1.1 Explain the importance of using a pre-exercise questionnaire and undertaking relevant health screening by exercise and fitness professionals

1. Pre-exercise questionnaires and health screening

Exercise and fitness professionals use pre-exercise questionnaires and relevant health screening before someone starts an exercise program or significantly increases training load. The aim is to check whether it is safe to begin, and to work out how the program should be designed.

These are related but different steps. A pre-exercise questionnaire is the information you report about yourself. This may include your medical history, symptoms, injuries, medications, lifestyle risk factors, current activity level and goals. Health screening is what the professional can check or observe, such as blood pressure, resting heart rate, basic body measurements, current injury status and simple movement observations.

What actually happens is:

• Pre-exercise questionnaire is completed first. This identifies any symptoms, medical history, or risk factors that could affect exercise safety.
• Health screening is then used to help check the person’s current status, but the level of screening can vary.
  • Basic checks such as blood pressure, resting heart rate and simple movement observation are commonly used.
  • More detailed checks, extra caution, or closer monitoring may be needed if something in the questionnaire suggests a concern.
• Decision point follows. Based on the questionnaire and screening information, the professional decides one of three things:
  • Low risk: safe to begin exercise at an appropriate intensity
  • Moderate risk or some concerns: modify the program, start conservatively, and monitor closely
  • High risk or clear red flags: do not proceed and refer for medical clearance

This is why health screening does not automatically mean the person will need medical clearance. Medical clearance is only required when the information collected suggests a significant risk that should be assessed by a medical professional before exercise continues.

Used together, the questionnaire and screening process act as a practical filter for medical conditions, symptoms, injuries and risk factors that could increase the chance of harm during exercise, especially when intensity is moderate to vigorous.

Example: A new client reports a family history of heart disease and chest tightness when climbing stairs. The professional pauses high-intensity exercise and recommends medical clearance before progressing.

These checks do not diagnose disease. Their purpose is to help the professional make safer decisions, reduce preventable harm, and choose a starting point that matches the person’s current health and movement needs.

2. Why they are important

Using a pre-exercise questionnaire and undertaking relevant health screening is important because it turns health information into clear training decisions. It helps exercise and fitness professionals decide:

• the right intensity and type of training to start with
• how fast to progress the program
• whether exercise can start now, or should wait until after medical clearance

2.1 Safety and risk management

The main purpose is risk management. These steps help identify warning signs linked to problems during exercise, such as cardiac symptoms, uncontrolled blood pressure, poorly managed asthma, or a recent musculoskeletal injury. If risks are found early, the professional can avoid triggers (such as very high-intensity intervals), increase supervision, and plan for emergencies (for example making sure an inhaler is available).

They cannot guarantee that nothing will go wrong. They reduce preventable problems by stopping a program being prescribed without the right information.

2.2 Personalised exercise prescription

Questionnaires and health screening also improve training effectiveness because they set a clear starting point (a baseline). When the professional understands your current activity level, injuries, goals, and constraints, they can apply the FITT principle and progress training at a pace your body can tolerate.

In Australia, the Adult Pre-Exercise Screening System (APSS) uses weekly activity levels to guide starting intensity and progression. When weighted activity is below 150 minutes per week, it recommends starting at light to moderate intensity and building up gradually.

2.3 Professional responsibilities

Exercise and fitness professionals have a duty of care, which means they have a legal and ethical responsibility to take reasonable steps to keep you safe from harm during exercise. This includes identifying risks, making informed decisions about exercise prescription, and avoiding actions that could reasonably cause injury or medical complications.

Using a pre-exercise questionnaire and undertaking relevant health screening are key ways this responsibility is met. These processes show that the professional has actively considered your health status, risk factors, and readiness for exercise before designing your program. Without this, exercise may be prescribed without enough information, increasing the likelihood of preventable harm.

It also supports:

• informed consent, meaning you are given clear information about the risks, benefits, and expectations of the exercise program, so you can make a voluntary and informed decision to participate
• confidentiality, meaning your personal health information is collected, stored and shared in a way that protects your privacy and is only accessed by authorised individuals for legitimate purposes

Together, these processes help ensure that exercise is not only effective, but also safe, ethical, and aligned with professional standards.

3. What is collected and how it is used

Most questionnaires and screening processes focus on information that changes exercise safety and program design. They commonly ask about:

• medical history and key signs or symptoms (for example chest discomfort with activity, fainting, or unusual shortness of breath)
• medications, because these can change how the body responds to exercise
• injury history and movement limitations
• current activity level and readiness, so the starting workload matches current capacity
• lifestyle risk factors (for example smoking) and goals, so the program is realistic and supports wellbeing and performance

Based on the results, the professional may:

• start exercise as planned
• modify the program (intensity, exercise selection, supervision, and progression)
• use the results as a baseline for ongoing monitoring
• refer to another professional when needed, based on scope of practice (for example to a GP or physiotherapist)

4. Screening tools

These tools do not diagnose medical conditions. Their purpose is to support risk management, safe starting intensity, appropriate exercise selection, and responsible referral decisions when a concern falls outside the professional’s scope of practice.

5. If screening is not done properly

When a pre-exercise questionnaire is not used, or health screening is skipped, rushed or treated as a formality, exercise can become less safe, less effective and less professional. Screening is not just paperwork. It is one of the main ways an exercise or fitness professional identifies whether a person is ready to begin exercise, whether the program needs to be modified, or whether medical clearance is needed before training starts.

For the client, poor screening can mean important medical conditions, symptoms, injuries or risk factors are missed. This may increase the chance of preventable harm, including:

• medical emergencies, such as chest pain, fainting, asthma complications or unsafe blood pressure responses
• worsening of an existing musculoskeletal injury
• incorrect starting intensity, leading to early overload, excessive fatigue or flare-ups
• poor exercise selection, where movements aggravate pain or place unnecessary stress on the body
• reduced confidence, motivation and participation if the program feels unsafe, too hard or poorly matched to the person’s needs

Poor screening also affects the quality of the program. Without accurate information about the client’s health history, current activity level, injuries, goals and limitations, it is much harder to apply the FITT principle appropriately. The program may progress too quickly, start at the wrong intensity, or fail to meet the client’s actual needs.

For the exercise or fitness professional, the consequences can also be serious. If a client is harmed and there is little evidence that screening was completed properly, it becomes harder to show that reasonable steps were taken to meet a duty of care. This can raise concerns about professional judgement, informed consent, record keeping, scope of practice and referral decisions.

In serious cases, poor screening may contribute to complaints, loss of trust, reputational damage, workplace consequences, insurance issues or legal responsibility. This is why pre-exercise questionnaires and health screening are not optional extras. They are essential parts of safe, ethical and personalised exercise prescription.