Health and Fitness Screening

Why Screen?

Not everyone is as healthy as they may appear, at first sight. And, a fair number of people aren’t as healthy as they might think. Seeing as exercise places strain on many of the bodies systems, it is imperative to check that a person is physically well enough, before beginning an exercise regimen. This is both for the safety of the person beginning the regimen, as well as legal cover for the person administering it. An unknown, underlying medical issue may have catastrophic effects. So, it is for this reason that everyone should undergo a screening process, before starting to exercise.

Clinical Screening

Of the two main ways of screening, clinical screening is the broader. Therefore, it is the one done first, and for everyone. This typically consists of questionnaires about both exercise history, and medical history. The medical history will include that of the participant, and the participants family, as many conditions have been shown to be hereditary. In other words, if a parent or grandparent suffered from a condition, the participant has a chance of the same condition being present. It is always paramount to ensure complete confidentiality, in terms of the information provided. This is not only in terms of record keeping, but for peace of mind of the participant. Just like medical practitioners must keep all information confidential, so should all other screening information be kept. A typical questionnaire is a PAR-Q, or physical activity readiness questionnaire. These usually include questions about symptoms of certain conditions, such as chronic diseases, or physical injuries. Having one, or more, of these conditions does not exclude the participant from being able to exercise. It just means that further investigation is needed, before they can be cleared to enter into an exercise program. And, this is where the next method of screening will come in, in the form of medical screening. Another example is an exercise history. As simply as the name suggests, this gives information about what exercise the participant has engaged in, before. This questionnaire can easily be coupled with a goal-setting questionnaire, as the two do play off each other, in terms of determining a course of action for program setting.

Data Collection Sheet

NAME: _________________________ DATE: _

HEIGHT: ___ WEIGHT: _ AGE: ______

PHYSICIANS NAME: ________________ PHONE: _

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q) Questions (Yes / No)

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
Do you feel pain in your chest when you perform physical activity?
In the past month, have you had chest pain when you were not performing any physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
Do you know of any other reason why you should not engage in physical activity?

If you have answered Yes to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered Yes to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.

GENERAL AND MEDICAL QUESTIONNAIRE

Occupational Questions

1 What is your current occupation? ______________________________________________

2 Does your occupation require extended periods of sitting? (Yes / No)

3 Does your occupation require extended periods of repetitive movements? (If yes, please explain.) ________________________________________________________________________

4 Does your occupation require you to wear shoes with a heel (dress shoes)? (Yes / No)

5 Does your occupation cause you anxiety (mental stress)? (Yes / No)

Recreational Questions

6 Do you partake in any recreational activities (golf, tennis, skiing, etc.)? (Yes / No)

(If yes, please specify.) _______________________________________________________

7 Do you have any hobbies (Yes / No) (reading, gardening, working on cars, exploring the Internet, etc.)?

(If yes, please specify.) _______________________________________________________

Medical Questions

8 Have you ever had any pain or injuries (Yes / No) (ankle, knee, hip, back, shoulder, etc.)?

(If yes, please specify.) _______________________________________________________

9 Have you ever had any surgeries? (Yes / No)

(If yes, please specify.) _______________________________________________________

10 Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes? (Yes / No)

(If yes, please specify.) _______________________________________________________

11 Are you currently taking any medication? (Yes / No)

(If yes, please list.) __________________________________________________________

_______________________________________________________________________________

Risk Factors

The following conditions can be viewed as risk factors for physical activity participation. If an individual with one of the following risk factors wishes to participate in a physical activity program, it is strongly advised that they obtain medical clearance from their medical practitioner prior to participation.

