Low compliance with national standards for cardiovascular emergency preparedness at health clubs

Cardiac emergency preparedness in health/fitness facilities in Australia

BACKGROUND

Health/fitness facilities are popular venues for physical activity, where increasingly more individuals at risk of cardiovascular events exercise to achieve positive health outcomes. The aim of our study was to analyze cardiac emergency preparedness in health/fitness facilities in Queensland, Australia.

DESIGN

Cross-sectional survey of health/fitness facilities in Queensland.

METHODS

A risk management questionnaire was administered over 7 months, July 2009 to January 2010, using an online or paper-based version. The data are presented as the proportion of survey respondents giving specific responses to questionnaire items related to cardiac emergency preparedness, especially the provision of automated external defibrillators (AEDs).

RESULTS

Fifty-two health/fitness facility managers responded to the survey. Most of the surveyed facilities conducted pre-activity screening (92%). Of those with a written emergency plan (79%), only 37% physically rehearsed their emergency response systems at regular intervals. Ninety-five percent of the facilities had fitness employees with a current first aid/cardiopulmonary resuscitation certificate and training. Of the 10 (19%) facilities with an on-site AED, only 6 had staff qualified to use the AED in an emergency, and only 6 had the AED as part of a public access defibrillator program.

CONCLUSION

This is the first study to report that cardiac emergency preparedness is not optimal in the health/fitness facilities in Australia. Development of policies and procedures for training health/fitness professionals in emergency procedures is needed to minimize the risk when exercise-induced cardiac events occur at health/fitness facilities.

Automated external defibrillators in health and fitness facilities

BACKGROUND

Exercise is encouraged to promote health, but it can be a trigger for sudden cardiac arrest (SCA) in individuals with underlying cardiovascular disease. In 2002, the American Heart Association and the American College of Sports Medicine issued recommendations for the presence of automated external defibrillators (AEDs) in health and fitness facilities.

OBJECTIVE

To assess emergency response planning for SCA and review the prevalence and past utilization of AEDs in health and fitness facilities in King County, WA.

METHODS

A cross-sectional survey was conducted in 2008 of health and fitness facilities (N = 136) in King County, WA, assessing the 2002 American Heart Association guidelines on AEDs and emergency response planning for SCA.

RESULTS

Sixty-three (46%) of 136 facilities completed the survey. Thirty-five percent of the total facilities had < 500 members, 21% had 500 to 1500 members, 16% had 1501 to 2500 members, and 29% had > 2500 members. Sixty-eight percent had an established emergency response plan for SCA. Only 40% of facilities had ≥ 1 AED on site (mean, 1.7; range, 0-6). Fitness centers with > 1500 members (71%) were more likely to have an AED on site compared with those with < 1500 members (14%) (P < 0.0001). Of the staff trained in cardiopulmonary resuscitation, 83% were fitness instructors, 73% were administrators, and 58% were front desk personnel. Four facilities reported an incident of SCA within the 12 months prior to completing the survey, which was a 6.4% incidence of SCA in responding facilities. All SCA cases occurred in facilities with > 1500 members. Only 2 of the 4 facilities with an SCA had an on-site AED. The individuals who had SCA were all men aged 50 to 65 years, with 2 men successfully resuscitated at the facility.

CONCLUSION

There is a substantial gap in guideline implementation between national recommendations and current emergency response planning for SCA in health and fitness facilities. Health and fitness facilities are strategic locations to place AEDs in an effort to improve outcomes from exercise-related SCA. Facilities with general memberships of > 1500 are encouraged to have on-site AEDs, given the high incidence of SCA.

An investigation of pre-activity cardiovascular screening procedures in health/fitness facilities--part II: rationale for low adherence with national standards

The purpose of this study was to explore the rationale provided by program directors and general managers of health/fitness facilities for low adherence to nationally accepted standards related to pre-activity cardiovascular screening procedures (PACSPs) for members and clients of personal trainers. Qualitative interviews were conducted with the directors/managers in a Midwest region representing 76 facilities who indicated they did not conduct PACSPs for members and clients of personal trainers. Analysis of the rationale provided revealed 6 major clusters: (1) Purpose or need for screening; (2) time and staffing; (3) barrier to participation; (4) personal responsibility for health and actions; (5) legal issues; and (6) company or franchise policy that categorized the reasons for low adherence to PACSPs. These findings highlight the need to increase awareness of the relevance of PACSPs among health/fitness managers, staff members, and current exercise science students as well as engage those in risk management for informed dialogue for consistent application of the standard of care.

An investigation of pre-activity cardiovascular screening procedures in health/fitness facilities--part I: is adherence with national standards decreasing?

