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ACSM's Guidelines for Exercise Testing and Prescription Chapters 1-12

Terms in this set (573)

- Apparently healthy participants who do not currently exercise and have no history or signs or symptoms of CV, metabolic, or renal disease can immediately, and without medical clearance, initiate an exercise program at light-to-moderate intensity. If desired, progression beyond moderate intensity should follow the principles of Ex Rx covered in Chapter 6.

- Participants who do not currently exercise and have (a) known CV, metabolic, or renal disease and (b) are asymptomatic should obtain medical clearance before initiating a structured exercise program of any intensity. Following medical clearance, the individual may embark on light-to-moderate intensity exercise and progress as tolerated following ACSM Guidelines.

- Symptomatic participants who do not currently exercise should seek medical clearance regardless of disease status. If signs or symptoms are present with activities of daily living, medical clearance may be urgent. Following medical clearance, the individual may embark on light-to-moderate intensity exercise and progress as tolerated following ACSM Guidelines (see Chapter 6).

- Participants who already exercise regularly and have no history or signs or symptoms of CV, metabolic, or renal disease may continue with their current exercise volume/ intensity or progress as appropriate without medical clearance.

- Participants who already exercise regularly; have a known history of CV, metabolic, or renal disease; but have no current signs or symptoms (i.e., are clinically "stable") may continue with moderate intensity exercise without medical clearance. However, if these individuals desire to progress to vigorous intensity aerobic exercise, medical clearance is recommended.

- Participants who already exercise regularly but experience signs or symptoms suggestive of CV, metabolic, or renal disease (regardless of disease status) should discontinue exercise and obtain medical clearance before continuing exercise at any intensity.
- To be clinically meaningful, ST-segment depression or elevation should be present in at least three consecutive cardiac cycles within the same lead. The level of the ST segment should be compared relative to the end of the PR segment. Automated computer-averaged complexes should be visually confirmed.

- Horizontal or downsloping ST-segment depression ≥ 1 mm (0.1 mV) at 80 ms after the J point is a strong indicator of myocardial ischemia.

- Clinically significant ST-segment depression that occurs during postexercise recovery is an indicator of myocardial ischemia.

- ST-segment depression at a low workload orlow rate-pressure product is associated with worse prognosis and increased likelihood for multivessel disease.

- When ST-segment depression is present in the upright resting ECG, only additional ST-segment depression during exercise is considered for ischemia.

- When ST-segment elevation is present in the upright resting ECG, only ST-segment depression below the isoelectric line during exercise is considered for ischemia.

- Upsloping ST-segment depression ≥ 2 mm (0.2 mV) at 80 ms after the J point may represent myocardial ischemia, especially in the presence of angina. However, this response has a low positive predictive value; it is often categorized as equivocal.

- Among patients after myocardial infarction (MI), exercise-induced ST-segment elevation (> 1 mm or > 0.1 mV for 60 ms) in leads with Q waves is an abnormal response and may represent reversible ischemia or wall motion abnormalities.

- Among patients without prior MI, exercise-induced ST-segment elevation most often represents transient combined endocardial and subepicardial ischemia but may also be due to acute coronary spasm.

- Repolarization changes (ST-segment depression or T-wave inversion) that normalize with exercise may represent exercise-induced myocardial ischemia but is considered a normal response in young subjects with early repolarization on the resting ECG.
- Trunk coordination, strengthening, and endurance exercises can be used to reduce LBP and disability in individuals with subacute and chronic LBP with movement coordination impairments (34). However, there is insufficient evidence for any benefit of emphasizing single-dimension therapies such as abdominal strengthening (62,86).

- Individual response to back pain symptoms can be improved by providing assurance, encouraging activity, and emphasizing that more than 90% of LBP complaints resolve without any specific therapies (62).

- There is a lack of agreement on the definition, components, and assessment techniques related to core stability. Furthermore, the majority of tests used to assess core stability have not demonstrated validity (73,75).

- Abdominal bracing (cocontraction of trunk muscles) (77) should be used with extreme caution because the increases in spinal compression that occur with abdominal bracing may cause further harm to the individual (4).

- Certain exercises or positions may aggravate symptoms of LBP. Walking, especially downhill, may aggravate symptoms in individuals with spinal stenosis (97).

- Certain individuals with LBP may experience a "peripheralization" of symptoms, that is, a spread of pain into the lower limbs with certain sustained or repeated movements of the lumbar spine (76). Limits should be placed on any activity or exercise that causes spread of symptoms (114).

- Repeated movements and exercises such as prone push-ups that promote centralization (i.e., a reduction of pain in the lower limb from distal to proximal) are encouraged to reduce symptoms in patients with acute LBP with related lower extremity pain (34).

- Flexibility exercises are generally encouraged as part of an overall exercise program. Hip and lower limb flexibility should be promoted, although no stretching intervention studies have shown efficacy in treating or preventing LBP (36). It is generally not recommended to use trunk flexibility as a treatment goal in LBP (111).

- Consider progressive, low intensity aerobic exercise for individuals with chronic LBP with generalized pain (pain in more than one body area) and moderate-to-high intensity aerobic exercise for individuals with chronic LBP without generalized pain (34).