Do you really need a doctor’s clearance to start exercising?

You might. And you might not. Getting a doctor’s clearance prior to starting an exercise program has one purpose, which is to answer this:

How much will your health status place you at risk for a medical emergency during exercise?

To some degree, common sense applies here. How healthy are you right now? Do you have any physical concerns, or anything going on with your body that doesn’t seem quite right? Anything you honestly can’t explain?

These are things that should prompt a visit to your doctor prior to starting an exercise program, according to many major exercise science and medicine associations (including the American College of Sports Medicine, the National Strength and Conditioning Association, Exercise and Sports Science Australia, and Sports Medicine Australia, among many others). The results of an examination or testing are used to gather information and provide guidelines, with an overall goal to decrease your risk of a sudden, serious medical event – in layman’s terms, a medical emergency that could lead to disability or death.

That’s scary stuff, and it makes sense to limit your risk. Good news for you though – for most people, that risk is actually really low. While these risks are elevated during and shortly after high-intensity exercise, it’s important to bear in mind the following:

  • There is a wealth of current and historical data show that heart-related events (those that are highest risk, and that you might be most worried about) are associated with exercise in only about 5% of cases. To put it another way, they happen to about 20 people out of every million.
  • Low- and moderate-intensity exercise is even less likely to trigger anything but improved fitness.

So if you’re ready to start an exercise program, what should you do to get started safely?

Gauge how hard you plan on working. According to current recommendations, low to moderate intensity exercise is a great place to start no matter what your current health status is – it’s actually high intensity exercise that is most likely to lead to problems during or immediately after a session. If your plan is to start high intensity workouts, you should examine the following points in a little more detail.

Intensity is relative – if you’re not used to doing much physical activity, you’ll likely find that as you start out, many things feel harder or more intense than you might expect. Use the talk test – can you comfortably carry on a conversation during activity? – to help keep yourself to an appropriate work intensity. And ease into exercise. For example, consider starting with a long walk rather than a short run.

Be smart about how you start. If you think you might have more than two risk factors for cardiovascular disease, or if you have another diagnosed health condition, including conditions like asthma or Type 2 diabetes, definitely go talk to your doctor. While your GP or PCP probably won’t be the ultimate expert in exercising with health conditions, they definitely are the experts in who you should see for that information, whether that be an exercise physiologist, a cardiologist, or another specialist. Plus, with the right referral from your doctor, you may have insurance options that help cover the costs of learning to exercise with expert guidance.

An additional point on this – if you haven’t been to see a doctor in some time, and have a sense that you may have some health risks, making that appointment and getting there can be scary. I know that, exactly and personally. But even if they have not-great news, it’s likely nowhere near as bad as you think, and there’s a lot you can do about it.

Self-diagnose (just not with Dr. Google). Use a pre-exercise readiness questionnaire (PAR-Q) form like the one here to help determine whether you are at higher risk of an exercise-associated medical emergency, and if you need talk to a doctor before starting high-intensity workouts. If you’re starting an organized (or even semi-organized) program, like personal training, exercise physiology, and programs like Crossfit, F45, HIIT training, and others, you should definitely be using this and your personal trainer or program coach should provide some version of it. If they don’t, or if you’re more likely to exercise on your own, it’s still worth using. Just print off your own copy and fill it out (it takes about a minute). And remember that it’s generally deemed safe to start with a low or even a moderate intensity exercise program – just listen to your body, and if says stop, then stop!

Exercise is generally awesome for your health, and while getting a medical clearance and/or a clinical exercise test can be beneficial, requiring this step can actually keep a lot of people from getting started in the first place. Going to the doctor for a medical or other testing can range from a painful waste of time to a frightening appointment with a lot of scary information that you previously lived with in blissful ignorance. On the other hand, is avoiding this clearance an unnecessary risk? Use the PAR-Q and be honest with yourself, start easy, and always always always pay attention to what your body is telling you!

For more information:
Pescatello, L. S., Arena, R., Riebe, D., & Thompson, P. D. (Eds.). (2014).  ACSM’s Guidelines for exercise testing and prescription (9th ed.). Philadelphia: Lippincott Williams and Wilkins.

 

HealthFit Coaching’s Exercise Physiology in-home and in-clinic programs provides expert guidance in safe exercise programs for existing health problems. Exercise is powerful medicine. Get healthy, feel better. Start now.

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