FSHP Academy
Assessment & Screening — all lessons

Screening

Preparticipation health screening

Resting and Body Composition Measures

Resting assessments and anthropometric measurements

Fitness Testing

Cardiorespiratory assessmentsMuscular strength, endurance and power assessmentsAthlete assessment and evaluation

Movement and Postural Assessment

Postural and functional assessment (Prehab assessment tool)Limits of movement screens and postural assessment

Preparticipation health screening

How to decide safely whether someone can start or progress exercise — the ACSM 2015 screening logic, the PAR-Q+, signs and symptoms that need referral, and documentation.

Beginner Evidence: Established consensus 3 min read Reviewed 2026-10-31 Status: draft

Learning objectives

  • Explain the purpose of preparticipation screening and its limits
  • Apply the ACSM (2015) screening logic using exercise status, known disease, symptoms and desired intensity
  • Use the PAR-Q+ and recognise signs and symptoms that require medical clearance
  • Document screening and referral within scope of practice

Why this matters

Exercise is safe for the vast majority of people, but a small number have conditions that make vigorous exercise risky without medical guidance. Screening aims to identify them without creating unnecessary barriers for everyone else [riebe2015].

Fundamental concepts

  • Screening — a structured process to decide whether medical clearance is advisable before starting or progressing exercise.
  • Medical clearance — approval from a qualified healthcare provider.
  • Scope: trainers screen and refer; they do not diagnose. See scope of practice.

The ACSM 2015 screening logic

Preparticipation health screening logic (ACSM 2015) A grid. Columns separate people who do not currently exercise regularly from those who do. Rows separate people with no known cardiovascular, metabolic or renal disease and no symptoms; people with known disease but no symptoms; and people with signs or symptoms. Recommendations range from no medical clearance needed, to clearance recommended before vigorous exercise, to stopping exercise and seeking clearance. Not exercising regularly Exercising regularly ≥30 min, moderate, 3 d/wk, last 3 months

No known CV, metabolic or renal disease, no signs/symptoms

No medical clearance needed. Start light–moderate; progress gradually.

No medical clearance needed. Continue moderate or vigorous; progress gradually.

Known CV, metabolic or renal disease, no signs/symptoms

Medical clearance recommended. Then start light–moderate; progress gradually.

Clearance not needed for moderate; continue. Clearance recommended before vigorous.

Any signs or symptoms suggestive of CV, metabolic or renal disease

Medical clearance recommended before starting.

Stop exercise; seek medical clearance before resuming.

 CV = cardiovascular. Simplified from Riebe et al. (2015). Clinical judgement and local regulations still apply.
Figure 1. Simplified ACSM preparticipation screening logic (Riebe et al., 2015). — Original diagram, FSHP Academy (schematic, not to scale).

The algorithm considers [riebe2015]:

  1. Current activity — ≥30 min of moderate exercise on ≥3 days/week for the last 3 months.
  2. Known cardiovascular, metabolic or renal disease.
  3. Signs or symptoms suggestive of these diseases.
  4. Desired intensity (light, moderate, vigorous).

Earlier versions counted cardiovascular risk factors; the 2015 update removed risk-factor counting from the clearance decision because it led to excessive referrals without clear benefit (risk factors still matter for programme design and education).

Signs and symptoms to ask about

Pain or discomfort in the chest, neck, jaw or arms at rest or on exertion; shortness of breath at rest or mild exertion; dizziness or fainting; orthopnoea or paroxysmal nocturnal dyspnoea; ankle swelling; palpitations or racing heart; intermittent claudication (calf pain on walking); known heart murmur; unusual fatigue or breathlessness with usual activities.

Tools

  • PAR-Q+ — a self-administered questionnaire with follow-up questions that directs people to clearance only when needed [warburton2011].
  • Health history form — conditions, medications, injuries, surgery, pregnancy.
  • Informed consent and emergency procedures.

Practical application

Common mistakes and misconceptions

Case study

Client: Ramesh, 58, sedentary, hypertension treated with medication, no symptoms, wants to join a running group.

Reasoning: In the ACSM 2015 algorithm, “cardiovascular disease” means cardiac, peripheral vascular or cerebrovascular disease; hypertension is a risk factor rather than a disease category for this decision [riebe2015]. With no known CV, metabolic or renal disease and no symptoms, medical clearance is not required to begin light–moderate exercise.

Action: The trainer measures resting blood pressure (well controlled at 128/82 mmHg), starts walk–run intervals at light–moderate intensity, advises him to tell his doctor he is starting (good practice with medication), and will re-screen before any progression to vigorous running. Uncontrolled blood pressure or any symptom would change this to referral first.

Further learning: video lessons

Video links are only marked “verified” after a human has watched them. Unverified entries open a YouTube search for that channel and topic rather than a guessed link.

Technical needs verification — opens a YouTube search

ACSM preparticipation screening algorithm explained

ACSM / exercise science educators (search)

You will understand: walking through the screening logic with examples

Why: Directly relevant professional skill.
Practical demo needs verification — opens a YouTube search

Using the PAR-Q+

physical activity organisations (search)

You will understand: how to administer the questionnaire

Why: Practical demonstration.

Knowledge check

Knowledge check · 0/5

1. Under the ACSM 2015 algorithm, an inactive adult with no known disease and no symptoms…

Answer C. Clearance is not needed; start light to moderate and progress.

2. A regularly active client with controlled type 2 diabetes and no symptoms wants to start vigorous intervals. ACSM suggests…

Answer A. Known disease without symptoms — continue moderate; clearance before progressing to vigorous.

3. Which is a sign or symptom suggestive of cardiovascular disease?

Answer B. Exertional chest pain, unusual breathlessness, dizziness/syncope, ankle oedema, palpitations, claudication and known heart murmur are listed signs/symptoms.

4. Compared with earlier versions, the 2015 ACSM update…

Answer B. Riebe et al. simplified screening and removed CVD risk-factor counting from the clearance decision.

5. If a client develops chest pain during a session, the trainer should…

Answer B. Possible cardiac symptoms require stopping and urgent medical assessment.

Short-answer & application questions

  1. Walk through the screening decision for a sedentary 58-year-old with hypertension and no symptoms who wants to join a running group.
  2. Explain why over-screening can be harmful to public health.
  3. List what you would document after a screening conversation.

Key takeaways

  • Screening identifies people who need medical clearance before exercise; it should not be a barrier for the healthy majority.
  • ACSM’s 2015 logic uses current activity, known cardiovascular/metabolic/renal disease, signs or symptoms, and desired intensity.
  • Risk-factor counting is no longer used to decide medical clearance in this algorithm.
  • Any signs or symptoms of cardiovascular, metabolic or renal disease warrant medical clearance before starting or continuing.

Connected topics

personal training

Role and scope of practice for personal trainers

assessment

Resting assessments and anthropometric measurements

personal training

Considerations for clients with chronic disease

metabolic health

Hypertension training guidelines

geriatric fitness

Health screening, risk stratification and medications

This is the canonical lesson for: Personal Training (ACE-aligned) → A Client-Centred Approach

References

  1. Riebe D, Franklin BA, Thompson PD, et al. (2015). Updating ACSM’s recommendations for exercise preparticipation health screening. Medicine & Science in Sports & Exercise, 47(11):2473–2479. doi:10.1249/MSS.0000000000000664 Position stand check pending
  2. Warburton DER, Jamnik VK, Bredin SSD, Gledhill N (2011). The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+). Health & Fitness Journal of Canada, 4(2):3–23. Guideline check pending

Educational content only — not medical advice. Consult a qualified clinician for diagnosis or treatment.