Prevention of Exercise-Related Cardiac Events
• Health care professionals should know the
pathologic conditions associated with
exercise-related events so that physically active children and adults can be appropriately evaluated.
• Physically active individuals should know the nature of cardiac prodromal symptoms and seek prompt
Prevention of Exercise-Related Cardiac Events
(cont.)
• High school and college athletes should undergo preparticipation screening by qualified
professionals.
Prevention of Exercise-Related Cardiac Events
(cont.)
• Health care facilities should ensure that their staffs are trained in managing cardiac emergencies, have a specified plan, and have appropriate resuscitation equipment (see Appendix B).
Chapter 2
Exercise
Introduction
Compared to previous editions of the Guidelines, the present version of Chapter 2:
• Does not include risk factor analysis or risk level classification
• Makes recommendations for physician clearance rather than specific recommendations for a medical
examination or exercise test.
Introduction (cont.)
• The new preparticipation health screening process is based on
1. The individual's current level of structured physical activity
2. The presence of major signs or symptoms
suggestive of CV, metabolic, or renal diseases (Table 2.1)
Table 2.1 Major Signs or Symptoms Suggestive of Cardiovascular, Metabolic and Renal Disease
• Pain; 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 edema
• Palpitations or tachycardia • Intermittent claudication • Known heart murmur
Introduction (cont.)
• This updated preparticipation process is based on the outcomes of a scientific roundtable sponsored by the American College of Sports Medicine (ACSM) in 2014
• The relative risk of a CV event is transiently increased during vigorous intensity exercise as compared with rest but that the absolute risk of an exercise-related acute cardiac event is low in healthy asymptomatic individuals (Figure 1.2)
Introduction (cont.)
• Insufficient evidence is available to suggest that the presence of CVD risk factors without underlying disease confers
substantial risk of adverse exercise-related CV events • CVD risk factor–based exercise preparticipation health
screening may be overly conservative due to the high prevalence of risk factors and may generate excessive physician referrals, particularly in older adults
• Exercise professionals are encouraged to complete a CVD risk factor assessment with their patients/clients as part of the
Preparticipation Health Screening
Preparticipation health screening before initiating PA or an exercise program is a two-stage process:
1. The need for medical clearance before initiating or
progressing exercise programming is determined using the updated and revised ACSM screening algorithm (see
Figure 2.2)
a) In the absence of professional assistance, interested individuals may use self-guided methods
2. If indicated during screening (see Figure 2.2), medical clearance should be sought from an appropriate health care provider
Self-Guided Methods
• Preparticipation health screening by self-reported medical history or health risk appraisal should be done for all individuals wishing to initiate a physical activity program.
• This self-guided method can be easily
FIGURE 2.1. The Physical Activity Readiness Questionnaire + (PAR-Q+). Reprinted with permission from the PAR-Q+
FIGURE 2.1. The Physical Activity Readiness Questionnaire + (PAR-Q+). Reprinted with permission from the PAR-Q+
FIGURE 2.1. The Physical Activity Readiness Questionnaire + (PAR-Q+). Reprinted with permission from the PAR-Q+
American College of Sports Medicine
Preparticipation Screening Algorithm
• The ACSM preparticipation screening algorithm
(Figure 2.2) is a new instrument designed to identify participants at risk for CV complications during or
immediately after aerobic exercise
• Although resistance training is growing in popularity, current evidence is insufficient regarding CV
complications during resistance training to warrant formal prescreening recommendations
American College of Sports Medicine
Preparticipation Screening Algorithm (cont.)
• Algorithm components
• Classifying individuals who do or do not currently participate in regular exercise
Figure 2.2. The American College of Sports Medicine preparticipation screening algorithm. ACSM, American College of Sports Medicine; HR,
Figure 2.2. The American College of Sports Medicine preparticipation screening algorithm. ACSM, American College of Sports Medicine; HR,
Risk Stratification for Patients in
cardiac Rehabilitation and Medical
Fitness Facilities
• Exercise professionals working with patients with known CVD in exercise-based cardiac rehabilitation and medical fitness
settings are advised to use more in-depth risk stratification procedures
Box 2.2 American Association of
Cardiovascular and Pulmonary
Rehabilitation (AACVPR) Risk
Stratification Criteria for Patients with
Cardiovascular Disease
Characteristics of patients at lowest risk for exercise participation (all characteristics listed must be present for patients to remain at lowest risk)
• Absence of complex ventricular dysrhythmias during exercise testing and recovery • Absence of angina or other significant symptoms (e.g., unusual shortness of breath,
light-headedness, or dizziness, during exercise testing and recovery)
• Presence of normal hemodynamics during exercise testing and recovery (i.e.,
appropriate increases and decreases in heart rate and systolic blood pressure with increasing workloads and recovery)
• Functional capacity ≥7 metabolic equivalents (METs)
