Sports Medicine: Just the Facts

the improvement stage. This stage of the exercise pro-

gram usually begins after the first 5 or 6 months of

training, but may begin at any time the participant has

reached preestablished fitness goals. During this stage,

the participant may no longer be interested in further

increasing the conditioning stimulus. Further improve-

ment may be minimal, but continuing the same work-

out routine enables individuals to maintain their fitness

(Franklin et al, 2000b; Wygand, 2001).

MEDICALCLEARANCE

• Exercise training may not be appropriate for every-
  one. Patients whose adaptive reserves are severely
  limited by disease processes may be unable to adapt
  to or benefit from exercise. In this small subpopula-
  tion of people with severe or unstable cardiac, respi-
  ratory, metabolic, systemic, or musculoskeletal
  disease—exercise programming may be fatal, injuri-
  ous, or simply not beneficial, depending on the
  clinical status and condition of the individual
  (Franklin et al, 2000c).

IDENTIFY CONTRAINDICATIONS TO EXERCISE

• Absolute
  
  
  1. Recent acute myocardial infarction
  
  
  2. Unstable angina
     3.Ventricular tachycardia or other dangerous
     arrhythmias
  
  
  3. Severe aortic stenosis
  
  
  4. Acute infection and/or fever
  
  
  5. Recent systemic or pulmonary embolus
  
  
  6. Thrombophlebitis or intracardiac thrombi
  
  
  7. Active or suspected myocarditis or pericarditis
  
  
  8. Acute congestive heart failure
     10.Dissecting aortic aneurysm (Franklin et al,
     2000 d)
  
  
  
  


• Relative
  
  
  1. Severe hypertension (uncontrolled or untreated)
     2. Complicated pregnancy
     3. Moderate aortic stenosis
     4. Severe subaortic stenosis
     5. Supraventricular dysrhythmias
     6. Ventricular aneurysm
     7. Frequent or complex ventricular ectopy
     8. Cardiomyopathy
     9. Uncontrolled metabolic disease (thyroid or dia-
     betes) or electrolyte abnormality
  
  
  
  

10. Chronic or recurrent infectious disease (malaria,
    hepatitis, and the like)


11. Neuromuscular, musculoskeletal, or rheumatoid
    diseases exacerbated by exercise (Franklin et al,
    2000 d)

IDENTIFY THOSE WHO NEED AN

EXERCISE STRESS TEST

• Indications for an exercise stress test according to
  American College of Cardiology (ACC) and
  American Heart Association (AHA) are as follows
  (Stephens et al, 2002):
  
  
  1. To evaluate patients for suspected coronary artery
     disease (typical and atypical angina pectoris)
  
  
  2. To evaluate patients with known coronary artery
     disease
  
  
  3. To evaluate healthy asymptomatic individuals in
     the following categories:
     a. High-risk occupations, such as pilots, firefighter,
     law enforcement officer, mass transit operator
     b.Men over age 40 and women over age 50 who
     are sedentary and plan to start vigorous exercise
     c. Individuals with multiple cardiac risk factors or
     concurrent chronic diseases
     4.To evaluate exercise capacity in patients with
     valvular heart disease, except severe aortic stenosis.
  
  
  4. Individuals with cardiac rhythm disorders for the
     following reasons:
     a. Evaluate response to treatment of exercise-
     induced arrhythmia
     b.Evaluate response of rate-adaptive pacemaker
     setting
  
  
  
  


• The ACSM and ACC/AHA guidelines discourage
  using exercise testing to screen asymptomatic adults
  unless they are at increased risk (Stephens et al, 2002).

SUMMARY

• Numerous studies have quantified the many health
  and fitness benefits associated with exercise.
  Although the optimal dose of physical activity has yet
  to be defined, significant health benefits can be
  obtained by including a moderate amount of physical
  activity on most, if not all, days of the week. With a
  modest increase in daily activity, most patients will
  improve their health and quality of life.

REFERENCES

Bryant C, Peterson J: Muscular strength and endurance, in

Roitman J, Haver E, Herridge M (eds.): ACSM’s Resource

Manual for Guidelines for Exercise Testing and Prescription.

Philadelphia, PA, Lipppincott Williams & Wilkins, 2001.

Demaree S, Powers S, Lawler J: Fundamentals of exercise metab-

olism, in Roitman J, Haver E, Herridge M (eds.): ACSM’s

82 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE