fit.test: pre-screening of your clients

fit.test: pre-screening of your clients

Hi, I’m Steve Selig, PhD, the founder of fit.test. This post is on preparticipation screening before you program a new client for an exercise program.

So why is it important to pre-screen? Well, there’s a very small increase in risk of sudden cardiac death during exercise compared to rest. But fit people are at lower risk of dying early or being chronically ill compared to unfit people. 

The very small increased risk of sudden death during exercise is outweighed by the reduced risk for the “rest of the day”, and this is sometimes known as the exercise paradox. It is important to know if people are likely to be at increased risk during exercise, and this is the basis of preparticipation screening and is the topic of this video. 

The American College of Sports Medicine recently updated their guidelines for preparticipation screening and a big change in the new ACSM guidelines was to move away from counting the numbers of risk factors such as high cholesterol or high blood pressure and instead collect more relevant information related to exercise itself. The ACSM decision-making framework is now based on each individual’s current level of physical activity, their desired exercise intensities for their exercise program and whether they have any significant signs or symptoms, especially related to exercise and also any known disease, especially cardiovascular or metabolic disease. 

We recently published a pre-screening flow chart on behalf of Exercise & Sports Science Australia (ESSA), Sports Medicine Australia (SMA) and Fitness Australia (FA). This is based on a clinical reasoning model for clinical exercise professionals, but also gives tools for non-clinical exercise professionals such as Personal Trainers. This is illustrated on the flow chart below.

Now just to give a bit of terminology. AEP is an accredited exercise physiologist as accredited by ESSA. PT represent physiotherapists in Australia or physical therapists in other part of the parts of the world. AES is an ESSA accredited exercise scientist. 

Now we come to the screening tools. The first one is called the Adult Pre-Exercise Screening System (APSS) and was jointly published by ESSA, SMA and FA. Another tool is the well-known Canadian Par Q questionnaire, the Physical Activity Readiness Questionnaire.

The pathway on the left of the model (flow chart) is the clinical pathway for the AEP and PT. These can be referrals from a primary care medical practitioner (e.g. GP or even a specialist). The other pathways are for the exercise scientist or the personal trainer who can get referrals through other means. For example, a personal trainer may receive self-referrals. They then need to rely on pre exercise screening tools and questionnaires to help them to assess risk of exercise participation. 

For ALL exercise professionals, if the practitioner observes any adverse signs or symptoms related to exercise, then this will require a referral back to the originating medical practitioner if that applies. Otherwise a recommendation that the client sees their primary care medical practitioner (either urgent on non-urgent depending on the adverse signs or symptoms). If there are no adverse signs or symptoms, then the client is deemed safe to commence exercise or continue exercise that they’re already doing. 

The big advantage with this scheme is that it is dynamic (regular monitoring that will pick up changes to a client’s signs or symptoms), compared to a static ‘set and forget’ scheme that is too often the case.

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