Lesson 1 · Exercise assessment and prescription
Screening before you train: pre-exercise questionnaires
A 42-year-old signs up at a gym, fills in a one-page form, and is on a treadmill twelve minutes later. That form is the only thing standing between a safe session and a medical emergency. This lesson is about what the form is for, what it can and cannot detect, and what a fitness professional is obliged to do with the answers.
Exercise reduces the risk of almost every major chronic disease. So why would a fitness professional ever make someone answer health questions before letting them start?
Write down two reasons before you read on. Then add one thing you think a short questionnaire could not possibly pick up.
- Explain why pre-exercise screening exists, in terms of risk, duty of care and personalised prescription.
- Describe the stages of a pre-exercise screening system and what each stage is designed to find.
- Identify when APSS Stage 1 advises professional guidance before exercise, and explain how Stage 2 findings inform prescription.
- Explain the limits of a questionnaire, and why screening is a filter rather than a diagnosis.
- Justify how screening information feeds into the design of an individual training program.
- Pre-exercise screening — a structured process for identifying people for whom exercise carries an unusual risk, before they begin.
- APSS — the Adult Pre-Exercise Screening System, the standard Australian tool, developed jointly by Exercise and Sports Science Australia, Fitness Australia and Sports Medicine Australia.
- Contraindication — a sign, symptom or condition that makes a particular activity inadvisable or unsafe.
- Stage 2 risk-factor assessment — information reviewed with an exercise professional to inform prescription and whether further medical advice may be needed.
- Referral — directing a participant to a medical practitioner or accredited exercise physiologist because their needs fall outside the professional's scope of practice.
- Scope of practice — the boundary of what a given professional is qualified and permitted to do.
The apparent contradiction resolves once you separate population risk from individual risk. Across a population, regular physical activity lowers the risk of cardiovascular disease, type 2 diabetes, several cancers and depression. For the individual standing in front of you, the risk of a serious adverse event during a single bout of vigorous exercise is briefly raised, and it is concentrated almost entirely in people with undiagnosed cardiovascular disease.
Screening exists to find that small group before they are asked to work hard. It serves three purposes at once:
- Safety. Identify conditions and symptoms that make unsupervised or vigorous exercise unsafe right now.
- Duty of care. A fitness professional has a legal and ethical obligation to take reasonable steps to avoid foreseeable harm. A documented screen is the evidence that those steps were taken.
- Personalisation. The same answers that flag risk also describe the participant, their history, medications, injuries, goals and starting point. That is the raw material for an individualised program.
Screening does not exist because exercise is dangerous. It exists because the benefits of exercise are spread across everyone, while the acute risks are concentrated in a few, and a short structured form is the cheapest reliable way to find the few.
Quick check: Which statement best explains why pre-exercise screening is justified even though physical activity reduces chronic disease risk?
A pre-exercise questionnaire is a short, standardised set of self-reported questions completed before a participant's first session. In Australia the standard instrument is the Adult Pre-Exercise Screening System, usually shortened to APSS. Internationally you will also meet the PAR-Q+, the Physical Activity Readiness Questionnaire for Everyone.
The current Australian Adult Pre-Exercise Screening System (APSS) has two stages. Stage 1 is compulsory for everyone. Stage 2 is recommended and is completed with an exercise professional to help shape an appropriate prescription. The stages identify when guidance is needed and how exercise may be tailored; they do not assign everyone a fixed low, moderate or high risk category.
| Stage | Who completes it | What it is looking for | Typical outcome |
|---|---|---|---|
| Stage 1 Compulsory |
Every participant; questions 1–6 may be self-administered and self-evaluated | Known heart disease or stroke; unexplained chest discomfort; faintness, dizziness or loss of balance during activity; a recent asthma attack needing immediate medical attention; difficulty controlling diabetes; or another condition needing special consideration | Any YES to questions 1–6: seek guidance from an appropriate allied health professional or medical practitioner before exercise. If all are NO, answer question 7 about weekly weighted activity |
| Stage 2 Recommended |
Completed with an exercise professional after Stage 1 | Established risk factors and other conditions, including age, family history, smoking, body composition, blood pressure, lipids, glucose, medication, recent hospital admission, pregnancy and musculoskeletal problems | Informs exercise prescription. For significant or multiple risk factors, the professional uses judgement about whether further medical advice is needed |
Source: ESSA's APSS resource page, with the APSS User Guide V2 (2019). The APSS is a screening aid, not a diagnosis or a guarantee of safety.
