Key Takeaways
- The PAR-Q+ is a self-administered screening tool that identifies individuals who need medical clearance before exercise testing.
- Risk stratification categorizes athletes as low, moderate, or high risk based on CVD risk factors.
- Health history questionnaires should include cardiovascular, pulmonary, metabolic, musculoskeletal, and medication information.
- Athletes with two or more CVD risk factors require physician clearance before maximal exercise testing.
- Injury history assessment identifies previous injuries, surgeries, and chronic conditions that may affect training.
Pre-Participation Screening
Quick Answer: Pre-participation screening uses the PAR-Q+, health history questionnaires, and CVD risk factor assessment to identify athletes who need medical clearance before exercise testing. Athletes with 2+ CVD risk factors or known cardiovascular, pulmonary, or metabolic disease require physician clearance for maximal testing.
Pre-participation screening is the first step in any testing or training program. It identifies potential health risks and ensures athlete safety before beginning exercise testing.
Physical Activity Readiness Questionnaire (PAR-Q+)
The PAR-Q+ is a self-administered screening tool that helps identify individuals who may need medical clearance.
PAR-Q+ General Health Questions
| Question | If YES |
|---|---|
| Has a doctor ever said you have a heart condition? | Medical clearance needed |
| Do you feel pain in your chest during physical activity? | Medical clearance needed |
| Have you had chest pain in the past month when not active? | Medical clearance needed |
| Do you lose balance due to dizziness or lose consciousness? | Medical clearance needed |
| Do you have bone/joint problems that could worsen with exercise? | Medical clearance needed |
| Are you taking medications for blood pressure or heart condition? | Medical clearance needed |
| Do you know of any other reason you should not exercise? | Medical clearance needed |
Key Point: If an athlete answers YES to ANY PAR-Q+ question, they should seek physician clearance before maximal exercise testing.
Health History Questionnaire Components
A comprehensive health history should include:
Medical History Categories
| Category | Information Collected |
|---|---|
| Cardiovascular | Heart disease, hypertension, murmurs, arrhythmias |
| Pulmonary | Asthma, COPD, exercise-induced bronchospasm |
| Metabolic | Diabetes, thyroid disorders, kidney disease |
| Musculoskeletal | Previous injuries, surgeries, chronic conditions |
| Medications | Current prescriptions, OTC drugs, supplements |
| Family History | CVD, sudden death, metabolic conditions |
| Lifestyle | Smoking, alcohol, exercise habits |
Cardiovascular Disease Risk Factors
The ACSM identifies the following CVD risk factors for risk stratification:
Positive Risk Factors
| Risk Factor | Defining Criteria |
|---|---|
| Age | Men ≥45 years; Women ≥55 years |
| Family History | MI, revascularization, or sudden death before age 55 (father/son) or 65 (mother/daughter) |
| Cigarette Smoking | Current smoker or quit within past 6 months |
| Sedentary Lifestyle | Not meeting minimum physical activity guidelines |
| Obesity | BMI ≥30 kg/m² or waist circumference >102 cm (men), >88 cm (women) |
| Hypertension | SBP ≥140 mmHg or DBP ≥90 mmHg, or on antihypertensive medication |
| Dyslipidemia | LDL ≥130 mg/dL, HDL <40 mg/dL, or on lipid-lowering medication |
| Prediabetes | Fasting glucose 100-125 mg/dL or impaired glucose tolerance |
Negative Risk Factor (Subtract One)
| Risk Factor | Defining Criteria |
|---|---|
| High HDL Cholesterol | HDL ≥60 mg/dL |
Risk Stratification Categories
| Category | Criteria | Medical Clearance |
|---|---|---|
| Low Risk | Asymptomatic with 0-1 positive risk factors | Not required for maximal testing |
| Moderate Risk | Asymptomatic with ≥2 positive risk factors | Recommended for maximal testing |
| High Risk | Known CVD, pulmonary, or metabolic disease OR signs/symptoms | Required for any testing |
Signs and Symptoms of Disease
The following signs/symptoms automatically classify an individual as HIGH RISK:
- Pain or discomfort in chest, neck, jaw, or arms
- Shortness of breath at rest or with mild exertion
- Dizziness or syncope
- Orthopnea or paroxysmal nocturnal dyspnea
- Ankle edema
- Palpitations or tachycardia
- Intermittent claudication
- Known heart murmur
- Unusual fatigue or shortness of breath with usual activities
Injury Assessment
Key Components of Injury History
| Component | Information to Gather |
|---|---|
| Previous Injuries | Type, location, mechanism, treatment, recovery time |
| Current Pain/Discomfort | Location, intensity, aggravating factors |
| Surgeries | Type, date, complications, physician restrictions |
| Chronic Conditions | Arthritis, tendinopathy, recurring injuries |
| Current Limitations | ROM restrictions, activity modifications |
Clearance Procedures
Medical Clearance Protocol
- Identify risk category using screening tools
- Refer high-risk individuals to physician
- Obtain written clearance specifying:
- Approved activities
- Exercise intensity restrictions
- Monitoring requirements
- Emergency protocols
- Document all clearances in athlete files
- Re-screen annually or after significant health changes
An apparently healthy 42-year-old male athlete has a BMI of 31, total cholesterol of 210 mg/dL, HDL of 38 mg/dL, and blood pressure of 128/82 mmHg. How many positive CVD risk factors does this athlete have?
Which of the following would automatically classify an athlete as HIGH RISK regardless of the number of CVD risk factors?
According to ACSM guidelines, which HDL cholesterol level would be considered a NEGATIVE risk factor (subtracted from total risk)?