Health Screening in Group Fitness Classes

April 05, 2011

Fitness Coordinator, Johns Hopkins University

If you supervise any group fitness classes, you’ve likely mulled over the professional standards for screening the participants that take part in the classes. The American Council on Exercise (ACE) states that a health-risk appraisal or medical health history should be obtained from every participant in an activity program. Strictly from a managerial and logistical perspective, the more participants that are in the program, the more general the health screening may need to be, and the less able you are to track individual health conditions. But from a prudent perspective, you should at least offer something to gauge a participant’s risk and it should be as in-depth as you can handle. When choosing how to screen for health problems, consider the following issues:

How many participants do you have in your drop-in class setting?
– If your facility and classes are “free” and open to anyone who can walk into your gym or recreation center, the logistics of personally screening and maintaining the paperwork of hundreds or possibly thousands of participants continuously over time is a bit daunting, if not impossible given the staffing required. In such large-numbered or anonymous situations without the requisite registration, it might be helpful to post a series of health screening questions in or near the participation settings. These postings should be large and in more than one place (good places would be at each entryway, inside classrooms or studios, in locker rooms, on your website, etc.). A downside to this approach is the lack of documentation that participants actually saw, read, and understood what was being asked of them to consider regarding their health.
– If your classes specifically require signups ahead of time, you should incur some type of screening tool in the sign-up process. Since the minimal screening tool is the PAR-Q, this is a good and relatively easy place to start, especially if you have a large number of registrants. Have each participant fill one out every time they register for a new class or session, or at least once a year. It’s also a good idea to re-post the PAR-Q or other health screening questions in some choice locations in or near classes at your facility as helpful reminders.

Do you have set classes that have a pre-determined group of participants?
– In classes with a specific class roster that is set for a given time period, more detailed health screening beyond the PAR-Q might be more manageable and appropriate. For example, registration for a specialized, extra-fee yoga class could require the completion of a history of injuries or other health-related questions as a requirement for enrollment, and warrant a physician’s clearance for conditions of concern. The benefit in this setting is that the instructor will get to know participants and their abilities — and while not a medical expert — will be in better position to modify exercises and be on the lookout for problematic responses to the exercise stress.

Do you have classes that serve special-needs participants exclusively?
– Classes that cater to special populations warrant in-depth medical screening and/or a doctor’s clearance, and need a well-trained, knowledgeable instructor. These types of classes include prenatal/postnatal sessions, seniors’ classes, or rehabilitative classes as examples. In such cases, it is in everyone’s best interest to obtain a medical clearance for each participant and applicable contraindications to exercise as per her/his physician. While this increases the workload for office staff, the standard of care is higher for these groups and such documentation creates a helpful paper trail should problems need to be prevented or arise later on.

Some other issues to consider in screening group fitness participants:
– What screening should you do for guests who want to participate in a class just once, or members who want to try out a class before enrolling in the program?
– What other classes does your facility offer that involve moderate to intense physical activity, but don’t fall under the auspices of the stereotypical group fitness program? For example, traditional dance classes, martial arts classes, or group swimming lessons typically aren’t lead by certified fitness instructors and often don’t use any health screening for participation. What do you think should be the standard for your program?
– How often will you require participants to update their forms, who is responsible for making sure this happens, and is this manageable for your office staff?
– How will you maintain the confidentiality of all forms and health screening tools used in your program? Are staff aware of the rules surrounding participant confidentiality at your facility?

The importance of health screening cannot be understated, and time, energy, and staffing must be adequately devoted to it. Whether your facility is large and open or your classes are tiny, you should ultimately check with your legal counsel for guidelines relevant to your programs.

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