Pre-Exercise Screening
You can add additional questions that you might ask a new client (e.g. client contact information, risk warnings/disclaimer statements or other information collected for the purposes of delivering your services). However, the questions and the process of the APSS must be used in their entirety, as they are in the tool, and must be referenced appropriately (Exercise and Sports Science Australia, AUSactive, Sports Medicine Australia and Exercise is Medicine Australia, 2019).
The reason for this is that they are evidence based and have been carefully designed to elicit client responses that will uncover health risks that might contra-indicate exercise and which require further guidance from a medical or allied health professional. Using only part of one of the stages or altering the intended process may prevent accurate risk factor calculation and risk assessment which could lead to unsafe and unsuitable exercise prescription and advice.
Stage 1 of the APSS tool is the compulsory stage, and so is expected to be used for all casual gym visits (either using gym facilities or participating in a group exercise class) to ensure businesses and professionals are meeting their duty of care in screening for high risk clients.
In relation to casual swim clients, the APSS would generally be applied for structured exercise as opposed to casual swimming; however Stage 1 could still be applied. AUSactive recommends that professionals and businesses liaise with Royal Life Saving and other Aquatics peak bodies for guidance in these situations.
No, one form is sufficient for ongoing attendance. It is recommended that the client management process that is used by a business or trainer should enable screening results to be kept on file and easily checked for casual visitors who wish to participate in a class or use a service
In a rehabilitation situation, a treating Physiotherapist is an appropriate allied health professional to be overseeing the exercise program. If a client attends without a Physiotherapist, having them complete stage 1 of the APSS and provide written confirmation from their treating Physiotherapist to guide exercise prescription is required. In this case it may also be appropriate for the Exercise Professional to phone the Physiotherapist to gain verbal advice about the client’s conditions as well (and to document this).
Clients with a disability should be treated in the same way as able-bodied clients and in both cases, pre-exercise screening is imperative to identify any health risks that require further direction and to guide exercise prescription. In any case, referral to a health professional is not about denying access but rather about seeking guidance prior to developing an appropriate exercise program.
ABS statistics demonstrate that approximately one in five Australians or 4 million people have a disability (such as mobility, vision, hearing and learning disabilities) and disability rates increase with age. Therefore, failing to incorporate disability and seniors facilities and services into your business strategy will place your business at a disadvantage. In addition, businesses have a legal obligation to provide equality of experience for all. Remember that staff training (not just of fitness staff but front desk and customer service staff as well) is an essential component of delivering an inclusive service and ensuring that appropriate practices are delivered when dealing with disabled clients.
It is true that clients have often overcome quite a few hurdles to even make an inquiry with a fitness or health service, and that the last thing we want to do is turn them away (potentially to competition down the road).
It is also true that the fitness and health industry has to date employed relatively inconsistent pre-exercise screening practices and for some sectors there has been little or no screening at all.
Aim to:
• Re-frame the situation, so that rather than denying access you are seeking guidance prior to developing an appropriate exercise program. Focus on the good that will come out of the process.
• Re-educate your clients about why screening is important, why we do it and what to expect from our industry. A client would be unlikely to be dissatisfied with a Physiotherapist or GP who wanted to ask health screening questions prior to prescribing treatment. This is because they expect it, based on the existing reputation of such professions.
• Be flexible. Does the client need to book an appointment with a medical or allied health professional, or if they are an existing patient, can you contact their treating professional by phone or email to gain further advice to assist in exercise prescription?
The APSS user guide stipulates that Stage 2 be “administered by a qualified exercise professional (Minimum Certificate III in fitness with completion of screening and assessment units SISFFIT301A and SISFFIT307A)”. SISFITT301A – Provide fitness orientation and health screening; SISFITT307A – Undertake client health assessment.
Equivalent units from the fitness training packages (after 2001) are also acknowledged as appropriate for undertaking Stage 2 of the APSS. Such units include:
SISFFIT001 – Provide health screening and fitness orientation;
SRFFIT001B – Provide orientation to clients prior to undertaking a fitness program;
SRFFIT003B – Undertake client induction and screening.
If you are not sure whether you have the necessary units within your qualification, please email your query to [email protected] and we can look into it for you.
Many people who have high blood pressure don’t know it, so just because they have not been told they have high blood pressure (BP) does not mean they don’t – they may just not know it. In fact they may go on to have it measured in stage 3 and find they do have high BP. This may feel like an inefficient method, rather than simply going ahead to measure it (as per common industry practice).
The reason for the Stage 2 question is to enable identification of elevated BP as a risk factor via a questionnaire, in the absence of it being measured, for example an exercise professional may not have the tools to measure BP (i.e. if outdoors). If an Exercise, Yoga or Pilates Professional chooses to take a measure at this point to confirm the actual BP status, this would be appropriate, and in fact is likely given accepted industry practice.
The health and fitness industry tends to stay away from using BMI as a health indicator as we are aware that lean people with a high muscle mass can present as “Obese” even though they have low body fat. However, Body mass index [BMI] is internationally the most commonly used metric to describe the level of fatness among populations and is useful for determining population trends. It is also easy for self-report data to be collected on this measure, hence its widespread use, despite the obvious limitations.
Many studies have found that overweight or obesity is associated with a wide range of elevated risk factors and an increase in death and disability rates. The most important of these are elevated rates of cardiovascular disease, diabetes and some forms of cancers [specifically breast and bowel] that occur as fatness levels increase among the population. The standard BMI cut-offs categorise people in terms of their population risk for such diseases and related mortality. As such, BMI adds to the health risk picture being put together throughout the Stage 2 & 3 process and should provide valuable information to assist in making a professional judgment about exercise intensity prescription. APSS Textbook provides further information about the prevalence and impact of high BMI.
The minimum qualification required for measures 1-3 (BMI, waist girth and resting blood pressure) is a Certificate III in Fitness
The minimum qualification required for measures 4 and 5 (fasting lipid profile and fasting blood glucose) is an Exercise Physiologist
It is important that the professional administering these measures has additional skills and knowledge to be able to safely perform metabolic measures, including a deeper understanding of blood lipids, the various sub-fractions, what dietary and lifestyle factors can influence these values and what the cut-offs and recommended levels are for optimal health.
To complete this stage, a business might aim to develop a network of Exercise Physiologists to refer to or may aim to have one that can contract their services on specific days. Alternatively, given that this stage is optional, a business may choose to only include the BMI, waist girth and resting blood pressure measures, utilising the skills of Certificate III & IV qualified trainers.
