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Major Coronary Risk Factors

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American College of Sports Medicine. What is a Risk Factor ? ... American College of Sports Medicine. Table 2-1 Page 24 in Guidelines or Page 19 in Heyward. ... – PowerPoint PPT presentation

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Title: Major Coronary Risk Factors


1
Major Coronary Risk Factors Pre-Participation
Guidelines___________________
  • As Established by the
  • American College of Sports Medicine

2
What is a Risk Factor ?
  • An aspect of personal behavior or lifestyle, an
    environmental exposure or inherited
    characteristic, which, on the basis of
    epidemiological evidence, is known to be
    associated with health-related conditions
    considered to be important to prevent.

3
The Realm of Risk Factor Modification
  • Primary Prevention - intervention prior to the
    onset of CAD
  • Secondary Prevention - intervention after the
    onset of CAD

4

The Purposes for Pre-Participation Health
Screenings
Review of ACSM Guidelines
  • 1. To identify and exclude individuals with
    medical contraindications to exercise.
  • 2. To identify persons with clinically
    significant disease conditions who should be
    referred to a medically supervised exercise
    program.
  • 3. To identify individuals with disease symptoms
    and risk factors for disease development who
    should receive further medical evaluation before
    starting an exercise program.
  • 4. To identify persons with special needs for
    safe exercise participation (e.g., elderly
    persons, pregnant women).

5
Health Screening DevicesBy order of cost and
complexity
  • Self administered health questionnaire
  • Par Q
  • Analysis of CAD Risk Profile
  • Physical exam by a physician
  • Basic diagnostic Exercise Testing (GXT)
  • Advanced diagnostic exercise testing (Nuclear
    stress, Stress Echo, Pharmacological Stress)

6
Risk Factors for CAD
American College of Sports Medicine
  • Positive Risk Factors
  • Age
  • Family History
  • Cigarette Smoking
  • Hypertension
  • Hypercholesterolemia
  • Diabetes Mellitus
  • Sedentary Lifestyle/Activity
  • Negative Risk Factors High Serum HDL
    Cholesterol

7
Risk Factors for CAD
American College of Sports Medicine
  • Table 2-1 Page 24 in Guidelines or Page 19 in
    Heyward.

8
Risk Factors
  • Count the number of positive risk factors and
    subtract the number of negative risk factors

9
Risk Factors for CAD
American College of Sports Medicine
Family History
  • At risk if Coronary Disease is present in the
    form of MI or Sudden Death
  • Father or Brother (1st degree relative) prior to
    the age of 55.
  • Mother or Sister (1st degree relative) prior to
    the age of 65.

10
Risk Factors for CAD
American College of Sports MedicineCigarette/Cig
ar Smoking
  • At risk if,
  • Current use is present.
  • Residual effects may be manifest even if smoking
    has stopped

Removal of Risk (?) Cessation for gt 2-6 months
11
Risk Factors for CAD
American College of Sports MedicineBlood
Pressure
  • Resting Blood Pressure gt 140/90 mm Hg
  • confirmed by 2 separate measurements (6th
    congress on hypertension)
  • systolicgt140 or diastolic gt90
  • Current Prescription for Blood Pressure Medicine
    (for hypertensive diagnosis)

12
Blood Pressure Systolic Diastolic Optimal lt1
20 lt80 Normal 120-129 80-84 High
Normal 130-139 85-89 Hypertension Stage 1
140-159 90-99 Stage 2 160-179 100-109 Stage
3 gt180 gt110
13
Risk Factors for CAD
American College of Sports MedicineHypercholeste
rolemia (Positive Risk)
  • On lipid lowering meds
  • If Lipoprotein profile is not available
  • at risk with Total Cholesterol gt 200 mg/dL
  • If Lipoprotein profile is available
  • at risk with HDL cholesterol lt 35 mg/dL
  • LDLgt130

14
Risk Factors for CAD
American College of Sports
MedicineHypercholesterolemia (Negative Risk)
  • Lipoprotein profile must be available.
  • Subtract one risk factor if HDL cholesterol is gt
    60 mg/dL

15
Risk Factors for CAD American College of
Sports MedicineDiabetes Mellitus
  • At Risk if
  • diagnosed with DM and conditions below are unmet
    (fasting glucose is gt110 mg/dl on two occasions)
  • Classified as Known Disease
  • diagnosed with Type 1 for more than 15 years or
  • diagnosed with Type 1 age gt 30 or
  • diagnosed with Type 2 and age gt 35

16
Risk Factors
  • Other risk factors
  • Obesity (AHA) BMIgt30 or waist of gt100 cm for men
    and gt88 for women
  • Use your best judgement due to the controversy

17
Risk Factors for CAD
American College of Sports
MedicinePhysical Inactivity
  • At risk if
  • A combination of a sedentary job involving
    sitting a large part of the day
  • The absence of regular exercise or a recreational
    pursuit (accumulating 30 min or more of moderate
    physical activity most days of the week)

