The PAVS has been established as a valid instrument for detecting patients who may need counseling on physical activity for chronic disease recognition, management, and prevention.17 Furthermore, there is a strong association between PAVS, elevated body mass index, and chronic disease burden.19 Therefore, we recommend that primary care physicians screen their patients for physical activity levels. It has been demonstrated, however, that many primary care visits for older individuals include discussions of diet and physical activity but do not provide recommendations for lifestyle change.19 Thus, exploring ways to counsel patients on lifestyle change in an efficient manner is recommended. It has been demonstrated that counseling and referral from primary care centers can promote increased adherence to physical activity practices.20,21
Determine physical activity readiness
Prior to recommending a physical activity regimen, it is important to evaluate the patient’s readiness to make a change. Various questionnaires—such as the Physical Activity Readiness Questionnaire—have been developed to determine a patient’s level of readiness, evaluating both psychological and physical factors (www.nasm.org/docs/pdf/parqplus-2020.pdf?sfvrsn=401bf1af_24). Questionnaires also help you to determine whether further medical evaluation prior to beginning an exercise regimen is necessary. It’s important to note that, as is true with any office intervention, patients may be in a precontemplation or contemplation phase and may not be prepared to immediately make changes.
Evaluate risk level
Assess cardiovascular risk. Physicians and patients are often concerned about cardiovascular risk or injury risk during physical activity counseling, which may lead to fewer exercise prescriptions. As a physician, it is important to remember that for most adults, the benefits of exercise will outweigh any potential risks,3 and there is generally a low risk of cardiovascular events related to light to moderate–intensity exercise regimens.2 Additionally, it has been demonstrated that exercise and cardiovascular rehabilitation are highly beneficial for primary and secondary prevention of cardiovascular disease.22 Given that cardiovascular comorbidities are relatively common in older adults, some older adults will need to undergo risk stratification evaluation prior to initiating an exercise regimen.
Review preparticipation screening guidelines and recommendations
Guidelines can be contradictory regarding the ideal pre-exercise evaluation. In general, the USPSTF recommends against screening with resting or exercise electrocardiography (EKG) to prevent cardiovascular disease events in asymptomatic adults who are at low risk. It also finds insufficient evidence to assess the balance of benefits and harms of screening with resting or exercise EKG to prevent cardiovascular disease events in asymptomatic adults who are at intermediate or high risk.22
Similarly, the 2020 ACSM Guidelines for Exercise Testing and Prescription reflect that routine exercise testing is not recommended for all older adult patients prior to starting an exercise regimen.17 However, the ACSM does recommend all patients with signs or symptoms of a cardiovascular, renal, or metabolic disease consult with a clinician for medical risk stratification and potential subsequent testing prior to starting an exercise regimen. If an individual already exercises and is having new/worsening signs or symptoms of a cardiovascular, renal, or metabolic disease, that patient should cease exercise until medical evaluation is performed. Additionally, ACSM recommends that asymptomatic patients who do not exercise but who have known cardiovascular, renal, or metabolic disease receive medical evaluation prior to starting an exercise regimen.17
Continue to: Is there evidence of cardiovascular, renal, or metabolic disease?