Health Screening, Risk Stratification, and Fitness Assessment
Screening framework
Preparticipation screening rests on the PAR-Q+ and a thorough health/medical history plus the ACSM preparticipation algorithm. That algorithm weighs three things together: current exercise participation, presence of known cardiovascular, metabolic or renal disease or signs/symptoms, and the intensity the client intends to perform. Medical clearance is recommended for clients with signs/symptoms or known disease who plan moderate-to-vigorous exercise, and for apparently healthy clients with two or more risk factors who plan to start vigorous exercise. Risk factors to count include age (men ≥45, women ≥55), family history of premature MI or sudden death, current smoking or quitting within 6 months, sedentary lifestyle, obesity, hypertension, dyslipidemia and prediabetes. HDL ≥60 mg/dL is a negative risk factor that subtracts one.
Assessment sequence
Obtain informed consent and health history first, then resting measures (HR, BP, height, weight, BMI, waist circumference), then cardiorespiratory fitness, muscular fitness and flexibility. Submaximal tests (YMCA cycle, 3-minute step, 6-minute walk) estimate VO2max; the Bruce protocol is maximal and requires monitoring.
Traps
BMI ≥30 and BP ≥130/80 both count as risk factors, and resting BP must be measured properly before counting it. Risk factor totals alone no longer dictate clearance-symptoms and known disease do. During exercise, systolic BP should rise while diastolic should change little; a sharp diastolic rise or drop in systolic is a stop signal. Screening identifies risk; it does not diagnose.
Rule of thumb
A 50-year-old sedentary man with treated hypertension and HDL of 65 has risk factors: age, sedentary, hypertension (3) minus HDL (1) = 2 net risk factors.