Health care professionals must be well trained and knowledgable in:

• Client Health Risk Appraisal
• A system in screening clients for signs and symptoof family history
• Risk factors for disease

New clients need new forms.  Information drawn from the screening can help....

• Determine
• Contraindications to exercise (Determining whether or not a client may participate in Exercise program)
• Who must undergo additonal texting including medical evaluatins due to increased risk for disease due to age, symtoms and/or risk factors.

In the presence of any of these one ay need medical supervision while exercising.

Before any exercise testing or health appraisals patients must provide their own informed consent which stresses:

• Risks
• Benefits of ex testing and programming
• while stating the occurrences which are possible during testing, such as risks, side effects, etc.

A signed informed consent serves as a legal and ethical document in the regards of a client's awareness of testing and exercise procedures.

• commonly used form for screening
• minimal standard for entry into exercise programs
• identifies the small #of adults for who physical activity might be inappropriate or who should receive medical advice concerning the most suitable type of activity.

The PAR-Q requires:

• client filling out a 7 ques. questionnaire re: health
• If yes to any of the questions then trainer is required to obtain a Medical Release or consent form from client's healthcare provider before beginning program

All Clients are required to fill out:

• Informed Consents
• Release of Liability

They are often combined into one form

Trainer may or may not require other information of other forms regarding specifics and coherency to a client's profile which can include:

• Orthopedic History
• Nutritional Profile
• Past and Present Activity History
• Exercise Attitude Questionnaire, etc.

The gathered info is used to make recommendations for lifestyle modifications, suggesting strategies for exercise testing, and prescribing exercises.

Physician's Referral is stated in the PAR-Q

• That clients should obtain a medical release from their physician prior to starting an exercise program (safe-guard for high risk clients who may compromise thier health w/out medically trained staff and necessary equipment)  It can be formal or a simple doctor's office script with the physician's name, diagnosis, and exercise prescription.
• Some clients may indicate contraindcations to testing.  In these cases refer patient to their physician for further testing regarding those issues.  This is Mandatory as well as for when the client requires medical clearance into an office or hospital-based program (or medical fitnes center).

The PAR-Q (ACSM Stratification)

• Assigns individuals to low, medium, or high risk, based on presence of conditions

Risk Stratification is determined by:

• Adding up the number of risk factors indicated by clients during their screenings

Positive Risk Factors include:

• Family History of Disease (Myocardial infarction,coronary revascularization, or sudden death before the age of 55 (Male) 65 (female)
• Cigarette smoking (current and those who have smoked w/in 6 months) quit and those who have been exposed to second hand smoke for over 6 months
• Hypertention:  currently taking HBP medications and those confirmed by at least two separate occasions with two separte measurements of a sys bp > or equal to 140 mm Hg or diastolic > or equal to 90 mm per Hg.
• Hypercholesterolemia/Dyslipidemia: currently taking lipid lowering meds and/or those with a total serum cholestorol > 200mg/dL (5.2 mmol/L), or high-density lipoprotein cholesterol of .35 mg/dL (.9 mmol/L). 
• Impaired Fasting Glucose: Fast blood Glucose of > or equal to 110mg/dL (6.1 mmol/L, confirmed by at least two sep measurements on two sep occasions
• Obesity: BML > or equal to 30mg/m² or a waist girth exceeding  approximately 39.4 in.
• Sendentary Lifestyle:  Those not meeting the recommended amount of PA provided by the US Surgeon General's Report of at least 30 minutes of PA at a moderate intensity of (40-60% VO2) at least 3 days a wk for at least 3 mons.

Negative Risks Factors:

• High Serum HDL Cholesterol: >60 mg/dL (1.6 mmol/L)

Emerging Risk Factors:

• Inflammatory Markers: i.e., Reactive C Protein (CRP) and fibrinogen.

Low Risk is men less than 45 yo and women less than 5yo, who are asymptomatic while meeting no more tan one risk factor.

Moderate Risk is Men greater than 45 yo and women greater than 55 yo, or those who meet the threshold for two or more risk factors.

High Risk are individuals with one or more signs and symtoms listed or a kown cardiovascular, pulmonary, or matalolic disease.

Moderate Exercise

is recommended for people with High Risk factors.

Vigorous Exercise is recommended for people with

Moderate and High Risk

Submaxial Test are recommended for

High Risk People

Maximal Text is recommended for

Moderal to High Risk People

Alternative measures can be classifies as

• Low Risk- ea present (no LVD (EF>50%), no dysrhythmias, No complications with MI, CABG, PTCA, aterectomy, and /or stents
• Absence of Chf or sign/syptoms indicating post-event iscemia
• Normal hemodynamics with exercise and recovery
• Patient is asymptomatic, which includes the absence of angina with exertion or recovery
• Function capacity > or equal to METS (if n/a, don't use FWC to determine risk).
• Absence of clinical depression

Moderate Risk (highest nor lowest level)

• Moderately-impaired LV function (EF = 40-50%)
• Angina signs and symptoms during moderate levels of ex (5-6.9 METs) or during recovery.
• Abnormal resting EKGs, including: LBBB; LVH, with or w/out resting ST-T chages; non specific intraventricular conduction delays; WPW; and ventricular paced rhythms
• Digitalis therapy
• Test negative for ischemia who fail to achieve 85% of maximal predicted heart rate.