Have you finally decided to sign-up for that spinning class at the gym? Or, have you determined that you want to start swimming laps at your local recreation center? These are great options for increasing your activity level and improving your overall health. But, how do you know you can participate in these and similar exercises safely, especially if you have led an inactive lifestyle up to this point?

Many chronic health conditions, such as hypertension, can be "silent." That is, you can have the condition without experiencing any symptoms. If left unchecked, these conditions can put you at an increased risk for medical complications during exercise. Other health problems, such as orthopedic conditions, can be exacerbated if you participate in the wrong type of physical activity.

For many healthy adults who are interested in starting a moderate-intensity exercise program, the risk of heart attack or sudden death is low. This risk increases, however, as the intensity of the exercise becomes vigorous. The risk also increases in individuals with cardiovascular disease. According to the American College of Sports Medicine, one death per year for every 15,000-18,000 people occurs from sudden cardiac arrest that was evoked from vigorous exercise. It should be noted that the rates for experiencing a heart attack or sudden death disproportionately increase in individuals who have been previously inactive and perform physical activity to which they are unaccustomed. Because of the lower prevalence of cardiovascular disease in individuals younger than 40 years of age compared to older counterparts, their risk of sudden death from exercise is very low. The most common causes of exercise-related death for the younger population are congenital and hereditary anomalies.

How do you know if you are an individual who is at risk when you exercise or if you should see a physician prior to beginning a program? To determine this, the American College of Sports Medicine advocates a risk stratification approach to classifying individuals into three categories: low, moderate, and high risk. The level of risk is determined by the presence or absence of known chronic diseases, the presence or absence of signs and symptoms of chronic diseases, and the presence or absence of risk factors for cardiovascular disease. The category descriptions are as follows:

Low Risk: In general, individuals who fall into this category can pursue exercise safely without getting medical clearance from their physician.

• Absence of signs and symptoms for cardiovascular, pulmonary, and/or metabolic disease
• Absence of cardiovascular, pulmonary, and/or metabolic disease
• Have no more than one risk factor for cardiovascular disease

Moderate Risk: In general, individuals who fall into this category can pursue low- to moderate-intensity exercise safely without getting medical clearance from their physician, but need doctor approval before engaging in vigorous-intensity exercise.

• Absence of signs and symptoms for cardiovascular, pulmonary, and/or metabolic disease
• Absence of cardiovascular, pulmonary, and/or metabolic disease
• Have two or more risk factors for cardiovascular disease

High Risk: Individuals who fall into this category need medical clearance from their physician prior to pursuing exercise at any intensity.

• Presence of one or more signs and symptoms of cardiovascular, pulmonary, and/or metabolic disease
• Presence of cardiovascular, pulmonary, and/or metabolic disease

Because the risk for exercise-related heart attack and sudden cardiac arrest increases with age, it is advisable that women who are 55 years of age and older and men who are 45 years of age and older seek physician approval prior to engaging in exercise. A good tool for you to use to determine if you need to seek medical advice prior to beginning an exercise program or before increasing the difficulty level of a current routine is the Physical Activity Readiness Questionnaire (PAR-Q), originally developed by the British Columbia Ministry of Health and later revised by the Canadian Society for Exercise Physiology and Fitness Canada. The PAR-Q is a self-guided screening tool for individuals between the ages of 15-69 years. It asks various questions about your current and past health history. Answering the questions truthfully will help you to determine if you need a physician's approval to engage in exercise.

Exercise can be both enjoyable and safe if you take the proper precautions. To get a general idea of your risk for a medical emergency during exercise, follow the link above to the PAR-Q form and answer the questions. If you answer yes to one or more of the questions, contact your doctor prior to beginning an exercise program or increasing the difficulty level of a current routine. Share your results of the PAR-Q with your physician so that issues of concern can be addressed. If at any point in your journey to improve or maintain your fitness level you question your health and safety during exercise contact your doctor for a thorough medical screening.

Resources

ACSM Current Comment "Off the Couch and Active: When to see a Physician Before Exercising," Kohl, H.W.

ACSM Guidelines for Exercise Testing and Prescription, Eighth Edition

Canadian Society for Exercise Physiology