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Active Voice: Part 2 of Preparticipation Health Screening before Exercise — Is It Time for a Change?

from By Barry A. Franklin, Ph.D., FACSM, MAACVPR, FAHA

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Barry A. Franklin, Ph.D., FACSM, is director of preventive cardiology and cardiac rehabilitation at William Beaumont Hospital in Royal Oak, Mich. He is a past president of ACSM and editor-in-chief of the Journal of Cardiopulmonary Rehabilitation, and is currently serving on editorial boards of 15 prominent scientific/clinical journals. For further biographical information, see Part 1 of this commentary at the SMB online archives.

Here, Dr. Franklin presents his views on the above-titled topic in relation to the recent study by Whitfield GP, et al. published in Circulation, March 2014. Given the scope of the topic, the text is presented in two installments. Part 1 presents his analysis of past evidence on the benefits and risks of increasing physical activity and the rationale for health screening of sedentary adults who begin structured exercise. In this final installment, he re-examines these preparticipation guidelines in the context of these new data from Whitfield et al.

The Whitfield et al, article in Circulation, March 2014, evaluated two commonly recommended self-screening exercise preparticipation questionnaires, the AHA/ACSM Preparticipation Questionnaire (AAPQ) and the Physical Activity Readiness Questionnaire. The aim was to clarify the utility of these screening tools in a systematic manner. Using relevant responses from the combined 2001 to 2004 National Health and Nutrition Examination Survey database for individuals > 40 years of age, as many as 96 percent and 94 percent of men and women, respectively, would be advised to consult a physician before embarking on an exercise regimen. The investigators concluded that widespread use of the AAPQ would result in excessive medical referrals and present unfounded barriers to exercise adoption. more

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