Notice the logic: Stage 1 is compulsory and asks about known conditions, symptoms and activity levels. If all answers to questions 1–6 are No, question 7 uses weighted physical activity to guide a starting recommendation: weighted minutes are light plus moderate minutes plus twice the vigorous/high minutes. Below 150 minutes per week, the APSS recommends light-to-moderate activity with gradual increases; at least 150 minutes, continue current activity levels. Stage 2 is recommended and is completed with an exercise professional, who uses risk-factor information to tailor the prescription and applies professional judgement when deciding whether further medical advice is needed.
Stage 1 provides the compulsory screen and activity recommendation. Stage 2 adds a recommended exercise-professional review so risk factors and other conditions can inform the prescription; significant or multiple factors call for judgement about further medical advice.
True or false: Stage 2 of the APSS is recommended, is completed with an exercise professional, and informs the participant's exercise prescription.
A screening tool is only useful if the professional acts on it. The APSS distinguishes Stage 1 answers that call for guidance before exercise from Stage 2 information that helps shape a prescription and may call for further advice.
Stage 1: when the APSS advises guidance
If a participant answers YES to any of Stage 1 questions 1–6, the APSS advises them to seek guidance from an appropriate allied health professional or medical practitioner before exercise. The questions cover known heart disease or stroke, unexplained chest discomfort, faintness or dizziness during activity, a recent asthma attack needing immediate medical attention, difficulty controlling diabetes, and other conditions needing special consideration.
Seeking guidance is not a diagnosis or a guarantee of safety. It recognises that an exercise professional must work within their scope: an appropriate health professional can advise on the participant's needs before exercise begins.
Stage 2 is different. The exercise professional reviews established risk factors and other conditions to inform the program. Significant or multiple Stage 2 factors do not produce an automatic referral or a fixed risk category; the professional uses judgement about whether further medical advice is needed. The resulting prescription can adjust starting intensity, progression and supervision.
Stage 1 answers that call for guidance should be acted on before exercise. Stage 2 informs the prescription, with professional judgement guiding whether significant or multiple factors need further medical advice.
Fill the gaps. A fitness professional is not qualified to a condition. Directing the participant to a medical practitioner instead is called .
An examiner asking you to explain the importance of screening is also inviting you to be precise about its limits. A questionnaire is a filter, not a diagnosis, and it has three well-understood weaknesses.
- It relies on self-report. The participant may not know they have a condition, may not remember it, or may understate symptoms because they want to train.
- It cannot detect asymptomatic disease. The very group screening most wants to find, people with undiagnosed cardiovascular disease and no symptoms yet, are the group a questionnaire is least able to see.
- It is a snapshot. Health status changes. A screen completed eighteen months ago describes a person who no longer exists in that form, which is why re-screening at intervals, and after any injury, illness or pregnancy, is part of the system.
None of this makes screening pointless. It makes screening the first step in a chain that continues with ongoing monitoring, participant education about warning signs, and a professional who keeps watching during the session.
Two truths and a lie. One of these statements about pre-exercise screening is false. Find it.
The inquiry question for this part of the course asks how exercise assessment and prescription can be personalised. Screening is where personalisation starts, because it is the first structured information you have about the individual.
Follow the APSS pathway through an example. A participant answers No to Stage 1 questions 1–6 and records fewer than 150 weighted activity minutes in question 7. The APSS recommends light-to-moderate activity with gradual increases. In the recommended Stage 2 review, the exercise professional considers the participant's health history, medications, current activity and goals when setting the starting load, progression and supervision. Significant or multiple factors call for professional judgement about whether further medical advice is needed.
Screening is not a gate that people pass through and forget. It is the first structured information used to decide whether guidance is needed and to build an individual program.
