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

Abstract

Background Although the American Heart Association/American College of Sports Medicine’s Preparticipation Questionnaire (AAPQ) is a recommended pre-exercise 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 or older. Methods and Results Under the assumption that respondents would respond to AAPQ items as they responded to NHANES questionnaire responses, we calculated the gender- and age-specific proportions of adult participants in NHANES, 2001–2004 who would be 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 (PAR-Q) in the study sample. AAPQ referral proportions were higher with older age. Across all age groups 40 years and older, 95.5% (94.3–96.8%) of women and 93.5% (92.2–94.7%) of men in the US 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 to that of the PAR-Q, the two screening tools produced similar results for 72.4% of respondents. Conclusions These results suggest that more than 90% of US adults aged 40 years or older 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. (228/250)

The Acute Risks of Exercise in Apparently Healthy Adults and Relevance for Prevention of Cardiovascular Events

“…This is because an overwhelming percentage of adults (older than 45 years of age) would be required to undergo a physician consultation and/or a graded exercise stress test before exercise participation simply because of 'age,' prescription medication use, or presence of medical conditions, who in fact would be recommended for exercise. 64 The new PAR-Q for Everyone and electronic Physical Activity Readiness Medical Examination were recently developed using an evidence-based approach (www.eparmedx.com), greatly reducing the barrier to PA participation for most adults. 17,65,66 Subsequently, the American College of Sports Medicine has since revised their guidelines and risk algorithm.…”

Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening

“…In addition, the risk of an acute cardiovascular event decreases with increasing volumes of regular exercise (31,39) and among people who are physically fit (40). Finally, recent reports have suggested that 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 (24,45,48).…”

Preventing Exercise-Related Cardiovascular Events

“…The ingenious study by Whitfield et al, 6 published in the current issue of Circulation, evaluated 2 commonly recommended self-screening exercise preparticipation questionnaires, the American Heart Association/American College of Sports Medicine Preparticipation Questionnaire (AAPQ) and the Physical Activity Readiness Questionnaire, to clarify the utility of these screening tools in a systematic manner.…”

“…The authors concluded that in its present form, widespread use of the AAPQ would result in excessive medical referrals, potentially placing an unnecessary burden on the healthcare system, and would present needless barriers to exercise adoption. 6 Several study limitations were acknowledged by the investigators, including the fact that 5 items for the AAPQ did not have matching items in NHANES 2001 to 2004, and 3 notable deviations were present in the matrix of Physical Activity Readiness Questionnaire items and their NHANES equivalents. Nevertheless, these were accounted for in the data analyses appropriately.…”

“…16 However, few data are available to substantiate these screening recommendations or that physician consultation improves exercise safety. 6 The US Preventive Services Task Force found insufficient evidence to support the use of exercise testing before exercise programs in low-risk asymptomatic adults. 17 Similarly, a systematic review of the evidence supporting the benefits and risks of physical activity and structured exercise in older adults argued that any policy (eg, the need for routine exercise testing) that deters a large number of people from participating in an exercise program may cause more harm than good.…”