Health Screening, Risk Stratification, and Fitness Assessment
Screening order
Screening begins with informed consent and the PAR-Q+; a positive PAR-Q+ answer routes the client through the follow-up clearance process, not straight into a program. Then collect a health history: current symptoms, known cardiovascular, metabolic, or renal disease, medications, orthopedic limitations, pregnancy, and risk factors.
Risk factors and clearance
Counters used in exams: age (men 45+, women 55+), family history of premature cardiovascular disease, smoking or quitting within six months, sedentary lifestyle, obesity (BMI 30+ or waist over 40 in for men, 35 in for women), hypertension (130+ systolic or 80+ diastolic, or on medication), dyslipidemia, and prediabetes. Low risk means no symptoms and one or fewer risk factors; moderate means two or more without symptoms; high means known disease or symptoms. Low and moderate risk clients may generally begin moderate-intensity exercise without medical clearance, while vigorous intensity typically requires clearance for moderate and high risk - confirm against the edition your exam uses.
Assessment selection
Resting heart rate and blood pressure, body composition (BMI, girth, skinfolds, bioelectrical impedance - BMI cannot separate fat from muscle), cardiorespiratory tests (YMCA cycle, Bruce protocol, 1.5-mile run, 6-minute walk, step test), muscular fitness (1RM or estimated 1RM, push-up and curl-up tests, grip strength), flexibility (sit-and-reach), and balance.
Traps
Items conflate heart-rate formulas (220 minus age versus Tanaka's 208 minus 0.7 times age), misclassify blood pressure thresholds, or assume a PAR-Q+ yes answer permanently bars exercise.
Rule of thumb: screen first, stratify second, test third, program fourth - never prescribe before those gates are cleared.