Inquiry : Determining the Need for Clinical Exercise Testing
With the printing of the 10th Edition of ACSM's Guidelines for Exercise Testing and Prescription, several changes to the exercise preparticipation screening algorithm have occurred.
If you are presented with an individual who does not participate in regular exercise, describe the process for deciding the appropriate level of clearance and exercise intensity.
In your discussion, clarify the signs/symptoms suggestive of CV disease to be aware of and how levels of intensity are defined in your decision.
If medical clearance is required prior to exercise, what considerations are given to the procedures during clearance?
Perform a preparticipation screening on the following individual:
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60 yrs, male
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Single vessel AMI at 50 yrs old, stent placed in LAD artery
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No recent changes to medical status
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Walks 3x/wk/30 min
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Cardiac Rehab unremarkable/successful
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Goal: Wants to climb Mt. Rainier
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Taking simvastatin and ACE inhibitor, and baby aspirin regimen
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Certain individuals will nevertheless require clinical exercise testing for a number of reasons.
Discuss the indications for a clinical exercise test to include an analysis of the pretest likelihood of ischemic heart disease.
Prior to conducting an exercise test on a 65 year old male, you note during resting EKG the onset of previously undiagnosed atrial fibrillation.
What would your recommendation be on whether or not to proceed with symptom-limited maximal exercise testing? Explain the process of coming to your decision in this case.