Rationale for Conducting a Health and Fitness Appraisal
Most newcomers to exercise are apparently healthy individuals seeking to become fitter and lose weight. For most of these individuals, becoming more active is safe and desirable (ACSM, 2001). Furthermore, individuals who remain physically active are less likely to develop several major chronic diseases such as heart disease, obesity and diabetes. In support, a recent report by the Chief Medical Officer (2004) stated that:
“Physically active adults have a 20-30% reduced risk of premature death and up to a 50% reduced risk of developing major chronic diseases such as coronary heart disease, stroke, diabetes and cancers”
However, for some individual’s exercise can actually have the opposite effect. For example; a diagnosed hypertensive may be at risk during physical activity due to already having elevated blood pressure. Consequently, the likelihood of a life-threatening event is increased. Its prudent, therefore, that personal trainers (PTs) understand the potential risks that exercise poses to some individuals.
- cardiovascular complications (MI, cardiac arrest, arrhythmias etc)
- bronchospasm or exercise-induced asthma
- immune impairment (resulting in colds, flu, viruses, etc)
- overtraining syndrome (fatigue, loss of vitality, etc)
- amenorrhea or dysmenorrhoea
- traumatic injury (e.g. pulled muscle)
- overuse injury (e.g. runner’s knee)
- hypertension or hypotension
PT’s have a legally bound duty to minimise the risks and maximise the benefits (also to protect themselves from litigation) of exercise participation. Screening tools should be used to identify individuals who require further medical evaluation before embarking on an exercise programme. Hence, there is a need to identify those individuals that are of a higher health risk status and take the most appropriate action.
Using industry accepted techniques such as questionnaires, diaries and oral questioning; a client health and fitness profile can be established. Decisions are then made on each client’s readiness for exercise, so the most appropriate action can be taken (Kordich, 2004). In the event of a client deemed unsuitable for immediate exercise, they can be referred to an appropriate health care professional such as a General Practitioner (GP). It must be noted, the client will need to seek medical clearance prior to starting an exercise programme.
It is stressed that PT’s are not qualified to diagnose any medical conditions or rehabilitate from injury (unless they have a relevant professional qualification). This is beyond the PT’s scope of practice set out in the National Occupational Standards released from Skills Active (government agency). In other words, diagnosis or intervention must be supported or supervised by a suitably qualified health care professional i.e. a registered medical practitioner or chartered physiotherapist.
Generally speaking, a health and fitness appraisal should be conducted for the following reasons:
- through questionnaires, diaries and oral questioning, clients at high risk (medical contraindications) can be identified
- high risk clients can be referred to appropriate health care professionals
- gain client consent
- test results can be used to establish a set of fitness baselines
- individualised exercise programme can be prescribed
- health/fitness appraisal should be an ongoing process
- provides an opportunity to monitor a client’s rate of progress
Total lifestyle evaluation:
- opportunity to evaluate current lifestyle behaviours such as stress, activity levels, occupation and eating habits
- consideration should be given to all lifestyle factors, as they will influence the success of any lifestyle intervention programme
- opportunity for the trainer to get to know the client and establish a positive connection
- opportunity to determine an appropriate communication style
- successful working relationships are always built on rapport
- educate clients to make informed lifestyle choices
clients must understand the pro’s and con’s of pursuing certain lifestyle
- trainer credibility
- opportunity to explain working practices, policies and procedures
Motivation and adherence:
- short, medium and long-term goals can be established and agreed
- goals increase focus and raise levels of motivation and exercise adherence
Conducting a Comprehensive Health and Fitness Appraisal
In principle, two components make up a health and fitness appraisal. First, an individual’s current health and lifestyle status should be classified. Secondly, this information should be used to screen clients before testing physical fitness. The following procedures should be followed.
The purpose of a health evaluation is to identify the presence of disease and to assess an individual’s disease risk status (Heyward, 1998). Some simple pre-test and test measures to assess current health status can be followed. Based on the results a professional judgement is made whether to refer or not. Measures include:
- administering the Physical Activity Readiness Questionnaire (PAR-Q)
- assessing the clients coronary risk profile using CHD risk factor table
- administering medical and lifestyle questionnaire
- performance of static tests
Physical Activity Readiness Questionnaire (PAR-Q):
The Physical Activity Readiness Questionnaire (PAR-Q) developed by the Canadian Society for Exercise Physiology (appendix 1) is a popular screening tool. When used in its unadulterated form, the seven questions PAR-Q is effective in identifying medical contraindications to exercise. If the client answers ‘yes’ to any of the questions then medical clearance should be sought from their GP before exercise begins.
Coronary risk factor profile:
Using the ‘primary and secondary’ risk factor table PTs can quickly assess the client’s current coronary risk status. The client can then be assigned to one of three categories, these are:
- medical referral -clients in this category have a serious condition or serious medical risk factor for coronary heart disease (CHD). They should always be referred to their GP. However, the majority of clients in this group will benefit from a regular exercise programme. It is advisable to write a letter to the client’s doctor outlining assessment results. In most cases, the trainer will know much more about exercise than the client’s GP.
- special attention -clients may be placed into this category for several reasons. Clients present with several factors that together contribute a risk for CHD. Or, it may simply be because they are older or have not exercised before. Many factors have to be taken into consideration. It becomes a matter of personal judgement whether or not to refer.
- fit and healthy -clients in this group have no health problems, no risk factors for CHD and have been following a regular exercise programme for at least two months. This group includes most sports specific athletes.
Criteria for medical referral:
There are four criteria for referring a client to their GP. These are as follows:
- instant medical referral
- any factor in the ‘medical referral’ category of the primary and secondary risk factor table
- any diagnosed metabolic, pulmonary or cardiovascular disease
- signs or symptoms of a pulmonary or cardiovascular disease
- several measurements require special attention
- for example, BP 140/90, current smoker and positive family history of CHD
- doubt or uncertainty
- doubt or uncertainty regarding any aspect of the client’s health. The PT should play safe and refer
- client preference or doubt
- if the client expresses a desire to be medically referred before starting an exercise programme, again play safe and refer
Referring a client to another health care professional:
If a referral has been identified, the client will need to seek medical clearance (GP or physiotherapist) before carrying on. However, it’s important the client is kept in the loop and doesn’t just disappear out of the door never to return. In other words, some form of follow up procedure is needed.
Furthermore, networking with other health care professionals is recommended if PT’s are to best serve their clients. Standard referral letters can be drafted (with the client’s consent) or contact can be made direct. Any letter should contain results and comments of areas of concern that have been identified through testing (appendix 3).
Other health care professionals are likely to feel assured of the PT’s ability if this professional approach is adopted. On a final note, schedule an alternative appointment and follow this up with a phone call.