causes and symptons of food-borne illness/CHAPTER-5

What are foodborne illnesses?

Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that contain harmful bacteria, parasites, viruses, or chemicals. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Common symptoms of foodborne illnesses include vomiting, diarrhea, abdominal pain, fever, and chills.

Most foodborne illnesses are acute, meaning they happen suddenly and last a short time, and most people recover on their own without treatment. Rarely, foodborne illnesses may lead to more serious complications.

What causes foodborne illnesses?

The majority of foodborne illnesses are caused by harmful bacteria and viruses.² Some parasites and chemicals also cause foodborne illnesses.

Bacteria

Bacteria are tiny organisms that can cause infections of the GI tract. Not all bacteria are harmful to humans.

Some harmful bacteria may already be present in foods when they are purchased. Raw foods including meat, poultry, fish and shellfish, eggs, unpasteurized milk and dairy products, and fresh produce often contain bacteria that cause foodborne illnesses. Bacteria can contaminate food—making it harmful to eat—at any time during growth, harvesting or slaughter, processing, storage, and shipping.

Foods may also be contaminated with bacteria during food preparation in a restaurant or home kitchen. If food preparers do not thoroughly wash their hands, kitchen utensils, cutting boards, and other kitchen surfaces that come into contact with raw foods, cross-contamination—the spread of bacteria from contaminated food to uncontaminated food—may occur.

If hot food is not kept hot enough or cold food is not kept cold enough, bacteria may multiply. Bacteria multiply quickly when the temperature of food is between 40 and 140 degrees. Cold food should be kept below 40 degrees and hot food should be kept above 140 degrees. Bacteria multiply more slowly when food is refrigerated, and freezing food can further slow or even stop the spread of bacteria. However, bacteria in refrigerated or frozen foods become active again when food is brought to room temperature. Thoroughly cooking food kills bacteria.

Many types of bacteria cause foodborne illnesses. Examples include

·         Salmonella, a bacterium found in many foods, including raw and undercooked meat, poultry, dairy products, and seafood. Salmonella may also be present on egg shells and inside eggs.

·         Campylobacter jejuni (C. jejuni), found in raw or undercooked chicken and unpasteurized milk.

·         Shigella, a bacterium spread from person to person. These bacteria are present in the stools of people who are infected. If people who are infected do not wash their hands thoroughly after using the bathroom, they can contaminate food that they handle or prepare. Water contaminated with infected stools can also contaminate produce in the field.

·         Escherichia coli (E. coli), which includes several different strains, only a few of which cause illness in humans. E. coli O157:H7 is the strain that causes the most severe illness. Common sources of E. coli include raw or undercooked hamburger, unpasteurized fruit juices and milk, and fresh produce.

·         Listeria monocytogenes (L. monocytogenes), which has been found in raw and undercooked meats, unpasteurized milk, soft cheeses, and ready-to-eat deli meats and hot dogs.

·         Vibrio, a bacterium that may contaminate fish or shellfish.

·         Clostridium botulinum (C. botulinum), a bacterium that may contaminate improperly canned foods and smoked and salted fish.

Viruses

Viruses are tiny capsules, much smaller than bacteria, that contain genetic material. Viruses cause infections that can lead to sickness. People can pass viruses to each other. Viruses are present in the stool or vomit of people who are infected. People who are infected with a virus may contaminate food and drinks, especially if they do not wash their hands thoroughly after using the bathroom.

Common sources of foodborne viruses include

·         food prepared by a person infected with a virus

·         shellfish from contaminated water

·         produce irrigated with contaminated water

Common foodborne viruses include

·         norovirus, which causes inflammation of the stomach and intestines

·         hepatitis A, which causes inflammation of the liver

Parasites

Parasites are tiny organisms that live inside another organism. In developed countries such as the United States, parasitic infections are relatively rare.

Cryptosporidium parvum and Giardia intestinalis are parasites that are spread through water contaminated with the stools of people or animals who are infected. Foods that come into contact with contaminated water during growth or preparation can become contaminated with these parasites. Food preparers who are infected with these parasites can also contaminate foods if they do not thoroughly wash their hands after using the bathroom and before handling food.

Trichinella spiralis is a type of roundworm parasite. People may be infected with this parasite by consuming raw or undercooked pork or wild game.

Chemicals

Harmful chemicals that cause illness may contaminate foods such as

·         fish or shellfish, which may feed on algae that produce toxins, leading to high concentrations of toxins in their bodies. Some types of fish, including tuna and mahi mahi, may be contaminated with bacteria that produce toxins if the fish are not properly refrigerated before they are cooked or served.

·         certain types of wild mushrooms.

