7.1. Health Assessment

A health assessment performed by a personal trainer involves gathering critical information about a client’s health status and exercise-related risk of health complications before conducting any exercise-related assessments. This information is crucial for ensuring exercise safety and helping clients achieve their goals effectively and safely (Pimenta et al., 2016).

The health assessment typically includes obtaining a client’s medical history, lifestyle habits, and family history. Personal trainers may also administer questionnaires, such as the Physical Activity Readiness Questionnaire (PAR-Q) or the Health History Questionnaire, to identify any potential health risks or contraindications for exercise (ACSM, 2018). This information allows personal trainers to create individualized exercise programs for clients’ needs and limitations, reducing the risk of injury or adverse health events during physical activity.

It is important to note that health assessments conducted by personal trainers are not equivalent to those performed by healthcare providers, which may include physical examinations, laboratory tests, and diagnostic imaging. However, personal trainers can use the information obtained from a health assessment to refer clients to healthcare professionals when necessary and collaborate with them to develop safe and effective exercise programs.

Methods of health screening prior to gym-based exercise are:

1) Physical Activity Readiness Questionnaires (PAR-Q) and Health History Questionnaire

2) Gaining medical clearance (if necessary)

followed by

3) Contract, liability waiver, interview

and the pre-exercise assessment:

4) Observation

5) Physical measurements

The first three methods mentioned above (PAR-Q and HHQ, medical clearance and signing documents) are also known as »pre assessment screening« which means gathering a client’s demographic and health-related information along with some health risk/medical assessments (ACSM 2014). There are many reasons for pre assessment screening, for example, to identify those with a medical contraindication and to identify those who should receive medical clearance etc.

1) Health-risk appraisal

A health risk appraisal, also known as a health risk assessment, is a questionnaire that evaluates an individual’s lifestyle factors and health risks. Based on the results, appropriate actions can be planned to reduce risks, maintain health, and prevent disease (PDHI, 2023).

The concept of health risk appraisal can be traced back to the late 1940s when Dr Lewis C. Robbins began documenting patients’ health hazards to treat and prevent disease. Over the next two decades, the idea of a health hazard chart for physicians’ use evolved into a comprehensive health risk appraisal, incorporating a patient questionnaire, health risk computation, and feedback strategies. In 1979, Dr Don Hall developed the first U.S.-based computerized health risk appraisal (Welsource, 2023).

A health risk assessment typically includes questions in the following areas:

Demographic characteristics – age, gender

Lifestyle behaviors – exercise, eating habits, alcohol and tobacco use

Emotional health – mood, stress, life events

Physical health – weight, blood pressure, cholesterol levels

Current and previous health conditions

Preventive screenings

Readiness to change behaviors to improve health

Today, health risk appraisals are utilized in various settings, including medicine, workplaces, fitness centers, and more.

PAR-Q, HHQ, medical release forms...

Physical Activity Readiness Questionnaire (PAR-Q)

The Physical Activity Readiness Questionnaire (PAR-Q) is a preliminary screening tool used to assess an individual’s readiness for exercise testing and prescription (Thomas, 1992). It is a minimal yet safe pre-exercise screening measure for low-to-moderate exercise training. However, it is not recommended for vigorous exercise training. Nevertheless, individuals or personal trainers can use PAR-Q, as it provides an initial understanding of the client’s exercise readiness.

Conducting a health-risk appraisal involves gathering detailed information and reviewing a client’s health information, medical history, and lifestyle habits. This information enables the trainer to determine risk stratification or the need for a medical examination and develop recommendations for lifestyle modifications and strategies for exercise testing and programming (ACSM, 2018).

Risk stratification is crucial because someone with only one positive risk factor will be treated differently than someone with multiple positive risk factors. If PAR-Q identifies a person as having several health risks, a referral to a physician is recommended (Shephard, 2015). Recommendations for physical activity, medical examinations, or exercise testing are based on the number of associated risks, with risk stratification categorized as low, moderate, or high.

Signs or symptoms of medical conditions included in risk stratification encompass the following:

Pain (tightness) or discomfort in the chest, neck, jaw, arms, or other areas that may result from ischemia
Shortness of breath or difficulty breathing at rest or with mild exertion (dyspnea)
Orthopnea (dyspnea in a reclined position) or sudden breathing problems during the night (paroxysmal nocturnal apnea)
Ankle swelling (edema)
Rapid throbbing (palpitations) or fluttering (tachycardia) of the heart
Severe pain in the leg while walking (intermittent claudication, associated with inadequate blood supply)
Known heart murmur
Unusual fatigue or difficulty breathing with usual activities
Dizziness or syncope, most commonly caused by reduced perfusion to the brain

Trainers should be familiar with these conditions and document them in a client’s file if the client has a history of any of these symptoms or develops these signs or symptoms while under the trainer’s supervision. It is also essential that the client’s physician be made aware of any signs or symptoms mentioned above.

Health History Questionnaire (HHQ)

The Health History Questionnaire (HHQ) is an opportunity to gather the information that will assist fitness professionals in evaluating a client’s current health and fitness level. The HHQ covers basic information like known medical diagnoses, family history, potential disease symptoms & current health habits. A well-designed HHQ should note the individual’s current activity habits; identify any serious medical conditions (contraindications to exercise); document any known cardiovascular, pulmonary or renal diseases or the presence of diabetes and determine cardiovascular disease risk factors (ACSM, 2014).

A trainer usually uses HHQ to identify those individuals with risk factors or other conditions to assist with appropriate exercise prescription or to recognize that a client may have medical conditions for which exercise should not be performed until the condition is resolved.

ACSM recommends classifying individuals into one of three levels of risk according to the criteria presented in the table below:

Regardless of the intensity of exercise, clients classified as high risk are advised to have a medical examination, and those with low risk have no such recommendation. The recommendation for clients in the moderate risk classification depends on moderate-intensity activities or assessments. However, such an exam is recommended prior to the performance of vigorous-intensity activity (ACSM 2014).

You can find an example of PAR-Q and HHQ in Appendix B at this chapter's end.

2) Medical clearance

A medical clearance is a formal authorization provided by a healthcare professional, typically a physician, indicating that an individual is physically able to participate in an exercise program. This clearance is crucial for individuals who have specific health risks, have answered “yes” to one or more questions on the PAR-Q, or are categorized as high risk on the Health History Questionnaire (HHQ). In these cases, further investigation is necessary before the client can safely begin an exercise program (ACSM, 2018).

If a personal trainer lacks the qualifications or expertise to investigate the client’s condition further, the client should consult their physician before starting an exercise program. To obtain medical clearance, clients can:

Schedule an appointment with their physician and ask for a written letter containing their recommendations.
Bring a medical approval form to their physician for completion or mail it to the physician for completion and return.

A personal trainer can prepare a medical clearance form for a physician to sign, as many countries do not have a standardized document. Obtaining medical clearance helps ensure the client can safely engage in an exercise program without exacerbating existing health issues or putting their well-being at risk (Shephard, 2015).

You can find a sample of a medical clearance form in appendix B at this chapter's end.