Appraising Your Exercise Risk

 

Do you need a physical or stress test before you exercise?

Exercise is safe for most of us, but if you’re sedentary, extremely out of shape, or have a number of health risk factors (see list below), you need to check with your doctor before exercising.  It’s important for older people or people who are ill to make sure the planned exercise is safe, appropriate, and effective.  It’s also important to know the state of your health in order to design an exercise program appropriate for your needs. Of course, you don't want to cause yourself harm, but you also want to target problem issues.  If you have osteoporosis, you want to include strength exercises in your program, beginning gently if the bones are fragile and working with exercises that best enhance bone density.  If you have high blood pressure, you need to learn the right exercise techniques for improving and not worsening the problem.

How do you know if you should check with your doctor before beginning an exercise program?  I follow the safety guidelines established by the American College of Sports Medicine.  Don't get discouraged if you're considered "at risk."  You likely have all the more to gain from beginning an exercise program, and you'll feel safer with your physician’s approval.  If you are at very high risk, you can still improve your health by enrolling in a medically supervised exercise program.

Finally, understand how your medications affect your exercise and make sure your trainer is informed about your medications.  For example, beta-blockers taken for high blood pressure keep the heart rate low even during exercise, although many high blood pressure medications don’t have this effect on blood pressure.

Low risk and apparently healthy individuals

If you have only one risk factor (see list below) and are healthy, you won’t need a medical exam or diagnostic exercise test before beginning an exercise program of moderate intensity.  For example, a woman over 50 who is apparently healthy doesn’t need medical approval to begin a walking program. (Moderate intensity is noncompetitive exercise that can be comfortably sustained for as much as 60 minutes and includes gradual and slow progression.)  If you’re extremely out of shape, you'll need to begin moderately anyway.  If you want to begin a more vigorous program (intense enough to represent a substantial challenge at your level of fitness and cause fatigue within 20 minutes), get your doctor's OK.

Moderate risk individuals

If you have two or more risk factors and no symptoms of poor health, you technically don’t need doctor’s approval for moderate exercise. For example, if you’re over 50 and are obese, but have no symptoms of disease, you can begin a walking program or beginning level water aerobics—anything that is a low enough intensity to sustain the exercise comfortably for more than 60 minutes.  Moving from a sedentary life to walking around 30 minutes each day will improve your health dramatically.

If you have two risk factors (for example, age and high cholesterol) and no symptoms of poor health, but want to achieve a higher level of fitness by engaging in somewhat more intense exercise, get your doctor’s approval and a stress test.  This will allow you to raise your heart rate to higher levels of intensity by including activities like walking up hills or wearing a backpack as you walk.  If you have two risk factors and want to increase your physical fitness with a strength-training program, get your doctor’s approval and a supervised exercise stress test.


Higher risk individuals

If you have two or more risk factors with active symptoms or you’ve been diagnosed with coronary, pulmonary, or metabolic disease, you need a thorough medical evaluation and a physician-supervised maximal exercise test before beginning any exercise program.  Your doctor should give you and your trainer guidelines for exercise intensity and maximum heart rate.

Most Common Risk Factors