What is risk classification and how does it work?
Purpose and Process
The purpose of performing a pre-participation screening is to become informed about the presence or absence of disease (cardiovascular, pulmonary, renal or metabolic), identify individuals with medical contraindications who should be excluded from exercise until the condition is resolved or under control, detect at-risk individuals who should first undergo a medical evaluation and clinical testing before becoming more physically active, and to identify individuals who should participate in medically supervised programs.
The process of conducting a risk classification involves gathering and reviewing health information, medical history and lifestyle habits in order to classify clients into one of three categories:
- Low risk (0-1 points or risk factors)
- Moderate risk (2-8 points or risk factors)
- High risk?based on the presence of these known diseases:
It is important to understand that the total number of positive risk factors is not used to determine high risk. High risk is only determined if symptoms or known diseases are present. The number of total positive risk factors is only used to determine whether a client is at low or moderate risk. For example, even if a client has all 8 positive risk factors but is asymptomatic he or she would be classified as only moderate risk.
Commonly Misunderstood Positive Risk Factors
There are several commonly misunderstood positive risk factors, for instance the defining criteria for family history. Remember, with family history you need to know the age at which the first degree male or female relative was diagnosed and if he or she specifically had a myocardial infarction (heart attack), coronary revascularization (bypass), or died suddenly. A first degree relative is a parent, sibling or child and you are looking at the conditions mentioned above and no others. Take, for example, a client who tells you that his father is 53 years old, has diabetes and obesity, smokes, is sedentary, and has hypertension and dyslipidemia. Even though the father’s health status is poor, the father did not have a heart attack or bypass surgery, nor did he die before age 55, so your client would not get a +1 for this category.
Another risk factor that causes confusion is dyslipidemia. For this condition, remember to use the total serum cholesterol level (≥200 mg/dl) only if you do not know the specific HDL and LDL values. If the LDL and HDL values are present, determine if the client gets a +1 in this category based on the HDL (<40) and LDL (≥130) scores and not the total serum cholesterol level. In other words, only use the total serum cholesterol if that is all that is available.
Once the number of total positive risk factors and the presence or absence of disease or symptoms have been determined, a client can be classified in a risk level using the total number of positive risk factors to determine low or moderate risk and the presence or absence of disease or symptoms of disease to determine high risk. If a client is considered low risk (< 2 risk factors), he or she is ready to get started with an exercise program. If a client is moderate risk (≥2), he or she is ready to begin a low- to moderate-intensity exercise program, but would need a medical exam prior to performing vigorous exercise. If a client is in the high risk category (symptomatic, or known cardiovascular, pulmonary, renal, or metabolic disease) he or she would need a medical exam before initiating any level of physical activity.
The risk classification system is not meant to be a barrier to becoming more physically active, but is designed to ensure it is safe and appropriate for new clients to begin an exercise program. The best way to learn more about risk classification is to practice classifying both real and fictitious clients.