Client Screening, Assessment, and Evaluation
What the exam is really testing
Screening answers two questions: is exercise safe today, and what testing is appropriate? Know the current preparticipation logic rather than rote risk-factor counting. Modern algorithms ask whether the client is currently active, whether there is known cardiovascular, metabolic, or renal disease, and whether there are signs or symptoms suggesting disease. Medical clearance is triggered by symptoms or known disease in a sedentary person, not by age alone. Also know the PAR-Q+ and its follow-up pages, informed consent elements (purpose, risks, benefits, confidentiality, right to withdraw), and absolute versus relative contraindications to exercise testing.
Assessment tools to name
Resting heart rate and blood pressure with proper technique (seated five minutes, correct cuff size, repeated measurement). Body composition with awareness of BMI limits in muscular or older clients, plus waist circumference. Functional and capacity measures: 6-minute walk test, timed up-and-go, 30-second chair stand, grip strength, sit-and-reach or goniometry, balance testing, and RPE scales. Condition-specific screening includes blood glucose and foot checks in diabetes, oxygen saturation and dyspnea scales in pulmonary disease, fall and ADL history in older adults, and autonomic screening in spinal cord injury.
Traps
Treating a single PAR-Q+ yes as automatic exclusion instead of a trigger for follow-up. Mixing up absolute contraindications (unstable angina, decompensated heart failure, acute myocarditis, suspected acute pulmonary embolism) with relative ones. Estimating maximal heart rate with 220 minus age in clients on beta blockers or with pacemakers. Applying BMI cutoffs to a lean, muscular client. Skipping blood pressure measurement or using an undersized cuff, which falsely elevates readings.
Worked example
A client with type 2 diabetes arrives with a glucose of 288 mg/dL and positive urine ketones. You do not train. Hold the session, refer to the physician, and document the decision. Rule of thumb: glucose above 250 mg/dL with ketones, or resting BP at or above 180/110 mmHg, means stop and refer.