This investigation determined the number of health/fitness facilities within a Midwestern region conducting pre-activity cardiovascular screening procedures (PACSPs) consistent with American Heart Association/American College of Sports Medicine (AHA/ACSM) standards. Interviews were conducted with 123 commercial, community, corporate, and academic settings (84% response rate), with 40 (33%) facilities requiring members to complete a pre-activity screening device. Of those, 20 (50%) required physician clearance for "at-risk" members prior to physical activity participation. Personal training clients completed a pre-activity screening device at 50 (61%) facilities, with 32 (64%) requiring physician clearance for at-risk clients. The data were analyzed by setting, with corporate facilities having a significantly higher (P=.0049) adherence rate with AHA/ACSM standards than other facilities. Data were compared with previous studies and indicated a decrease in the number of facilities conducting PACSPs. Findings indicate that health/fitness personnel need to become aware of the relevance of conducting PACSPs.

The Risk in Exercise Training

Although exercise training is unequivocally of benefit relative to the risk of cardiovascular disease, there is a definable risk of complications during exercise training. In younger individuals, the risk is almost exclusively related to the presence of congenital abnormalities, whereas in older (∼40 years) individuals, the risk is largely related to atherosclerotic disease. In both groups, the risk of the underlying pathology leading to clinical presentation is increased by higher intensity exercise. In older individuals, preexercise screening is of potential benefit but is not generally well done. Exercise prescription should favor lower intensity exercise during the early weeks of an exercise program. Subjective methods, which do not rely on the results of an exercise test, including the Rating of Perceived Exertion and the Talk Test, are to be recommended because preliminary exercise testing is performed inconsistently. There are inadequate data regarding the spontaneous exercise training intensity in both healthy individuals and patients.

Revised clearance for participation in physical activity: greater screening responsibility for qualified university-educated fitness professionals

For many individuals, pre-participation clearance using the PAR-Q and the PARmed-X has become a barrier to adopting a physically active lifestyle. An extensive project is therefore planned to reduce the number of medical referrals from the PAR-Q and to revise the PARmed-X so that it becomes more effective, user friendly, and evidence based. The entire process will likely require 3 years to complete; therefore, as an interim solution, we propose giving greater pre-participation screening responsibility to qualified university-educated fitness professionals. The highest level of professional fitness qualification in Canada is the Canadian Society for Exercise Physiology Certified Exercise Physiologist; the requirements for this certification are such that it could serve as a model allowing other countries that use the PAR-Q to develop similarly qualified university-educated fitness professionals who could also be entrusted with greater pre-participation screening responsibility.

Cardiovascular Emergency Preparedness in Recreation Facilities at Major US Universities: College Fitness Center Emergency Readiness

Recent American Heart Association/American College of Sports Medicine (AHA/ACSM) guidelines advocate preparticipation screening, planning, and rehearsal for emergencies and automated external defibrillators in all health/fitness facilities. The authors evaluated adherence to these recommendations at 158 recreational service departments in major US universities (51% response rate for 313 institutions queried). Many made their facilities available to unaffiliated residents, with 39% offering programs for those with special medical conditions. Only 18% performed universal preparticipation screening. Twenty-seven percent reported having 1 or more exercise-related instances of cardiac arrest or sudden cardiac death within the past 5 years. Seventy-three percent had an automated external defibrillator, but only 6% reported using it in an emergency. Almost all had written emergency plans, but only 50% posted their plans, and only 27% performed the recommended quarterly emergency drills. The authors' findings suggest low awareness of and adherence to the AHA/ACSM recommendations for identifying individuals at risk for exercise-related cardiovascular complications and for handling such emergencies in university-based fitness facilities. (

Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology

Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No strategies have been adequately studied to evaluate their ability to reduce exercise-related acute cardiovascular events. Maintaining physical fitness through regular physical activity may help to reduce events because a disproportionate number of events occur in least physically active subjects performing unaccustomed physical activity. Other strategies, such as screening patients before participation in exercise, excluding high-risk patients from certain activities, promptly evaluating possible prodromal symptoms, training fitness personnel for emergencies, and encouraging patients to avoid high-risk activities, appear prudent but have not been systematically evaluated.

Exercise and Acute Cardiovascular Events

Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No strategies have been adequately studied to evaluate their ability to reduce exercise-related acute cardiovascular events. Maintaining physical fitness through regular physical activity may help to reduce events because a disproportionate number of events occur in least physically active subjects performing unaccustomed physical activity. Other strategies, such as screening patients before participation in exercise, excluding high-risk patients from certain activities, promptly evaluating possible prodromal symptoms, training fitness personnel for emergencies, and encouraging patients to avoid high-risk activities, appear prudent but have not been systematically evaluated.