·         unwashed fruits and vegetables that contain high concentrations of pesticides.

Who gets foodborne illnesses?

Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others, including

·         infants and children

·         pregnant women and their fetuses

·         older adults

·         people with weak immune systems

These groups also have a greater risk of developing severe symptoms or complications of foodborne illnesses.

What are the symptoms of foodborne illnesses?

Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include

·         vomiting

·         diarrhea or bloody diarrhea

·         abdominal pain

·         fever

·         chills

Symptoms can range from mild to serious and can last from a few hours to several days.

C. botulinum and some chemicals affect the nervous system, causing symptoms such as

·         headache

·         tingling or numbness of the skin

·         blurred vision

·         weakness

·         dizziness

·         paralysis

What are the complications of foodborne illnesses?

Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute foodborne illnesses may also lead to chronic—or long lasting—health problems.

Dehydration

When someone does not drink enough fluids to replace those that are lost through vomiting and diarrhea, dehydration can result. When dehydrated, the body lacks enough fluid and electrolytes—minerals in salts, including sodium, potassium, and chloride—to function properly. Infants, children, older adults, and people with weak immune systems have the greatest risk of becoming dehydrated.

Signs of dehydration are

·         excessive thirst

·         infrequent urination

·         dark-colored urine

·         lethargy, dizziness, or faintness

Signs of dehydration in infants and young children are

·         dry mouth and tongue

·         lack of tears when crying

·         no wet diapers for 3 hours or more

·         high fever

·         unusually cranky or drowsy behavior

·         sunken eyes, cheeks, or soft spot in the skull

Also, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched and released.

Severe dehydration may require intravenous fluids and hospitalization. Untreated severe dehydration can cause serious health problems such as organ damage, shock, or coma—a sleeplike state in which a person is not conscious.

HUS

Hemolytic uremic syndrome is a rare disease that mostly affects children younger than 10 years of age. HUS develops when E. coli bacteria lodged in the digestive tract make toxins that enter the bloodstream. The toxins start to destroy red blood cells, which help the blood to clot, and the lining of the blood vessels.

In the United States, E. coli O157:H7 infection is the most common cause of HUS, but infection with other strains of E. coli, other bacteria, and viruses may also cause HUS. A recent study found that about 6 percent of people with E. coli O157:H7 infections developed HUS. Children younger than age 5 have the highest risk, but females and people age 60 and older also have increased risk.³

Symptoms of E. coli O157:H7 infection include diarrhea, which may be bloody, and abdominal pain, often accompanied by nausea, vomiting, and fever. Up to a week after E. coli symptoms appear, symptoms of HUS may develop, including irritability, paleness, and decreased urination. HUS may lead to acute renal failure, which is a sudden and temporary loss of kidney function. HUS may also affect other organs and the central nervous system. Most people who develop HUS recover with treatment. Research shows that in the United States between 2000 and 2006, fewer than 5 percent of people who developed HUS died of the disorder. Older adults had the highest mortality rate—about one-third of people age 60 and older who developed HUS died.³

Studies have shown that some children who recover from HUS develop chronic complications, including kidney problems, high blood pressure, and diabetes.

Other Complications

Some foodborne illnesses lead to other serious complications. For example, C. botulinum and certain chemicals in fish and seafood can paralyze the muscles that control breathing. L. monocytogenes can cause spontaneous abortion or stillbirth in pregnant women.

Research suggests that acute foodborne illnesses may lead to chronic disorders, including

·         reactive arthritis, a type of joint inflammation that usually affects the knees, ankles, or feet. Some people develop this disorder following foodborne illnesses caused by certain bacteria, including C. jejuni and Salmonella. Reactive arthritis usually lasts fewer than 6 months, but this condition may recur or become chronic arthritis.⁴

·         irritable bowel syndrome (IBS), a disorder of unknown cause that is associated with abdominal pain, bloating, and diarrhea or constipation or both. Foodborne illnesses caused by bacteria increase the risk of developing IBS.⁵

·         Guillain-Barré syndrome, a disorder characterized by muscle weakness or paralysis that begins in the lower body and progresses to the upper body. This syndrome may occur after foodborne illnesses caused by bacteria, most commonly C. jejuni. Most people recover in 6 to 12 months.⁶

A recent study found that adults who had recovered from E. coli O157:H7 infections had increased risks of high blood pressure, kidney problems, and cardiovascular disease.⁷

When should people with foodborne illnesses see a health care provider?

