Pre-Exercise Health Screening

It is essential that an industry-standard pre-exercise health screening tool is provided to and administered to the client in a professional and courteous manner, ensuring that all procedures and risk stratification procedures are followed.

In 2019 this screening tool was updated. The latest version can be viewed here.

The process for completing the industry-endorsed screening tool is to:

• Download the screening document/tool.

• Question the client.

• Complete the tool with the client.

• Take all required measurements.

• Make all fitness assessments.

• Make referrals as required.

• Use this information to plan safe and effective fitness activities for that specific client.

The purpose of stage one of the pre-exercise health screening tool is to identify if the client may be at a higher risk of having an adverse physical event during physical exercise.  This section is used to separate those clients that may require further investigations and actions prior to them being approved to undertake physical exercise. Stage one of this screening tool is compulsory.

Questions asked in stage one include:

1. Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?

2. Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?

3. Do you ever feel faint, dizzy or lose balance during physical activity/exercise?

4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?

5. If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?

6. Do you have any other conditions that may require special consideration for you to exercise?

If the client answers YES to any of the six initial questions in stage one, they are considered to be high risk and will need to be advised or referred to seek medical guidance from their General Practitioner (GP) or Allied Health Professional. This is to ensure it is safe for them to undertake exercise and determine what types of exercise is recommended for them.

If they answered NO to all six initial questions, then they are generally considered low risk and can proceed on to the seventh question which asks them to describe their current physical activity/exercise levels in a typical week using the Exercise Intensity Guidelines as a reference point. The guidelines are arranged into four categories:

A formula is applied to determine the total minutes of weighted physical activity/exercise per week:

Total minutes = (minutes of light + moderate) + (2 x minutes of vigorous/high). 

For example, Sarah has indicated that she undertakes three sessions (20 minutes each) of moderate walking per week and also one session (30 minutes) of vigorous tennis per week. Therefore, her total minutes per week based on the equation would be 60 minutes (moderate) + 60 minutes (vigorous/high, actual minutes x 2) equalling 120 minutes per week.

The screening tool provides the following recommended guidelines based on the results of the equation.

• If the total is less than 150 minutes per week then light to moderate-intensity exercise is recommended, with slow increases of volume and intensity.

• If the total is more than or equal to 150 minutes per week then continue with the current physical activity/exercise intensity levels.

Stage two of the pre-exercise health screening tool consists of a series of questions that are completed with the client to further determine appropriate exercise prescription based on established risk factors. This stage is not compulsory but is recommended. The aim of stage two is to identify those individuals with a known disease, and/or signs or symptoms of a disease, who may be at a higher risk of an adverse event due to physical activity/exercise. 

Clients are asked 11 questions:

1. Demographics, their age and if they are male or female.

2. Family history of heart disease.

3. Whether or not they smoke cigarettes and if so how frequently.

4. Body composition, their weight, height, Body Mass Index (BMI), and waist circumference.

5. Whether or not they have ever been diagnosed with high blood pressure, and if so whether they are taking medication.

6. Whether or not they have ever been diagnosed with high cholesterol, and if so whether they are taking medication.

7. Whether or not they have ever been diagnosed with high blood sugar.

8. Whether or not they are taking prescribed medications for any conditions (in addition to any already discussed).

9. Have they spent time in hospital in the last 12 months.

10. For women, are they pregnant or have they given birth in the last 12 months.

11. Whether or not they have ever been diagnosed with muscle, bone, tendon, ligament or joint problems.

Each question has guidelines for assessing risk. For example, the demographics question indicates that risk increases with age particularly in males older than 45 and females older than 55. Other risk assessment guidelines include healthy ranges for BMI, blood pressure and cholesterol to use as a comparison against any information the client provides about their actual results/levels.

Fitness professionals are also provided with a User Guide which provides more in-depth information regarding the use of the pre-exercise health screening tool.

As part of the completion of Stage 2 of the Pre-Exercise Health Screening tool, certain measurement data needs to be gathered:

• Weight - Use a set of scales, preferably digital, that provides body weight in kilograms (kg).

• Height - Ensure the client is standing straight against a wall, bare feet flat on the ground, use a metric measuring tape to determine height in centimeters (cm).

• Waist Circumference - Use a metric measuring tape, measure the smallest section of the abdomen, usually below the rib cage and just above the navel, to determine waist circumference in centimeters (cm). 

