9.6 Recognizing & Responding to Adverse Events During Exercise
Key Takeaways
Normal responses to dynamic exercise are a heart rate and systolic blood pressure that rise with workload while diastolic pressure stays about the same; a falling systolic pressure, a heart rate that fails to rise, or symptoms are abnormal.
Possible heart attack signs include chest pressure or pain that may spread to the arms, neck, jaw or back, with sweating, nausea or shortness of breath; stop the exercise and call 9-1-1.
Heart & Stroke's FAST signs are Face drooping, Arm weakness, Speech difficulty and Time to call 9-1-1.
Diabetes Canada defines hypoglycemia as blood glucose below 4.0 mmol/L; a conscious person takes 15 g of fast-acting carbohydrate and rechecks in 15 minutes.
Vigorous exercise briefly raises the risk of a cardiac event, especially in habitually inactive people, but regular activity lowers overall risk; that is why screening and gradual progression matter.
9.6 Recognizing & Responding to Adverse Events During Exercise
Three CSEP-CPT safety competencies apply here:
- 5.1: monitor a client during exercise and identify normal and abnormal responses;
- 5.2: recognize and properly respond to signs and symptoms of an adverse event (asthmatic attack, angina, myocardial infarction, hypoglycemia, hyperglycemia, stroke and others);
- 5.7: identify the benefits versus risks of moderate- to vigorous-intensity aerobic exercise.
CSEP requires current CPR Level C and emergency first aid at registration. The Theory Exam expects you to know what the signs mean and what to do first.
Normal vs. Abnormal Responses
| Variable | Normal response to dynamic exercise | Abnormal (stop and assess) |
|---|---|---|
| Heart rate | Rises roughly in proportion to workload, then plateaus at a steady submaximal workload | Fails to rise, drops, or becomes irregular; excessive rise for the workload |
| Systolic BP | Rises with workload | Falls by more than 10 mmHg despite increasing workload, or rises excessively |
| Diastolic BP | Little change or slight fall | Rises markedly |
| Breathing | Faster and deeper, proportional to effort | Wheeze, gasping, or breathlessness out of proportion to effort |
| Appearance | Flushed, sweating appropriate to effort | Pallor, grey or blue colour, cold clammy skin |
| Coordination and mood | Normal | Confusion, stumbling, slurred speech, unusual behaviour |
| Recovery | HR and BP fall steadily in the recovery protocol | Values stay above pre-screening limits after recovery |
General first response:
- Stop the exercise.
- Have the client sit or lie down, whichever eases the symptoms.
- Stay with them, ask about the symptoms and monitor.
- Activate the Emergency Action Plan and call 9-1-1 for serious or persistent symptoms.
- Be ready for CPR and the AED.
- Document the event.
Specific Adverse Events
| Event | Warning signs | First response (within first-aid training) |
|---|---|---|
| Angina (temporary lack of blood flow to heart muscle) | Chest pressure, tightness, squeezing or pain during effort, possibly spreading to arm, neck, jaw or back; usually eases with rest | Stop and rest; if the client has prescribed nitroglycerin, they use it as directed; if symptoms do not settle quickly or are new or worsening, treat as a possible heart attack |
| Myocardial infarction (heart attack) | Chest discomfort (pressure, fullness, burning, heaviness), upper-body discomfort, shortness of breath, sweating, nausea, lightheadedness; symptoms may be less typical in women and older adults | Stop activity; call 9-1-1; keep the person at rest; follow first-aid protocols; if they become unresponsive and are not breathing normally, start CPR and use the AED |
| Stroke | FAST: Face drooping, Arm weakness (cannot raise both arms), Speech jumbled or slurred, Time to call 9-1-1; also sudden vision loss, severe headache, loss of balance | Call 9-1-1 immediately; note the time symptoms started; keep the person safe and at rest; give nothing by mouth |
| Hypoglycemia (blood glucose below 4.0 mmol/L) | Shakiness, sweating, hunger, pounding heart, anxiety, confusion, difficulty concentrating, weakness | If conscious: stop exercise, have them take 15 g of fast-acting carbohydrate (for example glucose tablets or about 150 mL of juice or regular soft drink), recheck after 15 minutes and repeat if still low, then a snack if the next meal is more than an hour away; if unconscious or unable to swallow, call 9-1-1 |
