MODULE 9C - PHYSICAL ACTIVITY FOR SPECIAL CONDITIONS |
risk stratification
Physicians are sometimes wary of telling people to exercise, because exercise acutely stresses the heart. Although the risks of having an acute cardiac event are very low, and there are significant benefits to be gained, there are some patients who require medical screening and clearance before beginning an exercise program.
The American College of Sports Medicine's Guidelines for Exercise Testing and Prescription, details a system of risk stratification that can help guide physicians and allied healthcare professionals in making an assessment of whether or not it is appropriate for a patient to exercise, and to what degree. ACSM cites three risk categories that should be considered - low, moderate, and high.
LOW-RISK PATIENT FOR INITIATING EXERCISE
low-risk patients are men age <45 years old or women age <55 who have no symptoms of cardiovascular disease and have no more than one risk factor for cardiovascular disease. Positive risk factors include family history (such as father who had a heart attack or stroke before 55 or a mother who had a heart attack before the age of 65), cigarette smoking, a sedentary lifestyle, obesity, an abnormal lipid profile, and pre-diabetes. A negative risk factor is a high HDL cholesterol level.
Patients who fall into low-risk category can be cleared for low-, moderate-, or vigorous-intensity exercise, without further intervention form a physician or cardiologist. It is always best, however, for the patient to see their own primary care physician before initiating an exercise program. In general, people need to start out at low intensity level of exercise, especially if they are basically sedentary. It is also important to remember to progress slowly. Start low and go slow.
A MODERATE-RISK PATIENT FOR INITIATING EXERCISE
Moderate-risk patients are men >45 years old and women >55 years who are asymptomatic, but have two or more risk factors for cardiovascular disease. These patients can be cleared for low- and moderate-intensity exercise. Further evaluation by an exercise physiologist, cardiologist, or another physician is recommended, if the patient wishes to engage in vigorous-intensity physical activity. They might need an exercise stress test, depending on their specific disease processes and risk factors.
A HIGH-RISK PATIENT INITIATING EXERCISE
High-risk patients are individuals with one or more signs or symptoms of cardiovascular, metabolic, or pulmonary disease. This category includes patients who are diagnosed with diabetes, given that they are considered to have metabolic disease. Does this mean that someone with a history of heart attack or stroke should not exercise at all? No. However, they may need to go through cardiac rehabilitation and be cleared by a physician to exercise on their own. They may be required to perform a specific progression of exercise before switching to a home exercise routine that they can undertake safely.
Unlike patients who a low- or moderate-risk, it is recommended that patients who are at high risk of having an adverse event while exercising receive further evaluation prior to initiating any noteworthy level of intensity of physical activity. Going directly from a sedentary lifestyle to vigorous exercise can e dangerous and could result in sudden cardiac arrest or myocardial infarction. With habitual vigorous exercise, however, it has been shown that the relative risk of heart attack can be dramatically reduced.
The American College of Sports Medicine's Guidelines for Exercise Testing and Prescription, details a system of risk stratification that can help guide physicians and allied healthcare professionals in making an assessment of whether or not it is appropriate for a patient to exercise, and to what degree. ACSM cites three risk categories that should be considered - low, moderate, and high.
LOW-RISK PATIENT FOR INITIATING EXERCISE
low-risk patients are men age <45 years old or women age <55 who have no symptoms of cardiovascular disease and have no more than one risk factor for cardiovascular disease. Positive risk factors include family history (such as father who had a heart attack or stroke before 55 or a mother who had a heart attack before the age of 65), cigarette smoking, a sedentary lifestyle, obesity, an abnormal lipid profile, and pre-diabetes. A negative risk factor is a high HDL cholesterol level.
Patients who fall into low-risk category can be cleared for low-, moderate-, or vigorous-intensity exercise, without further intervention form a physician or cardiologist. It is always best, however, for the patient to see their own primary care physician before initiating an exercise program. In general, people need to start out at low intensity level of exercise, especially if they are basically sedentary. It is also important to remember to progress slowly. Start low and go slow.
A MODERATE-RISK PATIENT FOR INITIATING EXERCISE
Moderate-risk patients are men >45 years old and women >55 years who are asymptomatic, but have two or more risk factors for cardiovascular disease. These patients can be cleared for low- and moderate-intensity exercise. Further evaluation by an exercise physiologist, cardiologist, or another physician is recommended, if the patient wishes to engage in vigorous-intensity physical activity. They might need an exercise stress test, depending on their specific disease processes and risk factors.
A HIGH-RISK PATIENT INITIATING EXERCISE
High-risk patients are individuals with one or more signs or symptoms of cardiovascular, metabolic, or pulmonary disease. This category includes patients who are diagnosed with diabetes, given that they are considered to have metabolic disease. Does this mean that someone with a history of heart attack or stroke should not exercise at all? No. However, they may need to go through cardiac rehabilitation and be cleared by a physician to exercise on their own. They may be required to perform a specific progression of exercise before switching to a home exercise routine that they can undertake safely.
Unlike patients who a low- or moderate-risk, it is recommended that patients who are at high risk of having an adverse event while exercising receive further evaluation prior to initiating any noteworthy level of intensity of physical activity. Going directly from a sedentary lifestyle to vigorous exercise can e dangerous and could result in sudden cardiac arrest or myocardial infarction. With habitual vigorous exercise, however, it has been shown that the relative risk of heart attack can be dramatically reduced.
exercise and pregnancy
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exercise for children
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exercise for elderly
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cardioworkout structure
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ARTICLE REVIEW
TASK - Reflective Journal |
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