Is the AHA/ACSM Scientific Statement “Recommendations for Cardiovascular Screening, Staffing, and Emergency Policies at Health/Fitness Facilities” in Need of Revision?
To the Editor:
The Scientific Statement of the American Heart Association and American College of Sports Medicine entitled “Recommendations for Cardiovascular Screening, Staffing, and Emergency Policies at Health/Fitness Facilities”1 is an important and meaningful contribution to the professional literature. One premise of the Scientific Statement is to strike a balance between encouraging more people to increase their physical activity involvement while concurrently helping protect those same people from the various health risks associated with physical activity involvement (most notably, sudden cardiac death). The authors present the Scientific Statement in a logical and thorough manner. It is also reasonably easy to read and assimilate, which increases its utility for professionals in the health/fitness industry.
While commending the premise of the Scientific Statement and the authors who developed it, I do want to point out what I believe to be an oversight in the paper. Specifically, my comments are directed at Table 1 of the Scientific Statement and the associated text on page 2285. In Table 1 of the Scientific Statement, a version of the Physical Activity Readiness Questionnaire (PAR-Q) is displayed. The version displayed appears to have been taken from Appendix D of an article by Thomas, Reading, and Shephard published in 1992.2 However, this is not the same version of the PAR-Q instrument published and endorsed by Health Canada and the Canadian Society for Exercise Physiology in 1994.3 In fact, each of the 7 PAR-Q items has been revised since the 1992 publication cited in the Scientific Statement. For example, in the 1992 publication, the question on blood pressure remained rather vague: “Has a doctor ever recommended medication for your blood pressure or a heart condition?” In the 1994 edition of the PAR-Q, the revised version of this question was: “Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?” The latter version of the revised PAR-Q has been examined in a series of studies conducted by Cardinal and associates4 5 and is being distributed by Health Canada and the Canadian Society for Exercise Physiology.3 On the contrary, I do not believe the former version (the version cited in the Scientific Statement) has been empirically investigated.
If indeed Table 1 of the Scientific Statement contains the oversight alluded to in this letter, I suggest the statement be rereleased to include the 1994 (ie, the most recent, professionally endorsed, empirically tested) edition of the PAR-Q instrument.
- Copyright © 1999 by American Heart Association
Balady GJ, Chaitman B, Driscoll D, Foster C, Froelicher E, Gordon N, Pate R, Rippe J, Bazzarre T. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation. 1998;97:2283–2293.
Canadian Society for Exercise Physiology. PAR-Q and You. Gloucester, Ontario, Canada: Canadian Society for Exercise Physiology; 1994:1–2.
Cardinal BJ, Cardinal MK. Screening efficiency of the Revised Physical Activity Readiness Questionnaire in older adults. J Aging Physical Activity. 1995;3:299–308.
The AHA/ACSM RecommendationsR1 aim to promote and foster routine cardiovascular screening of all new members and/or prospective users at all facilities offering exercise equipment or services. The Recommendations suggest, at the least, the use of the PAR-Q or the more comprehensive AHA/ACSM Health Fitness Facility Preparticipation Screening Questionnaire. These are both contained in the document. More importantly, they encourage the use of some systematic mechanism for screening at all facilities. Screening tools should be appropriate for their client population. Proper interpretation of screening results with subsequent action, as outlined in the Recommendations, is integral to their successful implementation.
The questions used in the 1994 version of the PAR-Q differ only slightly from those of the 1992 version, which was provided in the Recommendations. The main focus of each question is quite similar in both versions. The 1994 version, when used in the format put forth by the Canadian Society for Exercise Physiology,R2 does provide additional direction to the respondent regarding what action to take after completion of the questionnaire. Such action directives are also present in the AHA/ACSM Questionnaire. Thus, no revision of the Recommendations is needed at this time. However, if the PAR-Q instrument is chosen to be the screening tool used by a health/fitness facility, the 1994 version would be preferable, particularly in an unsupervised (Level 1) facility, which is without the advantage of staff-administered screening. The 1994 PAR-Q is presented in the ACSM guidelines for exercise testing and prescription.R2
As newer and better screening tools become available, we would encourage their appropriate use. However, no questionnaire can serve as a surrogate for broad-based awareness and preparedness on the part of health/fitness facilities, healthcare providers, and consumers to ensure the promotion and implementation of safe and effective exercise.
Balady GJ, Chaitman B, Driscoll D, Foster C, Froelicher E, Gordon N, Pate R, Rippe J, Bazzarre T. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation.. 1998;97:2283–2293.
American College of Sports Medicine. Guidelines for Graded Exercise Testing, and Exercise Prescription. 5th ed. Baltimore, Md: Williams & Wilkins; 1995:14–16.