Pre-exercise screening: role of the primary care physician
Open accessAbstract
Participation in regular physical activity is associated with a multitude of benefits including a reduction in chronic disease and premature mortality, and improved quality of life. All segments of society need to collaborate with one another in an effort to promote active lives. The Israeli "Gymnasium Law" requires pre-exercise evaluation prior to exercise participation in a health club. Recently that law was modified to allow for participant pre-screening with the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+). This change reflects the evidence that the risk of catastrophic events (e.g. heart attack) during moderate intensity physical activity is low, and the likelihood of detecting heart disease in asymptomatic adults is low. This change will likely reduce the number of individuals who require physician evaluation. The American College of Sports Medicine (ACSM) recently updated their recommendations for pre-exercise evaluation. The ACSM guidelines have replaced risk factor assessment, with an algorithm that first stratifies based on current physical activity level, then by the presence of chronic disease, and/or signs and symptoms of chronic disease, and last by desired exercise intensity. The goal of these efforts is to reduce barriers to regular physical activity, by eliminating unnecessary medical evaluations. All adults should be encouraged to be physically active.
AI snapshot
Written from the paper’s full text.
TL;DR
This commentary argues that pre-exercise screening should not be a barrier to physical activity, highlighting Israel’s Gymnasium Law change allowing PAR-Q+ self-screening and ACSM’s updated algorithm that removes routine CVD risk-factor-based clearance. It concludes that exercise-related cardiac risk is low for most adults and that physicians should use clinical judgment for the remaining pre-exercise certificates.
Key findings
- Israel’s Gymnasium Law was modified to allow PAR-Q+ self-screening in lieu of physician evaluation; it is estimated that 1% of PAR-Q+ completers will require further physician evaluation, but the authors caution that more than 1% may need clearance given chronic disease prevalence (prediabetes >470 million globally by 2030; high blood pressure in 40% of adults 25 years and older worldwide; nearly 70% of US adults regularly taking at least one prescription medication).
- The 2014 ACSM expert panel replaced risk-factor assessment with an algorithm based first on current physical activity level, then chronic disease and/or signs and symptoms, and last desired exercise intensity; the new guidelines no longer include a CVD risk factor profile or a low/moderate/high risk classification scheme.
- In the cited Hoffman et al. survey of 135 Israeli Family Medicine physicians, 63% were aware of guidelines for issuing pre-exercise certificates, 78% provided the certificate after performing and documenting a medical history, and 77% would not issue a certificate to patients with heart disease and would refer to a specialist; physicians who exercised regularly were more likely to promote exercise and provide clearance to all patients (46% vs. 14.5%) and less likely to order a cardiac stress test for cardiac patients.
- The authors conclude that evidence for pre-exercise screening as a strategy to prevent exercise-related cardiac morbidity and mortality is lacking, that screening may be a barrier and financial burden, and that the risk of sitting on a couch far outweighs the risk of moderate-intensity exercise for the vast majority of adults.
Methods
- Design: narrative policy/clinical commentary synthesizing Israeli law, ACSM guidelines, and a physician survey; no primary data collection by the authors is described.
- Described survey (Hoffman et al.): anonymous paper-based questionnaire, convenience sample of Israeli Family Medicine physicians, 135 included in final analysis; constructs included willingness to provide pre-exercise certificates, actions taken before providing a certificate, knowledge of employer recommendations and regulations, and personal weekly exercise.
- Analysis: narrative synthesis; for the survey, descriptive percentages are reported; no statistical methods or formal systematic search are described in this paper.
Limitations
- The paper states no limitations.
- Evident: it is a commentary/narrative synthesis rather than original research or a systematic review.
- Evident: conclusions rely on cited literature and one convenience-sample survey of Israeli Family Medicine physicians; no formal search strategy, quality appraisal, or primary data are described.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
22 of 38 cited sources checked · 15 supported · 0 flagged · accuracy not yet measured
- Premisecitation
There is limited/conflicting evidence as to the effectiveness of the PPE in identifying conditions that may place largely healthy adolescents and young adults at risk for injury or illness as a result of sport participation.
