Pre-Activity Screening and Risk Assessment
Screen before you prescribe
Screening protects the client and the trainer. The goal is to identify who needs medical clearance or modification before exercise begins.
Key tools and concepts:
- PAR-Q+ - a self-report screen; positive answers trigger follow-up questions and may require medical clearance.
- Pre-participation health screening (e.g., ACSM logic) - considers current activity level, known cardiovascular/metabolic/renal disease, and symptoms. Asymptomatic, active clients generally need no clearance; symptomatic or sedentary-with-disease clients do.
- Red flags: chest pain, unexplained dyspnea, dizziness, syncope, palpitations, unusual fatigue.
- Fall risk screening: history of falls, gait/balance concerns, fear of falling. A positive screen warrants balance assessment and possibly referral.
- Medical history and medications: polypharmacy is common; note beta-blockers (blunt HR response), anticoagulants (bruising/bleeding risk), diuretics (dehydration, orthostasis), and hypoglycemia risk in diabetes.
- Scope of practice: trainers do not diagnose. Refer when in doubt.
Traps
A classic trap is treating a "no" on a single question as clearance when other red flags exist. Another is assuming a doctor's note means unrestricted exercise - read it. Also watch for questions that blur the trainer's role into clinical decision-making.
Rule of thumb
If a client has symptoms, a new diagnosis, or a recent hospitalization, refer for clearance before progressing intensity.