I’m sure you’ve heard it everywhere: Check with a doctor before beginning any exercise program. This is the standard disclaimer on fitness advice of any sort, which most of us probably ignore. But should you? Not necessarily, it turns out.
Why are you supposed to check with a doctor before exercising?
The concern underlying this oft-repeated statement is that there are rare cases where a person can die suddenly during exercise. When this happens, it’s usually in a person who (a) had some kind of underlying medical issue; (b) was not used to exercising; and (c) did very intense exercise that they were unprepared for.
For a long time, there was a sense among many medical and fitness professionals that the best way to handle the issue was to focus on the first part: the people who had an underlying medical issue. And because not everybody knows if they have one, you should also see a doctor if you might have an underlying medical issue. Or if you had a family history of a medical issue.
While it sounds like a good idea, the screening got out of hand. One of the most common screening tools was a questionnaire that would ask about your own health as well as things like how old you were, whether you had smoked, and whether you were overweight. One study from 2014 found that it would flag more than 90% of middle-aged and older adults. In other words, these are people who wouldn’t be permitted to exercise until and unless they got a medical clearance.
With the price and availability of healthcare in this country (not to mention difficulties involved in getting an appointment, taking time off work if needed, and so on) that’s a huge barrier for a lot of people. Pretty ironic, considering that exercise is good for your health.
The American College of Sports Medicine did a deeper dive into the numbers, and found that the risks they were screening for were very common; the outcomes they were trying to prevent were very rare (one sudden cardiac death per 1.5 million vigorous workouts, in one study), and screening people based on risk factors didn’t actually seem to reduce the number of people dying during exercise.
How to know if you’re one of the people who really should check with a doctor before exercise
The current guidelines for screening people before exercise have been changed. The American College of Sports Medicine now says “most people can exercise without visiting a doctor first.” The current guidelines—which most gyms and trainers should be using—only use three factors to screen people:
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How much you exercise currently
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Whether you have signs or symptoms of certain health conditions
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How intensely you would like to exercise
The health conditions that trigger that second bullet point are cardiovascular, metabolic, and kidney diseases. If you have diabetes, that’s a metabolic disease. If you have been told you have a heart condition, peripheral artery disease, or cerebrovascular disease, that counts as a cardiovascular disease.
What do you think so far?
Even if you have one of these health conditions, you can usually exercise if you’ve gotten clearance from your doctor in the last 12 months (and your condition hasn’t worsened since then), or if you already exercise regularly and you just want to continue at the same level. There is a flowchart here to walk you through the question of whether you need medical clearance.
Even without a prior diagnosis, signs and symptoms of those previously mentioned diseases mean that you should stop exercising and check with a doctor before continuing. These include shortness of breath at rest or with mild activity; chest, arm, or jaw pain; dizziness or fainting; and others. If you’re curious if you would qualify, start by taking the PAR-Q test, which is seven yes-or-no questions; if you answer yes to any of them, there is a slightly longer questionnaire called the PAR-Q+ that gets more detailed.
Compared to the old guidelines, the proportion of people over 40 who need to get medical clearance before exercise has been cut almost in half. And as part of the same guidelines, the doctor’s visit itself will probably be a lot simpler. Specific tests are no longer recommended; what happens at that visit is up to your provider and their clinical judgment.
So, yes, some people do still need to check with a doctor before starting an exercise program. But it’s nowhere near everybody. Most people can get started right away, and even people with medical conditions will likely be told that there is some kind of exercise they can do.