18
Signs/Symptoms of CAD
  • Angina
  • Shortness of breath at rest or with exercise
  • Dizzy
  • Nocturnal dyspnea
  • Edema (ankle)
  • Tachycardia or palpations
  • Heart murmur
  • Unusual fatigue
  • Claudicating (limping)

19
Pre-Participation Screening Guidelines
American
College of Sports Medicine
ACSM Risk Stratification Categories
  • Low Risk (apparently healthy) 0 -1 Risk
    Factor and younger
  • Moderate Risk gt 2 Risk Factors OR
  • older (gt45 males gt55 female)
  • High Risk Current diagnosis of Cardiac,
    Pulmonary, Metabolic disease (known
    disease) or
  • gt 1 Sign/Symptom of CAD

20
Pre-Participation Testing Guidelines
American
College of Sports Medicine
  • Pre-participation testing is recommended for
  • Low Risk Mod Risk High Risk
  • Mod NA NA Rec
  • Vig NA Rec Rec
  • Physician Present at Exercise Tests
  • Sub NA NA Rec
  • Max NA Rec Rec

21
Pre-Participation Testing Guidelines
American
College of Sports Medicine Moderate Intensity
  • Exertional level of 40-60 of maximal oxygen
    consumption
  • Exertional level 3-6 METS
  • Brisk walking 3-4 mph (may be hard for some)
  • An exertional level that allows for sustained
    exercise for 45 minutes or more (non-competitive,
    well within the individuals capacity)

22
Pre-Participation Testing Guidelines
American
College of Sports Medicine Vigorous
  • Exertional level gt 60 of maximal oxygen
    consumption
  • Exertional level gt 6 METS
  • an effort great enough to cause fatigue within 20
    minutes

23
Risk Factor Review
  • Non-Modifiable
  • Age
  • Male gender
  • Family history
  • Modifiable
  • Cigarette smoking
  • Hypertension
  • Poor cholesterol profile (High TC, LDL, Low HDL)
  • Diabetes
  • Physical Inactivity

24
Case Study
  • A 48-year old female desires to start an exercise
    program in your facility. Following an initial
    questionnaire and interview you find that she has
    no personal history of heart disease, but her
    father died following a heart attack at the age
    of 60. In addition, she has a resting BP of
    145/85. Her total cholesterol is 220 with an HDL
    of 69. She is not obese. She currently walks 30
    minutes 4 times per week, but does not strength
    train. According to ACSM this person is at low
    risk, at moderate risk, at high risk, or none of
    the above.

25
Case Study from previous slide
  • A. Undergo medical exam prior to starting a
    vigorous program with a physician available to
    supervise max exercise
  • B. Undergo medical exam prior to starting a
    vigorous program but no physician is necessary
    for max exercise
  • C. No medical exam prior to vigorous program but
    a physician is necessary for max exercise
  • D. No medical exam prior to vigorous program and
    no physician is necessary for max exercise.

26
Case Study
  • John Smith is 43. His blood pressure is 128/82,
    and his cholesterol is 222. He has a very
    stressful job and has not exercised in 7 years.
    Johns 70-year old mother had a heart attack last
    year. According to ACSM, how many positive risk
    factors does John have? 5, 4, 3, or 2?

27
Contraindications to Exercise
  • Absolute Contraindications
  • Recent significant change in resting ECG
  • Severe CAD Unstable angina and/or acute MI
  • Acute CHF
  • Uncontrolled ventricular arrhythmias

28
Contraindications
  • Uncontrolled atrial arrhythmias (compromising
    cardiac function)
  • Third degree AV block w/o pacemaker
  • Suspected or known dissecting aneurysm
  • Aortic stenosis (narrowed)
  • Myocarditis or pericarditis
  • Thrombophlebitis or intracardiac thrombi
  • Recent systemic or pulmonary embolus

29
Contraindications
  • Acute infections
  • Significant emotional stress
  • Relative Contraindications
  • Hypertension Resting DP gt 110 mmHg or resting SP
    gt 200mmHg
  • Moderate valvular disease
  • Electrolyte abnormalities
  • Fixed rate pace-maker

30
Contraindications
  • Frequent or complex ventricular ectopy
  • Ventricular aneurysm
  • Uncontrolled metabolic disease (i.e., diabetes)
  • Chronic infectious disease
  • Neuromuscular, musculoskeletal, or rheumatoid
    disorders exacerbated by exercise
  • Advanced or complicated pregnancy

31
Musculoskeletal Risk Factors
  • Tables 57.1 57.2 Resource Manual
  • Intrinsic Factors
  • Bony alignment abnormalities
  • Leg length discrepancies
  • Muscle weakness and imbalances
  • Lack of flexibility
  • Joint laxity
  • Body composition

32
Musculoskeletal Risk Factors
  • Previous injury
  • Previous physical activity
  • Gender
  • Predisposing musculoskeletal disease
  • Warm-up, stretching exercises (???)

33
Musculoskeletal Risk Factors
  • Extrinsic Factors
  • Excessive load on the body
  • Training errors
  • Adverse environmental conditions
  • Faulty equipment (I.e., worn shoes)
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