3.1 Medical History, Health Appraisal, and Lifestyle Questionnaires

Why administration order is an exam item

Domain 1 (Client Consultation and Assessment) is 23% of the NSCA-CPT exam (32 scored items). Under the Detailed Content Outline effective 1 July 2025, task 1.B.1 is to administer a detailed personal and family medical history/health appraisal form and a lifestyle questionnaire (including exercise and injury history). That task sits before Performance Evaluation (1.C). A sample-style item you should expect: the client wants to get testing over with in the first hour. The correct sequence is still paperwork and interpretation first, then testing.

Health-appraisal forms exist to answer a safety question, not a marketing question: is it currently appropriate for this person to be fitness-tested and trained in an unsupervised or lightly supervised setting? They also create a written record that you asked, the client answered, and you acted on the answers. A signed liability waiver does not replace screening. Looking fit, being young, or paying for a package does not replace screening.

Health appraisal is the systematic collection of personal medical history, family medical history, medications, injuries, and lifestyle so you can decide whether to proceed, modify, obtain medical release, or refer. It is not a diagnosis. You are collecting and organizing information; you are not naming a disease, interpreting an MRI, or writing a drug order.

Three instruments, three jobs

Do not treat PAR-Q+, a facility health-history form, and a lifestyle questionnaire as interchangeable. They overlap, and NSCA still expects you to administer the detailed history, not only a seven-item screen.

Use all three in the onboarding packet (along with informed consent and any facility waiver, which are legal documents taught in Domain 4). Review answers in person. Clients omit chest pain, depression, or supplement use on paper and mention them once they trust you.

PAR-Q+: the seven-question gate, then follow-up

PAR-Q+ replaced the older PAR-Q for most contemporary practice. The original PAR-Q was limited to ages 15–69 and sent almost every Yes to a physician, which produced many unnecessary referrals. PAR-Q+ has no age restriction, is designed for self-screening, and uses a three-step path so that only a small fraction of people need a physician visit. Research on the tool reported on the order of about 1% physician referral when follow-up pages and ePARmed-X+ are used as intended.

Step 1 — Page 1, seven general health questions. Themes include: a doctor-identified heart condition or high blood pressure; chest pain at rest, during daily living, or during activity; dizziness with loss of balance or loss of consciousness in the last 12 months (with a stated exception when dizziness is from over-breathing, including during vigorous exercise); any other chronic medical condition besides heart disease or high blood pressure; current prescribed medication for a chronic condition; a current or past-12-month bone, joint, or soft-tissue problem that could be made worse by more activity (answer No if an old problem does not limit current activity); and a doctor's instruction to do only medically supervised activity.

• All No on page 1: the person is cleared for unrestricted physical activity, signs the participant declaration, and does not complete pages 2–3.
• Any Yes on page 1: complete the follow-up questions on pages 2–3 (condition-specific items spanning domains such as cardiovascular disease, diabetes, cancer, respiratory disease, spinal cord injury, stroke, arthritis, and mental health).

Step 2 — Follow-up pages. If follow-up answers are all No, the person can still be cleared for activity with minimal supervision and condition-aware general advice (for example, building toward weekly moderate activity rather than jumping to all-out intervals). If any follow-up item is Yes, go to ePARmed-X+ and/or a qualified exercise professional, and obtain healthcare clearance when that process classifies the person as higher risk.

Step 3 — ePARmed-X+. Condition-specific questions yield a practical recommendation: low risk (unrestricted), intermediate risk (low-to-moderate intensity with consultation or supervision), or high risk (low intensity until a qualified professional or other clinician is involved; physician clearance may be required). PAR-Q+ is commonly treated as valid for 12 months; ePARmed-X+ for 6 months because health status can change faster after a more detailed screen.

Delay becoming more active during a temporary illness such as a cold or fever. Pregnancy and recent childbirth are not fail PAR-Q+ and never train; they are reasons to follow the form's follow-up logic and clinician guidance (Domain 2 special-population content covers prenatal programming later).

Exam trap: The client answered Yes to one page-1 item, so refuse all training forever is wrong. Follow pages 2–3. The client looks healthy, skip PAR-Q+ is also wrong.

