My gym said I need medical clearance before being active: am I OK to exercise?
For the vast majority of people, medical clearance is not required to safely undertake progressive, moderate intensity activity . Important exceptions to this are people experiencing active symptoms (see below) or previously inactive people who disregard advice to build up gradually. An additional list of contraindications is listed below [2,3].
Significant events are so rare that medical screening has the potential to be an unnecessary barrier to physical activity. Screening is most effective when focused on active symptoms and co-morbidity .
It is fairly common for gyms to request a medical letter for people to use their facilities. Consider the option of providing a signed letter to overcome this barrier for individuals. Encouraging a slow start with gradual build up of activity (over 3 months or so) reduces the chances of poor outcomes.
This flow diagram will help you decide who might need referral for formal assessment before increasing their physical activity levels and may help address queries from gyms:
- Signs and symptoms, at rest or during activity; includes pain, discomfort in the chest, neck, jaw, arms, or other areas that may result from ischemia; shortness of breath at rest or with mild exertion; dizziness or syncope; orthopnea or paroxysmal nocturnal dyspnea; ankle edema; palpitations or tachycardia; intermittent claudication; known heart murmur; or unusual fatigue or shortness of breath with usual activities
- An easy way to explain the intensity of exercise is the talk test:
- Moderate intensity: breathing rate is increased but you can still talk
- Vigorous intensity: breathing rate is further increased and it is not possible to talk in full sentences
- Patients with active symptoms or high risk necessitating medical screening will require formal investigations such as cardiac stress testing
Contraindications to physical activity include:
- Unstable angina
- Severe valvular stenosis or regurgitation
- Active myocarditis or pericarditis
- Ventricular tachycardia (uncontrolled)
- Decompensated heart failure
- Blood pressure >200/115 mmHg
- Recent myocardial infarction (< six weeks)
- Other clinical entities known to worsen during exercise
- Acute Systemic infection
1) Reid H, Ridout AJ, Tomaz SA, Kelly P, Jones N; Physical Activity Risk Consensus group. Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. Br J Sports Med. 2022 Apr;56(8):427-438. doi: 10.1136/bjsports-2021-104281. Epub 2021 Oct 14. PMID: 34649919; PMCID: PMC8995821.
2) Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873-934.
3) 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.
4) Thompson PD, Arena R, Riebe D, Pescatello LS, Medicine ACoS. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013;12(4):215-7.