Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a Nationally Representative Sample of US Adults Aged ≥40 Years From the National Health and Nutrition Examination Survey 2001 to 2004

Study Questions:

Is the American Heart Association (AHA)/American College of Sports Medicine (ACSM) Preparticipation Questionnaire (AAPQ) effective among adults ages ≥40 years?


Under the assumption that participants would respond to AAPQ items as they responded to a general health survey, the sex- and age-specific proportions of adult participants in the National Health and Nutrition Examination Survey 2001 to 2004, who would receive a recommendation for physician consultation based on AAPQ referral criteria, were calculated. Additionally, recommended AAPQ referrals to a similar assessment using the Physical Activity Readiness Questionnaire in the study sample were compared.


AAPQ referral proportions were higher with older age. Across all age groups ≥40 years, 95.5% (94.3% to 96.8%) of women and 93.5% (92.2% to 94.7%) of men in the United States would be advised to consult a physician before exercise. Prescription medication use and age were the most commonly selected items. When referral based on AAPQ was compared with that of the Physical Activity Readiness Questionnaire, the two screening tools produced similar results for 72.4% of respondents.


These results suggest that >90% of US adults ages ≥40 years would receive a recommendation for physician consultation by the AAPQ. Excessive referral may present an unnecessary barrier to exercise adoption, as well as stress the health care infrastructure.


In an attempt to prevent physical activity-associated cardiac events, a self-administered health questionnaire (self-screening) is a common preparticipation screening method intended to identify people with cardiovascular symptoms or risks who might benefit from physician consultation prior to initiating or increasing the intensity of physical activity. Using data from an existing health and nutrition survey and extrapolating responses to the AHA/ACSM preparticipation questionnaire, this study suggests that essentially all people ≥40 years of age in the United States would be advised to seek physician consultation prior to initiation of moderate or vigorous physical exercise. Excessive medical referrals probably do not benefit most patients undergoing screening, and could paradoxically serve to deter habitual physical exercise among patients who would benefit from it.

Keywords: Drug Prescriptions, Sulfides, Cardiovascular Diseases, Motor Activity, Sports Medicine, Nutrition Surveys, United States, Mental Disorders

< Back to Listings