Lynch, Daniel J. M.S.
Daniel J. Lynch, M.S., has been in the health and fitness business for 30 years and is currently president and CEO of AgeWell Partners, LLC. New York-based AgeWell develops hospital-affiliated, medically based health and fitness centers in joint ventures with hospitals. He can be reached at firstname.lastname@example.org. Mr. Lynch is an associate editor of ACSM’s Health & Fitness Journal®.
The health & fitness industry has made dramatic changes in the past 10 years. Club operators have become more sophisticated about their business strategies, while trade associations and member-based organizations continue to grow in all areas of this dynamic business. The International Health, Racquet & Sportsclub Association (IHRSA) reports that U.S. club membership has grown from 17.3 million in 1987 to 36.3 in 2002 (1). Meanwhile, the baby boom population continues to age and demonstrate significant risk factors like obesity and cardiovascular disease. As a result of this increased demand for healthier lifestyles there also becomes a need for more specific diagnostic screening equipment and fitness assessment tools that are critical to properly evaluating the safety of starting an exercise program. In order to design exercise programs for people with lifestyle-related disorders like diabetes, hypertension, elevated cholesterol, etc., the medical and fitness profession has to rely on new and innovative tools that can be as accurate as possible in predicting the risks associated with starting an exercise program.
If we look at the basic fitness assessment tools, there are many traditional methods for screening an individual for baseline fitness levels. Some typical measurements include body fat analysis, circumference measurements, predictive oxygen consumption tests, strength, flexibility, and vestibular balance measurements.
Some of the newer technologies on the market can help a fitness instructor actually measure oxygen consumption with portable equipment and also measure basal metabolic rate through the use of a simple instrument that the member breathes into for about one minute. These new tools can help the fitness instructor better prepare an exercise program for the individual and by working with a nutritionist, can properly balance calories consumed with calories expended for safe weight loss and weight management.
Equipment companies also are following suit with improved accuracy with regard to calories burned during exercise, heart rate monitoring, and information capture systems regarding the individual’s performance during exercise.
One of the newer and more exciting developments in the medical arena is called Computed Tomography Angiography (CTA). “CTA is part of a revolutionary advancement in super fast imaging using a 16 slice CT scanner. This technique is referred to as “non-invasive imaging,” which allows the medical professional to quantify and qualify the disease for a definitive diagnosis. The 16-slice CT takes 360 degrees of x-ray at 1 mm intervals around the body. A computer then assembles the raw data into cross sectional images. From these source images, three dimensional and multiplanar pictures of the anatomy can be generated for a radiologist’s or cardiologist’s review.” (2)
This technique can be used to accurately diagnose disease in the arterial system from the head to the lower extremities and review cross sectional information about the arterial system that could be critical to a life or death situation.
One of the most fascinating uses of this technology is the 16-slice CT of the heart, aorta, and major/minor coronary vessel system. What normally was done in 1.5 hours in a Cath Lab can now be done with a 30 second breath hold by the patient. Here is what usually happens:
* Patient arrives for their CT screening;
* The patient is prepared for their test by lying on a treatment table that will ultimately place them inside the CT scanner;
* To control heart rate a small injection of a beta blocker is used to slow the heart rate;
* The patient is asked to hold their breath for 30 seconds;
* Within thirty minutes, the test is over and the patient is going home!
When the test is over, the fascinating detail begins. The CT computer takes the raw images (literally thousands of them) and composites them into an image of the heart and corresponding coronary arteries (depending on the position of the heart). Literally all major and minor vessels can be seen when the radiologist or cardiologist rotates the image of the heart to examine for hard and soft plaque deposits, lesions, aneurysms, or other maladies that might make the heart subject to severe damage during exercise.
The sudden, tragic death of actor John Ritter in September 2003 is a clear example of the use of this technology. Mr. Ritter died of an aortic dissection, a tearing of the wall of the aorta. “CTA clearly has the ability to provide early detection for aortic dissections,” according to Stephen Koch, M.D., Medical Director for Imaging Heart (2).
The added beauty of this procedure is that the computerized images can be transferred over the Web to be read by the physician at a convenient location and in a much more timely matter. The test also is reimbursable if a client has certain risk factors for starting an exercise program or signs or symptoms of cardiovascular disease. The procedure is not inexpensive, but for the piece of mind, or in the prevention of sudden death, it might be well worth the expense if you can’t get it reimbursed.
As a result of this technology, a traditional stress test could be virtually eliminated from the diagnosis of coronary artery disease with a more efficient and accurate method of predicting cardiovascular disease. This also could give the physician and fitness instructor critical information on how to treat a patient or write an exercise program. Realizing a stress test can often give us good information about an individual’s level of fitness, there are clearly alternative methods of determining this for purposes of writing an individualized exercise program.
The future is looking brighter for the purpose of accurately predicting disease that may affect how we start developing an exercise program for the many baby boomers and seniors that are looking to get back to a healthy lifestyle.