DALLAS, June 9 -- The American Heart Association and the American College of Sports Medicine today announced a new health-screening tool to help fitness clubs keep their clients' interests at heart.
Gary J. Balady, M.D., reporting in an American Heart Association journal, says, "The association recognized that health clubs need a tool to help provide adequate evaluation and screening before individuals, especially those with heart disease, engage in moderate to vigorous levels of physical activity," he says.
"Many Americans are surviving their heart attacks and are being told by their doctors to exercise more. So there may be more individuals showing up at health clubs who have heart disease," says Balady, chairperson of the AHA's Committee on Exercise and Cardiac Rehabilitation, which helped develop the new statement. About one in four adult Americans has some form of cardiovascular disease, ranging from congenital conditions (those that occur since birth) to high blood pressure and atherosclerosis.
In addition, the fastest-growing segment of health club members is those over 34, an age when the risk of heart disease begins to rise, says Balady, professor of medicine at Boston University School of Medicine. About 20 million Americans already exercise at health/fitness facilities.
During exercise, people with heart disease are at a 10-times higher risk of having a heart-related problem, such as a heart attack, than people who are disease-free. "But you can't tell who has heart disease just by looking at people," says Balady.
The guidelines on screening, staffing and emergency policies are jointly published in Circulation: Journal of the American Heart Association and the American College of Sports Medicine (ACSM) journal Medicine and Science in Sports and Exercise.
The AHA, ACSM and the International Health, Racquet and Sports Clubs Association say the screening tool is a quick, effective test for a wide range of facilities. "It's a very simple screen," says Balady, who was the lead author of the AHA statement. "It takes two minutes to complete, if that."
In addition to a questionnaire, the AHA-ACSM guidelines include a chart for health clubs and their clients to ensure a good match. The chart divides health clubs into five levels, ranging from unsupervised to medically supervised. It divides clients into six levels based on heart disease risk factors and prior heart disease.
The guidelines cover emergency policies and provide sample forms for getting physician advice for clients who have cardiovascular-related conditions. "Sometimes health facilities will contact me and ask what restrictions I would like them to set for my patients," he says. "I like it when they do that. That's the mark of a good club."
Balady hopes the screening tool will be widely used by fitness centers to identify people who may need to be monitored more closely because of their increased risk of heart disease. Ideally, people interested in joining an exercise facility should ask whether it uses such a tool, he says. Enlightened self-interest may also spur its use, he says. "It's not only good care, but a good marketing strategy," says Balady. "It says this club is taking an interest in the member's medical problems.
"If you have heart problems and the club doesn't ask any questions when you sign up, it probably isn't the club for you," he says.
Yet a survey conducted of health facilities in Massachusetts found that efforts to provide a health screen to new members were limited and inconsistent. The two-page questionnaire asks clients to check off true statements from two categories: (1) medical history and symptoms and (2) cardiovascular risk factors. People who have had a heart attack, heart valve disease or similar conditions are told they should consult their physician before engaging in exercise and to consider using a facility with a medically qualified staff. The symptom list asks whether the client has chest discomfort with exertion, breathlessness, dizziness or fainting.
Anyone who checks off one item in the medical history and symptoms or two items on the risk factor list is encouraged to consult a doctor before starting an exercise program.
The risk factor section includes questions about whether an individual smokes and is over age 45 for males, or over 55 for females. The screening tool asks if the client has a father or brother who had a heart attack before age 55 or a mother or sister who had a heart attack before age 65. Other risk factors include: high blood pressure and physical inactivity -- defined as engaging in less than 30 minutes of physical activity three times a week.
A person who does not know his or her cholesterol level and blood pressure is also encouraged to consult a physician about heart disease risk. However, such a person should not be discouraged from participating in health club activities. "We don't want health clubs to exclude individuals just because they don't know their cholesterol levels, but the tool should serve as a reminder to have it checked out," says Balady. "Our purpose is not to set up barriers, but to bridge the gap between the physician, the patient and the health club."
The third section of the questionnaire is for people without a heart disease history, symptoms or risk factors. Those participants should be able to exercise safely.
If a client has known heart disease or refuses to fill out the questionnaire, the fitness center may exclude that person for safety purposes, to the extent permitted by law. Each facility may want to set up guidelines on limiting the use of certain facilities or deny use of the facility unless clients are willing to sign a waiver. The waiver would state that the clients would not hold the facility liable if they had a heart attack or stroke while exercising at the facility.
Because the health club industry, unlike hospital and medical centers, is not regulated, clubs are not forced by law to follow the recommendations in the statement, says Balady.
"But will health clubs that don't comply be liable if someone suffers a heart attack while exercising?" asks Balady. "We don't know, but the best thing for the facility is to do the screening. That would help ensure the safety of their clientele."
The statement doesn't insist that health clubs have in place automated external defibrillators -- portable devices used to restart hearts after a sudden heart attack (cardiac arrest).
"Since we don't know what the rate of heart attack emergencies are at health clubs and since most facilities will be able to access the city's emergency or 911 service, we have not recommended that health clubs install their own AEDs," says Balady.
"However, it's important for the health club staff to know what to do in an emergency, for example, to know to call 911 and how to perform cardiopulmonary resuscitation (CPR)," he says.
Balady's co-researchers include Bernard Chaitman, M.D.; David Driscoll, M.D.; Carl Foster, Ph.D.; Erika S. Froelicher, Ph.D., R.N.; Neil Gordon, M.D.; Russell Pate, Ph.D.; James Rippe, M.D.; and Terry Bazzarre, Ph.D.