If you are new to exercise or are coming back from a long period of inactivity, there are things you should do to make sure that your exercise program is effective and brings benefits, not injury or pain.
Pre-exercise screening
Pre-exercise screening is used to identify people with medical conditions that may put them at a higher risk of experiencing a health problem during physical activity. It is a filter or ‘safety net’ to help decide if the potential benefits of exercise outweigh the risks for you, and whether you require referral to a GP or allied health professional prior to undertaking physical activity. Print a copy of the adult pre-exercise screening tool and discuss it with your doctor or exercise professional.
You may need to visit your doctor before starting physical activity
If you answer ‘yes’ to some of the questions from the adult pre-exercising screening tool, see a doctor before starting physical activity. These questions include:
- Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
- Do you ever experience unexplained pains in your chest at rest or during physical activity and exercise?
- Do you ever feel faint or have spells of dizziness during physical activity and exercise that causes you to lose balance?
- Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
- If you have diabetes (type I or type II), have you had trouble controlling your blood glucose in the last three months?
- Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity or exercise?
- Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity or exercise?
Setting goals for physical activity
Setting goals gives you something to work towards and provides you with a way to measure how well you are doing over a period of time. When it comes to succeeding at your exercise program, setting goals and monitoring your progress will help you stay on track and get you to where you want to go.
One of the first steps is to identify why your health is important to you. Ask yourself what you want to get out of becoming more active. Think about the benefits you want to experience if you choose to be more active, as well as the barriers that are holding you back. It may be helpful to make a list of the pros and cons. Which barriers do you feel strongest about? What are the benefits that you want to experience?
Start physical activity gently
If you are currently inactive or feel your fitness level is low, it is highly recommended that you consult a health or exercise professional before commencing activity. Otherwise, start gently with a short session of an activity that you feel you can manage. Build your confidence and fitness level with a number of short sessions.
Exercise progression is unique to every person, so if you have not exercised for some time, progress slowly. Increase the length and the intensity of your exercise session gradually. Don’t push yourself straight away. Injury or discomfort can occur and this may reduce your motivation levels.
Stretching, warming up and cooling down
As the name suggests, the warm-up is designed to increase your body’s internal temperature and warm your muscles to prevent muscle strains and joint sprains. The best way is to start off at a leisurely pace, and then pick up speed. Usually a 5 to 10-minute warm-up is all you'll need, but this will vary from person to person and if the weather is cold.
Start with light aerobic exercise such as walking, cycling or rowing – you can do these easily using the exercise machines at the gym, but if you are at home, here is another five-minute warm-up suggestion – and a few dynamic stretches.
Dynamic stretching involves slow, repetitive, controlled movements through the full range of motion, performing movements you will be using in your chosen physical activity. You can start slower, and with a smaller range of motion, and increase speed and range of motion gradually.
For the last five minutes of your exercise, slow down and allow your body to cool down gradually, letting your heart rate and breathing rate come back to normal.
Stretching suggestions
Stretching should be part of your warm-up and cool-down routines. Stretching can help prepare your body and mind for exercise. Recent research suggests that including dynamic stretching in your warm up, which focuses on the muscles you are about to use, is probably best.
Wear comfortable clothes and shoes for physical activity
Make sure you have comfortable clothing, a suitable pair of shoes and water (as well as sunscreen and a hat if you are outside). Your shoes should provide good support and the best type will depend on the activity you are doing. The wrong type of shoe may cause foot pain or blisters.
Getting the technique right for your chosen physical activity
If you are trying something new, or getting back into an activity you have not done for a while, it might pay to get some coaching or expert instruction. Depending on the activity, incorrect or poor technique may lead to injury or soreness.
Where to get help
All exercise involves some increase in stress on the systems of the body, this is what creates the fatigue, which is then ‘repaired and adapted to’ in order for (ideally) positive progress to be made.
