Recommendations for Cardiovascular Screening, Staffing, and Emergency Policies at Health/Fitness Facilities

Abstract

T he message from the nation's scientists is clear, unequiv- ocal, and unified: physical inactivity is a risk factor for cardiovascular disease, 1,2 and its prevalence is an important public health issue.New scientific knowledge based on epidemiological observational studies, cohort studies, controlled trials, and basic research has led to an unprecedented focus on physical activity and exercise.The promotion of physical activity is at the top of our national public health agenda, as seen in the publication of the 1996 report of the US Surgeon General on physical activity and health.3 The attention now being given to physical activity supports the goals of Healthy People 2000 4 and should lead to increased levels of regular physical activity throughout the US population, including the nearly one fourth of adult Americans who have some form of cardiovascular disease.5 Although regular exercise reduces subsequent cardiovascular morbidity and mortality, 1,2,6 the incidence of a cardiovascular event during exercise in patients with cardiac disease is estimated to be 10 times that of otherwise healthy persons.7 Adequate screening and evaluation are important to identify and counsel persons with underlying cardiovascular disease before they begin exercising at moderate to vigorous levels.Moderate (or higher) levels of physical activity and exercise are achieved in a number of settings, including Ͼ15 000 health/fitness facilities across the country.A recent survey of 110 health/fitness facilities in Massachusetts found that efforts to screen new members at enrollment were limited and inconsistent.8 Nearly 40% of responding facilities stated that they do not routinely use a screening interview or questionnaire to evaluate new members for symptoms or history of cardiovascular disease, and 10% stated that they conducted no initial cardiovascular health history screening at all.This statement provides recommendations for cardiovascular screening of all persons (children, adolescents, and adults) before enrollment or participation in activities at health/fitness facilities.Staff qualifications and emergency policies related to cardiovascular safety are also discussed.Health/fitness facilities are defined here as organizations that offer health and fitness programs as their primary or secondary service or that promote high-intensity recreational physical activity (eg, basketball, tennis, racquetball, and swim clubs).Ideally such facilities have a professional staff, but those that provide space and equipment only (eg, unsupervised hotel exercise rooms) are also included.A health/fitness facility user is defined as a dues-paying member or a guest paying a regular daily fee to use the facility specifically to exercise.These recommendations are intended to assist health/fitness facility staff, healthcare providers, and consumers in the promotion and performance of safe and effective physical activity/exercise.The writing group based these recommendations on a review of the literature and the consensus of the group.Earlier statements from the American Heart Association (AHA) and the American College of Sports Medicine (ACSM) are highlighted and supplemented.These recommendations were peer reviewed by selected authorities in the field representing the AHA, the ACSM, the American College of Cardiology, the International Health Racquet and Sports Clubs Association (IHRSA), and the Young Men's Christian Association.The recommendations are not mandatory or all-encompassing, nor do they limit provision of individualized care by practitioners exercising independent judgment.With this statement the AHA and the ACSM assume no responsibility toward any individual for whom this statement may be applied in the provision of individualized care.Specific details about exercise testing and training of persons with and without cardiovascular disease and those with other health problems are provided elsewhere.7,9 -11 The ACSM has published comprehensive guidelines for operating health/fitness facilities.12 Although issues in competitive sports are beyond the scope of this statement, the 26th Bethesda Conference 13 on sudden cardiac death in competitive athletes and the AHA 14 provide specific recommendations for the screening and evaluation of athletes for congenital heart disease, systemic hypertension, and other cardiovascular diseases before participation in competitive sports. Cardiovascular Screening RationaleRegular exercise results in increased exercise capacity and physical fitness, which can lead to many health benefits.Persons who are physically active appear to have lower rates of all-cause mortality, probably because of a decrease in "Recommendations for Cardiovascular Screening, Staffing, and Emergency Policies at Health/Fitness Facilities" was approved by the American Heart Association Science Advisory and Coordinating Committee in March 1998.This statement is being published simultaneously in Medicine and Science in Sports and