Professional Standards and
Health Screening
• Readings – CSEP-PATH
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B1 - Ask
B2 – Assess (51-56)
D1 – Professional Standards
D2 – Basic Legal Considerations
D3 – Reputation and Marketing (Read on own)
• Resources - ACSM Resource Manual 6th ed
(American College of Sports Medicine)
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Ch 10
Ch 18 (p 284-290)
Ch 19 (p 297-304)
Ch 51
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Outline - Health Screening
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Professional Standards and Credentials
Safety and Legal Considerations
Role Of Appraiser
Goals of Health Screening
– Health Screening Forms
• details and limitations
– Overview of Risk Factors
• Physical Screening Tests
– Resting Blood Pressure and Heart Rate
– BMI
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Professional Standards and
Credentials
• CSEP – Canadian Society for Exercise Physiology
– Certified Personal Trainer
– Certified Exercise Physiologist*
• ACSM – American College of Sports Medicine
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Certified Personal Trainer
Health Fitness Specialist*
Clinical Exercise Physiologist*
Comparison of CSEP and ACSM certifications
* Require 4 year university degree in Kinesiology
• BCRPA – BC Recreation and Parks Association
• BCAK – BC Association of Kinesiologists
• Certification at any level allows you to practice within
the limitations of your training and qualifications
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CSEP Code of Conduct
• Certified members have the responsibility of:
– Enhancing public understanding of the exercise profession
– Building their professional reputation on the basis of merit of
services offered and performed
– Not competing unfairly with others or competing primarily on
the basis of fees without due consideration of other factors;
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– Maintaining a special obligation to demonstrate
understanding, professionalism and technical expertise to
apprentice members under their supervision
• Professionalism, competence, confidentiality, factual
marketing, clear record keeping (log book)
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Safety and Legal Concerns
• The main concern of a fitness program is that it be conducted safely
for everyone permitted to participate in the program.
• screen and exclude those individuals who should not be exercising
prior to checking with a physician.
• ensure that the program is designed so those individuals cleared for
exercise are able to perform their exercise in a safe manner.
• regular check of the equipment and facilities and periodic reviews of
the procedures used by the staff in classes and during testing.
– A written record of maintenance and safety checks should be kept. “If it isn’t
written down….it wasn’t done”.
– Written records showing when the review, training, and practice were carried out
• A written emergency procedure should be established and staff
members trained to carry out the procedure.
– Local emergency services to be used should be contacted to help establish the
procedures, and comprehend and agree with the procedures that are to be
followed.
• Fortunately, the same kinds of things done to make the program
safe also help protect the program legally.
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Basic Legal Considerations
• Nature of injury associated with physical activity
– Inherent risks – injuries can occur despite no fault being
attributable – risk inseparable from activity
– Ordinary negligence – failure to meet standard of care
– Gross negligence – deliberate or reckless conduct –
professional does not take steps to correct risk
– Product defect/liability – manufacturer at fault due to defect
in design, manufacture or inadequate warnings
• Liability exposure
– Injury is attributable to actions of exercise professional
– Improper instruction or supervision or failure to respond with
appropriately emergency procedures
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Inadequate staff training
Improper pre exercise health screening
Inappropriate exercise prescription
Equipment / facility maintenance
Improper execution or development of an emergency action plan
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Basic Legal Considerations
• Negligence
– “Failure to do something that a reasonable / prudent
professional would have done, or it can be doing something
that a reasonable/prudent professional would not have done”
– To establish negligence the following will be examined.
• what was the standard of care? Was it breached?
• Did the breach cause the harm?
• What damages will the defendant owe if negligence is proven?
• Standard of Care
– Provide ‘reasonably safe’ programs and services for clients.
• Risk management and mitigation
– Conduct consistent with CSEP ‘ standard of care’ as
documented in CSEP’s
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Certification procedures – liability insurance – 3 million (BCAK)
Code of conduct
Scope of practice
CSEP-PATH procedures
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Informed Consent:
• Voluntary acknowledgement of purpose,
procedures, and assumption of known
(informed) dangers/risk(s)
– Although getting the participant's consent
does not prevent legal actions or protect
against negligence, it does indicate that the
program is concerned with the participant
and has acted in good faith. This may be
enough for legal protection.
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Waivers:
• Voluntary abandonment of a right to file a
lawsuit. Waives all claims to damage
including negligence.
– Waivers are becoming more common and are
better written. It is possible for some waivers to
stand up even if the program (person) was
negligent. I believe this is rather worrying from an
ethical viewpoint, but spending the money up front
to get a well-written legal waiver drawn up does
make good fiscal sense.
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Determinants of Health
Social and Economic Environment
Physical Environments
Personal Health Practices
POPULATION HEALTH
Individual Capacity and Coping Skills
Health Services
Determinants of Health
Social and Economic Environment
Physical Environments
Personal Health Practices
POPULATION HEALTH
Individual Capacity and Coping Skills
Health Services
Wellness Continuum
Figure 1.1
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Role Of Exercise Professional
• Assess clients physical activity and lifestyle
habits
– CSEP-PATH uses Health Benefit Ratings to assist
in the provision of advice to the client
• Design program (along with client) to improve
fitness, coping skills and sense of mastery
• Refer clients to other health professionals
• Rely on these professionals to provide
information and support for the goals you
have assisted the client in developing
• Client Based Approach, part of a team of
Professionals
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CSEP-PATH Health Benefit Ratings
• Excellent - Associated with optimal health benefits
• Very Good - Associated with considerable benefits
• Good - Associated with many health benefits
• Fair - Associated with some benefits, but also some
health risks
• Poor- Associated with considerable health risks
Pre-participation Screening
• Most prospective participants are apparently
healthy
• Primary safety goal of health screening is to
identify those who should receive further
medical evaluation prior to exercise testing or
training
– identify medical conditions
– identify possible contraindicated activities
– Is referral to a medically supervised exercise program needed?
• Information gathered can assist in designing an
individualized exercise program
• Following screening protocol will fulfill legal and
insurance requirements
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Pre-participation Screening
• CSEP-PATH guidelines
• Forms
– Welcome Letter – Appropriate preparation for first meeting
– AAL-Q – Abilities for Active Living
– PAR-Q - Physical Activity Readiness
• PARMED X if client fails PAR-Q
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Informed Consent form
PASB-Q – Physical Activity and Sedentary Behaviour
LIFESTYLE checklist
SOC-Q – Stages of Change
*BPK 343 adds health history to CPAFLA requirements
• Physical Screening
• HR, BP, and observations
• We will also add height, weight and girth measurements in lab this
week, to determine BMI and health risk
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Physical Activity Readiness
• PAR-Q - developed in BC, used worldwide
– Brief, Self administered
• Appraiser can not assist or interpret for client
• Sensitivity - nearly 100%
– % with medical contraindications who answer Yes
• Specificity - ~ 80%
– % of persons without medical conditions who answer NO
• Limitations
– sensitivity and specificity for predicting exercise ECG
abnormalities
– Inability to screen out persons with 2 or more major CAD
(Coronary Artery Disease) risk factors
– Inability to Identify medications that may affect exercise safety
– Inability to Identify pregnancy
– Absence of questions that identify adverse health behaviors 17
Health History
• Limitations of PAR-Q addressed in part by
– Health History form and
– CSEP forms
– physical screening (resting BP and HR)
• Important to assess risk for CAD and other chronic
diseases
– PASB –Q, Health History, Lifestyle Checklist, Body
composition, Physical Screening
– See slide 21 for ACSM risk factors for CAD
• Several risk factors depend on health behavior
– Lifestyle checklist
• Personal History is used to
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Clarify risk of CAD events during exercise
Prioritize interventions
Encourage change in lifestyle and reduce disease
Develop or modify exercise program
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Pre-participation Screening
• ACSM guidelines
– Minimum required is self
administered questionnaire
such as PAR-Q
– Does not require medical exam
for asymptomatic, apparently
healthy men under 45 and
women under 55 with fewer
than two CAD risk factors (see
slides 27 and 28 for details)
• For vigorous exercise above
60% VO2max
– Also, medical exam
unnecessary for anyone
asymptomatic and apparently
healthy to undergo
• moderate exercise at 40-60%
VO2max
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Other Considerations
• The properties of drugs must be understood and
discussed with a physician
– May alter HR / BP; ECG response, exercise capacity
• Link between dietary habits and development of
disease
• Past and current exercise behaviours / habits
• What do they enjoy?
• Type A behaviour?
• Eating Disorders?
• Age and Exercise Intentions?
– how old is this person and how vigorously does he or she
want to exercise?
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Physical Screening Tests
Client may be
unaware of a risk
factor!
• blood pressure
• heart rate
• observation
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Blood Pressure indications that fail
screening
• CSEP-PATH
- systolic > 145
- diastolic > 95
- On BP medication
• ACSM
- systolic > 140
- diastolic > 90
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Classification of Blood Pressure for Adults
Classification
Systolic (mmHg) Diastolic (mmHg)
Normal
< 120
< 80
Pre
Hypertension
120 - 130
80 - 89
Stage 1
140 - 159
90 - 99
Stage 2
> 160
> 100
Risk of CVD, beginning at 115 / 75 mmHg, doubles
with each increment of 20 / 10 mmHg
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Heart Rate indications that fail
screening
• CSEP-PATH and ACSM
HR > 100 bts/min at rest
• ACSM cautions about HR < 60 in an untrained
individual at rest
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Observation indicating failure of
screening
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shortness of breath
coughing persistently
pregnant
lower extremity swelling
posture
limp
flexibility and strength?
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