engleski

What Primary Health Care Physicians Need to Know on Preparticipation Health Assessment and Risk Classification?

Physical activity is associated with many health benefits. Its role in prevention, treatment, and rehabilitation of numerous diseases is well-recognized. Although recommended for all people, engagement in physical activity and exercise programs, especially in previously sedentary individuals, can pose some health risks. Primarily, these include cardiovascular incidents and musculoskeletal injuries. Preparticipation health assessment and risk classification is, therefore, necessary before starting with a physical activity/exercise program. Due to their professional authority and direct contact with patients/potential novice exercisers, the primary health care physicians could play a major role in physical activity promotion and counselling, which obviously should incorporate a preparticipation health risk assessment. According to the guidelines provided by the American College of Sports Medicine (ACSM), the assessment should include screening for the presence of risk factors, signs, symptoms and/or presence of several cardiovascular, pulmonary, and metabolic diseases. Other conditions and/or disorders—such as pregnancy or musculoskeletal injuries—that would require particular attention regarding exercise participation, should also be screened for. Such an assessment provides information needed for subsequent safe performance of exercise testing and safe and effective exercise programming. The physicians should collect information on the patient’s health history, family history, their present medical conditions, signs, symptoms and risk factors, as well as current physical activity habits and medications. There are questionnaires available that can help the physicians in collecting the information needed for accurate risk assessment, such as the PAR-Q or the AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire. They can also be self- administered. The cardiovascular disease (CVD) risk factors that should be taken into account are: age, family history of cardiovascular diseases and sudden death, cigarette smoking, sedentary lifestyle, obesity (measured by body mass index or waist circumference), hypertension, dyslipidemia (evidenced by elevated low-density lipoprotein or total serum cholesterol, or low high-density lipoprotein (HDL)), prediabetes (impaired fasting glucose or impaired glucose tolerance). In the risk classification, a person is considered to be at low risk if asymptomatic and having one (or no) mentioned CVD risk factors. Persons at moderate risk are also asymptomatic, but have two (or more) CVD risk factors. It should, however, be noted that a high-serum HDL cholesterol is considered a negative (protective) risk factor and should, if present, be subtracted from the sum of positive risk factors in the risk classification. A person is immediately considered at high risk if he/she has one or more signs or symptoms of, or is diagnosed with relevant cardiovascular, pulmonary, or metabolic diseases. Based on the risk classification, a decision is made on whether: 1) the person should undergo a complete medical exam and obtain clearance before enrolling in an exercise program (depending also on the intensity of the program), 2) a graded exercise testing should be performed before starting with the exercise program, and 3) a medical doctor should supervise the maximal or submaximal exercise testing.

medical doctors ; exercise ; risk factors ; screening

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