1. ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 3 Pretest Clinical Evaluation David Arnall, Ph.D., P.T., FACSM, ES

2. What is Necessary ? l Medical History l Medical diagnosis l Previous medical history l Hx of presenting symptoms l Recent illnesses, hospitalizations, etc. l Orthopedic problems l Medication history

3. l Review of habits - tobacco use, ETOH, caffeine use, illicit drugs l Exercise history l Work history l Family history of sudden death, stroke, metabolic disease, COPD, and presence of cardiac problems

4. Components Of The Physical Exam l Body weight l BP - rest, supine, sitting, standing l Heart & lung auscultation l Palpation of pulses l Palpation of BLE’s for edema & staining l Inspection for xanthomas l Neurological tests - balance, cognition, etc.

5. Recommended Lab Tests l Total serum cholesterol and HDL l Fasting triglycerides l Fasting blood glucose l EKG, PFT, Chest X-Ray l Complete panel & blood count l Thyroid function

6. What are the Desirable Lipoprotein Values ? l Cholesterol : < 200 mg/dl l HDL : > 35 mg/dl l LDL : < 130 mg/dl l Triglycerides : < 200 mg/dl

7. Some Important Blood Values l RBC : l  4.5 - 6.5 x 10 12 /L l  3.9 - 5.6 x 10 12 /L l Hematocrit : l  40% - 52% :  36% - 48% l Hemaglobin : l  14 - 17 g/dl :  11 - 15 g/dl

8. l WBC : 4 - 11 x 10 9 /L l Platelets : 150 - 450 x 10 9 /L l Fasting Glucose : 60 -110 mg/dl l Blood Urea Nitrogen : 4 - 24 mg/dl l Creatinine : 0.3 - 1.4 mg/dl

9. Contraindications To Exercise l Absolute Contraindications l Unstable angina l Uncontrolled dysrhythmias l Recent EKG changes & cardiac events l Acute myocarditis/pericarditis

10. l Acute pulmonary embolism/infarction l Severe aortic stenosis l Dissecting aneurysm l Acute infections

11. Contraindications To Exercise l Relative Contraindications l Left main coronary stenosis l Severe hypertension (>200/110) l Tachycardias/bradycardias l Uncontrolled metabolic disease l High-degree AV blocks

12. l Chronic infectious diseases l Cardiomyopathy & outflow obstructions l Stenotic valve disease l ventricular aneurysm

13. l Informed Consent l Purpose & benefits of the testing l Risks associated with the test l A statement indicating that the patient can ask questions l A statement saying the patient can stop the test whenever they want l Emergency equipment is available

14. Patient Preparation For Testing l Refrain from food & alcohol before test l Patient should be well rested l Patient wears loose fitting clothing l Patient should have a family member to take them home

15. l Patient may need to alter current medication use if this effects the test (antianginal drugs alter EKG responses) l Patient may need to continue their medications to guarantee consistent outcomes (beta-blockers) l Patient should bring all of their medications to the test site