Medical Clearance & Pre-Participation Screening

Pre-participation health screening identifies people who should obtain medical clearance before starting or intensifying exercise, without creating unnecessary barriers for the majority who can safely begin light-to-moderate activity.

Self-screening — PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone): a validated self-administered tool. A "yes" answer flags the need to consult a qualified professional (ePARmed-X+ or a physician) before becoming more active. See par-q-plus.

Professional screening — ACSM algorithm (2015 update, current in the 11th ed., 2021): the decision to recommend medical clearance is based on three factors:

1. The individual's current physical activity level (regular exercise: ≥3 days/week of moderate-intensity for ≥3 months).
2. Presence of known cardiovascular, metabolic, or renal disease, and/or signs/symptoms suggestive of these diseases (e.g., chest discomfort, unusual breathlessness, dizziness/syncope, palpitations, ankle edema, claudication, known heart murmur).
3. The desired exercise intensity (light, moderate, or vigorous).

General logic of the ACSM algorithm:

• Currently inactive, no disease/symptoms: medical clearance not necessary for light-to-moderate exercise; progress gradually.
• Currently active, no disease/symptoms: may continue; clearance not needed to progress.
• Known disease but asymptomatic and currently active: clearance recommended before moving to vigorous intensity.
• Any signs/symptoms suggestive of CV/metabolic/renal disease (active or not): discontinue exercise and obtain medical clearance regardless of intensity.
• The 2015 update de-emphasized routine exercise testing for asymptomatic people to reduce barriers, while preserving caution for symptomatic or higher-risk individuals.

ACSM/AMA still flag the universal warning signs to stop and seek care (see cardio-safety-contraindications).

Screening tools support, but do not replace, clinical judgment. When in doubt, consult a physician.

• PAR-Q+: validated self-screen; any "yes" → consult a professional before increasing activity.
• ACSM screening decision uses: current activity level + known disease/symptoms + desired intensity.
• Regular exercise defined as ≥3 days/week moderate intensity for ≥3 months.
• Symptoms suggestive of CV/metabolic/renal disease → stop and get clearance at any intensity.
• 2015 ACSM update reduced routine testing for asymptomatic individuals to lower barriers.

• exercise-is-medicine — clearance sits inside the broader prescribe-and-progress model.
• par-q-plus — the self-screening questionnaire.
• cardio-safety-contraindications — warning signs to stop.
• consult-fitness-instructor — who to involve when a flag appears.