Exercise and Sports Medicine Assessment Procedures

Clinical and Exercise/Sports Anamnesis

Every Exercise Medicine assessment begins with a detailed survey of the client´s health history and practice of physical activity, physical exercise and sports throughout the client´s life, which makes it possible for the procedure to be directed towards providing relevant information to the clients’ specific goals.

Directed Physical Examination

The doctor will submit the client to a physical examination aimed at guiding physical exercise, seeking to identify problems and/or conditions that affect, harm or put the client´s health at risk during physical exercise.

Resting Electrocardiogram

 A conventional 12-lead electrocardiogram is obtained at rest in the lying position, with the aim of analyzing the electrical conditions of the heart and identifying possible abnormalities that may represent impeding or restrictive factors to the practice of physical exercise or even characteristics related to the intense and regular practice of sports or sports, physical exercise for many years, which are encompassed within the generic name of athlete´s electrocardiogram.

Resting Pulmonary Function Test or Resting Spirometry

The functionality of the respiratory system at rest is assessed by a ventilatory test. In this test, performed on a state-of-the-art digital pneumotachograph, data are obtained on maximum lung volumes, capacities and flows. In general, three complete maneuvers are performed and the best of the results is used for the evaluation.

Kinanthropometric Assessment

 It comprises a series of measurements aimed at quantifying somatotype (body type), body composition (anthropometric measurements), flexibility, muscle power and strength, and the ability to sit down and get up from the ground.

Initially, height and body weight are carefully determined. Next, measurements of bone diameters, circumferences and skinfolds are taken which, when inserted into appropriate formulas, allow obtaining data on the amount of body fat, possible differences between the current weight and a desired reference weight, body linearity and the characterization of the physical type. The weight-height ratio is presented by the conventional method of body mass index and by the new strategies of the reciprocal of the ponderal index and the calculation of ectomorphy (relative linearity). Through these measurements, it is also possible to verify the distribution pattern of body fat, whether predominantly located in the central region of the body (pattern associated with higher cardiovascular risk) or in the limbs (children´s pattern).

The next step consists of evaluating the specific body flexibility by movements and by joints and globally through the FLEXITEST technique. Briefly, this method uses the passive measure of the maximum joint mobility of 20 movements, each one of them measured with increasing scores from 0 to 4. The variability indices and the global flexibility profile are also determined.

 https://clinimex.com.br/videos2.asp?cod_video=18&tipo=2

Next, the muscle components of handgrip strength are evaluated using a hand dynamometer and the maximum muscle power in the standing rowing exercise, the latter determined by the FITRODYNE produced in Slovakia.

Finally, the kinanthropometric assessment incorporates the SIT-RISE test, a simple instrument for analyzing dexterity in everyday conditions, encompassing the items of flexibility, motor coordination, balance and, mainly, the relationship between maximum power of the lower limbs and body weight.

This test had great repercussions in the international media.

http://www.wmdt.com/news/more-local-news/47-abc-attempts-the-sitting-rising-test/32204294

Live from Dr. Claudio Gil Araujo with journalist Marcia Peltier - Sitting and Standing Test    https://clinimex.com.br/blog_detail.asp?cod_blog=178

And the institutional video about TSL  https://clinimex.com.br/videos2.asp?cod_video=11&tipo=2

Assessment of cardiac vagal tone

It is now known that the autonomic nervous system plays important roles in health and disease, through its sympathetic and parasympathetic branches. Parasympathetic activity is usually quantified by studying cardiovascular reflexes that utilize the vagus.

In our evaluation, we used a special protocol called the 4-second test.

 The individual sitting on the cycle ergometer and under electrocardiographic monitoring is instructed to perform four actions under verbal command every four seconds, namely:

1. inhale as deeply and quickly as possible through your mouth and keep your lungs full of air;

2. pedal as fast as possible (the cycle ergometer is without any resistance or load) without exhaling;

3. suddenly stop pedaling and stand still with air still retained;

4. Slowly exhale and start breathing normally. The maneuver is repeated one to two minutes later to obtain a more accurate assessment.

In the electrocardiographic record, which is obtained during this short effort test, the heart´s response to the respiratory maneuver and to the sudden start and interruption of the exercise without load is observed.

Watch a video on how to measure T4s and how to guide the procedure at this link

https://clinimex.com.br/videos2.asp?cod_video=16&tipo=2

Maximal Cardiopulmonary Exercise Test

Often called a stress test, exercise test or ergometry, our procedure is as complete as possible. Initially, the equipment that will be used for the test is defined, which can be: cycle ergometer for lower limbs, cycle ergometer for upper limbs, treadmill or rowing ergometer.  Next, based on clinical and morphological data, the characteristics of the protocol to be performed are established.

Typically, a ramping strategy (small increments at short intervals) is followed. The purpose of individualizing the protocol and the ergometer is to achieve a test that effectively responds to the proposed objectives and questions, either in the athlete or in an elderly woman who has just had a heart attack, which should last between 8 and 12 minutes.

All tests are performed with direct measurements of expired gases, in order to continuously measure oxygen consumption, pulmonary ventilation and allow the identification of the anaerobic threshold. In addition, the electrocardiogram and arterial oxygen saturation are monitored, and blood pressure and the subjective feeling of exertion are measured every minute.

With this methodology, there is no need for fitness estimates – normally accompanied by an error of up to 20% – since oxygen consumption is effectively measured. It is still possible, from the anaerobic threshold, to trace a schedule of scientifically based aerobic physical exercise.

Watch the video that details the evaluation in exercise medicine: