Pre-Exercise Screening

Screening by interview or questionnaire is recommended for all elderly patients starting an exercise program. Because exercise is inappropriate for only a small percentage of elderly adults, the main purpose of screening is to assign patients by triage to appropriate programs. Community exercise classes and fitness centers commonly screen new participants to identify those with chronic disorders or symptoms of chronic disorders. Participants are asked about a history of chest pain, heart disease, and other disorders. Some organizations use the Physical Activity Readiness Questionnaire (PAR-Q), a screening tool that refers participants to a physician to ensure that the proposed exercise is safe and that any medical conditions are stable and appropriately treated. Generally, exercise is unsafe for patients with unstable medical conditions (see Table 31-1).

The need for further pre-exercise screening (ie, full medical screening, including medical examination and, possibly, laboratory tests) of elderly patients with chronic disorders depends on what tests have already been performed and on clinical judgment. When exercise is a recommended treatment for patients with a chronic disorder, medical screening should be part of the initial evaluation. For the ambulatory elderly, a program emphasizing walking does not introduce a new activity, and gradually increasing walking time is probably safe, so full medical screening is usually not required. Comprehensive medical screening is not recommended for healthy patients of any age before starting a moderate-intensity activity program. However, some experts recommend such screening, possibly with an exercise stress test, for patients who have two or more cardiac risk factors (eg, hypertension, obesity). The American College of Sports Medicine recommends full medical screening and fitness testing for men > 40 years and for women > 50 years who want to start a high-intensity exercise program.

Fitness Testing

Although fitness testing is usually unnecessary, it may sometimes be useful. Performance on a 6-minute walk test can indicate the level of aerobic fitness and suggest the intensity level at which to start exercise. Fitness testing can also include measures of body build and composition (eg, body mass index, percentage of body fat). When periodic fitness testing is used, providing the patient with feedback on fitness improvements can increase adherence.