Physical activity comes with risks. Athletes may get injured. Some may have conditions or lifestyles that make participating riskier, and others may take risks by taking performance-enhancing drugs.
ischaemic heart disease. The latter study questioned the
ability of screening methods to identify those who were at
risk because of exercise. The investigation included ‘self-
administered procedures’, ‘clinical examination’ and ‘lab-
oratory procedures’ (Shephard, 1984). Shephard (1984)
stated that the PARQ was ‘reasonably successful in
predicting undesirable acute outcomes to exercise’.
Flaws in the PARQ had been highlighted (Shephard et al.,
1981; Shephard, 1988) but little was done to address these
concerns until Cardinal et al. (1996) attempted to ‘improve
the PARQ’s specificity without unduly sacrificing its
sensitivity’ by altering the wording to clarify the questions.
These alterations achieved the desired results as far as they
reduced needless exclusion from exercise participation
(Cardinal et al., 1996).
Currently, the Revised Physical Activity Readiness
Questionnaire (rPARQ) is recommended as the bare
minimum medical screening tool, by the American College
of Sports Medicine (ACSM), for those starting ‘low –
moderate intensity exercise’ (ACSM, 1997, 1998). Heyward
(1991) identified the PARQ as a general pre-exercise
screening tool. However, there are no viable alternatives
to the PARQ and rPARQ except specialist forms such as the
RISKO Coronary Heart Disease Risk Appraisal (McArdle
et al., 1981).
The pre-exercise screening questionnaires are often
employed alongside additional lifestyle questionnaires that
attempt to gain a broader picture of a client’s lifestyle,
habits and exercise limitations. This study evaluated the
effectiveness of a variety of pre-exercise screening tools,
singularly and in combination, in an applied setting.
2. Methodology
The subjects were new and existing clients using, or
intending to use, the fitness suite at a leisure centre in South
Wiltshire. The size of the group ðn¼50Þwas dictated by
the number of volunteers who met the inclusion criteria of
the questionnaires used (i.e. aged between 16 and 69 years
old). The age characteristics of the group presented a mean
value of 36.06 years with a standard deviation of 13.32
years. In addition, 54% of the sample were male, 46%
female and 96% ‘White European’ while the remaining 4%
were ‘Other’ (e.g. West Indian and South African).
Each subject was asked if he/she would mind taking part
in the study. Participants were escorted into the centre’s
induction room where they completed the questionnaires
and were interviewed. The data collection was carried out
throughout the autumn of 1999 and the spring of 2000. Any
subject found to be unsuitable for exercise, because of a
positive rPARQ or high blood pressure, was referred to their
doctor (as per normal practice at the leisure centre).
Due to the lack of ECG equipment availability, the
decision was taken to make use of the RISKO coronary
heart disease appraisal questionnaire, which looks at an
individual’s coronary heart disease risk factors (McArdle
et al., 1981). These results could then be compared with the
findings of the other two questionnaires.
The subjects received the three questionnaires in
chronological order with the original PARQ first, followed
by the rPARQ, the RISKO coronary heart disease appraisal
form and finally the subject interview. The decision to
present the questionnaires in this order was made because it
was felt that the rewording of the PARQ may have biased
the subjects’ responses and this order represented the stages
of development. All subjects were given the same scripted
instructions before completing each questionnaire. The
debriefing interviews were conducted in a less formal,
unscripted manner than the previous stages.
Notes of each subject’s comments were recorded, which
was compared with the information obtained using the
questionnaires (PARQ, rPARQ and RISKO forms). The
interview also gave the researcher the opportunity to gain
clarification concerning subject responses, obtain infor-
mation (e.g. when subjects failed to understand a question)
and to answer any questions that arose. It also gave the
subjects the opportunity to pass comment and make
criticisms concerning the questionnaires.
The blood pressure of each subject was taken using a
mercury sphygmomanometer and stethoscope on the left
arm, following ACSM guidelines (ACSM, 1995). This was
chosen as a simple indicator of the subject’s health and to
corroborate responses given in the questionnaires. Follow-
ing ACSM guidelines, the blood pressure level at which a
subject was excluded from exercise was set at 160/100, with
contraindication occurring if either observed figure was
higher than these limits (ACSM, 1995).
The statistical element of the study consisted of
comparisons between the numbers of subjects excluded by
the screening methods using Chi-squared. Results were
analysed in order to make comparisons with the results from
other studies, and between the methods employed. The 5%
level of significance was selected as the minimum
acceptable level of probability. The Yates correction was
employed during the statistical analyses due to the small
sample size, relative to the United Kingdom population.
3. Results
All 50 subjects completed the PARQ and the rPARQ. As
hypothesised and observed by Cardinal et al. (1996), the
PARQ excluded more subjects than the rPARQ. Table 1
shows the rate of subject inclusion/exclusion found between
the PARQ and the rPARQ in this study.
Statistical analysis of the PARQ and rPARQ was carried
out. Both were found to include significantly more than they
excluded. However, the critical value for chi-squared was
lower ð
x
2ðdf ¼1Þ¼3:94;P,0:05Þfor the PARQ than
that observed for the rPARQ ð
x
2ðdf ¼1Þ¼6:50;P,
0:05Þ:When the PARQ and rPARQ were compared,
R.A. Humphrey, J. Lakomy / Physical Therapy in Sport 4 (2003) 187–191188