Use each part for its stated purpose: follow Stage 1 guidance, apply the question 7 activity recommendation, and use Stage 2 information with professional judgement to tailor the exercise prescription.
Text description
- Everyone completes compulsory Stage 1 questions 1–6. A YES to any of them advises the participant to seek guidance from an appropriate allied health professional or medical practitioner before exercise.
- If all six answers are NO, question 7 uses weighted weekly activity to guide a starting recommendation: below 150 minutes per week, light-to-moderate activity with gradual increases; at least 150 minutes, continue current activity levels.
- Recommended Stage 2 is reviewed with an exercise professional and informs the prescription. Significant or multiple factors require professional judgement about whether further medical advice is needed. The APSS does not assign fixed low, moderate or high risk categories.
Activities · apply the screening logic
For each participant, identify any Stage 1 YES and follow the APSS advice. If Stage 1 questions 1–6 are all No, explain how question 7 and Stage 2 inform the starting prescription. Where Stage 2 factors are significant or multiple, state what professional judgement is needed about further medical advice.
A 55-year-old reports tightness in the chest when climbing two flights of stairs, first noticed last month. No diagnosis.
A 19-year-old has a fully healed ankle sprain from two years ago, no current symptoms or other condition needing special consideration, and wants to start a running program.
A 38-year-old with type 2 diabetes whose blood glucose has been unstable for several weeks and who has not seen a doctor about it.
A 44-year-old answers No to Stage 1 questions 1–6, smokes, records fewer than 150 weighted activity minutes per week, and says their father had a heart attack at 52.
Match each term to its meaning.
- Contraindication
- Stage 2 risk-factor assessment
- Scope of practice
- Referral
- A sign or condition that makes an activity inadvisable or unsafe
- Reviewing risk factors with an exercise professional to inform prescription and whether further medical advice may be needed
- The boundary of what a professional is qualified and permitted to do
- Directing a participant to a medical practitioner or exercise physiologist
A 60-year-old answers No to APSS Stage 1 questions 1–6 and reports fewer than 150 weighted activity minutes per week in question 7. In the recommended Stage 2 review with an exercise professional, they report a fully recovered knee replacement from four years ago, blood-pressure medication, no current symptoms, and a goal of walking a ten-kilometre charity event in six months.
Identify what the APSS can recommend from the Stage 1 and question 7 responses, then explain how the Stage 2 information should shape the first four weeks of the program. Do not assign a fixed risk category; state when professional judgement may call for further medical advice.
Lock it in. In one sentence, state the single strongest reason a fitness professional should not skip pre-exercise screening for a client who “looks fit”.
Explain the importance of pre-exercise questionnaires and health screening conducted by exercise and fitness professionals.
Explain asks for cause and effect. Describing what a screening form contains is not an answer; the marks are for what screening prevents and how.
Plan: name the principle, build linked pairs showing what screening changes, then answer the question directly.
Exercise imposes an acute physiological load on the cardiovascular, respiratory and musculoskeletal systems. Screening identifies, before that load is applied, whether an individual carries a condition that makes the load unsafe or that requires the program to be modified — so it converts an unknown risk into a managed one.
The APSS Stage 1 questions identify known conditions and symptoms that call for guidance before exercise. Stage 2 then reviews risk factors and other conditions with an exercise professional, who can tailor the prescription and use judgement about further medical advice when factors are significant or multiple.
Screening also establishes baseline fitness, activity history and current medications, so intensity can be prescribed from where the person actually is rather than from an assumption, which reduces the risk of musculoskeletal injury from a load their tissues are not conditioned to absorb.
Because the exercise professional prescribes the load, they carry a duty of care for its consequences, so documented screening establishes both that the risk was assessed and what it was assessed to be, which protects the client from foreseeable harm and the professional from liability for a risk they could not have known.
Screening additionally serves participation rather than only safety: identifying a condition allows the program to be adapted so the person can train, whereas without screening the same condition may be discovered through an adverse event that ends their participation altogether.
