Why consult?

• Ask the patient why he/she comes to see you
  • Expectations and goals
  • Knowledge
  • Motivation
• Current PA/PF (top level)
  • brief PA assessment
• 

Documentation of PA in clinical practice

• Physical Activity Vital Sign Questionnaire
  • 
• Speedy Nutrition and Physical Activity Assessment (SNAP) Questionnaire
  • 
  • Examples of activities are:
    • Walking
    • Household work
    • Work in the yard or garden
    • Dancing
    • Jobs that require walking, lifting, or other hard work
    • Exercise
• Physical activity short questionnaires
  • Correlation with objectively assessed PA is modest/poor
  • Good identification of inactive patients
  • Less accurate to identify active patient
  • Simple quick screening
  • When PA as Vital sign is assessed, better counselling and advice around PA is provided
    • Centers with EVS assessment 12% more progress notes and 14% more referrals for PA, although values for referral are generally too low
• ‘activity’ trackers
  • 
  • Problem:
    • Inconsistency and overestimation
    • Be critical of wearable data
    • Make sure you understand the technology and its limitations

Medical Problems

• CV/respiratory/metabolic/neurologic/muscular
• Contra-indications for exercise (-testing)
• Absolute:
  • Acute myocardial infarction (MI), within 2 days
  • Ongoing unstable angina
  • Uncontrolled cardiac arrhythmia with hemodynamic compromise
  • Active endocarditis
  • Symptomatic severe aortic stenosis
  • Decompensated heart failure
  • Acute pulmonary embolism, pulmonary infarction, or deep vein thrombosis
  • Acute myocarditis or pericarditis
  • Acute aortic dissection
  • Physical disability that precludes safe and adequate testing
• Relative contraindications
  • Known obstructive left main coronary artery stenosis
  • Moderate to severe aortic stenosis with uncertain relation to symptoms
  • Tachyarrhythmias with uncontrolled ventricular rates
  • Acquired advanced or complete heart block
  • Hypertrophic obstructive cardiomyopathy with severe resting gradient
  • Recent stroke or transient ischemic attack
  • Mental impairment with limited ability to cooperate
  • Resting hypertension with systolic or diastolic blood pressures >200/110mmHg
  • Uncorrected medical conditions
  • Significant anaemia
  • Important electrolyte imbalance
  • Hyperthyroidism
• CAVE: undiagnosed chronic disease with impact on exercise!
• Also look at risk profiles (smoking/obesity/hidden complaints/etc.)
• Document actual medication (and look up its pharmacologic action)

Exercise Symptoms

• Pain?
• Shortness of breath?
• Weakness/fatigue/exhaustion
• Dizziness, fainting

Past Experiences with exercises

• Positive experience?
• Injuries or negative experience?

Any Specific Circumstances

• Prosthetics
• Medications
• Etc...