Introduction

Within the fitness industry induction and medical screening is an important component in the overall package for our clients.

A majority of training providers offer individuals a free ‘taster’ of their product, known as a trial session, and it is an effective means of enticing people to purchase the product; on average 2 out of 3 will make a purchase.

An important element of the trial session is the induction process, and if conducted in an empathetic and professional manner it can be a deciding factor in an individual’s reason to purchase. During the induction process individuals are commonly termed ‘trial members’.

Another important element of the trial session is the medical screening process which is critical not only from an insurance perspective for the training provider but also from a safety perspective for the trial member.

Induction

Induction, in the context of boot camps, can be divided into three distinct categories: pre-session, in-session and post-session (these also link into the framework identified in the Outdoor Fitness Training Framework). Although training providers may vary in the format and type of questions they ask a trial member there are some general principles each will follow.

Pre-Session Principles

Introduction (of each trial member, fitness instructor, and ethos of training provider);
Complete and/or review health questionnaire for each trial member;
Check for any injuries that may affect a trial member’s ability to take part in the session;
Structure and format of a session (including session rules and safety guidelines);
Purpose of the trial session;
Hydration and clothing advice;
Trial member can stop if they need a ‘breather’ (e.g. niggles or muscle pain felt);
Questions from trial member; and
Introduce each trial member to a ‘buddy’ member (a current member who can provide a reassuring ‘shoulder-to-lean-on’ to the trial member during the trial session).

In-session Principles

Introduce trial member to the group;
Instructor ‘keeps an eye’ on the trial member;
Ensure buddy member aids trial member, as required; and
Apply adaptation and progression techniques, as required.

Post-session Principles

Did the trial member enjoy the session (yes, and hopefully said with a big smile);
How is the trial member feeling (in relation to injury prevention);
Advice on post exercise muscle soreness and stiffness (see injury symptoms & prevention);
Sign-up process and cost of membership;
Promotional pack (e.g. flyers, car stickers etc);
Questions from trial member; and
Finish with look forward to next time.

As stated above, although the precise language and questions asked may vary, reputable training providers will observe, as a minimum, these principles. However, if the training provider does not include: this essential information; advice on exercise; ask questions relating to trial member health; and allow a trial member to ask questions then the trial member should be cautious with proceeding any further.

The above principles, in addition to information gained through the trial member’s questions, should be enough to allow an individual to make an informed decision on the suitability of the training provider to cater for their training needs in a safe and effective manner.

In general, most training providers request that trial members turn up 15-30 minutes before the start of a session in order to provide an adequate amount of time to review health questionnaires and to chat with trial members without feeling rushed.

Medical Screening: Individual and Training Provider Perspective

As part of the induction process members should be asked to complete medical screening in the form of a PAR-Q form (Physical Activity Readiness Questionnaire), commonly known as a Health Questionnaire. PAR-Qs can normally be downloaded from the training provider’s website or completed at the venue.

The PAR-Q was created by the British Columbia Ministry of Health and the Multidisciplinary Board on Exercise, and although the exact wording and questions on PAR-Q forms varies between training providers, the general health information is the same. It was designed to be a self-screening tool that can be used by anyone planning to start an exercise programme and it is often used by fitness professionals to determine the safety or possible risk of exercising for an individual based upon their answers to specific health history questions.

Although being physically active is very safe for most people there are some people who should check with their medical professional before they increase their current level of physical activity. With this in mind, the PAR-Q has been designed to identify the small number of adults for whom physical activity may be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.

There a number of versions of the PAR-Q depending upon your requirements:

PAR-Q and YOU: this is a 2-page form to see if you should check with your medical professional before becoming much more physically active.
PAR-Q+: this is a 4-page form for pre-screening prior to physical activity participation and includes additional questions on chronic conditions for further probing by qualified exercise physiologists (this form should not be offered by fitness instructors).
PARmed-X: this is a 4-page physical activity-specific checklist to be used by a medical professional with patients who have had positive responses to the PAR-Q and YOU.
PARmed-X for Pregnancy: this is a 4-page guideline for health screening prior to participation in a prenatal fitness class or other exercise. It is for use by health care providers and fitness professionals.
GPPAQ (General Practice Physical Activity Questionnaire): this is a 1-page validated screening tool for use in primary care by general practitioners that can be used to assess adult (16-74) physical activity levels (NICE, 2006). The tool generates a simple 4-level Physical Activity Index (PAI) categorising people as:
- Inactive: sedentary job and no physical exercise or cycling.
- Moderately inactive: sedentary job and some but <1 hour physical exercise and/or cycling per week; or standing job and no physical exercise or cycling.
- Moderately active: sedentary job and 1-2.9 hours physical exercise and/or cycling per week; standing job and some but <1 hour physical exercise and/or cycling per week; or physical job and no physical exercise or cycling.
- Active: sedentary job and ≥3 hours physical exercise and/or cycling per week; standing job and 1-2.9 hours physical exercise and/or cycling per week; physical job and some but <1 hour physical exercise and/or cycling per week; or heavy manual job.