“Despite the required nature of this evaluation, there is limited/conflicting evidence as to the effectiveness of the PPE in identifying conditions that may place largely health adolescents and young adults, at risk for injury or illness as a result of sport participation [10].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [10] Hainline B, Drezner JA, Baggish A, Harmon KG, Emery MS, Myerburg RJ, Sanchez E, Molossi S, Parsons JT, Thompson PD. Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes. J Am Coll Cardiol. 2016. doi: 10.1016/j.jacc.2016.03.527 . [Epub ahead of print]. source
The section on evidence evaluating pre-participation screening for cardiovascular risk says there is limited evidence that screening prevents sports-related death in athletes, and that its cardiovascular history questions have not been scientifically validated (page unavailable). This supports concern about PPE effectiveness for cardiovascular risk, but the paper does not establish the broader claim about identifying conditions that put adolescents and young adults at risk for injury or illness generally. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Premiseown data
A majority (78%) provided the certificate after performing a medical history and documenting it in the medical record.
“Likewise, a majority (78 %) provided the certificate after performing a medical history and documenting it in the medical record.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] Hoffman RD, Golan R, Vinker S. Dealing with ambiguity: Israeli Physician’s attitudes and practices regarding pre-exercise certificates: a questionnaire study. Israel J Health Policy Res. 2016;5:8. source
- Premisecitation
The Israeli Gymnasium Law was recently modified to allow those seeking health club participation to self-complete the PAR-Q+ in lieu of a physician evaluation.
“Recently the law was modified to allow those seeking health club participation, to self-complete the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) [13] in lieu of a physician evaluation [14].”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [13] Warburton DER, Jamnik VK, Bredin SSD, Gledhill N on behalf of the PAR-Q+ Collaboration. The physical activity readiness questionnaire for everyone (PAR-Q+) and electronic physical activity readiness medical examination (ePARmed-X+). Health Fitness J Canada. 2011;4(2):3–23. source
- cites [14] Israeli Ministry of Health. Gymnasium Law revision 2015. In: Ministry of Health, editor. Israel (published in Israeli Parliament Notes) page 237.
Not checked in the free run.
- Premisecitation
The ACSM guidelines have replaced risk factor assessment with an algorithm that first stratifies based on current physical activity level, then by presence of chronic disease, and/or signs and symptoms of chronic disease, and last by desired exercise intensity.
“The ACSM guidelines have replaced risk factor assessment, with an algorithm that first stratifies based on current physical activity level, then by the presence of chronic disease, and/or signs and symptoms of chronic disease, and last by desired exercise intensity.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
- Interpretationcitation
Given the prevalence of chronic conditions such as prediabetes, high blood pressure, and prescription medication use, it is possible that more than the reported 1% of adults completing the PAR-Q+ will need physician clearance before participation in a health club.
“When one considers the prevalence of chronic conditions such as prediabetes (an estimated global prevalence of >470 million by 2030) [18], high blood pressure (40 of adults 25 years of age and older worldwide) [19], and the percentage of US adults regularly taking at least one prescription medication (nearly 70 %) [20], it is possible that more than the reported 1 % of adults completing the PAR-Q+”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [18] Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for developing diabetes. Lancet. 2012;379(9833):2279–90. source
- cites [19] A global brief on hypertension: Silent killer, global public health crisis. http://ish-world.com/downloads/pdf/global_brief_hypertension.pdf . Accessed 5 Jan 2016.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [20] Zhong W, Maradit-Kremers H, St Sauver JL, Yawn BP, Ebbert JO, Roger VL, Jacobson DJ, McGree ME, Brue SM, Rocca WA. Age and sex patterns of drug prescribing in a defined American population. Mayo Clin Proc. 2013;88(7):697–707. source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
- Rests on an assumption: The prevalence of chronic conditions in adults completing the PAR-Q+ in health clubs is similar to the global or general population prevalence figures cited.
- Rests on an assumption: A single 'yes' answer on the PAR-Q+ follow-up questions prompts recommendation to seek medical evaluation.
- Premisecitation
The risk of catastrophic events (e.g., heart attack) during moderate intensity physical activity is low.
“This change reflects the evidence that the risk of catastrophic events (e.g. heart attack) during moderate intensity physical activity is low, and the likelihood of detecting heart disease in asymptomatic adults is low.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
- Premisecitation
The new ACSM guidelines no longer recommend a low/moderate/high risk classification scheme.
“Likewise, the guidelines no longer recommend a low/moderate/high risk classification scheme.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
- Premiseown data
Most respondents (63%) were aware of guidelines for issuing pre-exercise certificates.
