I’ll be honest – I’m a little bit in shock from an article I read the other day on Medscape (you may be required to create a log in to view the article) that summarized a report from the January 13, 2014 issue of Circulation. The article called into question one of those foundational truths in our industry that has been integral to how NIFS does business.
Authors of this report, from the Centers for Disease Control (CDC), are questioning the effectiveness of (and therefore the need for) a prescreening tool – a medical clearance form – for individuals before they begin an exercise program. Their position is based on two concerns:
- Prescreening tools are sending 90% of individuals to see their physician before they being an exercise regimen. And,
- The demand on the health care system seems to be an undue burden for a relatively safe undertaking such as exercise.
I take issue with both of these so-named concerns.
Prescreening tools “catch” too many people.
From the angle that the extra step of needing to get physician clearance limits an individual’s likelihood of engaging in exercise at all, I see their point. Additional barriers are not needed. We don’t have enough people meeting minimum exercise requirements as it is. Why would we establish an additional barrier? But I’m unconvinced that eliminating this tool is the answer.
Honestly, our staff run into this all the time. Anyone who has ever managed a fitness program with a policy in place that requires a medical release for individuals with specific health risks before they can participate knows how many would-be exercisers get disgusted with that policy and thus never return to join your program. I get it, it’s frustrating.
But that screening tool is there for a reason.
If you need the clearance before you can participate, as identified by American College of Sports Medicine’s (ACSM) risk stratification criteria, there’s a good chance you have multiple risk factors that indicate your treating physician should know about your plans to engage in exercise before you start a program. Exercise is a powerful tool to improve an individual’s health and embarking on a training regimen should be taken no less seriously than changing your medication. Medication carries health risks, and so does exercise.
The ACSM risk stratification criteria aren’t just pulled from some random list of health circumstances that the ACSM didn’t like. The criteria are grounded in science that tells us if an individual presents with risk X and risk Y, they are in a precarious enough position health-wise, that it’s best if they get clearance from their physician before they start an exercise program.
I would argue that in most instances, if the individual is really at risk, they should be in regular communication with a physician anyway, and getting the clearance from that doctor should not be a barrier. Unfortunately, there are a lot of adults living under gigantic rocks assuming that just because they don’t feel bad, they must not have health risks.
Perhaps the health care system could help us address this with a more preventive and less reactive approach to patient care.
There’s a crystal clear line here that is not to be crossed in my opinion. If an individual wants to start exercising, there is a really strong chance that a basic walking and stretching regimen will be safe, and, if adhered to, potentially effective at improving the individual’s health. No medical clearance needed. But, if the individual wants advice from an exercise specialist about a customized exercise program that’s tailored around his needs and goals, that specialist has every right and in fact, a professional responsibility, to require medical clearance if certain health risks are present.
Some of that is about managing risk and establishing quality practices that adhere to industry standards. But it’s also about making sure that the exercise specialist has all the information she can get about the member before she crafts an individual exercise program for that person. The program is more tailored and likely to be more successful when all of the information is available.
The authors in the report are ready to throw out that layer of information and protection for an exercise specialist so that the health care system can be unburdened. Interesting.
Prescreening tools place an undue burden on the health care system.
At the practitioner level, we’ve heard this loud and clear for years.
Countless times we’ve sent willing individuals in pursuit of medical clearance only to be told they must make an appointment with the office before the doctor will fill out the form. One co-pay and eight weeks later, we might get the individual back with a medical release that states nothing specific and that fully releases the individual to exercise with no restrictions. Seems like a wasted eight weeks and $25.00.
On the high risk end of the spectrum, I’ve had individuals with complicated heart conditions including multiple medications, recent surgeries, and other health concerns return to me with a “no restrictions” signature from their treating physician. Either the form was forged or the doctor didn’t pause to thoughtfully engage the patient in a brief discussion about forging ahead with an exercise program. Can you say missed opportunity?
I can think of some ways to ‘unburden’ the system:
- How about in the truly uncomplicated cases, the chart gets reviewed without the office visit and the form gets signed without the office visit. If the MD isn’t going to put thought into the recommendations anyway, then why require the office visit?
- What if the MD sat down beside her patient with a complicated medical history who wanted to exercise, and had a good discussion with him, about risks, rewards, limits related to exercise? She could thoughtfully (although briefly…I do want to be sensitive to the substantial case load of patients who need to be treated reactively) fill out the medical clearance form, and if the conversation with the patient was meaningful, and the form was well completed, there’s a strong chance that the exercise specialist working with that patient will play an important role in un-complicating that individual’s health. Thus, fewer office visits, less medication, less complicated care to manage, and poof! Healthcare system unburdened.
This isn’t an easy issue to unpack – there are complicating factors and nuances that dictate specific circumstances. But a recommendation to take away a tool that is central to an exercise specialist’s work with an individual is short-sighted and incomplete.
Our staff is kicking off our annual Maintain Not Gain program at our client sites. This program is structured to help individuals maintain their weight through those months filled with tasty food and delicious treats that surround the holidays. As you gear up for the holiday parties and events stay on track by following our Free Workout Friday blog postings to keep your workouts on track. We aren’t saying you can’t enjoy the food, we just suggest proper portion sizes and that you don’t skip out on your workouts! 
Thanksgiving is almost here! That means it’s time to sign up for your local Turkey Trot, Drumstick Dash or your own personal Thanksgiving Day 5K! Studies have proven that your metabolism increases for several hours post-workout, so make a priority to squeeze in some exercise and boost your body’s calorie burning abilities before the big feast. If you do happen to be training for a 5K on Thanksgiving Day, see below for a sample training program that starts on Monday, 11/11. So today, we want you to go for a brisk walk because you need to pick up the pace on Monday!
Did you know that you can exercise your abs every single day of the week? Normally with strength training, you should wait 48 hours before lifting with those same muscles again—however, since the abdominal muscles are made for endurance by performing jobs like supporting posture and breathing, they can be worked all 7 days of the week! If you are particularly sore after an ab workout, still use your best judgment, and delay working them until the soreness is gone.
What is a tabata workout and why should you try it?
We have all heard the phrase “quality over quantity,” and most of us have even directed this adage at someone else. But do we really believe it? And if we do, why is every gym and fitness center in the country filled with people sacrificing form for a few additional reps and pounds?
It only comes around once per year, so why not indulge with dinner at the fair? Well some of your favorite fair foods might only be consumed once per year, but if you aren’t increasing the amount of exercise to go along with them, the extra weight gained can stick around for longer! Here are some of the more popular fair food items and how far the average person would need to walk around to burn it off!
When you are exercising on an elliptical or stationary bike, it’s easy to go on auto-pilot and stay at the same easy to intermediate level that your body is used to. Next time you find yourself of one of these machines, try adding in some interval training! Intervals will make the heart rate jump, then allow for periods of recovery where the heart rate will fall, thus providing better conditioning for the cardiovascular system and burning more calories than the slower, steady-state cardio.
It's the Fourth of July and many of you are probably gearing up to enjoy the outdoors at family gatherings and pool parties. Start your day off right with a workout. During the summer months, exercise is seen as a daunting task by many, however it can be enjoyable if you follow these suggestions for exercising in warm weather. 
Are you one of those people that only use the elliptical machine when told to lie off of exercise due to a lower body injury? Even though most studies have found that the treadmill may burn a few more calories, it’s still important to mix up your workouts. If you are a runner I’m sure you have heard about the importance of cross training your muscles to prevent injuries. The elliptical is a good way to cross train and can be just as challenging!