| Hyperglycemia (high blood glucose) | Thirst, frequent urination, fatigue, blurred vision; with ketoacidosis, nausea, vomiting, abdominal pain, fruity breath, rapid breathing | Stop exercise; encourage water; the client follows their diabetes plan and contacts their health care provider; call 9-1-1 if vomiting, drowsy or confused |
| Asthma attack | Wheeze, cough, chest tightness, difficulty speaking, shortness of breath | Stop; sit upright; the client uses their own reliever inhaler as prescribed; if no improvement or severe distress, call 9-1-1 |
| Fainting (syncope) or near-fainting | Lightheadedness, pallor, tunnel vision, collapse | Lie the person down and raise the legs if no injury; check breathing; call 9-1-1 if not quickly recovered or if fainting occurred during exertion |
| Heat illness | Heavy sweating, headache, nausea, weakness; in heat stroke, confusion and hot skin | Stop; move to a cool place; cool and hydrate if conscious; heat stroke is a 9-1-1 emergency |
Warning
Any client who has an adverse event is screened again before their next session. A new cardiac, neurological or respiratory event normally requires physician clearance, and possibly a CSEP-CEP, before exercise resumes.
Benefits vs. Risks of Moderate-to-Vigorous Exercise (Competency 5.7)
Benefits: regular moderate-to-vigorous activity lowers the risk of premature death, cardiovascular disease, stroke, type 2 diabetes, hypertension, several cancers, depression, falls and frailty. It also improves fitness, mood, sleep and function.
Risks:
- Acute cardiac events: vigorous exertion briefly increases the risk of heart attack or sudden cardiac death. The relative increase is highest in habitually inactive people who suddenly exercise hard, and in people with existing heart disease. The absolute risk is very low, and regular activity lowers a person's overall risk.
- Musculoskeletal injury: rises with high volume, high impact and rapid progression.
How CSEP-PATH manages the balance:
- Pre-participation screening: the GAQ, resting vitals, medical history and the Health Screening Tool.
- The GAQ's advice to consult a qualified exercise professional before vigorous activity if not already meeting the guidelines.
- Gradual progression: inactive clients with a condition start with light-to-moderate activity.
- Scope limits on effort: submaximal testing, and interval work below 90% of peak heart rate.
- Preparation and monitoring: warm-up, cool-down, monitoring during sessions, and a rehearsed Emergency Action Plan.
During a treadmill session, a client suddenly has trouble speaking clearly, one side of the face droops, and they cannot lift their left arm. What is the most appropriate immediate action?
Have the client drink juice in case blood glucose is low, then continue walking slowly while you watch them.
Help the client into your car and drive them to the nearest hospital emergency department yourself.
Ask the client to rest quietly for 10 minutes and then decide together whether to call for help.
Stop the treadmill, call 9-1-1, note when symptoms began, and keep the client safe and at rest.
A client with type 2 diabetes who takes a sulfonylurea becomes shaky, sweaty and confused mid-session. They are conscious and able to swallow. What should the CSEP-CPT do first?
Continue at a lower intensity so the working muscles keep using up the extra glucose in the blood.
Stop exercise; the client takes about 15 g of fast carbohydrate and rechecks after 15 minutes.
Give the client a high-fat snack such as nuts or cheese, and resume the session after 5 minutes.
Inject the client's own insulin for them so that their blood glucose stabilizes more quickly.
Which statement about the risks and benefits of vigorous aerobic exercise is correct?
Inactive people face the greatest relative risk during vigorous exertion, but regular activity lowers overall risk.
Vigorous exercise carries no cardiac risk at all for anyone who has completed and signed the GAQ.
Regular exercisers have a higher overall lifetime risk of sudden cardiac death than inactive people do.
The risks of vigorous exercise are greater than its benefits for most adults, so moderate activity is always preferred.
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