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ACE-CPT · Chapter 5

Preparticipation Health Screening

ACSM Algorithm, 3-Step Checklist, PAR-Q+, Signs & Symptoms, Medications & Exercise Heart Rate — before the first rep, know the risks.

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35Case Studies
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ACSM Algorithm · 3-Step Checklist · PAR-Q+ · Signs & Symptoms · Medications

Chapter 5 Theory Quiz

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Chapter 5 Case Studies

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ACSM Preparticipation Algorithm

Exercise StatusNo Disease / No SymptomsKnown Disease, AsymptomaticAny Signs or Symptoms
NOT exercising regularly Medical clearance NOT necessary. Begin light–moderate; progress gradually. Medical clearance RECOMMENDED before vigorous. Light–moderate permitted. Medical clearance RECOMMENDED regardless. STOP if symptoms appear.
IS exercising regularly Continue moderate–vigorous. Progress as tolerated. Continue moderate without clearance. Clearance recommended before vigorous. DISCONTINUE exercise. Seek clearance. May return after clearance.

3-Step Checklist

Step 1 — Symptoms (STOP if yes)Chest discomfort with exertion, unreasonable breathlessness, dizziness/fainting/blackouts, ankle swelling, rapid/irregular HR, burning/cramping in legs when walking
Step 2 — Activity Level≥30 min moderate intensity, ≥3 days/week, ≥3 months = "regularly exercising"
Step 3 — Medical ConditionsHeart attack, heart surgery/cath/angioplasty, pacemaker/ICD/rhythm disturbance, heart valve disease, heart failure, heart transplant, congenital heart disease, diabetes, renal disease
Step 3 LogicNo Step 3 conditions → no clearance needed. Step 2 Yes + Step 3 → light–moderate OK, clearance before vigorous. Step 2 No + Step 3 → clearance recommended

PAR-Q+ Pathways

No to all 7 (Page 1)Cleared — no need to complete Pages 2–3
Yes to any (Page 1) + No to all follow-ups (Pages 2–3)Cleared with caution — start slow, build gradually
Yes to any follow-up (Pages 2–3)Complete ePARmed-X+ at eparmedx.com before becoming more active
ValidityValid for 12 months; invalid if health status changes. Pregnant → ePARmed-X+. Temporarily ill → delay activity

9 Signs & Symptoms (Red Flags)

Chest PainPain in chest, neck, jaw, arms — possible myocardial ischemia
DyspneaShortness of breath at rest or mild exertion
Dizziness/SyncopeFaintness — reduced brain perfusion
Orthopnea/PNDDyspnea lying down or 2–5 hrs after lying down
Ankle EdemaSwelling — possible cardiac/circulatory dysfunction
PalpitationsForceful, rapid, or irregular heartbeat awareness
ClaudicationBurning/cramping in lower legs during exercise
Heart MurmurKnown murmur → follow-up before vigorous exercise
Unusual FatigueDisproportionate fatigue or SOB with usual daily activities

Medications & Exercise HR Effects

DrugResting HRExercise HRVO₂maxTrainer Notes
Beta Blockers↓ dose-relatedUse RPE or talk test — NOT target HR
Ca Channel Blockers↓ or →↓ or →Effect varies by specific agent
ACE InhibitorsNo HR effect; BP lower at rest + exercise
ARBsWell tolerated; no lipid/rebound issues
DiureticsDehydration + electrolyte imbalance → arrhythmia risk
Stimulants / Decongestants↓ enduranceADHD meds, some decongestants
Bronchodilators↑ (COPD/asthma)Minimal effect in healthy; improves exercise capacity in airway obstruction
Caffeine↑ enduranceErgogenic at moderate doses
Antihistamines↑ or ↓↑ or ↓↑ perf/enduranceDrowsiness + drying effect in airways
AlcoholvariablevariableNo exercise while under influence
NSAIDs↓ possibleMay mask pain — caution with intensity

Key Documents

Agreement to ParticipateAcknowledges understanding + voluntary participation — fundamental liability doc
Informed Consent / Assumption of RiskExplains exercise risks; client acknowledges and consents — must be reviewed by local legal professional
Lifestyle & Health-History QuestionnaireComprehensive beyond screening: medications, injuries, family history, nutrition, sleep, stress, substance habits, weight history, goals
Medical Release FormSent to physician → provides trainer with medical info + physical-activity limitations/guidelines. Any deviation must be physician-approved