People with any of the following symptoms should see a health care provider immediately:

·         signs of dehydration

·         prolonged vomiting that prevents keeping liquids down

·         diarrhea for more than 2 days in adults or for more than 24 hours in children

·         severe pain in the abdomen or rectum

·         a fever higher than 101 degrees

·         stools containing blood or pus

·         stools that are black and tarry

·         nervous system symptoms

·         signs of HUS

If a child has a foodborne illness, parents or guardians should not hesitate to call a health care provider for advice.

How are foodborne illnesses diagnosed?

To diagnose foodborne illnesses, health care providers ask about symptoms, foods and beverages recently consumed, and medical history. Health care providers will also perform a physical examination to look for signs of illness.

Diagnostic tests for foodborne illnesses may include a stool culture, in which a sample of stool is analyzed in a laboratory to check for signs of infections or diseases. A sample of vomit or a sample of the suspected food, if available, may also be tested. A health care provider may perform additional medical tests to rule out diseases and disorders that cause symptoms similar to the symptoms of foodborne illnesses.

If symptoms of foodborne illnesses are mild and last only a short time, diagnostic tests are usually not necessary.

How are foodborne illnesses treated?

The only treatment needed for most foodborne illnesses is replacing lost fluids and electrolytes to prevent dehydration.

Over-the-counter medications such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol and Kaopectate) may help stop diarrhea in adults. However, people with bloody diarrhea—a sign of bacterial or parasitic infection—should not use these medications. If diarrhea is caused by bacteria or parasites, over-the-counter medications may prolong the problem. Medications to treat diarrhea in adults can be dangerous for infants and children and should only be given with a health care provider’s guidance.

If the specific cause of the foodborne illness is diagnosed, a health care provider may prescribe medications, such as antibiotics, to treat the illness.

Hospitalization may be required to treat lifethreatening symptoms and complications, such as paralysis, severe dehydration, and HUS.

Eating, Diet, and Nutrition

The following steps may help relieve the symptoms of foodborne illnesses and prevent dehydration in adults:

·         drinking plenty of liquids such as fruit juices, sports drinks, caffeine-free soft drinks, and broths to replace fluids and electrolytes

·         sipping small amounts of clear liquids or sucking on ice chips if vomiting is still a problem

·         gradually reintroducing food, starting with bland, easy-to-digest foods such as rice, potatoes, toast or bread, cereal, lean meat, applesauce, and bananas

·         avoiding fatty foods, sugary foods, dairy products, caffeine, and alcohol until recovery is complete

Infants and children present special concerns. Infants and children are likely to become dehydrated more quickly from diarrhea and vomiting because of their smaller body size. The following steps may help relieve symptoms and prevent dehydration in infants and children:

·         giving oral rehydration solutions such as Pedialyte, Naturalyte, Infalyte, and CeraLyte to prevent dehydration

·         giving food as soon as the child is hungry

·         giving infants breast milk or fullstrength formula, as usual, along with oral rehydration solutions

Older adults and adults with weak immune systems should also drink oral rehydration solutions to prevent dehydration.

How are foodborne illnesses prevented?

Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods.

·         Raw and cooked perishable foods—foods that can spoil—should be refrigerated or frozen promptly. If perishable foods stand at room temperature for more than 2 hours, they may not be safe to eat. Refrigerators should be set at 40 degrees or lower and freezers should be set at 0 degrees.

·         Foods should be cooked long enough and at a high enough temperature to kill the harmful bacteria that cause illnesses. A meat thermometer should be used to ensure foods are cooked to the appropriate internal temperature:

o 145 degrees for roasts, steaks, and chops of beef, veal, pork, and lamb, followed by 3 minutes of rest time after the meat is removed from the heat source

o 160 degrees for ground beef, veal, pork, and lamb

o 165 degrees for poultry

·         Cold foods should be kept cold and hot foods should be kept hot.

·         Fruits and vegetables should be washed under running water just before eating, cutting, or cooking. A produce brush can be used under running water to clean fruits and vegetables with firm skin.

·         Raw meat, poultry, seafood, and their juices should be kept away from other foods.

·         People should wash their hands for at least 20 seconds with warm, soapy water before and after handling raw meat, poultry, fish, shellfish, produce, or eggs. People should also wash their hands after using the bathroom, changing diapers, or touching animals.

·         Utensils and surfaces should be washed with hot, soapy water before and after they are used to prepare food. Diluted bleach—1 teaspoon of bleach to 1 quart of hot water—can also be used to sanitize utensils and surfaces.

Traveler’s Diarrhea

People who visit certain foreign countries are at risk for traveler’s diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. Traveler’s diarrhea can be a problem for people traveling to developing countries in Africa, Asia, Latin America, and the Caribbean. Visitors to Canada, most European countries, Japan, Australia, and New Zealand do not face much risk for traveler’s diarrhea.

