The Importance of Screening
Think screening and evaluations prior to exercise are simply an annoyance? Consider this: according to a recent CDC report, nearly half of U.S. adults have not been receiving key preventive health services. When someone over age 45 hires a personal trainer to lose weight and “get in shape” the likelihood that they have pre-existing health risks or special considerations is surprisingly high. More concerning is that this risk increases significantly with each passing decade. In fact, most people over 65 have one or more diseases. And while many Americans are not seeking medical assistance in the prevention and treatment of common diseases, even those who are may not be in compliance with the recommended behavior modifications and therapies.
The report found:
- Of patients with heart disease primarily affecting the blood vessels, only 47% were prescribed the recommended daily use of aspirin during visits to their doctors.
- The U.S. Preventive Services Task Force guidelines for the prevention of high blood pressure state that adults 18 years of age and older with high blood pressure should receive a clinical treatment plan that might include medications and monthly follow-up visits until healthy blood pressure is achieved, yet less than half (44%) of people with high blood pressure had it under control.
- Similarly, despite strong evidence that screening and treating for high cholesterol reduces sickness and death due to heart disease, about 33.4% of men and 25.6% of women were not screened during the preceding five years. Of those adults identified with high levels of LDL (bad) cholesterol, only about 32% of men and 32% of women had it under control.
- According to data from the National Ambulatory Medical Care Survey and the National Health Interview Summary, fewer than 1 in 13 tobacco users were prescribed medications to help them end their tobacco use when they saw their doctor.
This data suggest that many Americans do not monitor or manage their health and the presence of disease, particularly in the early stages, is going undetected, as there are often no signs or symptoms indicative of a problem. Heart disease, high blood pressure, and high cholesterol do not hurt, so unless they are screened, most people are not aware of their condition. The early management of these disorders can have a dramatic impact on preventing the disease altogether, or at least inhibiting its maturation to life-threatening levels. "Clinical preventive services prevent heart attack, stroke, cancer and other diseases and save lives," said CDC Director Thomas R. Frieden, M.D., M.P.H. "This report provides a snapshot of preventive services for U.S. adults before 2010. As we look to the future, we can track how our nation’s health is progressing through better prevention in health care."
CDC has several programs in place to increase the use of, and improve access to, clinical preventive health services. They include the Million Hearts Initiative, a program through which CDC and its partners work to provide effective treatment for high blood pressure, high cholesterol, and tobacco addiction. The initiative works to increase the number of clinicians who deliver appropriate counseling on the use of aspirin and other blood-thinning therapies for patients at high risk of heart attack or stroke.
Personal trainers should screen and evaluate all clients using a medical history and current health status evaluation before making program decisions. The presence of disease is becoming more common in Americans, and age is no longer the strongest predictor. Individuals with a central girth size of 40 inches (male) or 35 inches (female) and/or BMI over 27 should be considered high-risk for the onset of disease, particularly if they are sedentary. Likewise, individuals with resting heart rates over 90 bpm or a rate pressure product (SBP x HR) over 11,000 are also at elevated risk for heart disease. Trainers should use assessments both to identify current health status and educate clients about the risks associated with their condition. Medical referrals are warranted for stage II hypertension, tachycardia, and both hyper- and dyslipidemia.
Personal trainers who create professional relationships with physicians and doctor groups have a great opportunity for referral-based business. Trainers who offer preventive services, compliance management assistance (diet and exercise), and ongoing motivation and tracking services stand to grab a growing portion of the market. While third-party reimbursements for personal trainer services are still in the hope stage, many people are willing to spend money on their health but need guidance and direction. A recommendation from a physician goes a long way in starting the process.