Risk Stratification

Question 1

The PAR - Q+ is used as an ______ risk assessment tool.

Answer 1

initial

Question 2

The questions in the PAR - Q+ are worded to obtain information that generally _____ an individual’s ____.

Answer 2

• stratifies

- risk

Question 3

The PAR - Q+ ____ the assessment of risk, but we should perform a _____ ______ _____ ourselves as well.

Answer 3

• simplifies

- secondary risk assessment

Question 4

Secondary risk assessment provides the health/fitness, clinical exercise, and health care professionals with important information for…

Answer 4

the development of an individual’s exercise prescription

Question 5

Secondary risk assessment is important when making decisions about:

Answer 5

• the level of medical clearance
• the need for pre-exercise testing
• the level of supervision for exercise testing and exercise program participation

Question 6

3 parts to the secondary risk factor assessment:

Answer 6

1. do we KNOW there is pathology present?
2. do we SUSPECT there is pathology present?
3. are there other risk factors for CVD present? How many?

Question 7

If we suspect that there is pathology present, then the patient immediately becomes…

Answer 7

high risk

Question 8

Positive CVD risk factors (ACSM): Are they non-modifiable or modifiable?

Answer 8

• age (non-modifiable)
• family history (non-modifiable)
• cigarette smoking (modifiable)
• hypertension (modifiable)
• dyslipidemia (modifiable)
• prediabetes (modifiable)
• obesity (modifiable)
• sedentary lifestyle (modifiable)

Question 9

Defining criteria for age:

Answer 9

• men: > (or equal to) 45 years

- women: > (or equal to) 55 years

Question 10

Defining criteria for family history:

Answer 10

• myocardial infarction (heart attack)
• coronary revascularization (heart surgery)
• sudden death
• before 55 years of age for father or first degree male relative
• before 65 years of age in mother or other first degree female relative

Question 11

Other non-modifiable risk factors:

Answer 11

• sex

- ethnicity

Question 12

How is sex a non-modifiable risk factor?

Answer 12

sex hormones protect against CVD

Question 13

Why is the defining criteria for age lower in males than females?

Answer 13

• menopause: lose protection from sex hormones

- women often catch up to and surpass men after menopause

Question 14

How is ethnicity a non-modifiable risk factor?

Answer 14

• genetic predisposition
• African Americans have higher risk of renal disease, CVD
• Asians have higher risk of high BP during pregnancy

Question 15

Defining criteria for cigarette smoking:

Answer 15

current smoker or those who quit with the previous 6 months

Question 16

Defining criteria for hypertension:

Answer 16

• SBP > (or equal to) 140/90 mmHg
• or DBP > (or equal to) 90 mmHg
• measured on 2 separate occasions
• or taking anti-hypertensive medication

Question 17

Defining criteria for dyslipidemia:

Answer 17

• LDL > 3.37 mmol/l
• or HDL < 1.04 mmol/l
• or on lipid lowering meds
• if total serum cholesterol is all that is available, use > 5.18 mmol/l

Question 18

Defining criteria for prediabetes:

Answer 18

• impaired fasting blood glucose of > (or equal to) 5.5 mmol/L
• or impaired glucose tolerance > (or equal to) 7.7 mmol/L
• confirmed on 2 seperate occasions

Question 19

Describe the interactive effect between LDL and HDL.

Answer 19

• LDL = bad
• as LDL gets higher, risk goes up
• HDL = good
• regardless of where your LDL is, the risk comes down if you have elevated HDL

Question 20

Positive risk factor vs negative risk factor:

Answer 20

• positive risk factor contributes to risk
• negative risk factor takes away from risk
• negative risk factor is a positive thing

Question 21

Defining criteria for obesity:

Answer 21

• BMI: > (or equal to) 30 kg/m^2

- or waist girth: > 102 cm for men and > 88 cm for women

Question 22

Defining criteria for sedentary lifestyle:

Answer 22

• not participating in PA
• or not meeting the min. recommendation of 30 min of moderate exercise at least 3 days of the week for the last 3 months

Question 23

If information is absent….

Answer 23

it should be counted as a risk factor

Question 24

Prediabetes is counted as a risk factor if:

Answer 24

• age > (or equal to) 45 years and BMI > (or equal to) 25a

- OR age < (or equal to) 45 years and BMI > (or equal to) 25 and additional risk factors

Question 25

Negative risk factor for CVD:

Answer 25

person with serum HDL-C > 60 mg/dL (1.6 mmol/L)

Question 26

Low risk (ACSM risk stratification):

Answer 26

- apparently healthy | - asymptomatic men and women who have < 2 (ie. 1 or 0) CVD risk factors

Question 27

Moderate risk (ACSM risk stratification):

Answer 27

- increased risk | - asymptomatic men and women who have > (or equal to) 2 risk factors

Question 28

High risk (ACSM risk stratification):

Answer 28

- known disease | - individuals with one or more signs/symptoms or known cardiovascular pulmonary, or metabolic disease

Question 29

ACSM risk stratification has bearing on....

Answer 29

- medical screening | - how exercise assessments are carried out

Question 30

Differences between ACSM and ESSA pre-exercise screening tool:

Answer 30

- stage 2 is optional - PA level > (or equal to) 150 min/week = - 1 risk factor - stage 3 is optional - HDL cholesterol > 1.55 mmol/L = -1 risk factor

Question 31

If there are extreme or multiple risk factors, the exercise professional should...

Answer 31

use professional judgement to decide whether further medical advice is required

Question 32

Example of tertiary (other) risk assessment:

Answer 32

ACSM health status and health history questionnaire

Question 33

ACSM health status and health history questionnaire includes:

Answer 33

- personal information - ACSM health screen - medical history - family history - medications - lifestyle - other health history information

Question 34

Other tertiary (other) risk assessments:

Answer 34

- smoking - alcohol - physical inactivity - diet

Question 35

What is the name of the website that calculates your life expectancy after assessing risk assessments?

Answer 35

The Big Life Project