To prevent traveler’s diarrhea, people traveling from the United States to developing countries should avoid

·         drinking tap water, using tap water to brush their teeth, or using ice made from tap water

·         drinking unpasteurized milk or milk products

·         eating raw fruits and vegetables, including lettuce and fruit salads, unless they peel the fruits or vegetables themselves

·         eating raw or rare meat and fish

·         eating meat or shellfish that is not hot when served

·         eating food from street vendors

Travelers can drink bottled water, bottled soft drinks, and hot drinks such as coffee or tea.

People concerned about traveler’s diarrhea should talk with a health care provider before traveling. The health care provider may recommend that travelers bring medication with them in case they develop diarrhea during their trip. Health care providers may advise some people—especially people with weakened immune systems—to take antibiotics before and during a trip to help prevent traveler’s diarrhea. Early treatment with antibiotics can shorten a bout of traveler’s diarrhea.

Points to Remember

·         Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that contain harmful bacteria, parasites, viruses, or chemicals.

·         Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others, including infants and children, pregnant women and their fetuses, older adults, and people with weakened immune systems.

·         Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include vomiting, diarrhea or bloody diarrhea, abdominal pain, fever, and chills.

·         Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute foodborne illnesses may also lead to chronic—or long lasting—health problems.

·         The only treatment needed for most foodborne illnesses is replacing lost fluids and electrolytes to prevent dehydration.

·         Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods.

Stages of Change model/chap-3

 Transtheoretical Model (Stages of Change)

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The Transtheoretical Model (also called the Stages of Change Model), developed by Prochaska and DiClemente in the late 1970s, evolved through studies examining the experiences of smokers who quit on their own with those requiring further treatment to understand why some people were capable of quitting on their own. It was determined that people quit smoking if they were ready to do so. Thus, the Transtheoretical Model (TTM) focuses on the decision-making of the individual and is a model of intentional change. The TTM operates on the assumption that people do not change behaviors quickly and decisively. Rather, change in behavior, especially habitual behavior, occurs continuously through a cyclical process. The TTM is not a theory but a model; different behavioral theories and constructs can be applied to various stages of the model where they may be most effective.

The TTM posits that individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Termination was not part of the original model and is less often used in application of stages of change for health-related behaviors. For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.

1.    Precontemplation - In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior.

2.    Contemplation - In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior.

3.    Preparation (Determination) - In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life.

4.    Action - In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.

5.    Maintenance - In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.

6.    Termination - In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.  

To progress through the stages of change, people apply cognitive, affective, and evaluative processes. Ten processes of change have been identified with some processes being more relevant to a specific stage of change than other processes. These processes result in strategies that help people make and maintain change.

1.    Consciousness Raising - Increasing awareness about the healthy behavior.

2.    Dramatic Relief - Emotional arousal about the health behavior, whether positive or negative arousal.

3.    Self-Reevaluation - Self reappraisal to realize the healthy behavior is part of who they want to be.

4.    Environmental Reevaluation - Social reappraisal to realize how their unhealthy behavior affects others.

5.    Social Liberation - Environmental opportunities that exist to show society is supportive of the healthy behavior.

6.    Self-Liberation - Commitment to change behavior based on the belief that achievement of the healthy behavior is possible.

7.    Helping Relationships - Finding supportive relationships that encourage the desired change.

8.    Counter-Conditioning - Substituting healthy behaviors and thoughts for unhealthy behaviors and thoughts.

9.    Reinforcement Management - Rewarding the positive behavior and reducing the rewards that come from negative behavior.

10.  Stimulus Control - Re-engineering the environment to have reminders and cues that support and encourage the healthy behavior and remove those that encourage the unhealthy behavior.

Limitations of the Transtheoretical Model

There are several limitations of TTM, which should be considered when using this theory in public health. Limitations of the model include the following:

·         The theory ignores the social context in which change occurs, such as SES and income.

·         The lines between the stages can be arbitrary with no set criteria of how to determine a person's stage of change. The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated.

·         There is no clear sense for how much time is needed for each stage, or how long a person can remain in a stage.  

·         The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true.

The Transtheoretical Model provides suggested strategies for public health interventions to address people at various stages of the decision-making process. This can result in interventions that are tailored (i.e., a message or program component has been specifically created for a target population's level of knowledge and motivation) and effective. The TTM encourages an assessment of an individual's current stage of change and accounts for relapse in people's decision-making process.

