The most award winning
healthcare information source.
TRUSTED FOR FOUR DECADES.
The growing number of Americans, including senior citizens, exercising in fitness facilities has increased concerns that more individuals with undiagnosed heart disease will suffer cardiac arrests during exercise. This concern has led the American Heart Association (AHA) in Dallas, and the American College of Sports Medicine (ACSM) in Indianapolis, to issue a joint statement urging fitness facilities to install automated external defibrillators (AEDs) and train staff to use them.
While occupational health professionals may be well aware of the potential risks of strenuous exercise, the joint AHA/ACSM statement holds valuable messages for them as well, especially for those who operate clinics in private industry and do not have the access to defibrillators that their colleagues in hospital settings do.
"Coronary artery disease can be asymptomatic in 25% of all myocardial infarctions that occur, and it’s estimated that 10% of heart attacks are totally silent," says Gary Balady, MD, professor of medicine at Boston University School of Medicine, director of preventive cardiology at Boston Medical Center and chair of the joint writing group that drafted the statement. The statement, published in a March edition of Circulation, the AHA journal, noted that the demographics of the more than 30 million individuals who exercise at health and fitness facilities demonstrates a steady increase in the number of members who are older than 35. "It is reasonable to assume that the number of members with cardiovascular disease [and other comorbidities] is rising as well,"1 wrote the authors.
They go on to note a database of more than 2.9 million members of a large fitness chain showed the highest death rate to be among those members who exercised less frequently; nearly half of the exercise-related deaths occurred in individuals who exercised less than once a week. Even in occupational health programs where health risk appraisals) are regularly given, you have to ask the right questions to help prevent such incidents, notes Balady. "If you ask orthopedic or neurologic questions, which is usually the case, you may not [uncover at-risk individuals]."
The AHA/ACSM statement recommends that health and fitness facilities establish a Public Access to Defibrillation (PAD) plan. It should include the following:
Of course, a number of these would be redundant in the hospital setting. "With a hospital-based clinic, they all have a code team and access to defibrillators," notes Balady. "So while it may take one or two minutes to first shock, it’s not what it takes when you have to wait for [emergency medical technicians] or paramedics [at a corporate facility]. And of course, in cardiac rehab programs, they actually have to have a defibrillator at the site."
Is the AHA/ACSM statement important for occupational health facilities outside the hospital setting? "I think so," Balady offers, noting that the AHA considers any location where individuals go to improve their fitness levels to be an "exercise" facility. "Even if you’re a hospital satellite facility, or you’re not attached to the main building, it would probably be prudent to have one," he says.
AEDs cost between $3,000 and $4,500 per unit, and Balady says one is really all you need. "Fitness facilities are not like airports, where they need to be placed frequently," he says. "We would be happy if all facilities screened their clients, had a plan in place, practiced it and had an AED — that would be the goal," he concludes.
[A reprint of the AHA/ACSM statement is available by calling (800) 242-8721 or writing the American Heart Association, Public Information, 7272 Greenville Ave., Dallas, TX 75231-4596. Ask for reprint number 71-0222. You can contact Gary Balady, MD, at (617) 638-8968.]
Balady GJ, Chaitman B, Foster C, et al. Automated external defibrillators in health/fitness facilities. Circulation 2002; 105(9):1147.