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Exercise Risk Assessment

By Lt. Col. Marty Thomas, USA
Special to American Forces Press Service

WASHINGTON, March 18, 1998 – So you're taking the big step and you're ready to get started in a physical activity regimen that will lead to a healthier lifestyle.

That's great! But before you get started, let's take a minute to determine the risks involved in the physical activity and whether you're ready to undertake the program.

Ideally, regular physical activity is simple, safe and a natural part of healthy living. Excessive physical activity can cause a variety of muscle and skeletal injuries, but a common fear is that physical activity will provoke a fatal heart attack. While high- profile deaths do occur during exercise, such as what happened to runner Jim Fixx, the overall risk that vigorous physical activity will provoke a heart attack is quite low, and that risk appears to be even lower for regular than occasional exercisers.

For individuals in uniform aged 40 or older, testing and screening during a physical examination serve as a "gate" for continued regular physical activity. Without a screening, some practical advice will reduce the likelihood of an exercise catastrophe. Many physicians believe this simple advice may be the best method for determining readiness for a modest increase in physical activity.

These tips suggest that risk associated with moderate physical activity is increased if:

  • There is a history of fainting or chest pain during exercise.
  • There is a family history of sudden death at a young age.
  • The intensity and duration of activity are much greater than the subject has recently experienced.
  • Competition, publicity or pride encourages persistence with exercise in the face of warning symptoms.
  • The individual exercises while under pressure of time, or when oppressed by business or social problems.
  • The activity involves heavy lifting or prolonged isometric effort.
  • The weather is unduly hot or cold.
  • The participant has a viral infection, senses chest discomfort or cardiac irregularity, or feels "unwell."

Recent research indicates that while a formal medical examination is unwarranted for most people who plan to begin a simple exercise program, there remains merit in simple screening procedures. Pre- exercise screening by a doctor is recommended for men aged 40 or older, and women 50 older. Indications for people who should seek medical advice are: the presence of disease; the intent to undertake vigorous exercise above the specified age limit; and two or more major risk factors or symptoms suggestive of cardiopulmonary or metabolic disease.

The Canadian Physical Activity Readiness Questionnaire has proven to be a safe screening tool for people wishing to undertake increased physical activity. The questionnaire follows.

Individuals wishing to move from a nonactive lifestyle to a lifestyle that includes a moderate level of physical activity should understand that there are low-level risks involved in the undertaking. However, if consideration is given to risk factors involved in increased physical activity and pre-screening is conducted for individuals as outlined, these risks can be lowered and the physical activity undertaken. Physical Activity Readiness Questionnnaire

If you answer "yes" to any of these questions, consult a doctor prior to undertaking increased physical activity:

1. Has a doctor said that you have a heart condition and recommended only medically supervised activity?

2. Do you have chest pain brought on by physical activity?

3. Have you developed chest pain in the past month?

4. Do you tend to lose consciousness or fall over as a result of dizziness?

5. Do you have a bone or joint that could be aggravated by the proposed physical activity?

6. Has a doctor ever recommended medication for your blood pressure or a heart condition?

7. Are you aware through your own experience, or a doctor's advice, of any other physical reason against you exercising without medical supervision?

(Thomas is an action officer in the Office of the Deputy Assistant Secretary of Defense for Personnel Support, Families and Education.)

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