“The authors found that most respondents (63 %) were aware of guidelines for issuing pre-exercise certificates.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] Hoffman RD, Golan R, Vinker S. Dealing with ambiguity: Israeli Physician’s attitudes and practices regarding pre-exercise certificates: a questionnaire study. Israel J Health Policy Res. 2016;5:8. source
- Premisecitation
The new ACSM guidelines no longer include a cardiovascular disease risk factor profile as part of the decision making for referral to a healthcare provider prior to initiating a moderate-to-vigorous intensity exercise program.
“Of note, the new guidelines no longer include a cardiovascular disease risk factor profile as part of the decision making for referral to a healthcare provider prior to initiating a moderate-to-vigorous intensity exercise program.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
- Premisecitation
The ACSM recently updated their recommendations for pre-exercise evaluation.
“The American College of Sports Medicine (ACSM) recently updated their recommendations for pre-exercise evaluation.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
- Premisecitation
For the person who is regularly physically active, the presence of known disease, albeit asymptomatic, does NOT prompt the need for medical clearance for moderate intensity physical activity.
“However, for the person who is regularly physically active, the presence of known disease, albeit asymptomatic, does NOT prompt the need for medical clearance for moderate intensity physical activity.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
The exercise preparticipation screening algorithm says that physically active, asymptomatic people with known cardiovascular, metabolic, or renal disease need not revisit their health care provider to continue moderate-intensity exercise if they were cleared to exercise within the last 12 months. The claim omits that prior-clearance condition and therefore overstates the recommendation. No page number is available in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measured
- Premisecitation
Physicians who exercise regularly were more likely to promote exercise and provide clearance to all of their patients (46 vs. 14.5%).
“Consistent with prior research [17], physicians who exercise regularly were more likely to promote exercise and provide clearance to all of their patients (46 vs. 14.5 %) [16].”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [16] Hoffman RD, Golan R, Vinker S. Dealing with ambiguity: Israeli Physician’s attitudes and practices regarding pre-exercise certificates: a questionnaire study. Israel J Health Policy Res. 2016;5:8. source
The Results report that regularly exercising physicians were more likely to provide pre-exercise certificates to all patients (46% vs. 14.5%). The paper does not report that its surveyed physicians were more likely to promote exercise; its Background describes an association between physicians’ exercise engagement and recommendations in a separate survey. The percentages therefore support the clearance finding, not both findings. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [17] Lewis CE, Clancy C, Leake B, Schwartz JS. The counseling practices of internists. Ann Intern Med. 1991;114:46–53. source
- Premisecitation
A physician-performed pre-participation physical evaluation (PPE) is considered a standard, generally required process for clearance to participate in competitive sports at many levels.
“A physician-performed pre-participation physical evaluation (PPE) is considered a standard, generally required, process for clearance to participate in competitive sports at many levels (e.g., high school, college, elite sport) [9].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] American Academy of Family Physicians, American Academy of Pediatrics, American Collegeof Sports Medicine, American Medical Society for Sports Medicine. Preparticipation physical evaluation. 4th ed. Elk Grove Village: American Academy of Pediatrics; 2010. source
- Premisecitation
Adults, in contrast to children and adolescents, are at greater risk for complications and consequences related to an interaction among physical activity or exercise, chronic conditions, and orthopaedic limitations.
“Interestingly, the PPE process for adults participating in recreational sport or fitness activities is not generally required; yet adults, in contrast to children and adolescents, are at greater risk for complications and consequences related to an interaction among physical activity or exercise, chronic conditions, and orthopaedic limitations [11].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of sports medicine and the American heart association. Med Sci Sports Exerc. 2007;39(8):1423–34. source
- Premisecitation
The PPE process for adults participating in recreational sport or fitness activities is not generally required.
“Interestingly, the PPE process for adults participating in recreational sport or fitness activities is not generally required; yet adults, in contrast to children and adolescents, are at greater risk for complications and consequences related to an interaction among physical activity or exercise, chronic conditions, and orthopaedic limitations [11].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of sports medicine and the American heart association. Med Sci Sports Exerc. 2007;39(8):1423–34. source
- Interpretationreasoning
The new ACSM recommendations simplify the prescreening process by eliminating the need for medical clearance and/or exercise testing in many individuals, especially when low-to moderate intensity exercise is contemplated.
“They simplify the prescreening process by eliminating the need for medical clearance and/or exercise testing in many individuals, especially when low-to moderate intensity exercise is contemplated.”
