Pre-Exercise Screening (Chapter 1)/Informed Consent and Waiver Form

PE 254

Evaluate the health status of each client, especially sedentary individuals.

Identify any existing medical conditions or risk factors.

The American College of Sports Medicine (ACSM) recommends:

Identifying and excluding individuals with medical contraindications (i.e. risk factors) to exercise.

Identify individuals at risk for disease because of age, symptoms, and/or risk factors who should undergo a medical evaluation and exercise testing before starting an exercise program.

The American College of Sports Medicine (ACSM) recommends (continues):

Identify individuals with clinically significant disease who should participate in a medically supervised exercise program.

Identify individuals with other special needs.

Purpose: To detect the presence of disease and to assess the initial disease risk classification of your clients.

Component PurposePAR-Q (Physical Activity Readiness Questionnaire) To determine client’s readiness for physical

activity

Signs and symptoms of disease To identify individuals in need of medical referral

Coronary risk factory analysis To determine the number of CHD risk factors for client

Disease risk classification To categorize client as apparently healthy, at increased risk or with known risk

Medical history To review client’s past and present personal and family health history, focusing on conditions requiring medical referral and clearance

Physical examination To detect signs and symptoms of disease

Medical clearance To obtain physician approval for exercise testing and participation

Laboratory tests To provide a more in-depth assessment of client’s health status, particularly for someone with known disease.

Cholesterol and lipoprotein profile To determine if client has hyperlipidemia; these values are also used in the coronary risk factory analysis

Blood pressure assessment To determine if client is hypertensive; these values are also used in the coronary risk factor analysis

Resting heart rate and 12-lead ECG To evaluate cardiac function and detect cardiac abnormalities that are contraindications to exercise

Graded exercise test To assess functional aerobic capacity and to detect cardiac abnormalities due to exercise stress

Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?

Do you feel pain in your chest when you do physical activity?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity?

http://uwfitness.uwaterloo.ca/PDF/par-q.pdf

Family history (e.g., heart attack, stroke, hypertension)

Cigarette smoking Hypertension Hypercholesterolemia Diabetes Obesity Sedentary lifestyle

Low risk: Men <45 years of age and women <55 years of age who are without symptoms and meet no more than one risk factor threshold.

Moderate risk: Men ≥45 years and women

≥55 years or those who meet the threshold for two or more risk factors.

High risk: Individuals with one or more signs

and symptoms or known cardiovascular, pulmonary, or metabolic disease.

Greet the client

Explain the purpose of the health evaluation and lifestyle evaluation

Obtain the client’s information consent for health screening. Administer and evaluate PAR-Q; refer client to physician if necessary

Administer and evaluate client’s medical history, focusing on signs, symptoms

Evaluate client’s lifestyle profile

Evaluate and classify the client’s cholesterol and lipoprotein levels if test results are available

Measure and classify the client’s coronary risk factors. Classify the client’s disease risk

Evaluate the client’s blood chemistry profile if test results are available

Explain the purpose of and answer any question about the 12-lead resting (ECG) and graded exercise test (GXT)

Obtain the client’s informed consent for these tests

Prepare the client and administer the 12-lead resting ECG

Have a physician interpret the results and the 12-lead resting ECG

Use the client’s disease risk classification to determine whether a maximal or submaximal GXT should be administered and whether a physician needs to be present during this test

Assess the client’s resting blood pressure and heart rate

Administer the GXT

Assess and classify the client’s functional aerobic capacity

ACSM recommends:

Moderate exercise: Activities that are approximately 3 to 6 metabolic equivalents (METs) or the equivalent of brisk walking at 3 to 4 mph for healthy adults.

Vigorous exercise: Activities requiring energy expenditure of >6 METs such >60% maximal oxygen uptake.

