Must You be Screened before Starting an Exercise Program?

Try to join a gym for your health’s sake, and you’ll be told to check first with your doctor before starting to exercise regularly. If you’re over a certain age, you may have to produce a note from your doctor before you can begin. But now an Israeli study has shown that this sort of screening is not helpful. It’s published in the Journal of General Internal Medicine.

Specifically, the study evaluated whether an exercise tolerance test (ETT) before starting regular physical activity reduced the risk of sudden death during exercise (which is a rare event, anyway). The findings showed that it depended on the subjects risk of coronary heart disease at the time of the test. Subjects who had a pre-exercise ETT had decreased mortality if they were in a high- or intermediate-risk group, whereas there was no benefit in those at low risk. The investigators conclude that routine screening of this type is not recommended for the purpose of reducing the risk of sudden death during exercise.

They add a warning, however, with which I agree wholeheartedly: “Sedentary people should start exercise gradually and go to a physician if they feel chest discomfort or dizziness during exercise”. I would go further. Before older people start any exercise regime, they should, as a minimum, check with their family doctor; they may have conditions - other than cardiovascular risk factors - that could preclude some or any forms of exercise, or at least lead to a modified program.