August 2015 Issue

Sports Nutrition: Fitness Screening and Recommendations
By Leesha Lentz
Today's Dietitian
Vol. 17 No. 8 P. 20

RDs can play a role in helping clients develop suitable fitness plans.

According to the Academy of Nutrition and Dietetics (the Academy), "regular physical activity is just as important to a healthful lifestyle as smart eating," which may be why many RDs recommend their clients and patients maintain or begin an exercise regimen—and with good reason. Research shows that moderate physical activity has many health benefits, including reducing risk of chronic disease, improving mental health, and aiding in weight management.1 But while clients and patients may be eager to commit to regular physical activity, RDs should screen them before they begin a fitness plan, as many present with risk factors for heart disease.

"A risk factor could be having a past myocardial infraction, having high blood pressure or high cholesterol, being on blood pressure or cholesterol medication, being obese, and currently smoking or having smoked within the last six months," says Jim White, RDN, ACSM, HFS, owner and president of Jim White Fitness & Nutrition Studios in Virginia Beach, Virginia, and a spokesperson for the Academy. According to White's policy, "If a patient presents with two or more of these risk factors, then he or she needs a physician release. Many dietitians, if they don't have the right screening skills, could be missing that, and it could be dangerous."

In addition, many patients may never have exercised before. "Many clients we work with have been sedentary for years and are nonexercisers," says Kim Larson, RDN, CD, CSSD, of Total Health in Seattle, also a spokesperson for the Academy.

This article takes a closer look at proper screening techniques for these patient populations, and provides advice and tips on what RDs should recommend to clients and patients who want to start or maintain a fitness regimen.

Assessing the Client
"When seeing a client, it's important to do a medical/health history and/or health risk appraisal to assess the client's overall health and chronic disease state," Larson says. Patients who have chronic disease will likely need a physical activity clearance from their primary care doctor, which identifies whether the patient needs to be supervised by a professional when exercising, Larson says. These forms may provide guidelines and restrictions for physical activity.

When looking at medical history, White says it's also important to assess patients' medication and supplement use. "Medications and supplements could affect blood pressure for clients, which in turn could affect their exercise," he explains.

Both White and Larson agree that RDs should ask clients and patients about physical activity history. For example, RDs should evaluate past and current exercise patterns and interests, as well as beliefs and attitudes about exercising in general. In her practice, Larson has clients fill out a Physical Activity Readiness Questionnaire (PAR-Q). "If a person is healthy, doesn't have any chronic disease, is under age 65, and answers no to each of the questions on the PAR-Q, then it's safe for the person to begin a general exercise program," she says.

White also recommends RDs inquire about clients' possible barriers and goals. "Maybe they don't have the time or maybe someone in their family doesn't want them to do it," he says. "On the other hand, you're looking at their exercise goals. For example, do they want more flexibility? Are they looking to reduce stress or to improve their cardiovascular system?"

In addition, RDs should do anthropometric data measurements, such as waist-to-hip measurements, percentage of body fat, and weight before determining a fitness plan for clients. "These measurements are great because they give a quantitative number both the RD and client can use to track progress and the effectiveness of the exercise program," White says.

Tools and Certifications
If RDs want to assess their own knowledge, skills, and competence in evaluating and providing specific fitness plans or physical activity guidelines, Larson says Academy members can access the Decision Analysis Tool through the Physical Activity Toolkit to assist them, since it's an important part of their daily practice. "RDs have a responsibility as health care practitioners to address the physical activity component of someone's lifestyle because it's an important part of the nutrition care process. Physical inactivity or being sedentary is actually a diagnosis," she says.

White says dietitians also may recommend their clients and patients see a certified personal trainer if they don't have the proper screening skills; however, there are more than 400 certifications, so they should make sure the personal trainer has accreditations recognized by the National Commission for Certifying Agencies.