Quote in the paperSubstantial claim - Interpretationreasoning
The change to allow PAR-Q+ will likely reduce the number of individuals who require physician evaluation.
“This change will likely reduce the number of individuals who require physician evaluation.”
Quote in the paperSubstantial claim - Premisecitation
A 1994 Israeli 'Gymnasium Law' mandates that adults seeking to exercise in a health club receive a clearance physical evaluation prior to their participation in fitness activities at a club.
“Contrary to the aforementioned observation that PPEs are seldom required for recreational adult athletes, a 1994 Israeli “Gymnasium Law” mandates that adults seeking to exercise in a health club receive a clearance physical evaluation prior to their participation in fitness activities at a club [12].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] Israeli Ministry of Health. Gymnasium Law 1994. In: Ministry of Health, editor.Israel 1994. p. 1–3. http://health.gov.il/LegislationLibrary/Rishuy08.pdf . Accessed 5 May 2016.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
The risk of sitting on a couch far outweighs the risk associated with moderate intensity exercise for the vast majority of adults.
“The risk of sitting on a couch far outweighs the risk associated with moderate intensity exercise for the vast majority of adults.”
Quote in the paperNot a substantial claim - Premisecitation
It is estimated that 1% of PAR-Q+ completers will require further evaluation by a physician prior to exercise participation.
“It is estimated that 1 % of PAR-Q+ completers will require further evaluation by a physician prior to exercise participation [15].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Bredin SS, Gledhill N, Jamnik VK, Warburton DE. PAR-Q+ and ePARmed-X+: new risk stratification and physical activity clearance strategy for physicians and patients alike. Can Fam Physician. 2013;59(3):273–7.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
The evidence for pre-exercise screening as a strategy to prevent exercise-related cardiac morbidity and mortality is lacking.
“The evidence for pre-exercise screening as a strategy to prevent exercise-related cardiac morbidity and mortality is lacking [22]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] Lauer M, Froelicher ES, Williams M, Kligfield P. Exercise testing in asymptomatic adults: a statement for professionals from the American heart association council on clinical cardiology, subcommittee on exercise, cardiac rehabilitation, and prevention. Circulation. 2005;112:771–76. source
- Classified as probably not a substantial claim. 15
- May combine two claims. 8
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPhysical inactivity is a global health problem and is vital to the primary prevention of over 35 chronic diseases.
“Physical inactivity is a global health problem that is vital to the primary prevention of over 35 chronic diseases [1, 2].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [1] Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143–211. source
Section 2.11 (page not provided) says physical activity—avoiding or treating inactivity—is primary prevention for 35 chronic diseases or conditions. Section 5.12 (page not provided) describes inactivity affecting billions worldwide, supporting the global framing. The paper specifies 35, not over 35, and attributes the preventive role to physical activity rather than inactivity itself. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [2] Kohl 3rd HW, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380:294–305. source
The section “The pandemic of physical inactivity should be a public health priority” describes inactivity as a global problem and links it to preventable deaths from noncommunicable diseases. Our copy does not substantiate the specific claim that physical activity is vital to the primary prevention of over 35 chronic diseases; a search for that number and phrasing found no supporting passage. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Classified as probably not a substantial claim.
PremisecitationThe ACSM guidelines specifically state that the manner of clearance is left to the discretion of the healthcare provider.
“The guidelines specifically state that the manner of clearance is left to the discretion of the healthcare provider.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
May combine two claims.
PremisecitationThe authors concluded that while virtually all physician respondents were willing to issue a pre-exercise certificate to most patients, there was heterogeneity in the pre-exercise evaluation.
“The authors concluded that while virtually all of the physician respondents were willing to issue a pre-exercise certificate to most patients, there was heterogeneity in the pre-exercise evaluation.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [16] Hoffman RD, Golan R, Vinker S. Dealing with ambiguity: Israeli Physician’s attitudes and practices regarding pre-exercise certificates: a questionnaire study. Israel J Health Policy Res. 2016;5:8. source
Classified as probably not a substantial claim. May combine two claims.
PremisecitationFor the person who does NOT participate in regular exercise, known cardiovascular, metabolic or renal disease, or signs and/or symptoms of disease should prompt medical clearance.
“For the person For the person who does NOT participate in regular exercise, known cardiovascular, metabolic or renal disease, or signs and/or symptoms of disease should prompt medical clearance.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
May combine two claims.
