Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities.

The message from the nation’s scientists is clear, unequivocal, and unified: physical inactivity is a risk factor for cardiovascular disease,1 2 and its prevalence is an important public health issue. New scientific knowledge based on epidemiological observational studies, cohort studies, controlled trials, and basic research has led to an unprecedented focus on physical activity and exercise. The promotion of physical activity is at the top of our national public health agenda, as seen in the publication of the 1996 report of the US Surgeon General on physical activity and health.3 The attention now being given to physical activity supports the goals of Healthy People 20004 and should lead to increased levels of regular physical activity throughout the US population, including the nearly one fourth of adult Americans who have some form of cardiovascular disease.5 Although regular exercise reduces subsequent cardiovascular morbidity and mortality,1 2 6 the incidence of a cardiovascular event during exercise in patients with cardiac disease is estimated to be 10 times that of otherwise healthy persons.7 Adequate screening and evaluation are important to identify and counsel persons with underlying cardiovascular disease before they begin exercising at moderate to vigorous levels. Moderate (or higher) levels of physical activity and exercise are achieved in a number of settings, including >15 000 health/fitness facilities across the country. A recent survey of 110 health/fitness facilities in Massachusetts found that efforts to screen new members at enrollment were limited and inconsistent.8 Nearly 40% of responding facilities stated that they do not routinely use a screening interview or questionnaire to evaluate new members for symptoms or history of cardiovascular disease, and 10% stated that they conducted no initial cardiovascular health history screening at all. This statement provides recommendations for cardiovascular screening of all persons (children, adolescents, …