While this is a voluntary option, White's top advice for RDs is to get certified. "There are more than 6 million people using personal trainers in the United States, and a lot of those trainers are giving impractical advice," he says. "So if dietitians were certified, they'd not only increase their number of clients but they'll also see better results in their clients and even increase their income. They can grow in the field by being able to give those detailed recommendations on exercise."

Starting Slowly
After screening, if the client's doctor deems him or her healthy enough to begin a basic exercise regimen, RDs should advise him or her to start slowly. This recommendation becomes especially important when considering the dangers of beginning an exercise regimen too fast, too soon. According to a HealthDay News article posted in January 2014, nearly 500,000 workout-related injuries occur each year in the United States.2

Some common injuries are muscle pulls and strains, sprained ankles, and knee injuries, according to WebMD.3 In addition, vigorous physical activity also can increase the risk of myocardial infarction and sudden cardiac death, which makes screening patients before participation in exercise that much more important, according to a May 2007 study in Circulation.4 However, the study concludes, "a variety of epidemiological, basic scientific, and clinical evidence suggests that habitual physical activity decreases the risk of fatal and nonfatal CAD [coronary artery disease] events and that the benefits of regular physical activity outweigh its risks."4 The study authors recommend moderate-intensity physical activity for more than 30 minutes per day for most individuals, in accordance with the Centers for Disease Control and Prevention and the American College of Sports Medicine recommendations.

Patients who have been sedentary need to slowly build up their strength and endurance, so it's best to start with a low-impact exercise such as walking. "We start slowly and set goals to increase the frequency, intensity, and duration of the walking, as tolerated each week, using goals that are specific, measurable, realistic, and time-sensitive," Larson says. She has clients keep a log of their daily exercise activity so they stay accountable.

"The American College of Sports Medicine recommends that people work out at least 30 to 60 minutes per day, and that's pretty much moving," White says. He advises clients and patients to use a pedometer or a fitness device to keep track of their movements and to shoot for 10,000 steps per day.

Larson sums up the approach of RDs when working with clients and patients who need to incorporate more exercise into their daily lifestyles. "As RDs, we can teach clients how to use a pedometer/step counter and how to make lifestyle adjustments to increase physical activity throughout the day by parking farther away from the grocery store, etc," she says. "We can also educate clients on the importance of exercise and its benefits, help them remove the barriers they have that keep them from activity, and support their efforts."

— Leesha Lentz is a freelance writer based in Pottstown, Pennsylvania.

References
1. Physical activity and health: the benefits of physical activity. Centers for Disease Control and Prevention website. http://www.cdc.gov/physicalactivity/everyone/health/index.html. Updated June 4, 2015. Accessed June 24, 2015.

2. Ease into a workout program to prevent injuries. Health.com website. http://news.health.com/2014/01/13/ease-into-a-workout-program-to-prevent-injuries/. Updated January 13, 2014. Accessed May 20, 2015.

3. Marks H. Workout injuries: prevention and treatment. WebMD website. http://www.webmd.com/fitness-exercise/guide/workout-injuries-prevention-and-treatment. Updated March 4, 2014. Accessed May 20, 2015.

4. Thompson PD, Franklin BA, Balady GJ, et al. 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. Circulation. 2007;115(17):2358-2368.

TIPS FOR BEGINNING EXERCISERS
Jim White, RDN, ACSM, HFS, owner and president of Jim White Fitness & Nutrition Studios in Virginia Beach, Virginia, and a spokesperson for the Academy of Nutrition and Dietetics, offers the following recommendations dietitians can provide to clients and patients who are beginning a fitness regimen:

• Warm up for five to 10 minutes before exercise.

• Keep track of the number of steps per day with a pedometer or fitness device, such as Fitbit, Torrent, or Jawbone.

• Weight train two to three times per week under the supervision of a certified personal trainer if the client doesn't know proper lifting techniques.

• Cool down for five to 10 minutes and stretch after exercise.

— LL