Exercise imposes an acute physiological load on the cardiovascular, respiratory and musculoskeletal systems, and screening helps a professional identify what needs guidance or modification before that load is applied. In the APSS, a YES to any of Stage 1 questions 1–6 advises the participant to seek guidance from an appropriate allied health professional or medical practitioner before exercise. If all six answers are NO, question 7 uses weighted weekly activity to guide a starting recommendation. The recommended Stage 2 review is completed with an exercise professional; significant or multiple factors call for professional judgement about whether further medical advice is needed. Screening also establishes activity history and other personal information, so intensity is prescribed from where the person actually is rather than from an assumption, reducing the risk of a load their tissues are not conditioned to absorb. Because the exercise professional prescribes that load they carry a duty of care for its consequences, so documented screening establishes both that the information was assessed and how it informed the plan. Screening finally serves participation as well as safety, since identifying a need for guidance or an adaptation allows exercise to be tailored rather than universally restricted.
Justify why an exercise professional should act on APSS Stage 1 answers and use professional judgement when Stage 2 identifies significant or multiple factors.
Justify asks you to argue for the requirement with supporting evidence, and to meet the obvious objection rather than ignore it.
Plan: state the position, give the strongest reasons in order, deal with the objection, then restate the position as established.
The exercise professional should follow the APSS advice when a participant answers YES to any of Stage 1 questions 1–6: seek guidance from an appropriate allied health professional or medical practitioner before exercise. Stage 2 is different; significant or multiple risk factors call for the professional's judgement about whether further medical advice is needed, rather than an automatic referral.
Stage 1 asks about known conditions and symptoms associated with a higher chance of an adverse event. Following its guidance before exercise keeps the fitness professional within scope and gives the participant a chance to discuss their situation with an appropriate health professional.
The recommended Stage 2 review considers established risk factors and other conditions with an exercise professional. It helps tailor exercise type, intensity and progression; significant or multiple factors call for professional judgement about further medical advice.
A blanket requirement for medical clearance could create an unnecessary barrier to activity. The APSS avoids that rule: it gives specific Stage 1 guidance and leaves further advice for significant or multiple Stage 2 factors to the exercise professional's judgement. This keeps the response proportionate to the information collected.
An exercise professional should follow the APSS advice when a participant answers YES to any of Stage 1 questions 1–6 and advise them to seek guidance from an appropriate allied health professional or medical practitioner before exercise. This is a screening response, not a diagnosis or a guarantee of safety. If all six answers are NO, question 7 uses weighted activity to guide a starting recommendation. The recommended Stage 2 review is completed with an exercise professional and informs the exercise prescription; if its risk factors are significant or multiple, the professional uses judgement about whether further medical advice is needed. A blanket clearance rule could deter people from activity, while ignoring Stage 1 guidance or treating multiple Stage 2 factors as automatically harmless would also be unsafe. The APSS offers a proportionate response: follow its Stage 1 advice, use Stage 2 to tailor the program, and apply professional judgement where the findings warrant further advice.
Go back to what you wrote in card 01. Did you name safety, duty of care and personalisation? And was the thing you said a form could not detect the same as the one this lesson identified, asymptomatic disease?
Multiple choice · 5 questions
MC 1. The primary purpose of the compulsory Stage 1 questions in the Adult Pre-Exercise Screening System is to identify:
- A. every risk factor a participant carries
- B. known disease and current symptoms for which the APSS advises professional guidance before exercise
- C. a participant's maximal aerobic capacity
- D. the participant's preferred training methods
MC 2. A participant reports dizziness on exertion. The most appropriate action for a fitness professional is to:
- A. begin a light program and monitor closely
- B. diagnose the likely cause and adjust intensity
- C. advise the participant to seek guidance from an appropriate health professional before exercise
- D. proceed as normal because dizziness is common in beginners
MC 3. Which of the following is the clearest limitation of a self-report pre-exercise questionnaire?
