Client Screening, Health Risk Assessment, and Medical Clearance
Purpose of screening
Screening answers one question: is exercise safe for this client, at this intensity, right now? A defensible process combines a health history questionnaire, a medication and supplement review, a PAR-Q+-style readiness tool, documented informed consent, and a structured search for signs and symptoms such as chest pain or pressure, unusual dyspnea, dizziness or syncope, palpitations, claudication, and orthopnea. The specialist must also recognize absolute contraindications to exercise testing - acute myocardial infarction, unstable angina, uncontrolled arrhythmia, severe aortic stenosis, acute decompensated heart failure, uncontrolled hypertension - and relative contraindications that call for clinical judgment, such as electrolyte abnormalities, tachyarrhythmias, or high-degree AV block.
Medical clearance decisions
Clearance hinges on two variables: whether the client has known cardiovascular, metabolic, or renal disease, and whether they are symptomatic - plus the intensity planned. An asymptomatic client with stable, treated disease may generally continue light-to-moderate activity without a physician visit, whereas vigorous intensity, new symptoms, or unstable status warrant referral. Traps: treating a completed questionnaire as clearance; demanding a physician signature for every client with hypertension; forgetting that beta blockers blunt heart rate so target HR zones are unreliable; and missing that women, older adults, and people with diabetes often present atypically.
Rule of thumb
Screen for symptoms at every session, not just at intake. New or worsening breathlessness, chest discomfort, or a change in medication resets the decision.
Worked example: a 64-year-old with type 2 diabetes, no symptoms, wants to walk 30 minutes most days - moderate intensity, no clearance needed. If he now wants interval sprint training, refer first.