Because exercise involves introducing some level of stress to cause change any underlying health issue, or a client’s condition on the day (for example if they are; dehydrated, allready stressed, ill or under-recovered), or a programme that is too hard for the client’s capabilities can be problematic. For this reason a personal trainer must gather sufficient health related information during the consultation with every client, and observe and act on any unexpected responses that occur in clients during or after exercise.
How can we screen for risk during the consultation?
Collecting written information
Questioning
Another important way to gather information about your client, their state at any time and how they are responding to exercise is to question them. Throughout your work with a client in personal training sessions you need to be asking a few pertinent questions consistently. The answers to these questions (for example rating their perceived exertion) will give you a guide as to your client’s situation at any given time.
Observation
Some of the information you need is written on your client’s face, their skin colour and their body position. It is important that you learn to observe very carefully your client’s physical response to training and act upon these observations accordingly.
Why do we record risk factors?
With many diseases such as heart disease and diabetes there can be very few symptoms to let a person know they are ill. Often the first sign (and unfortunately the last) might be a fatal heart attack. This is why recording factors like blood pressure allow someone to know how likely it is they will have heart disease or an event (such as a heart attack) if they don’t change something.
What factors should be considered when assessing exercise risk?
There are modifiable factors (things we can change) and non-modifiable factors (things we can’t change) that need to be considered when assessing risk.
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Modifiable factors to consider |
Non-modifiable factors to consider |
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Smoking Inactivity Poor nutrition Stress Excess body fat. All increase the risk of the common diseases mentioned within this folder. |
Age Personal health history Gender Family health history Higher risk for older, history of poor health, male, history of related family members with similar disease. |
How do risk factors relate to common diseases?
Basically the more risk factors you have the more likely you are to have or contract one or more of the common diseases (diabetes, cardiovascular diseases, asthma, cancer). Some risk factors carry a greater risk than others for certain diseases. Generally a combination of risk factors significantly increases the overall risk of disease (for example being overweight, smoking, being inactive and being stressed will greatly increase disease risk).
The non-modifiable risk factors
As an example let’s look at Coronary Heart Disease (CHD) and see what the risk factors are and how they relate to the disease.
Age
In general, a persons risk for heart disease increases as they grow older. Specifically age is a risk factor for:
- Men older than 45 years
- Women older than 55 or with premature menopause without oestrogen replacement therapy
Gender
Women in general run a lower risk of developing heart disease than men, until menopause. After that, the hormonal changes brought on by menopause cause the heart disease risk to increase at a much faster rate. Of course, women who smoke have just as great a chance as men for developing heart disease.
Personal health history:
If you have a history of risk factors like high blood pressure, high cholesterol and being overweight you have a much higher risk of developing diseases like diabetes, cardiovascular disease and stroke. If you have already been diagnosed with any of the following this increases your risk of more serious complications:
- Cardiovascular disease
- Pulmonary disease including asthma
- Metabolic disease including diabetes
Personal health history is a non-modifiable risk factor as you cannot change your past. You can give up smoking now and reduce your risk, but your risk will still be higher than someone who never smoked.
Family health history
Research has shown that a person’s risk of developing heart disease is higher if they have a close relative (grandparents, parents, siblings) with a history of heart disease or stroke at an early age.
While genetics are thought to contribute, a family's lifestyle (lack of exercise, being overweight, smoking, eating large amounts of saturated fats and cholesterol) contributes significantly to heart disease.
The specific risk factors to look for are:
Myocardial infarction, coronary revascularization, or sudden death
- before 55 years of age in father or other male first degree relative (i.e. brother or son)
- before 65 years of age in mother or other female first degree relative (i.e. sister or daughter)
The modifiable risk factors
Smoking
Smoking also reduces the amount of oxygen available to the heart and other parts of the body. Smoking is a risk factor for someone who is
- Currently a smoker or quit in the last 6 months.
Poor Nutrition
Poor nutrition such as a diet high in saturated fat and sugar contributes directly to high cholesterol, high blood pressure, obesity, diabetes and heart disease. Signs of a poor diet can be measures like high cholesterol and triglyceride levels and high blood sugar levels.
