Contraindication

A contraindication is a condition or circumstance that rules out exercise or requires a physician’s medical clearance before a client starts.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 675.} It can also rule out a particular exercise for a client who can otherwise train.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 566.}

Pre-participation screening identifies concerns such as cardiovascular, pulmonary or metabolic disease, musculoskeletal problems and other conditions that put the client at higher than normal risk.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 675.} ACSM divides contraindications to a maximal exercise test into absolute and relative categories.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 284.} Absolute contraindications include a heart attack within the past 2 days and ongoing unstable angina; resting systolic pressure above 200 mmHg or diastolic pressure above 110 mmHg is a relative contraindication.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 284.}

In practice

• Distinguish a contraindication to exercise from a contraindicated exercise: for clients with hypertension, a prolonged Valsalva maneuver (longer than 2 seconds) is contraindicated, yet vigorous intensity is not.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 566.}
• Osteoporosis isn’t a contraindication to exercise.^{4International Personal Trainer Academy, Certified Personal Trainer Textbook, p. 444.} Spinal flexion, twisting of the neck and spine, and high-impact loading such as jumping are movements to avoid.^{5International Personal Trainer Academy, Certified Personal Trainer Textbook, p. 443.}
• Most pregnant clients can exercise, and few maternal medical conditions make aerobic exercise absolutely contraindicated.^{6American College of Obstetricians and Gynecologists, Physical Activity and Exercise During Pregnancy and the Postpartum Period, p. 2.} Questions about safety go to the client’s obstetric care provider.^{6American College of Obstetricians and Gynecologists, Physical Activity and Exercise During Pregnancy and the Postpartum Period, p. 2.}
• Before programming for a client with a cardiovascular or respiratory condition, collect their health history, current symptoms, medications and any absolute or relative contraindications.^{7Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 576.}