Men > 45 years
Women > 55 or premature menopause without estrogen replacement therapy

Diagnosed Disease (Absolute Contraindications)

Cardiovascular disease
Cardiac, peripheral vascular, or cerebrovascular disease
Pulmonary disease
Chronic obstructive pulmonary disease, asthma, interstitial lung disease, or cystic fibrosis
Metabolic disease
Diabetes mellitus (type I or II), thyroid disorders, renal or liver disease
Coronary Artery Disease Risk Factors

Diagnosed Disease (Relative Contraindications)

Hypertension
High blood pressure confirmed by measurement on at least two separate occasions
- Systolic blood pressure: 140 mmHg or greater
- Diastolic blood pressure: 90 mmHg or greater
Using Antihypertensive medication
Hypercholesterolemia
- Low Density lipoprotein: > 130 mg/dL (3.4 mmol/L)
- If low density lipoprotein is not available, use total cholesterol criteria instead:
- Total serum cholesterol: >200 mg/dl (5.2 mmol/L)
- High-density lipoprotein cholesterol: <40 mg/dl (1.03 mmol/L)
- Using lipid-lowering medication
- High serum HDL cholesterol (negative risk factor) >60 mg/dL (1.6 mmol/L)
- High serum HDL cholesterol decreases the risk of coronary artery disease
Impaired fasting glucose
- Fasting blood glucose: 100 mg/dL (5.6 mmol/L) or greater confirmed by measurements on at least 2 separate occasions

Obesity

Body Mass Index of 30 kg/m2 or greater
Waist Hip Ratio greater than 0.95 (men) and 0.86 (women)
Waist girth greater than 102 cm (men) and 88 cm (women)

Sedentary Lifestyle

Not participating in a regular exercise program
Not accumulating 30 minutes or more of moderate physical activity on most days of the week

Smoking

Current cigarette smoker
Quit within previous 6 months

Family History

Myocardial infarction, coronary revascularization, or sudden death
before 55 years of age in father or other male first-degree relative (i.e., brother or son) before 65 years of age in mother or another female first-degree relative (i.e., sister or daughter)

Major Symptoms or Signs Suggestive of Cardiovascular and Pulmonary Disease

The following signs and symptoms must be interpreted within the clinical context in which they appear since they are not all specific for metabolic, pulmonary, or cardiovascular disease.

Pain or discomfort in the chest, neck, jaw, arms, or other areas that may be
due to myocardial ischemia (lack of adequate circulation)
Shortness of breath at rest, during daily activities, or with mild exertion
Dizziness or syncope (fainting)
Orthopnea (breathing discomfort when not in an upright position) or paroxysmal nocturnal dyspnea (interrupted breathing at night)
Ankle edema (swelling)
Palpitations (abnormal rapid beating of the heart) or tachycardia (rapid heartbeat) Intermittent claudication (cramping pain and weakness in legs, especially calves, during walking due to inadequate blood supply to muscles)
Known heart murmur (atypical heart sound indicating a structural or functional abnormality)
Unusual or unexplained fatigue
Absolute Contraindications to Physical Activity
Under no circumstances may the individual participate in a physical activity program unless they are under strict medical supervision.
A recent significant change in the resting ECG suggesting significant ischaemia, recent myocardial infarction (within 2 days) or another acute cardiac event
Unstable angina
Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
Symptomatic severe aortic stenosis
Uncontrolled symptomatic heart failure
Acute pulmonary embolus or pulmonary infarction
Acute myocarditis or pericarditis
Suspected or known dissecting aneurysm
Acute systematic infection, accompanied by fever, body aches, or swollen lymph glands
Relative Contraindications to Physical Activity
Relative contraindications can be superseded if benefits outweigh risks of exercise.
In some instances, these individuals can be exercised with caution and/or using low-level end points, especially if they are asymptomatic at rest. It is recommended that medical clearance is obtained prior to starting physical activity.
Left main coronary stenosis
Moderate stenotic heart disease
Electrolyte abnormalities (e.g. hypokalemia, hypomagnesemia)
Severe arterial hypertension (i.e. systolic BP of >200mm Hg and/or a diastolic of BP of >110mm Hg) at rest
Tachydysrthythmia or bradydsrhythmia
Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
High-degree atrioventricular block
Ventricular aneurysm
Uncontrolled metabolic disease (e.g., diabetes, thyrotoxicosis, or myxedema)
Chronic infectious disease (e.g. mononucleosis, hepatitis, AIDS)
Mental or physical impairment leading to inability to exercise adequately

