Medical clearance

Medical clearance is a health care provider’s approval for a client to begin exercising or increase training intensity.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 131.} ACSM’s pre-participation screening process identifies who needs clearance before starting moderate- to vigorous-intensity exercise or increasing the intensity of a current program.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 131.}

The algorithm considers current exercise habits, known cardiovascular, metabolic or renal disease or its signs and symptoms, and intended exercise intensity.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 131.} ACSM defines a current exerciser as someone who has done planned activity of at least moderate intensity for 30 minutes or more on 3 or more days a week for the past 3 months.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 140.}

The provider decides what evaluation is needed, from a conversation to an electrocardiogram or imaging.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 141.} ACSM doesn’t recommend exercise testing as a routine part of clearance.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 131.}

In practice

• Screen every new client before exercise; the NSCA describes this as the standard of care, without exception.^{4Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 675.}
• When clearance is needed, wait for the signed form before starting training so you know what the physician considers acceptable.^{5International Personal Trainer Academy, Certified Personal Trainer Textbook, p. 120.}
• Ask for written clearance with any special instructions or restrictions, including intensity limits.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 141.}
• Continue watching for symptoms: a client who had none at intake can develop them later, changing the screening recommendation.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 141.}