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. As exercise places strain on many of the body’s 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 participant’s 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 have to keep all information confidential, so should all other screening information.
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. This is where the next method of screening will come in, in the form of medical screening. Another example of clinical screening 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)
1. Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
2. Do you feel pain in your chest when you perform physical activity?
3. In the past month, have you had chest pain when you were not performing any physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
7. 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 explain.)
_________________________________________________________________
_________________________________________________________________
7. Do you have any hobbies (Yes / No)
(reading, gardening, working on cars, exploring the Internet, etc.)? (If yes, please explain.)
_________________________________________________________________
_________________________________________________________________
Medical Questions
8. Have you ever had any pain or injuries (Yes / No)
(ankle, knee, hip, back, shoulder, etc.)? (If yes, please explain.)
_________________________________________________________________
_________________________________________________________________
9. Have you ever had any surgeries? (Yes / No)
(If yes, please explain.)
_________________________________________________________________
_________________________________________________________________
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 explain.)
________________________________________________________________
________________________________________________________________
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.
1. Age
• Men > 45 years
• Women > 55 or premature menopause without estrogen replacement therapy
2. 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
3. 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
- High blood pressure confirmed by measurement on at least two separate occasions
- 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
4. Family History
- Myocardial infarction, coronary revascularization, or sudden death
- before 55 years of age in father or other male first degree relative (ie, brother or son)
- before 65 years of age in mother or other female first degree relative (ie, sister or daughter)
5. 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 heart beat)
• 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 other 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. They all have the same underlying goal; they are used to determine how much the participant is capable of exercising. They are not aimed at preventing 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 it’s 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.