Pre-Exercise Screening (Chapter 1)/Informed Consent and Waiver Form

1. Pre-Exercise Screening (Chapter 1)/Informed Consent and Waiver Form PE 254

2. Prior to Starting an Exercise Program Evaluate the health status of each client, especially sedentary individuals. Identify any existing medical conditions or risk factors.

3. Pre-participation Health Screening The American College of Sports Medicine (ACSM) recommends: • Identifying and excluding individuals with medical contraindications (i.e. risk factors) to exercise. • Identify individuals at risk for disease because of age, symptoms, and/or risk factors who should undergo a medical evaluation and exercise testing before starting an exercise program.

4. Pre-participation Health Screening The American College of Sports Medicine (ACSM) recommends (continues): • Identify individuals with clinically significant disease who should participate in a medically supervised exercise program. • Identify individuals with other special needs.

5. Health Evaluation Purpose: To detect the presence of disease and to assess the initial disease risk classification of your clients.

6. Components of a Comprehensive Health Evaluation

7. PAR-Q: “Pre-Exercise” Questions • Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor? • Do you feel pain in your chest when you do physical activity? • In the past month, have you had chest pain when you were not doing physical activity? • Do you lose your balance because of dizziness or do you ever lose consciousness? • Do you have a bone or joint problem that could be made worse by a change in your physical activity? • Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? • Do you know of any other reason why you should not do physical activity?

8. PAR-Q & You http://uwfitness.uwaterloo.ca/PDF/par-q.pdf

9. Example of Risk Factors Family history (e.g., heart attack, stroke, hypertension) Cigarette smoking Hypertension Hypercholesterolemia Diabetes Obesity Sedentary lifestyle

10. ACSM Risk Stratification Categories • Low risk: Men <45 years of age and women <55 years of age who are without symptoms and meet no more than one risk factor threshold. • Moderate risk: Men ≥45 years and women ≥55 years or those who meet the threshold for two or more risk factors. • High risk: Individuals with one or more signs and symptoms or known cardiovascular, pulmonary, or metabolic disease.

11. Procedures for Comprehensive Pretest Health Screening

12. Exercise Intensity ACSM recommends: • Moderate exercise: Activities that are approximately 3 to 6 metabolic equivalents (METs) or the equivalent of brisk walking at 3 to 4 mph for healthy adults. • Vigorous exercise: Activities requiring energy expenditure of >6 METs such >60% maximal oxygen uptake.

13. Health-Related Components of Physical Fitness • Health-related fitness = physical capacities that contribute to health • Five components: 1. Cardiorespiratory endurance = the ability of the body to perform prolonged, large-muscle, dynamic exercise at moderate-to-high levels of intensity

14. Health-Related Components of Physical Fitness 2. Muscular strength = the amount of force a muscle can produce with a single maximum effort 3. Muscular endurance = the ability of a muscle or group of muscles to remain contracted or to contract repeatedly 4. Flexibility = the range of motion in a joint or group of joints

15. Health-Related Components of Physical Fitness 5. Body composition = the proportion of fat and fat-free mass (muscle, bone, and water) in the body

16. Informed Consent/Waiver PE 254

17. Informed Consent • Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of an action. The individual needs to be in possession of relevant facts and also of his reasoning faculties, such as not being mentally retarded or mentally ill and without an impairment of judgment at the time of consenting. Such impairments might include illness, intoxication, insufficient sleep, and other health problems.

18. Informed Consent • All clients should read and sign an informed consent before being tested. • The consent should explain the purpose and process of the testing and include a statement of the potential for benefits, discomfort, pain or even death associated with its implementation.

19. Informed Consent • Informed consent should include a statement that results will remain confidential and that participation is strictly voluntary. • Test administrators should obtain signed inform consent forms from every person who enters your programs and before every test you administer.

20. Samples of Informed Consent Forms • http://www.stanford.edu/group/ncpi/unspecified/student_assess_toolkit/pdf/sampleinformedconsent.pdf • http://www.crouse.org/MedicalAffairs/IRB/ChildConsentForm.pdf • http://srp.missouristate.edu/assets/orc/SAMPLE_CONSENT_FORM.pdf

21. Waiver • A waiver, also called a prospective release, is a contract between two parties (e.g., health/fitness facilities and their participants).

22. Waiver • A good waiver should clearly and specifically use the word “negligence” in the exculpatory (clear from guilt) clause. • Always consult an attorney in the state that you will be practicing (Cotton & Cotton, Legal Aspects of Waivers in Sport).

23. Waiver • A contractual waiver must include: • Agreement: Fitness facility offers to enter into a legal agreement and the other party agrees. • Consideration: The member agrees to give up their right (the waiver) negligence claim against the facility in exchange for receiving certain services (the promise). • Contractual capacity: Both parties must have the legal capacity to contract—those who do not have the legal capacity should not be allowed to sign waivers. • Legality: The waiver must not go against matters that are considered unlawful or against public policy.

24. Waiver • A waiver must be conspicuous. • A waiver must be signed at the time of contract signing.

25. 10 Tips for Analyzing a Waiver • Make the waiver conspicuous. • Make sure the consideration requirements for a contract is adequately stated. • Exculpatory clause should be bold and conspicuous and include the words “ordinary negligence.” • Wording should be broad to cover all types of situations. • Duration of the waiver should be clear (“present and future claims”)

26. 10 Tips for Analyzing a Waiver • All parties clearly listed in the waiver. • Clause should cover inherent risk of activity as well as any specific risk associated with participation. • Maybe include an indemnification (i.e. compensation or reparation) clause which will require the person who signed to reimburse for losses due to a lawsuit. • Severability clause will insure that even if part of the waiver is considered invalid, the rest is still valid. Rather than having the court throw out the entire waiver. • Must include that the individual is of legal age. Place this statement just about the signature.

27. Proper Administering of the Waiver • Explain verbally, honestly, and clearly. • Participant should have adequate time to read the waiver and should be asked verbally if they read and understood the waiver. Verify age and identification. • Read the waiver to the participant who cannot read it. • Retain waivers for a certain period of time (based on state law). • Preserve the waiver so it can be quickly and easily accessible.

28. Samples of Waiver Forms • http://www.snowiasa.org/guidelines-resources/waiver-sample.pdf • http://www.sadlersports.com/riskmanagement/sports-insurance-waiverminor.html • http://www.snowmobile.org/docs/Take_A_Friend_Snowmobiling_Week%20_Sample_Waiver_Form_2009.pdf

29. Group Activities • Group 1: Administering a Fitness Gram Test (e.g., one-mile run, sit-ups, and push-ups) on adults (ages 30 to 45) for a research study on a college campus. • Group 2: Administering an agility test (e.g., shuttle run) on college students (ages 18 to 35) for a research study at the campus fitness center. • Group 3: Administering a gait and balance tests on older adults (ages 65 or older) for a research study at L.A. Fitness. • Group 4: Administering a flexibility test (e.g., sit-and-reach) on older adults (ages 65 or older) for a research study at a retirement housing center.