ACSM[042-082]

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CHAPTER 2 Preparticipation Health Screening and Risk Stratification 19Risk stratification procedures initially take into consideration whether individualsare guiding themselves through the process or are consulting a healthcare or fitnessprofessional. The self-guided individual will most likely need a relatively simpletool and decision-making process to determine if his or her risk is elevated tothe extent that a physician should be consulted before initiating a physical activityprogram, particularly if the intended exercise intensity is vigorous (1,6,7). A healthcareor fitness professional should have a logical and practical sequence for gatheringand evaluating an individual’s health information, assessing risk, and providingappropriate recommendations about additional screening procedures and physicalactivity recommendations (e.g., the Frequency, Intensity, Time, and Type or FITTframework; see Chapter 7). The American College of Sports Medicine (ACSM) providesguidelines for risk stratification in this chapter, but recognizes guidelines forrisk stratification published by other organizations such as the American HeartAssociation (AHA) (1,12,18,19) and the American Association of Cardiovascularand Pulmonary Rehabilitation (AACVPR) (4). Exercise and health/fitness professionalsshould also be familiar with these other guidelines when establishing individualand program-specific policies for preparticipation health screening and medicalclearance, particularly for populations with known cardiovascular disease.PREPARTICIPATION SCREENINGPreparticipation screening procedures and tools must be valid, providing relevantand accurate information about the individual’s health history, current medicalconditions, risk factors, signs/symptoms, current physical activity/exercise habits,and medications. Another consideration is the literacy level of the instrumentused to obtain this information (i.e., participant education level and language).SELF-GUIDED SCREENING FOR PHYSICAL ACTIVITYA self-guided screening for physical activity program is initiated and guided bythe individual with little or no input or supervision from an exercise or health/fitness professional. Individuals seeking to start a physical activity program ontheir own may have questions about whether it is appropriate and safe to do so.Therefore, they need an easy-to-use screening tool to guide them through theprocess. At the most basic level, participants may follow the recommendation ofthe Surgeon Generals’ Report on Physical Activity and Health (1996) (23): “previouslyinactive men over age 40 and women over age 50, and people at high riskfor cardiovascular disease (CVD) should first consult a physician before embarkingon a program of vigorous physical activity to which they are unaccustomed.”The participant may also use a self-guided questionnaire or instrument such asthe Physical Activity Readiness Questionnaire (PAR-Q; Fig. 2.1) (9) or theAHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire(Fig. 2.2), which serves to alert those with elevated risk to consult a physician(or other appropriate healthcare provider) before participation (6,7).Other types of self-administered surveys that may be incorporated into theexercise screening process include (a) routine paperwork completed within thescope of a physician office visit, (b) entry procedures at health/fitness or clinical
20 GUIDELINES FOR EXERCISE TESTING • www.acsm.orgFIGURE 2.1. Physical Activity Readiness (PAR-Q) Form. (Source: Physical Activity ReadinessQuestionnaire [PAR-Q], Public Health Agency of Canada and the Canadian Societyfor Exercise Physiology, reproduced with the permission of the Minister of Public Worksand Government Services Canada, 2007).exercise program facilities, and (c) physical activity promotional materialsdesigned for and distributed to the general public. When a participant completesa self-guided instrument and medical clearance is recommended from the questionnaireresults, participants should consult their physician and obtain clearancebefore participation in a physical activity/exercise program. For self-guided physical
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