All persons who receive a score less than ‘Active’ should be offered a brief intervention supporting behaviour change to increase their physical activity. It is used as part of the NHS Health Check programme to assess people’s risk of heart disease, stroke, kidney disease and diabetes.

PAR-Q Questions

Although the format and structure of the PAR-Q may vary between training providers, generally a trial member will be asked the following questions:

Serial	Question	Answer
1	Do you have a bone or joint problem such as arthritis, which has been aggravated by exercise or might be made worse with exercise?	Yes/No
2	To your knowledge, do you have high blood pressure?	Yes/No
3	To your knowledge, do you have low blood pressure?	Yes/No
4	Do you have Diabetes mellitus or any other metabolic disorder?	Yes/No
5	Has your doctor ever said that you have raised cholesterol (serum level above 6.2mmol/L)?	Yes/No
6	Do you have or ever suffered a heart condition?	Yes/No
7	Have you ever felt pain in your chest when you do physical exercise?	Yes/No
8	Is your doctor currently prescribing you drugs or medication?	Yes/No
9	Have you ever suffered from shortness of breath at rest or with mild exercise?	Yes/No
10	Is there any history of Coronary Heart Disease within your family?	Yes/No
11	Do you ever feel feint, have spells of dizziness or have ever lost consciousness?	Yes/No
12	Do you currently drink more than the average amount of alcohol per week? 21 units for men and 14 units for women (1 unit = 1⁄2 pint of beer/cider or 1small glass of wine)	Yes/No
13	Do you currently smoke?	Yes/No
14	You do NOT currently exercise regularly (at least 3 times per week) and/or work in a job that is physically demanding.	Yes/No
15	Are you, or is there any possibility that you might be pregnant?	Yes/No
16	Do you know of any other reason why you should not participate in a programme of physical activity?	Yes/No

PAR-Q and Self-declaration

One of the issues with self-declaration is probity. A fitness professional will review the completed PAR-Q form, and may need to ask further questions, to make a reasoned judgement on whether a trial member should proceed onto an exercise programme or be referred to a medical professional for assessment. As noted in the associated page ‘Medical Screening: Military Perspective’ self-declaration has some problems.

Adult Pre-Screening System

In 2014 the Adult Pre-Exercise Screening System (APSS) was published. The new APSS provides an evidence-based system for identifying and managing health risks for exercise. APSS was developed in partnership by Fitness Australia, Exercise and Sports Science Australia (ESSA) and Sports Medicine Australia (SMA).

Exercise Professionals are all too aware (or should be) of the risks involved in prescribing exercise and the need for a consistent standard of professional practice in the fitness industry. Besides the actual Pre-Exercise Screening Tool there are a number of other useful media:

Pre-Exercise Screening Tool;
Pre-Exercise Screening Textbook;
Recorded Pre-Exercise Screening System webinar;
Factsheet; and
Frequently Asked Questions (FAQs).

Summary

The induction process should form an important element of a trial member’s session. Instructors and trial members should note that there are important principles that should be followed in order to provide an informative and smooth process for the trial member.

Medical screening is an important element within the induction process and trial members should complete the PAR-Q (or health questionnaire) as honestly as possible, in order to gain the best possible outcomes from their training (i.e. a safe and effective physical exercise programme which takes account of their individual training and, where applicable, medical needs).

Having reviewed the factors affecting age and physical performance (see associated pages on Older, Younger and Female Exercisers) it is clear that physical and mental condition are more relevant than age when assessing physical risk in training. Training that is well planned, controlled and assessed will keep injuries to a minimum and cater for the ability of all individuals regardless of age. Ability group training can ameliorate issues identified with older/younger exercisers, but training providers should screen individuals considered being at higher risk.

Finally, training providers will have members of differing ages and gender. The physiological and psychological differences of these individuals will set challenges for those who plan and conduct physical training. The fitness professional that identifies the implications resulting from these differences and then allows for them during training will greatly enhance the group’s cohesion, overall performance and morale.

References

NICE (National Institute for Health and Clinical Excellence) (2006) The General Practice Physical Activity Questionnaire (GPPAQ). Available from World Wide Web: <http://www.nice.org.uk/nicemedia/live/11927/40195/40195.pdf> [Accessed: 20 December, 2012].

Adult Learning Inspectorate (2005) Safer Training: Managing Risks to the Welfare of Recruits in the British Armed Services. Available from World Wide Web: <http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/21_03_05_ali.pdf> [Accessed: 13 November, 2012].

Adult Learning Inspectorate (2007) Better Training: Managing Risks to the Welfare of Recruits in the British Armed Services: Two Years of Progress. Available from World Wide Web: <http://www.mod.uk/NR/rdonlyres/E82B3EE1-182B-47F6-8693-05AF88E6CF63/0/MODBettertrainingfull.pdf> [Accessed: 13 November, 2012].