Health-related fitness = physical capacities that contribute to health

Five components:

1. Cardiorespiratory endurance = the ability of the body to perform prolonged, large-muscle, dynamic exercise at moderate-to-high levels of intensity

2. Muscular strength = the amount of force a muscle can produce with a single maximum effort

3. Muscular endurance = the ability of a muscle or group of muscles to remain contracted or to contract repeatedly

4. Flexibility = the range of motion in a joint or group of joints

5. Body composition = the proportion of fat and fat-free mass (muscle, bone, and water) in the body

PE 254

Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of an action. The individual needs to be in possession of relevant facts and also of his reasoning faculties, such as not being mentally retarded or mentally ill and without an impairment of judgment at the time of consenting. Such impairments might include illness, intoxication, insufficient sleep, and other health problems.

All clients should read and sign an informed consent before being tested.

The consent should explain the purpose and process of the testing and include a statement of the potential for benefits, discomfort, pain or even death associated with its implementation.

Informed consent should include a statement that results will remain confidential and that participation is strictly voluntary.

Test administrators should obtain signed inform consent forms from every person who enters your programs and before every test you administer.

http://www.stanford.edu/group/ncpi/unspecified/student_assess_toolkit/pdf/sampleinformedconsent.pdf

http://www.crouse.org/MedicalAffairs/IRB/ChildConsentForm.pdf

http://srp.missouristate.edu/assets/orc/SAMPLE_CONSENT_FORM.pdf

A waiver, also called a prospective release, is a contract between two parties (e.g., health/fitness facilities and their participants).

A good waiver should clearly and specifically use the word “negligence” in the exculpatory (clear from guilt) clause.

Always consult an attorney in the state that you will be practicing (Cotton & Cotton, Legal Aspects of Waivers in Sport).

A contractual waiver must include:

• Agreement: Fitness facility offers to enter into a legal agreement and the other party agrees.

• Consideration: The member agrees to give up their right (the waiver) negligence claim against the facility in exchange for receiving certain services (the promise).

• Contractual capacity: Both parties must have the legal capacity to contract—those who do not have the legal capacity should not be allowed to sign waivers.

• Legality: The waiver must not go against matters that are considered unlawful or against public policy.

A waiver must be conspicuous.

A waiver must be signed at the time of contract signing.

1. Make the waiver conspicuous.2. Make sure the consideration

requirements for a contract is adequately stated.

3. Exculpatory clause should be bold and conspicuous and include the words “ordinary negligence.”

4. Wording should be broad to cover all types of situations.

5. Duration of the waiver should be clear (“present and future claims”)

6. All parties clearly listed in the waiver.7. Clause should cover inherent risk of activity as well

as any specific risk associated with participation.8. Maybe include an indemnification (i.e.

compensation or reparation) clause which will require the person who signed to reimburse for losses due to a lawsuit.

9. Severability clause will insure that even if part of the waiver is considered invalid, the rest is still valid. Rather than having the court throw out the entire waiver.

10. Must include that the individual is of legal age. Place this statement just about the signature.

Explain verbally, honestly, and clearly. Participant should have adequate time to

read the waiver and should be asked verbally if they read and understood the waiver. Verify age and identification.

Read the waiver to the participant who cannot read it.

Retain waivers for a certain period of time (based on state law).

Preserve the waiver so it can be quickly and easily accessible.

http://www.snowiasa.org/guidelines-resources/waiver-sample.pdf

http://www.sadlersports.com/riskmanagement/sports-insurance-waiverminor.html

http://www.snowmobile.org/docs/Take_A_Friend_Snowmobiling_Week%20_Sample_Waiver_Form_2009.pdf

Group 1: Administering a Fitness Gram Test (e.g., one-mile run, sit-ups, and push-ups) on adults (ages 30 to 45) for a research study on a college campus.

Group 2: Administering an agility test (e.g., shuttle run) on college students (ages 18 to 35) for a research study at the campus fitness center.

Group 3: Administering a gait and balance tests on older adults (ages 65 or older) for a research study at L.A. Fitness.

Group 4: Administering a flexibility test (e.g., sit-and-reach) on older adults (ages 65 or older) for a research study at a retirement housing center.