Medical Screening

Medical screening is performed by specialists. Depending on the severity of the symptoms, the more specialized the investigation may need to be. Tests performed may range from simple blood tests, to exercise stress tests, performed under laboratory conditions. But, they all have the same underlying goal. They are used to determine how much the participant is capable of exercising, but, not to prevent them from exercising, completely. There will be instances where the participant will have to undergo some form of treatment, before returning to general exercise. But, the chances of them never being able to exercise ever again are incredibly remote.

Examples of tests for screening include:

Blood tests:

Usually done for cholesterol levels, sugar levels (diabetes) and some cancers

Cardiac tests:

Tests such as baseline ECG, and stress ECG, will give an indication of the health of the heart, and therefore ability to cope with exercise. Blood pressure and resting heart rate are also mechanisms for testing the health of the cardiovascular system.

Respiratory tests:

Lung function tests can be done both at rest, and under exercise stress conditions, to evaluate health of the respiratory system.

Orthopaedic assessment:

Where an underlying injury may be present, an orthopaedic assessment may be needed to evaluate the participant’s ability, before entering an exercise program. This may result in certain restrictions, rehabilitation, or even surgery, as a means of dealing with the underlying injury.

Screening Assessment

These tests are essential in the screening process to determine the suitability of the individual to participate in a physical activity program. It is recommended that these tests are performed immediately after the client has completed their screening questionnaires, and prior to beginning other aspects of physical activity testing.

Height

Standing, barefoot, with heels back and head all against a wall, the height from the floor to the top of the head is measured. A variety of tape measures are available, for use in this test. Most important is to ensure that the measurement is perpendicular to the ground.

Weight

Wearing as little clothing as is practical, stand on a calibrated scale. Record the reading given by the scale. It is important to try, as best as possible, to wear the same amount of clothing each time the weight is measured, to ensure consistency.

Body Mass Index (BMI)

The Body Mass Index is represented as the Weight divided by the square of the Height.

BMI = Weight / Height

The result will give a comparison for healthy body weight.

It is important to note that resistance/strength training will very quickly make this reading invalid, as muscle mass increases. So, it is more for those not already involved in this type of training program.

BMI Categories:

Underweight = <18.5

Normal weight = 18.5 – 24.9

Overweight = 25 – 29.9

Obesity = BMI of 30 or greater

Resting Heart Rate

One of the most basic tests, which can be done by anyone, this test gives a baseline for comparison of how hard the heart is working. It is represented as the number of beats per minute, and can be tested at many sites on the body. The most common of these is the radial pulse (wrist). Two others that are very commonly used are the carotid pulse (neck) and dorsomedial pulse (top of the foot).

Procedure: Once the pulse is felt, using the first two index fingers, the beats are counted for a specified time. The most commonly used time is fifteen (15) seconds. But, ten seconds can also be used, as well as the full sixty. When using a shorter time space (10 or 15 seconds) the first beat felt is counted as zero. This is to prevent double counting between time spaces (i.e. the last beat of 15 seconds will usually be the first beat of the next 15 seconds). The number of beats is then multiplied by four (if using 15 seconds) or six (if using 10 seconds) to get the number of beats in a minute (60 seconds).

A heart rate of 72bpm is widely considered to be average. Fitter individuals will typically have a lower heart rate, and vice versa. It is always important to remember the effects of medications on heart rate, though.

Blood pressure

Another of the very simple tests, blood pressure can be performed by nearly anyone. Manual and automatic sphygmomanometers are widely available.