• Hip Circumference - Use a metric measuring tape, measure the widest section of the hips, to determine hip circumference in centimeters (cm).

• Blood Pressure - If a blood pressure Sphygmomanometer (cuff and pump) is available, follow operating instructions to take blood pressure reading.

Based on some of these measurements, certain calculations will be required. These are:

Clients with multiple or significant risk factors are generally considered to be moderate to high risk. Professional judgement is required to determine if they should undertake an exercise regime or if they do then at what intensity and with what level of collaboration with medical or allied health professionals.

The following video demonstrates how to conduct a pre-exercise health screening tool and also gather measurement information:

It will be necessary to ensure that a discussion is undertaken with the client to explain the outcomes of the pre-exercise health screening activities and the level of risk that has been assigned to the client, including any extra screening or involvement of other health professionals that is either required or recommended prior to the commencement of physical activity. 

This conversation must ensure that the client understands the screening process and how it may affect their future exercise goals. 

Through pre-exercise screening or as a result of a sustained injury, you may identify (or suspect) a health risk or condition that will impact your client's exercise program and which is outside of your scope of practice. Registered exercise professionals are qualified to work with low to moderate risk clientele and to work with higher risk clientele (whose high-risk conditions are stabilised and well managed), under documented guidance from the client's treating medical and/or allied health practitioner.

Operating outside of scope of practice is a common reason for misunderstanding and mistrust between the fitness industry and medical or allied professions. Therefore, if you have identified or suspect a health risk and the client does not currently consult with a medical or allied health professional you may need to refer them to the appropriate personnel prior to formulating their exercise program and commencing training.

An explanation of a fitness professional's liability and duty of care for client referral, provided by Fitness Australia, can be viewed here.

Examples of when this might be appropriate include:

• Pain upon presentation to the initial session / induction. Exercise should also be postponed and a referral considered if the client is currently ill or injured.

• Having a history of uncontrolled or unresolved pain. This may indicate an acute or chronic disease or condition.

• Abnormal or inconsistent pain patterns. This may indicate an acute or chronic disease or condition.

• Pain during movement or exercise. Difficulty with specific exercise movements can be a sign of muscle weakness or injury.

• Static postural deviations. Poor posture is quite common and can sometimes be corrected with targetted exercises. 

• Inability to correct static or dynamic posture. If, after various posture correcting exercises have been tried for a period of time, the problem persists then professional intervention may be required. Corrective measures such as massage, strapping, bracing, spinal manipulation, or even surgery may be undertaken by medical or allied health professionals depending on the type of postural variation.

• Limited joint function, balance, and coordination activities. This may indicate an acute or chronic disease or condition, such as osteoarthritis, sensory impairment, or even a neurological disorder.

• Diagnosed muscle, bone, or joint problems. Clients should be advised to consult with their medical or allied health professional before commencing an exercise program. These professionals can provide clearances and safe exercise guidelines which will assist in program planning. 

• Risks identified through the industry endorsed pre-exercise screening and risk stratification process. The pre-exercise health screening helps to identify potentially life-threatening conditions which may be exacerbated by exercise. Referring clients to appropriate medical or allied health professionals if any of these conditions is suspected is highly recommended to ensure the health and wellbeing of clients. These professionals can provide clearances and safe exercise guidelines which will assist in program planning. 

The role of the medical or allied health professional in the referrals process is to:

• See the client as requested.

• Conduct necessary appraisal or further testing.

• Advise the fitness professional and the client of recommendations and parameters to ensure that exercise can be safely conducted 

• Provide clearances and approvals for clients to participate in specific activities.

Referrals are usually letters directed to a specific type of medical practitioner or allied health professional summarising the pre-exercise health screening process you have completed and any risks that you have identified. Note: Only qualified and/or experienced personnel are able to complete referrals, this is usually Personal Trainers or Advanced Personal Trainers.

The referral may request a medical clearance and/or a summary of exercises or activities the client should not be undertaking. Provide the client with the letter so they can make the necessary appointment. 

Fitness Australia has developed a series of templates that can be utilised when constructing a referral. They are viewable/downloadable here. These templates help to ensure all necessary information is conveyed without overstepping scope of practice.

Types of health professionals that you may commonly direct the client to, include:

• General practitioners (GPs). Who may then further refer the client onto other types of medical specialists.

• Allied health professionals. Including: Accredited exercise physiologists; Chiropractors; Physiotherapists; Dietitians; Podiatrists; Osteopaths; Sports and exercise physicians.