Some of the high risk levels are total cholesterol above 200 mg/dL, triglyceride levels above 150 mg/dL and fasting blood glucose levels above 100 mg/dL
Sedentary Lifestyle
A sedentary lifestyle or a lack of exercise is a major risk factor for heart disease. Exercise helps to reduce risk factors including lowering blood pressure, lowering cholesterol, reducing stress, achieving and maintaining a healthy body weight, helping to quit smoking and improving your blood sugar levels. Low exercise levels are a risk factor if someone is:
- Not accumulating 30 minutes or more of moderate intensity physical activity on 5 - 7 days of the week
Obesity
Obesity or being very overweight causes the heart to work harder to pump blood throughout the body. Consequently, it is a risk factor in the development of heart disease.
Obesity raises blood pressure, raises blood cholesterol and triglyceride levels, lowers HDL and contributes significantly to developing diabetes as well.
How a person’s weight is distributed is also important. People who carry their weight in the middle have a greater risk of developing cardiovascular disease, compared to people who carry their weight in their arms and legs. Guidelines for obesity as a risk factor are:
- Waist hip ratio; greater than 0.95 (men) and greater than 0.86 (women)
- Waist girth; greater than 102 cm (men) and greater than 88 cm (women)
Excessive alcohol consumption
Check out your national nutrition guidelines to find out what your countries guidelines are for a safe intake of alcohol.
High blood pressure
High blood pressure or hypertension is sometimes called the silent killer, since there are usually no specific symptoms or warning signs. Uncontrolled hypertension adds to the workload of the heart, causing it to enlarge and become weaker. Without treatment, the risks for heart failure, heart attack, stroke, kidney failure and reduced eyesight increase.
Normal blood pressure is generally between 90/60 mmHg and 120/80 mmHg. When high blood pressure is combined with risk factors such as obesity, smoking, high cholesterol or diabetes, the risk for developing heart disease increases several times. If you have a client with blood pressure at or above the risk threshold below then proceed to exercise with caution and if other risk factors are also present then refer them to a doctor before starting an exercise programme.
- Systolic blood pressure: 140 mmHg or greater
- Diastolic blood pressure: 90 mmHg or greater
- Using antihypertensive medication
Cholesterol level
High lipid (fat) or cholesterol levels in the blood have been shown to speed the development of arteriosclerosis and heart disease. Cholesterol can't be dissolved in the blood, so it is carried via two types of lipoproteins:
- LDL (low-density lipoproteins), or ‘bad’ cholesterol, can build up fatty deposits and clog arteries. A good LDL reading is less than 100 mg/dL (mg/dl means milligrams per 100 millilitres of blood). A high risk level is more than 130 mg/dL.
- HDL (high-density lipoproteins), or ‘good’ cholesterol, helps remove bad cholesterol from the body. A good range for HDL is greater than 60 mg/dL.
- Total cholesterol is a risk factor above 200 mg/dL. Lowering cholesterol can decrease or stop the build-up of fatty deposits on the artery walls and decrease the risk of heart attack and stroke.
- Triglycerides are another form of fat. High levels of triglycerides contribute to high cholesterol levels and heart problems. A good level for triglycerides is less than 150 mg/dL.
Stress
In a normal stress response situation (boo!) the levels of the hormones adrenaline and cortisol are increased causing increased blood flow to the muscles and brain, accelerated respiration and heart rate. These hormones also stimulate the release of stored energy sources into the blood. This prepares the body for fast or demanding movement such as running away from the car. If you didn’t get away and injury to the body occurs, the hormones then ready the body for the healing process.
If you are under too much stress or are under stress too often, the normal stress responses such as increased heart rate, respiration, and blood pressure put more physical stress on bodily organs (they have to work harder all the time). Long-term stress can be a contributing factor in heart disease, high blood pressure, stroke, enlarged adrenal glands, and other illnesses.