Who should check with a doctor first?
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Most people can start walking today without a checkup. Talk to a doctor first if you’ve had chest pain, fainting or breathlessness with light effort, or if you have a heart condition, kidney disease or diabetes and aren’t active now. If you’re pregnant, your provider can tell you how to adjust.
For years, every workout video and gym form opened with the same line: consult your doctor before starting any exercise program. It sounds careful, and it had a cost. In 2015 the American College of Sports Medicine found that screening rules like that sent too many people to doctors and could keep them from exercising at all, so it rewrote its advice. Our own safety questions follow the new logic.
What we’d do
If none of the questions below apply to you, start with brisk walking today and build up slowly. If one does, follow what it says, which is usually a conversation with your doctor before anything hard. Either way, learn the stop signs before your first session, because heart problems during exercise often come with warning signs first. And if you ever feel chest pain or pressure while you exercise, stop and get help.
If you remember three things
- Exercise is safe for most people. The 2015 screening update dropped risk-factor counting because it sent too many people to doctors and kept them from starting.
- Symptoms and known disease are what count. So do whether you’re active now and how hard you plan to go.
- Know the stop signs. Chest pain or pressure, or pain in your arm, jaw or back, means call 911.
Why did the advice change?
In June 2014 the American College of Sports Medicine brought a group of experts together to look at its screening rules, which counted up risk factors like age, weight and cholesterol. Their 2015 paper found that those rules “can result in excessive physician referrals, possibly creating a barrier to exercise participation”. It also laid out three facts: there is “considerable evidence that exercise is safe for most people”, exercise-related heart events “are often preceded by warning signs/symptoms”, and the risks “lessen as individuals become more physically active/fit.”
The new screening rests on three questions instead: how active you are now, whether you have signs or symptoms or known heart, metabolic or kidney disease, and how hard you want to exercise. Risk factors still matter for your health, and your doctor still wants to know about them. They just stopped being a reason to wait before you go for a walk.
A picture from daily life
Think of the smoke alarm in your kitchen. You don’t call the fire department before you cook dinner. You cook, and you know what to do if the alarm goes off.
Most people can start exercising the same way. The stop signs below are the alarm. Learn them, and act on them if they ever go off.
Our safety questions
Before today’s session plays anything, it asks seven yes-or-no questions, once per device, and each yes takes options away. This screen is a draft written for a clinician to review before the session player ships. It follows the 2015 screening logic, and the answers stay in your browser.
| Question | If you answer yes |
|---|---|
| In the last month, have you had chest pain, pressure or tightness, at rest or when you’re active? | No session. Talk to a doctor before you start |
| Do you get dizzy, faint, or so short of breath with light effort that you have to stop? | No session. Talk to a doctor before you start |
| Has a doctor told you that you have a heart condition, kidney disease or diabetes? | Not active now: talk to your doctor first, then easy walking, strength and balance once they clear you. Active now: everything except interval walking and stair bursts, and ask your doctor before hard efforts |
| Are you pregnant? | Brisk walking, strength and balance. No stair bursts or intervals until your provider says so |
| Have you given birth in the last year and not yet been cleared by your provider? | Brisk walking only, and ask at your check before strength and harder sessions |
| Do you have joint or back pain that’s sharp, getting worse, or wakes you at night? | Seated and supported moves only, and see a doctor or physical therapist about the pain |
| Are you 65 or older? | The balance set comes first in every plan, and effort is judged against your own fitness |
When more than one applies, the most careful rule wins. Under 18, the tools show a short note instead and link How much exercise does a teenager need?
What are the stop signs?
MedlinePlus, the US National Library of Medicine’s health site, lists the signs to watch for during activity: dizziness or light-headedness, chest pain, an irregular heartbeat or pulse, shortness of breath and nausea. Its advice is to “Stop what you are doing. Rest.” If the symptoms are very bad or don’t go away when you stop, let your provider know right away.
The CDC lists the main signs of a heart attack as chest pain or discomfort, feeling weak, light-headed or faint, pain in the jaw, neck or back, pain in one or both arms or shoulders, and shortness of breath.
If you notice them in yourself or someone else, call 911 right away. Don’t wait to see if it passes.
Every session in the session player shows this line before you start and on the pause screen: stop and rest if you feel chest pain, dizziness, an irregular heartbeat, nausea or you can’t catch your breath. What should I do if I get chest pain while exercising?
What about a heart condition, kidney disease or diabetes?
The US guideline gives adults with chronic conditions the same targets as everyone else, for those who are able, and asks them to talk with their health care provider or a physical activity specialist about the types and amounts that suit them. For heart disease, MedlinePlus says to always talk with your provider before starting an exercise program. Our draft screen follows the 2015 logic. If you’re already active, keep going and ask your doctor before you add hard efforts. If you’re not active now, talk to your doctor first, then start at an easy pace once they clear you. When you can’t reach 150 minutes, the guideline’s line is to be as active as your abilities and conditions allow. Exercise also lowers blood pressure, and bloodpressure.guide has how much.
What about pregnancy and after giving birth?
The US guideline asks for at least 150 minutes a week of moderate activity during pregnancy and the year after, and says women who were active or did vigorous exercise before pregnancy can continue. It also says pregnant women should be under the care of a health care provider who can monitor the pregnancy. The American College of Obstetricians and Gynecologists says that “in the absence of obstetric or medical complications or contraindications, physical activity in pregnancy is safe and desirable”, and that activity after birth can help prevent postpartum depression. When to start after giving birth depends on the birth, so it’s your provider’s call. Can I exercise while pregnant? and When can I start exercising after giving birth?
What about joint or back pain?
Pain that’s sharp, getting worse or wakes you at night needs a doctor or physical therapist before you load it, and the session player holds you to seated and supported moves, like chair squats to a high seat and counter push-ups, until then.
What about adults 65 and up?
The guideline asks older adults to judge their effort “relative to their level of fitness” and to understand whether and how their conditions affect their ability to be active safely. Balance work belongs in every week, like walking heel to toe or standing up from a chair, and in 108 trials of people 60 and up living at home, exercise cut the rate of falls by 23%. How much exercise do seniors need?
Shouldn’t everyone just see a doctor first?
The cautious view
A checkup can’t hurt. Some heart problems have no symptoms, and a doctor can catch high blood pressure or other things that need treating anyway.
What the screening experts found
Sending everyone kept people from starting. The 2015 update found the old rules created excessive referrals and a barrier to exercise, that exercise is safe for most people, and that the risk falls as people get more active. A regular checkup is still a good idea for its own reasons, and it doesn’t need to come before your first walk.
7 sources
- Riebe D and others, Updating ACSM's recommendations for exercise preparticipation health screening, Medicine and Science in Sports and Exercise, 2015europepmc.org
- US Department of Health and Human Services, Physical Activity Guidelines for Americans, 2nd edition, executive summary, 2018odphp.health.gov
- MedlinePlus, Being active when you have heart disease, US National Library of Medicinemedlineplus.gov
- Centers for Disease Control and Prevention, Heart attack symptoms, risk, and recoverycdc.gov
- American College of Obstetricians and Gynecologists, Physical activity and exercise during pregnancy and the postpartum period, Committee Opinion 804, Obstetrics and Gynecology, 2020europepmc.org
- Centers for Disease Control and Prevention, Physical activity guidelines for older adultscdc.gov
- Sherrington C and others, Exercise for preventing falls in older people living in the community, Cochrane Database of Systematic Reviews, 2019europepmc.org