Personal medical history: what detailed means

The health-history form should force named conditions, not a single checkbox for healthy. Review at least:

• Cardiovascular: heart attack, angina, stent or bypass, heart failure, arrhythmia, pacemaker or ICD, stroke or TIA, peripheral artery disease, known murmur, uncontrolled hypertension.
• Metabolic and renal: type 1 or type 2 diabetes, thyroid disorders, chronic kidney disease, liver disease.
• Pulmonary: asthma, COPD, cystic fibrosis, supplemental oxygen. Pulmonary disease is still medically important for programming—bronchospasm, oxygen saturation, inhaler timing—even though current ACSM preparticipation logic no longer treats pulmonary disease as an automatic cardiovascular-event equivalent of CAD.
• Other: cancer (current treatment vs. survivor), blood clots, anemia, seizures, pregnancy, surgeries, hospitalizations, allergies, fainting, and any condition the client lists in free text.
• Orthopedic and injury history: fractures, sprains, chronic tendinopathy, disc complaints, joint replacements, and what still limits load, range, or impact.

Ask when the event happened, whether it is stable or changing, and who the treating clinician is. Unstable or recent events (chest pain this week, surgery last month, new unexplained syncope) stop testing even if the rest of the form looks ordinary.

Family history is its own DCO phrase

The 2025 wording is personal and family history. Family history is not small talk. For atherosclerotic risk education and for classic NSCA risk-factor counting, record first-degree relatives (parents, siblings, children) with myocardial infarction, coronary revascularization, or sudden death before 55 years in male relatives or 65 years in female relatives. Also note clustered family diabetes, premature stroke, or sudden unexplained death. You still do not diagnose the client from the father's stent. You do document it and use it when you interpret the packet in section 3.2.

Medications as information, never as a prescription

List prescription drugs, over-the-counter drugs, and supplements, with name, dose, frequency, and time of day if the client knows them. Then connect the list to session design:

• Beta blockers (for example, metoprolol) blunt heart-rate rise; percent-HRmax formulas become misleading—plan RPE or talk-test targets.
• Insulin and some sulfonylureas raise hypoglycemia risk around training; know the client's snack and glucose-monitor plan from their clinician, and do not invent a new insulin dose.
• Diuretics increase dehydration and electrolyte-shift risk in heat.
• Nitrates and some vasodilators increase post-exercise hypotension risk; extend cool-down and avoid abrupt standing after heavy sets.
• Statins plus new unexplained muscle pain is a referral cue, not a trainer diagnosis of rhabdomyolysis.
• Anticoagulants raise bleeding concern with contact or aggressive soft-tissue work.

Never tell a client to skip a dose so we can see true heart rate, double a dose, start a fat-burner, or replace a drug with a supplement. If the client asks what to take, the in-scope sentence is: that decision belongs to the prescribing clinician or pharmacist; I will train within the documented plan.

Lifestyle questionnaire: smoking, alcohol, sleep, occupation, training age

DCO 1.B.1 names exercise and injury history inside the lifestyle questionnaire. A useful form also captures:

• Tobacco: current smoker, quit within 6 months, or regular environmental smoke—classic positive CAD risk factor and a programming issue (carbon monoxide, delayed recovery).
• Alcohol: typical drinks per week, binge pattern, training-day use (impairs recovery and increases injury risk).
• Sleep: hours, shift work, snoring or apnea signs, daytime sleepiness. You do not diagnose obstructive sleep apnea; you do refer when the history is loud snoring plus gasping plus unrefreshing sleep.
• Occupation: hours seated, manual labor, repetitive lifting, heat, night shifts. A warehouse client is not untrained in the same way as a 10-hour desk client; overuse risk differs.
• Stress and mood (screening, not therapy): enough to know whether you need a mental-health referral (section 3.3).
• Exercise history: current FITT, longest continuous training streak, training age, sports, what they enjoy, what they quit because of pain, and prior injuries that occurred during exercise.

Worked example. Client A is 41, all-No on PAR-Q+ page 1, no medications, walks the dog twice a week, sleeps 5 hours, smokes, and works 9 hours at a computer. Client B is 41, all-No on page 1, sleeps 7 hours, never smoked, and has trained 4 days per week for 5 years. Same PAR-Q+ result; different lifestyle questionnaires; different first-month plans. The lifestyle form is what makes 1.B.1 more than a photocopy of PAR-Q+.

Exam scenario: the rushed first session

A 38-year-old books 60 minutes and says they already know they are fine and want the 1.5-mile run and body fat so they have numbers. The NSCA-correct action is to complete informed consent, PAR-Q+, personal and family medical history, and lifestyle, exercise, and injury forms, review them, and only then test. If a Yes on PAR-Q+ or a red-flag history appears, you do not salvage the hour with a maximal run. Submaximal testing is still a fitness evaluation; it is not a paperwork loophole.

Minors: a parent or guardian completes the history. Many facilities require physician clearance for children more readily than for apparently healthy adults. Follow the form, the facility policy, and the more conservative rule when they differ.