Chapter 3

3

Personal Health: ItPersonal Health: It’’s Your s Your ResponsibilityResponsibility

C H A P T E R

Objectives

This chapter will help you do the following:

•Recognize the values and limitations of both health screening and early detection

•Develop a schedule for periodic medical examinations

•Determine the need for a pre-exercise medical exam

•Understand the risks and benefits of regular, moderate physical activity

Health Screening

• Asks about health habits and some basic information (age, sex, weight, blood pressure, and cholesterol) to calculate health risks and compute one’s risk age

• Uses low-cost approaches to identify health habits and risks

• Allows more expensive tests to be reserved for those with the highest risk

Early Detection

• There is considerable interest in development of tests to detect problems early.

• Early detection will improve prognosis for recovery.

• Early detection is meaningless if no effective treatment for the disease is available.

• Medical opinion is changing; aggressive treatment is not always superior to watching and waiting.

(continued)

Early Detection (continued)

Use an early detection test if you are at risk for a disease based on your health screening, and if

•the disease has a significant effect on quality of life,•acceptable methods of treatment are available,•treatment during the asymptomatic (no symptom) period significantly reduces disability or death,•early treatment yields a superior result,•detection tests are available at reasonable cost, and•the incidence of the disease in the population is sufficient to justify the cost of screening.

Blood Pressure: The Silent Killer

Is early detection desirable?

– The disease has a significant effect on the quality of life: YES

– Acceptable methods of treatment are available: YES

– Treatment during the asymptomatic (no symptom) period significantly reduces disability or death: YES

– Early treatment yields a superior result: YES

– Detection tests are available at reasonable cost: YES

– The incidence of the disease in the population is sufficient to justify the cost of screening: YES

Annual Medical Examination

• Reasons people get annual medical exams.

• New research has shown no difference in groups that had annual exams and those that have not had them.

Joe: A Case Study

• Typical patient

• Battery of tests

– Blood panel, chest X-ray, resting ECG, pulmonary function test, and others

• Clean bill of health; he celebrates

• Heart attack next day

What happened with Joe?

Medical Exams

• Reasonable frequency is as follows:

– Around 18 and 25 years of age

– Every 5 years between 35 and 65

– Every 2 years after 65

• Take advantage of worksite wellness and community health-screening programs.

– Use wellness program blood draw to track blood panel yearly

Cholesterol Screening

Does this meet the criteria for early detection?

Preexercise Medical Examination

Recommended by AHA and ACSM under the following conditions:•Known cardiac, pulmonary, or metabolic disease (any age)•Men over 45 (women 55) beginning vigorous exercise

Also consider if individual•has been sedentary,•is concerned about health, and •has risk factors for heart disease.

Health Screening Questionnaire

• See form 3.1

• For those under 45 years of age with no conditions that warrant a medical examination

• Simple, self-administered

• Identifies risk factors for heart disease and other health issues

Exercise Stress Test

• See table 3.3, Age and Maximal Heart Rates, and the box on page 62.

• Maximal or near-maximal workloads are needed to elicit symptoms of undiagnosed heart disease.

• How do we monitor the heart during these tests?

Exercise Electrocardiogram

• Records the hearts electrical activity

• Different parts of heart cycle:

– P wave

– QRS complex

– T wave

Figure 3.5

Test Results

If ECG shows abnormality

•Cardiac catheterization

– Determine if true positive or false positive

– What is the probability of a false positive?

If ECG is true positive

– Coronary bypass

– Angioplasty

• Criteria for nonsurgical intervention (Dr. Graboys of Harvard Medical School)

– Pump condition good

– The electrical stability of the heart, especially under stress

– Absence of symptoms

• What is the nonsurgical alternative?

Nonsurgical Alternative

Risk of Activity

Risk of activity versus sedentary lifestyle

•Habitually active versus sedentary: 60 percent lower risk of heart attack

•Sudden cardiac death during vigorous exercise: 1/15,000-18,000 people

•Risk of a being in a major automobile accident 1/100

Maximize the benefits while minimizing the risks with regular, moderate activity

STOP Signs

• Abnormal heart action

• Pain or pressure in the middle of the chest or in the arm or throat during or after exercise

• Dizziness, light-headedness, sudden loss of coordination, confusion, cold sweat, glassy state, pallor, blueness, or fainting

• Persistent rapid heart rate

– Reduce exercise intensity, increase slowly over time

• Flare-up of bone joint condition

– Rest, resume exercise when condition subsides

YIELD Signs

CAUTION Signs

• Nausea or vomiting after exercise

• Extreme breathlessness lasting more than 10 minutes after stopping exercise

• Prolonged fatigue

• Side stitch

Special Considerations for Exercise

• Older adults: Levels for self-sufficiency

• Women: Pregnancy, pre- and postmenopausal

• Children: Not miniature adults; encourage active lifestyle

• People with disabilities: Uniqueness of individual

• Racial considerations: 1 in 3 African American adults have hypertension

Health and Wellness

• Idea of what health is has changed over the years.

• Wellness relies on individual responsibility.

• Active lifestyle keystone for health and wellness.

Summary

• It is important to visit a physician before beginning an exercise program if a health screening so indicates.

• However, physicians are not necessarily knowledgeable about exercise.

• If you feel good, start slowly, and increase duration and intensity gradually; use your knowledge from reading this book!