If you're starting a self guided fitness program you should complete a pre-participation assessment, like the PAR-Q, in order
to identify if you have an increased risk and to determine if a medical evaluation is warranted.
If the answers to PAR-Q suggests it's OK to exercise then it would be a good idea to have a fitness evaluation.
A fitness evaluation allows an understanding of where you're starting from, aids in the design of your program, and denotes
See Self-Test in the Evaluation Web page.
See PAR-Q and Signs and Symptoms of disease below.
From the ACSM's Guidelines for Exercise Testing and Prescription (2006-seventh edition).
Physical Activity Readiness Questionnaire (PAR-Q)
Please answer each question honestly, use common sense as your guide.
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended
by a doctor.
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness.
5. Do you have bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition
7. Do you know of any other reason why you should not do physical activity?
If you answered YES to one of the questions talk with your doctor by phone or in person BEFORE you start becoming much
more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered
You may be able to do any activity you want as long as you start slowly and build up gradually. Or, you may need to restrict
your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate
in and follow his/her advice. Find out which community programs are safe and helpful for you.
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can start becoming much more physically
active-begin slowly and build up gradually. This is the safest and easiest way to go. You should take part in a fitness appraisal
- this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It
is also highly recommended that you have your blood pressure evaluated. If your reading is over 140/90, talk with your doctor
before you start becoming much more physically active. PAR-Q: The Canadian Society for Exercise Physiology
After completing the PAR-Q find if you have any
coronary artery disease risk factors
and major signs or symptoms of disease.
Coronary Artery Disease Risk Factors
Positive risk factors
1. Family history
Myocardial infarction, coronary revascularization, or sudden death before 55 years of age in father or other male first
degree relative, or before 65 years of age in mother or other female first-degree relative.
2. Cigarette smoking
Current cigarette smoker or those who quit within the previous 6 months
Systolic blood pressure >140 mm Hg or diastolic >90 mm Hg, confirmed by measurements on at least two separate occasions,
or on antihypertensive medication.
Those with hypertension may need additional tests and clearance before participating in an exercise program. Consult with
Low-density lipoprotein (LDL) cholesterol >130 mg/dL (3.4 mmol/L or high-density lipoprotein (HDL) cholesterol <40
mg/dL (1.03 mmol/L), or on lipid-lowering medication. If total serum cholesterol is all that is available use >200 mg/dL
(5.2 mmol/L) rather than low-density lipoprotein (LDL) >130 mg/dL.
5. Impaired fasting glucose
Fasting blood glucose >100 mg/dL (5.6 mmol/L) confirmed by measurements on at least two separate occasion
Body mass index > 30 kg?m-2 or Waist girth >102 cm for men and >88 cm for women or Waist/hip ratio: >0.95
for men and >0.86 for women
7. Sedentary lifestyle
Persons not participating in a regular exercise program or not meeting the minimal physical activity recommendations>
from the U.S. Surgeon General's Report.
Depression may be a positive risk factor as well.
Negative risk factors
High serum HDL cholesterol > 60 mg/dl (1.6 mmol/L)
Special consideration is suggested to those with hypertension. The ACSM points out that the Joint National Committee on
the Prevention, Detection, and Treatment of High Blood Pressure recommends a thorough medical history, physical examination,
laboratory tests, and other diagnostic procedures when exercise screening those with hypertension.
Major Signs or Symptoms of Disease
Pain, discomfort (or other anginal equivalent) in the chest, neck, jaw. arms, or other areas that may result from ischemia
Shortness of breath at rest or with mild exertion
Dyspnea-abnormally, uncomfortable awareness of breathing
Orthopnea-dyspnea at rest that is relieved by sitting up or paroxysmal nocturnal dyspnea (dyspnea occurring 2 to 5 hours
after onset of sleep)
Dizziness or syncope (loss of consciousness)
Palpitations (unpleasant awareness of forceful or rapid beating heart) or tachycardia (racing heart rate)
Intermittent claudication-pain that occurs in a muscle due to inadequate blood flow during exercise. Feels like a cramp
that goes away after stopping.
Known heart murmur
Unusual fatigue or shortness of breath with usual activities-usually benign but might be a signal of a change.
The ACSM Risk Stratification
Men <45 years of age and women <55 years of age who are asymptomatic and meet no more than one risk factor
Men >45 years and women >55 years or those who meet the threshold for two or more risk factors
individuals with one or more signs and symptoms or known cardiovascular, pulmonary, or metabolic disease
The ACSM suggest that moderate to high risk individuals receive medical clearance with a stress test before starting a
vigorous exercise program.
Moderate to high risk individuals are
Men >45 and women>55
Those with more than one coronary risk factor
Those with known coronary artery disease
Those experiencing any sign or symptoms.
It is important to err on the side of caution. Talk to a Doctor if answered yes on the PAR-Q or have any signs or symptoms
of disease or have more than one risk factor.
People who are unfit have greater incidences of exercise related sudden cardiac death and myocardial infarction.
Question why you are starting an exercise program, unfortunately some initiate an exercise program due to having new symptoms.
They start to reassure themselves that they are well. These individuals are at risk.
Follow the mantra of start slowly, progress gradually.
Once again understand the signs and symptoms of disease; dyspnea, syncope, chest discomfort. Seek medical evaluation if
It's utmost importance to discuss with a physician the effects of medications. Some may affect heart rate and blood pressure
Before starting you'll need to learn how to judge your level of exercise exertion and measure heart rate and . These techniques
will be valuable in your training program as well as.
See RPE and measuring heart rate questions?