Health Screening (Online Support)

Going for a Run

Introduction

 

This module is designed to provide you with key competences in health screening various clients. At the end of this module  you should be able to devise and apply a prepared pre-exercise screening questionnaire. This module is designed to create a better understanding for when you work in the health and fitness industry setting. 

Key Outcome Measures

On successful completion of the module you will be able to: 

  1. Describe key factors relating to screening. 

  2. Apply appropriate screening procedures to a specific client. 

Outcome 1 

Describe key factors relating to health screening. 

Necessary Evidence To Demonstrate Understanding

  • Purpose of screening: health related/identification of goals and targets 

  • Screening procedures 

  • Contraindications 

  • Informed consent 

  • Data protection 

You are required to provide evidence which includes: 

  • A description of the purposes of screening. 

  • An explanation identifying appropriate screening procedure. 

  • A health screening questionnaire (incorporating medical history, current contraindications, informed consent, and data protection section). 

  • A lifestyle questionnaire (incorporating physical activity history, physical activity preferences, goals and targets, nutrition and diet, availability, smoking and alcohol use). 

Outcome 2 

Apply appropriate screening procedures to a specific client. 

Necessary Evidence To Demonstrate Understanding

  • Communication skills 

  • Application and analysis of screening questionnaires 

  • Identification and interpretation of contraindications 

  • Informed consent 

  • Data protection 

  • Client profiling 

 

The assessment for outcome 2 will be a practical exercise where you will explain to a client and complete the screening questionnaires (designed in Outcome 1). If this is performed with two separate questionnaires, then both need to incorporated (i.e informed consent and data protection detail). Throughout the practical you must:

  • Provide analysis of questionnaires including any contraindications (or GP referral issues if appropriate), and address the issues of informed consent and data protection. 

  • Communicate professionally with a client and relate to the client in a positive manner. 

  • Provide written/oral evidence of the client profile identifying and interpreting all relevant information, including identification of goals and targets. 

Pre-participation Health Screening 

For some medical conditions, there may be a relatively higher associated health risk with physical activity (PA). Although the risk of acute musculoskeletal injury during exercise is well recognised, the major concern for primary care practitioners remains the increased risk of sudden cardiac death (heart attacks) and acute coronary events for high risk individuals. Hence, it is important that fitness professionals understand that before prescribing a given dose of exercise, a pre-participation health screening and a risk stratification process should be conducted to identify if clients are of significant  risk while not creating a  barrier to exercise participation . The identification of risk factors for adverse exercise-related events can be achieved through a two-tier approach including a self-guided screening and/or a professionally guided screening.

 
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Free Example Lifestyle Questionnaire (Click image)

Free Customer Care Booklet (Click image)

Buy Health Screening Exam Prep book (Click image)

Self-guided Screening for Physical Activity

The fitness professional should initially ask the client to complete a risk evaluation ( with assistance from the exercising individual or by allied health professionals). For instance, subjects may follow the recommendation of the Surgeon General’s Report on Physical Activity and Health (1996): “previously physically inactive men over age 40 and women over age 50, and people at high risk for cardiovascular disease (CVD) should first consult a physician before embarking on a programme of vigorous physical activity to which they are unaccustomed” (1). Clients may also be asked to complete some validated questionnaires such as the American Heart Association (AHA)/ the American College of Sports Medicine (ACSM) Health/ Fitness Facility Pre-participation Questionnaire  or the revised Physical Activity Readiness Questionnaire (PAR-Q) before participation. These questionnaires are simple and easy-to-use by the lay person to determine if his or her risk is such that a primary care practitioner should be consulted before initiating physical activity, particularly if the intended exercise intensity is vigorous. 

Presentation (Above) On The Application of ACSM's Updated Exercise Pre-participation Health Screening Algorithm

ACSM Webinar on Updated Exercise Pre-participation Health Screening |

Learning Objectives (1) Provide information and overview of the changes in ACSM's exercise pre-participation health screening.

(2) Describe how this affects the jobs of currently practicing exercise professionals.

(3) Provide examples of how to apply the pre-participation algorithm.

(4) Which exams will be effected by the change and when those changes will take effect. Led by Meir Magal, PhD, FACSM

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Click image for download

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ACSM's Updated Recommendations for Exercise Pre-participation Health Screening | Webinar

ACSM's Updated Recommendations for Exercise Preparticipation Health Screening - Recent studies have suggested that using the current ACSM exercise preparticipation health screening recommendations can result in unnecessary physician referrals, possibly creating a barrier to exercise participation. The purpose of this webinar is to provide more information on the updated recommendations Presenters: Carol Ewing Garber, Ph.D., FACSM, Linda Pescatello, Ph.D., FACSM, and Deb Riebe, Ph.D., FACSM

Professionally Guided Screening for Physical Activity

A superior and more thorough assessment can be performed by the primary care practitioner into an individuals’ Coronary Vascular Disease (CVD) risk factors, signs and symptoms, and to identify a greater extent of chronic diseases that may need particular care before exercise participation. 