PremisecitationThe absolute and relative risk of exercise-related cardiac events in a general population of asymptomatic adults is low.
“Yet, the absolute and relative risk of exercise-related cardiac events in a general population of asymptomatic adults is low [21].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
Classified as probably not a substantial claim.
PremisecitationThe new ACSM guidelines make general recommendations for medical clearance versus recommendation for a specific set of medical exams or tests.
“The new American College of Sports Medicine guidelines make general recommendations for medical clearance versus recommendation for a specific set of medical exams or tests.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
May combine two claims.
Premiseown dataA similar percentage of physicians (77%) would not issue a certificate to patients with heart disease, and would refer to a specialist for further evaluation and clearance.
“A similar percentage of physicians (77 %) would not issue a certificate to patients with heart disease, and would refer to a specialist for further evaluation and clearance.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] Hoffman RD, Golan R, Vinker S. Dealing with ambiguity: Israeli Physician’s attitudes and practices regarding pre-exercise certificates: a questionnaire study. Israel J Health Policy Res. 2016;5:8. source
Classified as probably not a substantial claim.
PremisecitationMedical clearance would be advised if there was a desire to increase exercise intensity to vigorous.
“Medical clearance would be advised if there was a desire to increase exercise intensity to vigorous [21].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [21] Riebe D, Franklin B, Thompson PD, Garber CE, Magal M, Whitefiled GP, Magal M, Pescatello LS. Updatng the American college of sports medicine’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9. source
The new screening algorithm says that regularly active, asymptomatic people without known cardiovascular, metabolic, or renal disease may gradually increase exercise intensity; it does not advise medical clearance solely because they want to reach vigorous intensity. It advises clearance for people with relevant disease or symptoms, so the citing sentence omits a necessary condition. The indexed passages provide no page number. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe important role of healthcare providers in physical activity assessment and promotion is well established.
“The important role of healthcare providers in physical activity assessment and promotion is well established [8].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] AuYoung M, Linke SE, Pagoto S, Buman MP, Craft LL, Richardson CR, Hutber A, Marcus BH, Estabrooks P, Gorin SS. Integrating Physical Activity in Primary Care Practice. Am. J. Med. 2016. doi: 10.1016/j.amjmed.2016.02.008 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationExercise is an important treatment component for some of the most prevalent, costly, and deadly chronic diseases and health conditions, including cardiovascular disease, diabetes mellitus, some forms of cancer, obesity, dyslipidemia, and hypertension.
“Moreover, exercise is an important treatment component for some of the most prevalent, costly, and deadly chronic diseases and health conditions in the world, including cardiovascular disease (CVD), diabetes mellitus, some forms of cancer, obesity, dyslipidemia, and hypertension, among others [3–6].”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [3] Physical Activity Guidelines for Americans. Washington: Department of Health and Human Services; 2008. Available from: http://www.health.gov/paguidelines/pdf/paguide.pdf . Accessed 5 May 2016.
Not checked in the free run.
- cites [4] Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25 Suppl 3:1–72. source
- cites [5] Pescatello LS, Riebe D, Arena R. ACSM’s guidelines for exercise testing and prescription. 9th ed. Baltimore: Lippincott Williams & Wilkins; 2013.
- cites [6] Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP, American College of sports medicine. American College of sports medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59. source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationTo achieve health benefits, adults are recommended to accumulate 150 min/wk of moderate intensity or 75 min/wk of vigorous intensity physical activity, or a combination, on most, preferably all, days of the week.
“To achieve these health benefits adults are recommended to accumulate 150 min/wk of moderate intensity or 75 min/wk of vigorous intensity physical activity, or some combination of the two, on most, preferably all, days of the week [6].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP, American College of sports medicine. American College of sports medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59. source
Classified as probably not a substantial claim. May combine two claims.
PremisecitationThe 2008 Physical Activity Guidelines for Americans recommended that symptomatic persons or those with cardiovascular disease, diabetes, or other active chronic conditions who want to begin engaging in vigorous physical activity and who have not already developed a physical activity plan with their health care provider may wish to do so, but does not mandate such medical contact.
