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Pre-activity screening procedures

This is an excerpt from Fitness Professional's Handbook 7th Edition With Web Resource by Edward Howley & Dixie Thompson.

The AHA and ACSM recommend that exercise facilities provide their adult members with a preparticipation HSQ that is consistent with the exercise programs they plan to pursue. Although an exercise facility may not have a legal responsibility to conduct a preparticipation HSQ, this screening is in the best interest of exercise participants. Further, the results of the preparticipation HSQ should be interpreted and documented by qualified staff (1-5).


Regarding apparently healthy people, the risk of cardiovascular events during physical activity is remarkably low (adjusted risk of 1 to 3 per 1,000,000 participant hr), although increased age, greater physical activity level, and the presence of CVD risk factors are associated with greater risk (10, 11, 17). A well-designed and properly evaluated preparticipation HSQ serves several purposes, including identifying symptoms of chronic diseases that increase the risk of cardiovascular events during exercise participation, recognizing people with clinically significant diseases or conditions that warrant participation in medically supervised programs, and determining if people should seek medical clearance prior to fitness testing or exercise participation (5). Preparticipation screening is the first step in the fitness professional’s health risk appraisal of exercise participants, and it includes the following categories:

  • Make a classification as to whether or not the individual currently exercises regularly
  • Review medical history for established CV, metabolic, or renal disease
  • Pertinent signs and symptoms of CV, metabolic, or renal disease identified
  • Level of desired aerobic exercise intensity
  • Establish if medical clearance is necessary
  • Administration of fitness tests and evaluation of results
  • Setup of exercise prescription
  • Evaluation of progress with follow-up tests


It may help the fitness professional to remember the recommended health risk appraisal categories and the order in which they are performed by using the acronym MR. PLEASE, which could represent the participant asking, "Mister, may I please exercise?" This protocol expands on previous recommendations for working with new clients in fitness settings (12).


Two standard preparticipation screening questionnaires commonly used in the fitness industry are the PAR-Q+ and the preparticipation HSQ (1, 3, 28). Each level of MR. PLEASE is discussed in detail following the descriptions of the PAR-Q+ and the preparticipation HSQ, and additional categories of the health risk appraisal in Fitness Professional’s Handbook, Seventh Edition With Web Resource.