- A. It takes too long for most participants to complete
- B. It cannot reliably detect disease in people who have no symptoms
- C. It is not accepted by Australian fitness organisations
- D. It measures blood pressure inaccurately
MC 4. A participant answers No to APSS Stage 1 questions 1–6. During the recommended Stage 2 review, they report a well-managed condition and no current symptoms. The information should mainly be used to:
- A. prevent the participant from exercising
- B. modify the prescription, including intensity, progression and supervision
- C. record the session for insurance purposes only
- D. decide whether the participant should change gyms
MC 5. Re-screening participants at intervals is necessary primarily because:
- A. questionnaires expire after a fixed legal period
- B. participants tend to forget their original answers
- C. health status changes over time, so a screen is only a snapshot
- D. it increases the amount of data a gym can collect
Short answer · exam style
SA 1. Understand Band 4 Explain two reasons why exercise and fitness professionals use a pre-exercise questionnaire before a participant's first session. (4 marks)
SA 2. Analyse Band 5 A 48-year-old joins a gym. They answer No to APSS Stage 1 questions 1–6 and report fewer than 150 weighted activity minutes per week in question 7. In the recommended Stage 2 review, they report smoking and a family history of heart disease before age 55. Describe how the APSS information should influence the screening response and the design of their first month of training. (5 marks)
SA 3. Evaluate Band 6 “A pre-exercise questionnaire makes exercise safe.” To what extent do you agree? Justify your answer with reference to both the importance and the limitations of screening. (6 marks)
📖 Comprehensive answers (click to reveal)
Multiple choice: 1 → B. 2 → C. 3 → B. 4 → B. 5 → C.
Activity 1: 1 → A YES to Stage 1 question 2 advises guidance from an appropriate allied health professional or medical practitioner before exercise. 2 → With no current problem or condition needing special consideration, the healed ankle does not itself create a Stage 1 YES; question 7 and the person's current activity guide their starting level. 3 → Difficulty controlling diabetes is a Stage 1 question 5 YES, so the participant should seek guidance before exercise. 4 → The six Stage 1 answers are No, and question 7 recommends light-to-moderate activity with gradual increases because weighted activity is below 150 minutes. Stage 2 reviews smoking and premature family history with an exercise professional; because factors are multiple, the professional uses judgement about further medical advice. Do not assign an automatic risk category or referral outcome.
SA 1 (4 marks): Two reasons, each explained rather than named [2 + 2]. Acceptable reasons: identifying a Stage 1 response for which the APSS advises guidance before exercise [2]; meeting a duty of care by taking documented, reasonable steps to avoid foreseeable harm [2]; gathering the individual history, medications and baseline needed to personalise the program [2]. A response that names two reasons without explaining the mechanism earns half marks.
SA 2 (5 marks): Stage 1 questions 1–6 are all No, so the participant proceeds to question 7 [1]. With fewer than 150 weighted activity minutes, the APSS recommends light-to-moderate activity and gradual increases [1]. Stage 2 is reviewed with an exercise professional; smoking and premature family history are multiple factors, so the professional uses judgement about whether further medical advice is needed, rather than assigning a fixed risk band or automatic referral [1]. The first month should start at light-to-moderate intensity, progress gradually and monitor for symptoms [1]. Include education about warning signs and re-screening as health or activity changes [1].
SA 3 (6 marks): A sustained judgement is required, not a list. Agree in part [1]. Importance: Stage 1 identifies answers for which the APSS advises guidance before exercise, while Stage 2 informs prescription and may prompt further advice through professional judgement; screening also supports duty of care and personalisation [2]. Limitations: it depends on self-report and so is vulnerable to poor recall or deliberate understatement; it cannot detect asymptomatic disease, which is precisely the group of greatest concern; it is a snapshot of a changing health status [2]. Judgement: screening substantially reduces risk and is a necessary first step, but it cannot make exercise safe on its own, and must be combined with ongoing monitoring, participant education and re-screening [1]. A response that only praises screening cannot reach the top band.
Use the Practice phase and model answers to consolidate the APSS pathway: follow Stage 1 guidance, apply the weighted activity recommendation, then use Stage 2 information with professional judgement to inform an individual prescription.
Re-read your answers in the Practice phase against the model answers. Then summarise how Stage 1 guidance, question 7's activity recommendation and the Stage 2 review inform an individual program, and state one thing a questionnaire cannot tell you.
Mark lesson as complete
Tick when you've finished the practice and review.