Health Screening, Pre-Activity Evaluation, and Risk Management
What to know
Layered screening. The PAR-Q+ (general health questions plus condition-specific follow-up pages) is the minimal screen. A 'yes' sends the participant to the follow-up module, which determines whether self-guided activity is appropriate or whether medical clearance is advised. Always pair screening with informed consent, a health-history form, and vital signs.
Current clearance logic. ACSM retired the old risk-factor-count stratification in 2015. Clearance now hinges on two things: whether the person currently exercises regularly (at least 3 days/week, 30 minutes, for 3 months) and whether they have known cardiovascular, metabolic, or renal disease or related signs/symptoms. Those with known disease who want vigorous-intensity exercise are generally advised to obtain medical clearance; apparently healthy regular exercisers generally are not.
Signs and symptoms to flag. Chest pain or discomfort, dyspnea at rest or with mild exertion, dizziness or syncope, orthopnea or paroxysmal nocturnal dyspnea, ankle edema, palpitations, intermittent claudication, and unusual fatigue.
Vitals and hold points. Normal resting HR is about 60–100 bpm. ACC/AHA categories: normal <120/<80; elevated 120–129/<80; stage 1 = 130–139 or 80–89; stage 2 ≥140 or ≥90; crisis >180 and/or >120. Do not exercise a client with resting SBP >200 or DBP >110, or with acute illness, fever, or unstable cardiac conditions.
Traps
- Counting risk factors as if the old stratification still governs.
- Sending every new participant for medical clearance.
- Confusing the PAR-Q+ with a fitness test or with informed consent.
Rule of thumb
Use the two-question gate: Does this person already exercise regularly? and Is there known disease or a current symptom? Only the combination of known disease plus a plan for vigorous work pushes you toward referral.