Procedure:

If using an automatic one, place the cuff snugly on the right arm, and press start. The machine will do the rest, and give you the readings, when it is done.
When using a manual cuff:
1. Place the cuff snugly on the right arm, just above the elbow, with the palm turned to face upward. The arm should be supported, or resting on a table or some other surface.
2. Place the stethoscope over the brachial artery (usually found in the crease of the elbow), and put the earpieces into your ears.
3. Ensure the valve on the bulb of the sphygmomanometer is closed, and inflate the cuff by repetitively squeezing the bulb. Do this until the arm is constricted enough that you cannot hear a pulse with the stethoscope.
4. Slowly deflate the cuff, by releasing the valve.
5. Record the pressure reading of the first beat you hear, and continue deflating, recording the reading of the last beat you hear, as well.
6. Then, completely deflate the cuff, and remove it. The first beat recorded is the systolic reading, and the last is the diastolic reading.

While there is no normal or ideal blood-pressure reading, the following figures can be used as a guide:

low blood pressure – below 90/60
normal blood pressure – generally between 90/60 and 120/80
high – normal blood pressure between 120/80 and 140/90
high blood pressure -equal to or more than 140/90 (usually classified as hypertensive)
Very high blood pressure – equal to or more than 180/110.

Waist-to-hip Ratio

A measurement of the circumferences of the waist and hip region. These circumference measurements are used to calculate a ratio (waist/hip), which is presented as a decimal figure, I.e.

Waist (80cm) / Hip (102cm) = 0,78.

This measurement is used to provide an indication to adipose tissue distribution. Since research has shown that higher distribution of adipose tissue around the abdominal region is a risk factor for cardiovascular disease. The following measurements indicate a high risk of cardiovascular disease:

Male = > 0,95
Female = > 0,82

Screening Assessment Feedback and Management

Goal Setting

Once a participant is cleared to begin a program, the program then needs direction. Without an aim, or some form of achievement to strive towards, the exercise will not be very effective. Luckily, setting a goal is very easy to do. And, almost everyone who enters into an exercise program has done so with a goal in mind, already. The job of the person administering the program is then to shape these goals, and in turn design the program around achieving the goals. For goals to be successful, they should adhere to a certain format. This is known as SMART goal-setting. This format is popularly used, as it is very simple, and breaks down each aspect of the goals, to increase likelihood of achievement.

Specific:

The more specific the target, the easier it will be to hit. If a participant wants to lose weight (for example), then a specific amount of weight should be the goal, as opposed to the general statement of just losing weight.

Measurable:

Setting a goal that can be quantified allows it to be more easily striven towards. Sticking with the goal of losing weight; as the goal is a quantity, a count-down can even be implemented, as the goal weight is approached.

Attainable:

Goals must be reachable, for them to motivate. Goals that are out of reach, very quickly serve to demotivate.

Realistic:

This goes hand in hand with goals being attainable. Goals must be within the scope of what is practical, and possible, for everyone. Not everyone is capable of setting world records. It would be foolhardy for every person to set this as a goal.

Timed:

Having a time-limit on achieving a goal will drive the participant to attain it. But, as has been mentioned, the time-limit will need to be in line with the other aspects of goal setting. This can also be broken into different time periods, when initially setting the goals.

In other words, goals set can be Short-term, Medium-term, or long-term. If we continue with the example of losing weight; a short-term goal would be initially loss of a determined number of kilograms (or percentage body fat, depending on the approach), the medium-term goal could be further loss towards a final goal-weight, and finally the long-term goal could be maintaining the new weight. Again, these should have a set time. The importance of this is two-fold. First, it allows for constant tracking of the goals, and motivation through achieving the goals as time progresses. And, second is that it gives the goals overall direction (in other words, an end-point).

Manage Data

Once the participant has been screened, and goals set, an archive of this information must be kept.

This is to have the information readily available, when needed. It may be referred to, and updated, as necessary, as the participant progresses through the training program. But, it is also important to have the information on hand, in the event of any problem arising. As was mentioned, one of the reasons for doing the screening is to have cover, in case something unfortunate may occur. Keeping proof that the related screening was done will serve as legal back-up, in the event of a claim of negligence.

Health and Fitness Screening