Importance of Physical Activity/chapter-3

Importance of Physical Activity

Physical activity provides long-term health benefits for everyone! By being active, you will burn calories that you store from eating throughout the day and—it can be as easy as walking the dog or as rigorous as running a marathon. Providing opportunities for children to be active early on puts them on a path to better physical and mental health. It's never too late to jumpstart a healthy lifestyle.

Physical Activity & Obesity

Physical activity, along with proper nutrition, is beneficial to people of all ages, backgrounds, and abilities. And it is important that everyone gets active: over the last 20 years, there's been a significant increase in obesity in the United States. About one-third of U.S. adults (33.8%) are obese and approximately 17% (or 12.5 million) of children and adolescents (aged 2-19 years) are obese.¹

The health implications of obesity in America are startling:

·         If things remain as they are today, one-third of all children born in the year 2000 or later may suffer from diabetes at some point in their lives, while many others are likely to face chronic health problems such as heart disease, high blood pressure, cancer, diabetes, and asthma.²

·         Studies indicate that overweight youth may never achieve a healthy weight, and up to 70% of obese teens may become obese adults.³

·         Even more worrisome, the cumulative effect could be that children born in the year 2000 or later may not outlive their parents. ⁴

The impact of obesity doesn't end there. Obesity has personal financial and national economic implications as well. Those who are obese have medical costs that are $1,429 more than those of normal weight on average (roughly 42% higher).⁵ And annual direct costs of childhood obesity are $14.3 billion.⁶

By incorporating physical activity into your daily life—30 minutes for adults and 60 minutes for children—as well as healthy eating, you will experience positive health benefits and be on the path for a better future.

The Impact of Physical Activity on Your Health

Regular physical activity can produce long-term health benefits. It can help:

·         Prevent chronic diseases such as heart disease, cancer, and stroke (the three leading health-related causes of death)

·         Control weight

·         Make your muscles stronger

·         Reduce fat

·         Promote strong bone, muscle, and joint development

·         Condition heart and lungs

·         Build overall strength and endurance

·         Improve sleep

·         Decrease potential of becoming depressed

·         Increase your energy and self-esteem

·         Relieve stress

·         Increase your chances of living longer

When you are not physically active, you are more at risk for:

·         High blood pressure

·         High blood cholesterol

·         Stroke

·         Type 2 diabetes

·         Heart disease

·         Cancer

physical activity

Physical activity or exercise can improve your health and reduce the risk of developing several diseases like type 2 diabetes, cancer and cardiovascular disease. Physical activity and exercise can have immediate and long-term health benefits. Most importantly, regular activity can improve your quality of life. A minimum of 30 minutes a day can allow you to enjoy these benefits.  

Benefits of regular physical activity

If you are regularly physically active, you may:

·         reduce your risk of a heart attack 

·         manage your weight better 

·         have a lower blood cholesterol level 

·         lower the risk of type 2 diabetes and some cancers 

·         have lower blood pressure 

·         have stronger bones, muscles and joints and lower risk of developing osteoporosis 

·         lower your risk of falls 

·         recover better from periods of hospitalisation or bed rest 

·         feel better – with more energy, a better mood, feel more relaxed and sleep better

A healthier state of mind 

A number of studies have found that exercise helps depression. There are many views as to how exercise helps people with depression:

·         Exercise may block negative thoughts or distract you from daily worries. 

·         Exercising with others provides an opportunity for increased social contact. 

·         Increased fitness may lift your mood and improve your sleep patterns. 

·         Exercise may also change levels of chemicals in your brain, such as serotonin, endorphins and stress hormones.  

Aim for at least 30 minutes a day 

To maintain health and reduce your risk of health problems, health professionals and researchers recommend a minimum of 30 minutes of moderate-intensity physical activity on most, preferably all, days. 

Physical activity guideline

It states that:

·         Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount.

·         Be active on most, preferably all, days every week. 

·         Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week. 

·         Do muscle strengthening activities on at least two days each week.

Ways to increase physical activity

Increases in daily activity can come from small changes made throughout your day, such as walking or cycling instead of using the car, getting off a tram, train or bus a stop earlier and walking the rest of the way, or walking the children to school.  

See your doctor first

It is a good idea to see your doctor before starting your physical activity program if:

·         you are aged over 45 years 

·         physical activity causes pain in your chest 

·         you often faint or have spells of severe dizziness 

·         moderate physical activity makes you very breathless 

·         you are at a higher risk of heart disease 

·         you think you might have heart disease or you have heart problems 

·         you are pregnant. 

Pre-exercise screening is used to identify people with medical conditions that may put them at a higher risk of experiencing a health problem during physical activity. It is a filter or ‘safety net’ to help decide if the potential benefits of exercise outweigh the risks for you.