STEP 1

• Identify if the following applies to you.
  • Men ³ 45 years of age                                                                                  
  • Women ³ 55 years of age                                                                    

STEP 2

• Identify the presence of major positive (and one negative) coronary artery disease risk factors.

• Family History                                                                         
  • Myocardial infarction, coronary revascularization, or sudden death
    • Before 55 years of age in father or other male first degree relative (ie, brother or son)
    • Before 65 years of age in mother or other female first degree relative (ie, sister or daughter)

• Cigarette Smoking                                                                                         
  • Current cigarette smoker or those who quit within the previous six months

• Hypertension                                                                                        
  • Confirmed by measurement on at least two separate occasions
    • Systolic blood pressure: 140 mmHg or greater
    • Diastolic blood pressure: 90 mmHg or greater
  • Using Antihypertensive medication

• Dyslipidemia                                                                                        
  • Low Density lipoprotein (LDL, aka: bad cholesterol): > 130 mg/dL (3.4 mmmol/L) 
  • Total serum cholesterol: >200 mg/dl (5.2 mmol/L)
  • High-density lipoprotein (HDL, aka: good cholesterol): <40 mg/dl (1.03 mmol/L)
  • Using lipid-lower medication
  • USE LDL LEVLES UNLESS UNAVAILABLE

• Impaired fasting glucose                                                                        
  • Fasting blood glucose ³100 mg/dL (5.6 mmol/L) or greater confirmed by measurements on at least 2 separate occasions.

• Obesity                                                                                               
  • Body Mass Index > 30 kg×m^-2
    • Use BMI Tool
  • Waist girth > 102 cm (40.2 in) for men and > 88 cm (34.6 in) for women.
  • Waist to hip ratio ³ 0.95 for men and ³ 0.86 for women

• Sedentary lifestyle                                                                                
  • Persons not participating in a regular exercise program or not meeting the minimal physical activity recommendations from the U.S. surgeon General’s Report
    • Accumulating 30 minutes or more of moderate physical activity on most days of the week.

• High serum HDL cholesterol                                                                
  • >60 mg/dL (1.6 mmol/L)

STEP 3

• Identify the presence of major signs or symptoms suggestive of cardiovascular, pulmonary, and/or metabolic disease

• Pain or discomfort in the chest, neck, jaw, arms, or other areas that may be due to myocardial ischemia.                                                                       
  • Chest pain associated with reduction in blood supply to the heart muscle.

• Shortness of breath                                                                            
  • Rest, during daily activities, or with mild exertion

• Dizziness or syncope                                                                            
  • Fainting sensation

• Orthopnea or paroxysmal nocturnal dyspnea                            
  • breathing discomfort when not in an upright position
  • interrupted breathing at night

• Ankle edema                                                                                       
  •  Swelling at the lower leg

• Palpitations                                                                                          
  •  (abnormal rapid  heart rate

• Intermittent claudication                                                                       
  • Leg pain (during movement) that is associated with reduction in blood supply to the lower leg

• Known heart murmur                                                                         
  • atypical heart sound

• Unusual or unexplained fatigue                                                 

STEP 4

1.     Identify the presence of any diagnosed disease.

o       Cardiovascular disease                                                            

§         Cardiac, peripheral vascular, or cerebrovascular disease

 o       Pulmonary disease                                                                               

§         Chronic obstructive pulmonary disease, asthma, interstitial lung disease, or cystic fibrosis

o       Metabolic disease                                                                                

§         Diabetes mellitus (type I or II), thyroid disorders, renal or liver disease

RISK STRATIFICATION

1.      Age factors   

2.      Number of major coronary artery disease risk factors     

3.      Number of major signs or symptoms suggestive of cardiovascular, pulmonary, and/or metabolic disease     

4.      Number of known diagnosed diseases   

RISK LEVEL  

 LOW RISK

§        Further medical examination and exercise testing not necessary prior to initiation of exercise testing.

§        Medical supervision for submaximal or maximal exercise testing not necessary.

 MODERATE RISK

§        Medical examination and exercise testing recommended prior to the initiation of vigorous exercise training.

§        Medical supervision recommended for maximal exercise testing

 HIGH RISK

§        Medical examination and exercise testing recommended prior to the initiation of moderate or vigorous exercise training.

§        Medical supervision recommended for submaximal or maximal exercise testing.

 Ø     Moderate exercise intensity = 40-59% Heart Rate Reserve (HRR); Vigorous exercise intensity = >60%