ACSM proposed a risk stratification scheme (summarised in Figure 1) which assigns individuals into one of its three risk categories (Table 1) according to specific criteria (Tables 2 - 4). Once the risk category has been established, appropriate recommendations before initiating an exercise or significantly progressing the intensity and volume of an existing exercise may be made regarding the necessity for further medical workups and diagnostic exercise testing.

 
Preparticpation Health Screening & Risk.

Figure 1 - Logic Model for the ACSM Risk Stratification Scheme. Adopted from the Preparticipation Health Screening and Risk Stratification. In Walter R Thompson; Neil F Gordon; Linda S Pescatello. ACSM’s guidelines for exercise testing and prescription. 8th ed. American College ofSports Medicine; 2010. 

Table 1. The ACSM Risk Stratification Categories

 

Adopted from the Preparticipation Health Screening and Risk Stratification. In Walter R Thompson; Neil F Gordon; Linda S Pescatello. ACSM’s guidelines for exercise testing and prescription. 8th ed. American College of Sports Medicine; 2010

The ACSM recommendations on exercise testing are summarised in Table 5. It should be noted that the methodology of pre-participation risk assessment is both complex and controversial, and other organisations such as the European Society of Cardiology, the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation also published their own guidelines for risk stratification (2-5). Many of them rely on expert consensus in the absence of existing scientific evidence. Primary care practitioners should choose the most applicable tools and instruments for their own settings and populations when making decisions about the level of screening before exercise participation (2,6). Alternatively, primary care practitioners may also ascertain a global coronary and cardiovascular risk score for their patients, such as the Framingham Risk Score or the Systematic Coronary Risk Evaluation (SCORE), for combining the individual’s risk factor measurements into a single quantitative estimate of the absolute risk of atherosclerotic cardiovascular death within 10 years (7-8). 

Table 2. Cardiovascular Disease Risk Factors for Use with the ACSM Risk Stratification

* Modified from the Preparticipation Health Screening and Risk Stratification. In Walter R Thompson; Neil F Gordon; Linda S Pescatello. ACSM’s guidelines for exercise testing and prescription. 8th ed. American College of Sports Medicine; 2010.

+ If HDL is high, subtract one risk factor from the sum of positive risk factors.

 

# The above BMI classification is promulgated by the World Health Organisation (Western Pacific Region Office) for reference by Asian adults and is not applicable to children under the age of 18 or pregnant women.

 

Table 3. Cardiovascular Disease, Pulmonary Diseases and Metabolic Diseases Suggesting High Risk for Physical Activity*

* Modified from the Preparticipation Health Screening and Risk Stratification. In Walter R Thompson; Neil F Gordon; Linda S Pescatello. ACSM’s guidelines for exercise testing and prescription. 8th ed. American College of Sports Medicine; 2010.

Table 4. Major Signs and Symptoms Suggestive of Cardiovascular Disease, Pulmonary Disease or Metabolic Disease*^

* Modified from the Preparticipation Health Screening and Risk Stratification. In Walter R Thompson; Neil F Gordon; Linda S Pescatello. ACSM’s guidelines for exercise testing and prescription. 8th ed. American College of Sports Medicine; 2010.

^ These signs or symptoms must be interpreted within the clinical context in which they appear because they are not all specific for significant cardiovascular, pulmonary, or metabolic disease.

Table 5. The ACSM recommendations on exercise testing based on the ACSM risk stratification

Need Further or Additional Support 

If you require further online guidance then Strength-Physiology.Online also has a 1-to-1 online tutoring service that involves synchronous tutoring with real-time interaction between the student and myself. It involves specific software that allows both parties to communicate directly via video, audio, or text. Additionally, we provide a proofreading and editing service with a comprehensive, content-focused review. We will remove factual errors, clarify obscure passages, eliminate irrelevant content, ensure a smooth and unbroken flow, and reorganise text where needed. We can also edit in adherence to a specific style guide.

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References

  1. U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the SurgeonGeneral. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.

  2. Borjesson M, Urhausen A, Kouidi E, Dugmore D, Sharma S, Halle M, Heidbüchel H, Björnstad HH, Gielen S,Mezzani A, Corrado D, Pelliccia A, Vanhees L. Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2010;Jun 19.

  3. Balady GJ, Chaitman B, Driscoll D, Foster C, Froelicher E, Gordon N, Pate R, Rippe J, Bazzarre T.Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation 1998;Jun 9;97(22):2283-93.

  4. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, RodneyR, Simons-Morton DA, Williams MA, Bazzarre T. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001;Oct 2;104(14):1694-740.

  5. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitationand Secondary Prevention Programs. 4th ed. Champaign, (IL): Human Kinetics Publishers; 2004.

  6. Walter R Thompson; Neil F Gordon; Linda S Pescatello. ACSM’s guidelines for exercise testing and prescription.8th ed. American College of Sports Medicine; 2010.

  7. Wilson PWF, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heartdisease using risk factor categories. Circulation 1998;97:1837-47.

  8. Conroy RM, Pyo¨ ra¨ la¨ K, Fitzgerald AP, Sans S, Menotti A, deBacker G, et al. Estimation of ten-year risk offatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24:987–1003. 22