Concepts in Fitness Programming

Robert G. McMurray

• Publisher: CRC Press
• Year: 2019
• Print ISBN: 9781138454958
• eBook ISBN: 9781351458504
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Concepts in Fitness Programming presents comprehensive material about various aspects of exercise testing and prescription in a simple, straightforward manner. Intended for individuals who design exercise and fitness programs but who lack extensive background in fitness training, this book provides a wealth of knowledge beyond the basic "how to's"

Section II

Exercise & Fitness

2 Health Risks and Exercise

Purpose: To familiarize individuals with preprogram medical screening and exclusion criteria, and to make fitness instructors aware of medically related factors that could limit a participant’s exercise abilities.

Objectives: To obtain a basic understanding of the screening procedures needed both to ensure the safety of and reduce the risk of injury to participants of exercise programs. In addition, to become acquainted with criteria that would require the temporary or complete suspension of exercise.

INTRODUCTION

One of the primary considerations for all exercise programs is to ensure the safety of the participant. As such, specific policies, procedures, and guidelines regarding who should and should not participate in an exercise program, as well as when an exercise program should be suspended, should be developed to reduce the risk of injury. One must keep in mind that there is no way to completely eliminate the risk of injury during exercise. Exercise by its very nature involves risk. No one, not even the most highly trained athlete, is immune to injuries from exercise or even sudden death during exercise. Although in general the risk of serious medical complication is low during exercise, it is still higher than during sedentary activities. The American College of Sports Medicine (ACSM) points out that the death rate during vigorous exercise for individuals without cardiovascular disease is about one death per 187,500 hours of exercise.¹ In addition, the rate of having a heart attack for male joggers is about one a year for every 18,000 joggers.¹ The incidence of death is approximately doubled for those with cardiovascular disease.² Thus, for the protection of the potential participant, screening guidelines need to be developed. Screening guidelines also reduce the risk of legal liability for a fitness instructor.

Screening should be completed to identify and exclude those individuals with medical contraindications to exercise, identify persons that should receive further medical evaluation before starting an exercise program, identify persons with significant diseases that should be referred to a medically supervised program, and identify the special needs of a participant.² The first step in the screening process is to stratify individuals by potential risk category. Those individuals deemed apparently healthy can be included in a nonmedically supervised or nonsupervised program. Those deemed to be at “high risk” or “diseased” are better served by programs that provide medical supervision.

THE SCREENING PROCESS

The screening process determines a candidate’s ability to participate in the exercise program.² For the fitness instructor this process should result in either accepting the candidate into the program, referring the candidate for further medical testing and evaluation prior to acceptance into the exercise program, or referring the candidate to a more appropriate exercise program.

RISK STRATIFICATION

The first step is to obtain a medical history that will allow for stratification based on risk of cardiovascular disease. The American College of Sports Medicine (ACSM) suggests three risk strata:^1,2

1. Apparently Healthy: Those individuals who are less than 40 years of age, have symptoms or known heart disease, and have no more than one major cardiovascular disease (CVD) risk factor. The American College of Sports Medicine defines major risk factors to include:

A. Diagnosed hypertension: BP_systolic ≥140, BP_diastolic ≥90 mmHg

B. Serum total cholesterol of >200 mg/dl or HDL level < 35 mg/dl

C. Cigarette smoking

D. Family history of CVD in parents or siblings prior to age 55

E. Diabetes mellitus, particularly adult onset

F. Completely sedentary

These apparently healthy individuals can begin moderate intensity exercise programs without the need for exercise testing or medical examination. But for women above age 50 and men above age 40, it is highly recommended that these individuals have a medical examination and a graded exercise test before starting a vigorous exercise program.

2. High Risk: These are individuals that have two or more CVD risk factors, or symptoms suggestive of cardiovascular, metabolic or pulmonary disease. Besides the CVD risk factors listed above, individuals with the following signs or symptoms fall into this category:

A. Pain or discomfort in the chest or surrounding areas

B. Unusual shortness of breath or shortness of breath during mild exertion

C. Dizziness or syncope

D. Dyspnea — labored or painful breathing

E. Ankle edema — swelling

F. Palpations or tachycardia — resting heart rate over 100 bt/min

G. Claudications — lameness or pain during walking

H. Known heart murmur

A medical examination, as well as a physician-monitored, graded exercise test, prior to beginning a vigorous exercise program is highly recommended. The liability of having these individuals in a medically unsupervised program is increased dramatically. So, for their own safety, a medically supervised program may be in their best interest.

3. Individuals with Disease: These are persons with known cardiac, pulmonary or metabolic diseases. These individuals should not participate in an unsupervised, vigorous exercise program. These individuals should be referred to a medically supervised, structured program.

EXERCISE READINESS

Another way of determining readiness of an individual to participate in an exercise program is to obtain health information other than the specific CVD risk factors. The following questionnaire has been developed to identify adults who should receive medical advice before exercising or for whom exercise may not be appropriate. It was developed by the British Columbia Department of Health in June 1975. The questionnaire has been found to be 100% sensitive for the detection of medical contraindications to exercise. But because it is not very sensitive to ECG abnormalities, it is recommended only as a minimum for prescreening. (Copies can be obtained from: Government of Canada, Fitness and Amateur Sports, 365 Laurier Ave. West, Ottawa, Ontario, Canada K1A OX6.) An answer of yes to any of the following questions indicates the need for a candidate to obtain medical clearance before taking part in exercise testing or an exercise program.

A. Has your doctor ever said you have heart trouble?

B. Do you frequently suffer from pains in your chest?

C. Do you often feel faint or have dizzy spells?

D. Has your doctor ever told you that you have a bone or joint problem such as arthritis that is aggravated by exercise or might be made worse with exercise?

E. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?

F. Are you over age 65 and not accustomed to vigorous exercise?

The exerciser should also complete a self-administered health questionnaire. This questionnaire is used to obtain more in-depth information concerning the health of the candidate. The information can be used not only to screen the candidate but also to determine if limitations exist that need to be considered in the development of a customized exercise program for the candidate. As the title indicates, it is self-administered and should be signed by the participant. The following histories should be included.² Some of this information overlaps with the above questions and need not be obtained more than once. However, asking about the same information using a different question format could bring about a different answer. A candidate’s responses to this questionnaire will indicate to the instructor whether or not physician approval should be sought before the candidate begins an unsupervised exercise program.

1. Heart attack, coronary bypass surgery, angioplasty, or other cardiac surgery, including family historie...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Preface
• Author
• Acknowledgments
• Table of Contents
• Section I: The Physiology
• Section II: Exercise & Fitness
• Section III: Medical & Legal Implications
• Section IV: Lifestyle Considerations
• Appendices
• Index