Addressing Cardiovascular Risk as Part of Physical Therapist Practice-What about Practice Recommendations for Physical Therapists?

Physical therapists routinely make decisions as to the intensity and type of exercise or physical activity they prescribe as part of a plan of care. Exercise is an important component of an evidence based treatment for many conditions treated in physical therapy settings, and is an essential component of improving health.1 While the benefits of exercise are evident, exercise may present health risks to patients with certain cardiovascular, pulmonary, and metabolic diseases. Therefore, it is important that physical therapists make sound decisions to identify which exercise interventions are appropriate and safe for individual patients. Physical therapists in acute care or cardiac and pulmonary settings are guided by American Heart Association (AHA) guidelines2 for activity restrictions, client monitoring, and medical clearance. Recommendations for exercise decision making or medical clearance in outpatient or community based physical therapy settings are limited. The American College of Sports Medicine (ACSM) guidelines for pre-exercise screening and risk stratification are intended for community settings, but it is unclear whether this system is applicable in outpatient physical therapy practice settings.3 This commentary will review some implications and limitations of using the ACSM risk stratification system and medical clearance guidelines in outpatient physical therapy practice.