Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a Nationally Representative Sample of US Adults Aged ≥40 Years From the National Health and Nutrition Examination Survey 2001 to 2004
Open accessAbstract
BACKGROUND: Although the American Heart Association/American College of Sports Medicine's Preparticipation Questionnaire (AAPQ) is a recommended preexercise cardiovascular screening tool, it has never been systematically evaluated. The purpose of this research is to provide preliminary evidence of its effectiveness among adults aged ≥40 years. METHODS AND RESULTS: Under the assumption that participants would respond to AAPQ items as they responded to a general health survey, we calculated the sex- and age-specific proportions of adult participants in the National Health and Nutrition Examination Survey 2001 to 2004 who would receive a recommendation for physician consultation based on AAPQ referral criteria. Additionally, we compared recommended AAPQ referrals to a similar assessment using the Physical Activity Readiness Questionnaire in the study sample. AAPQ referral proportions were higher with older age. Across all age groups ≥40 years, 95.5% (94.3% to 96.8%) of women and 93.5% (92.2% to 94.7%) of men in the United States would be advised to consult a physician before exercise. Prescription medication use and age were the most commonly selected items. When referral based on AAPQ was compared with that of the Physical Activity Readiness Questionnaire, the 2 screening tools produced similar results for 72.4% of respondents. CONCLUSIONS: These results suggest that >90% of US adults aged ≥40 years would receive a recommendation for physician consultation by the AAPQ. Excessive referral may present an unnecessary barrier to exercise adoption and stress the healthcare infrastructure.
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Using current prescreening algorithms can result in excessive referrals to physicians for medical clearance, which could be a barrier to adopting and maintaining a regular exercise program.
“Recent studies have suggested that using the current ACSM exercise preparticipation health screening guidelines can result in excessive physician referrals, possibly creating a barrier to exercise participation.”
From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [48]
A recent study found that 95% of men and women over 40 years of age would be advised to consult a physician before exercise based upon the previous risk factor-based exercise preparticipation health screening process.
“A recent study found that 95% of men and women over 40 yr of age would be advised to consult a physician before exercise based upon the previous risk factor-based exercise preparticipation health screening process (48).”
From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [48]
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Cites
The Physical Activity Guidelines for Americans
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018) · JAMA · doi:10.1001/jama.2018.14854 · Cited by 9,755 · see citing works
Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us
Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.166082 · Cited by 1,548 · see citing works
(2009) · Nutrition Reviews · doi:10.1111/j.1753-4887.2008.00136.x · Cited by 593 · see citing works
Dahabreh, I. J. (2011) · JAMA · doi:10.1001/jama.2011.336 · Cited by 199 · see citing works
Physical Activity, Physical Fitness, and Sudden Cardiac Death
Kohl, H. W., Powell, K. E., Gordon, N. F., Blair, S. N., & Paffenbarger, R. S. (1992) · Epidemiologic Reviews · doi:10.1093/oxfordjournals.epirev.a036091 · Cited by 119 · cited 2× · see citing works
“precipitating physical activity-associated myocardial infarction and sudden cardiac death in adults aged ≥35 years.(2)”
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Research works printed but not linked: 12
- [1]Physical Activity Guidelines Advisory Committee Physical Activity Guidelines Advisory Committee Report, 2008 Department of Health and Human Services Washington, D.C 2008 19178654
- [4]American College of Sports Medicine Thompson WR Gordon NF Pescatello LS ACSM’s guidelines for exercise testing and prescription 8 Philadelphia Lippincott Williams & Wilkins 2010 23851406
- [5]Balady GJ Chaitman B Driscoll D Foster C Froelicher E Gordon N Pate R Rippe J Bazzarre T Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities Circulation 1998 97 2283 2293 9631884
- [6]Jamnik VK Warburton DE Makarski J McKenzie DC Shephard RJ Stone JA Charlesworth S Gledhill N Enhancing the effectiveness of clearance for physical activity participation: background and overall process App Physiol Nutr Me 2011 36 Suppl 1 S3 S13 21800946
- [7]Shephard RJ Bailey DA Mirwald RL Development of the Canadian Home Fitness Test Can Med Assoc J 1976 114 675 679 56979 PMC1956906
- [8]Shephard RJ Cox MH Simper K An analysis of “Par-Q” responses in an office population Can J Pub Health 1981 72 37 40 7225989
- [9]Cardinal BJ Esters J Cardinal MK Evaluation of the revised physical activity readiness questionnaire in older adults Med Sci Sports Exerc 1996 28 468 472 8778552
- [11]Ainsworth BE Haskell WL Whitt MC Irwin ML Swartz AM Strath SJ O’Brien WL Bassett DR Jr Schmitz KH Emplaincourt PO Jacobs DR Jr Leon AS Compendium of physical activities: an update of activity codes and MET intensities Med Sci Sports Exerc 2000 32 S498 504 10993420
- [12]National Cholesterol Education Program Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report Circulation 2002 106 3143 3421 12485966
- [18]Pignone M Fowler-Brown A Pletcher M Tice JA Screening for Asymptomatic Coronary Artery Disease: A Systematic Review for the US Preventive Services Task Force Rockville, MD Agency for Healthcare Research and Quality 2003 20722118
- [22]Deshpande SP DeMello J A comparative analysis of factors that hinder primary care physicians’ and specialist physicians’ ability to provide high-quality care Health Care Manag (Frederick) 2011 30 172 178 21537140
- [23]Reeves SW Tielsch JM Katz J Bass EB Schein OD A self-administered health questionnaire for the preoperative risk stratification of patients undergoing cataract surgery Am J Opthalmol 2003 135 599 606 12719065
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Updating ACSM's Recommendations for Exercise Preparticipation Health Screening
RIEBE, D., FRANKLIN, B. A., THOMPSON, P. D., GARBER, C. E., WHITFIELD, G. P., MAGAL, M., & PESCATELLO, L. S. (2015) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000664 · Cited by 688 · see citing works
Self-citationFranklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M.-F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., Eijsvogels, T. M. H., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000749 · Cited by 410 · see citing works
(2023) · International Journal of Exercise Science · doi:10.70252/eerp4920 · Cited by 20 · see citing works
- Authors
- Whitfield, G. P., Pettee Gabriel, K. K., Rahbar, M. H., & Kohl, H. W.
- Affiliations
- The University of Texas at Austin (US)
- From the Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Austin, TX (G.P.W., K.K.P.G., M.H.R., H.W.K.); Center for Clinical and Translational Sciences, University of Texas Health Science Center, Houston, TX (M.H.R.); and the Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX (H.W.K.).
- Venue
- Circulation
- Published
- 2014-03-11
- Volume
- 129
- Issue
- 10
- Pages
- 1113-1120
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC4094111
- OpenAlex
- W2064928893
- Cited by
- 54
- References
- 5
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 3 · 2018: 8 · 2017: 5 · 2016: 7 · 2015: 3 · 2014: 2
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (2 R25 CA 57712, R25‐CA57712, R25CA057712)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- pre-participation screening, exercise screening, cardiovascular risk, Physical Activity Readiness Questionnaire, physician referral, older adults, prescription drug use, NHANES
- MeSH terms
- Adult, Aged, Aged, 80 and over, American Heart Association, Female, Health Surveys, Humans, Male, Mass Screening, Middle Aged, Motor Activity, Nutrition Surveys, Surveys and Questionnaires, Referral and Consultation, Retrospective Studies, Sports Medicine, United States, Exercise, Checklist
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