness or syncope

Orthopnea or paroxysmal nocturnal dyspnea

Ankle oedema

Palpitation

Intermittent claudication

Known heart murmur

Unusual fatigue or shortness of breath with usual activities

An individual has known cardiovascular, pulmonary, and/or metabolic disease

if a physician has diagnosed one of the following conditions:

Cardiovascular disease (CVD): cardiac, peripheral artery (PAD) or cerebrovascular disease

Pulmonary disease: chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease or cystic fibrosis

Metabolic disease: diabetes mellitus (type 1 or type 2), thyroid disorders, renal or liver disease

Reference source: ACSM’s Resource Manual for Guidelines for Exercise Testing and

Prescription Sixth Edition

Appendix 2: Risk Categories

HIGH RISK: Individuals classified as high risk are those who have one or more

signs/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease

MODERATE RISK PATIENTS (≥2 RISK FACTORS): Individuals at moderate risk may participate

in aerobic physical activity/exercise at a light or moderate intensity

LOW RISK PATIENTS (< 2 RISK FACTORS or Negative PAR Q): Individuals at low risk may

participate in aerobic physical activity/exercise up to a vigorous or high intensity

LOW RISK MODERATE RISK HIGH RISK Need further medical clearance at a LOW or MODERATE intensity?

NO

Recommended Clients may initiate low to moderate exercise pending clearance

YES

Need further medical clearance before exercising at VIGOROUS intensity?

NO

YES

YES

Supervision required?

NO

Often recommended –depends on the reason for falling into this category

YES

Type of supervision recommended

None

Professional*

Clinical**

*Professional supervision = under the supervision of a health/ fitness professional possessing

a combination of academic training and certification equivalent to the EIMS Clinical Fitness Professional Level 1 **Clinical supervision = under the direct supervision of a health/ fitness professional possessing a combination of advanced college training and certification equivalent to the ACSM Registered Clinical Exercise Physiologist and Exercise Specialist or EIMS CFP level 2 and 3

Appendix 3: Exercise Intensity Guidelines

Adapted from ACSM’s Exercise is Medicine; A Clinician’s Guide to Exercise Prescription by Steven

Jonas and Edward Phillips

Intensity Category

Heart Rate Measure

Rate of Perceived Exertion (RPE)

Description

Light

< 64 % HR max

Very light to light RPE 1-2

An aerobic activity that does not cause a noticeable change in breathing rate An intensity that can be sustained for at least 60 minutes

Moderate

64-76 % HR max

Moderate to somewhat hard RPE 3-4

An aerobic activity that is able to be conducted whilst maintaining a conversation uninterrupted An intensity that may last between 30 and 60 minutes

Vigorous

>76- 90 % HR max

Hard RPE 5-6

An aerobic activity in which a conversation generally cannot be maintained uninterrupted An intensity that may last up to about 30 minutes

High

≥90 % HR max

Very Hard RPE ≥ 7

An intensity that generally cannot be sustained for longer than about 10 minutes

Appendix 4: Quantifying Exercise Intensity

The following information provides a step by step guide on calculating intensity using the

following methods

Percentage of Maximal Heart Rate

Percentage of Heart Rate Reserve

Percentage of Maximal Heart Rate (%HRmax)

In order to calculate a target heart rate (THR) based on a percentage of your client’s HRmax,

you must first either know (from exercise testing) or calculate her HRmax. The simplest way

to calculate HRmax is using the formula

HRmax = 220 − age; however, this method is not the most accurate.

A more accurate, but slightly more complicated method is the formula

HRmax = 206.9 − (0.67 × age)

Once the predicted HRmax for your client is established, multiply this number by the

percentage of HRmax that you would like your patient to exercise at.

The formula for calculating a target heart rate (THR) range using percentage of maximal

heart rate (%HR max) is:

THR = HRmax × desired %

Tutorial Question 1

For a 51 year old client to exercise at moderate intensity, calculate the upper and lower

range of target heart rate using both HR max estimate formulas. The ACSM suggests that

moderate-intensity exercise should be performed at 64%–76% of HRmax

Target Heart Rate (THR) = HRmax × desired %

Using HRmax = 220-age Using HRmax = 206.9 − (0.67 × age)

HRmax = 220 −_____ = _______ HRmax = 206.9 − (0.67 × _____) = _______

Lower range (64%) = 0.64 × ____ = _____ Lower range (64%) = 0.64 × ____ = ______

Upper range (76%) = 0.76 × ____ =______ Upper range (76%) = 0.76 × ____ = _____

Appendix 4: Quantifying Exercise Intensity

Percentage of Heart Rate Reserve (HRR)

Using heart rate reserve (HRR) is a more accurate measure of exercise intensity. This

method calculates the difference between a patient’s maximal and resting heart rate, i.e.,

heart rate reserve or “usable” heart rate range, and then multiplies this number by exercise

intensity (percentage).

In order to use this method, the client’s resting and maximal heart rates need to be known

or estimated using the calculations above.

The formula for calculating a target heart rate (THR) range using heart rate reserve (HRR) is:

THR = [(HRmax – HR rest) × % intensity] + HR rest

Tutorial Question 2

A 51 year old client who has a resting heart rate (HR rest) of 78 beats per minute and you

would like him to exercise at a moderate intensity (40- 60% HRR), then in order to

determine his target heart rate (THR), complete the following calculation.

HR rest: _______ beats/min

HRmax: _______ beats/min (use formula 220- age to determine HRmax)

Exercise intensity: _____- ____ % of HRR

THR = [(HRmax − HR rest) × % intensity] + HR rest

Upper range = [(______ − ______) × _____] + _______

= _________________________________beats per minute

Lower range = [(_______- ______) x _____] + ________

= ________________________________ beats per minute

Reference Source: ACSM’s Exercise is Medicine; A Clinician’s Guide to Exercise Prescription by Steven Jonas and Edward Phillips