“In support of this recommendation are the 2008 Physical Activity Guidelines for Americans that recommended that, “symptomatic persons or those with cardiovascular disease, diabetes, or other active chronic conditions who want to begin engaging in vigorous physical activity and who have not already developed a physical activity plan with their health care provider may wish to do so”, but does not”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] United States Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report, 2008. Washington (DC): ODPHP Publications No. U0049 http://www.health.gov/paguidelines/Report/pdf/CommitteeReport.pdf . Accessed 5 Mar 2016.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
InterpretationreasoningThe goal of these efforts is to reduce barriers to regular physical activity by eliminating unnecessary medical evaluations.
“The goal of these efforts is to reduce barriers to regular physical activity, by eliminating unnecessary medical evaluations.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningPre-exercise screening serves as a potential barrier to adopting regular exercise while placing additional financial burden on individuals and the healthcare system.
“and at a minimum it serves as a potential barrier to adopting regular exercise while placing additional financial burden on individuals and the healthcare system.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
InterpretationreasoningGiven the global burden of chronic disease, physicians will still find themselves in a position to provide the required pre-exercise certificates.
“however given the global burden of chronic disease, physicians will still find themselves in a position to provide the required pre-exercise certificates.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationnone givenThe new ACSM exercise preparticipation health screening recommendations emphasize the important public health message of regular physical activity for all.
“The new American College of Sports Medicine exercise preparticipation health screening recommendations emphasize the important public health message of regular physical activity for all.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
InterpretationreasoningUse of the PAR-Q+ will surely reduce the number of individuals seeking clearance by a physician.
“Use of the PAR-Q+ will surely reduce the number of individuals seeking clearance by a physician;”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenThe updated Israeli 'Gymnasium Law' allows for pre-exercise screening with the PAR-Q+, as a strategy to detect conditions that may put health club participants at risk for exercise-related adverse consequences.
“The updated Israeli “Gymnasium Law” allows for pre-exercise screening with the PAR-Q+, as a strategy to detect conditions that may put health club participants at risk for exercise-related adverse consequences.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningExercise is safe for most people, and has many health and fitness benefits.
“Exercise is safe for most people, and has many health and fitness benefits.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenThe guidelines recognize that the hazards of exercise-related cardiovascular events are likely to be reduced by careful attention to a safe and effective exercise prescription.
“The guidelines recognize that the hazards of exercise-related cardiovascular events are likely to be reduced by careful attention to a safe and effective exercise prescription.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The prevalence of chronic conditions in adults completing the PAR-Q+ in health clubs is similar to the global or general population prevalence figures cited.
“When one considers the prevalence of chronic conditions such as prediabetes (an estimated global prevalence of >470 million by 2030) [18], high blood pressure (40 of adults 25 years of age and older worldwide) [19], and the percentage of US adults regularly taking at least one prescription medication (nearly 70 %) [20], it is possible that more than the reported 1 % of adults completing the PAR-Q+”
The paper relies on this without support.
A single 'yes' answer on the PAR-Q+ follow-up questions prompts recommendation to seek medical evaluation.
“A single “yes” answer on the PAR-Q+ follow-up questions prompts recommendation to seek medical evaluation.”
The paper relies on this without support.
The cardiovascular risk associated with exercise lessens as an individual becomes more physically active and fit.
“In fact, the cardiovascular risk associated with exercise lessens as an individual becomes more physically active and fit.”
The paper relies on this without support.
The likelihood of detecting heart disease in asymptomatic adults is low.
“and the likelihood of detecting heart disease in asymptomatic adults is low.”
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Sorted by citations
Overview of Physical Activity Counseling in Primary Care
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(2026) · American Academy of PediatricsItasca, IL eBooks · doi:10.1542/9781610029070-ch1
- Authors
- Joy, E. A., & Pescatello, L. S.
- Affiliations
- Intermountain Healthcare (US)
- University of Connecticut (US)
- Corresponding author
- Joy, Elizabeth A.
- Venue
- Israel Journal of Health Policy Research
- Published
- 2016-06-28
- Volume
- 5
- Issue
- 1
- Pages
- 29-29
- ISSN
- 2045-4015 (ISSN-L)
- PMC
- PMC4926293
- OpenAlex
- W2472079636
- Semantic Scholar
- d6adcdcf8427264e966e3532ba8c2ff47bc85bfb
- Cited by
- 13
- References
- 26
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 1
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Israel Journal of Health Policy Research (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (submittedVersion, cc-by)
- PubMed Central (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- physical activity, primary care physician role, Physical Activity Readiness Questionnaire, ACSM exercise guidelines, exercise risk assessment, barriers to physical activity, fitness centers
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