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The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally known preparticipation screening tools developed on the basis of expert opinion. The primary purposes of this consensus document were to seek evidence-based support for the PAR-Q and PARmed-X forms, to identify whether further revisions of these instruments are warranted, to determine how people responding positively to questions on the PAR-Q can be safely cleared without medical referral, and to develop exercise clearance procedures appropriate for various clinical conditions across the human lifespan. Seven systematic reviews were conducted, examining physical-activity-related risks and effective risk-stratification procedures for various prevalent chronic conditions. An additional systematic review assessed the risks associated with exercise testing and training of the general population. Two gap areas were identified and evaluated systematically: the role of the qualified exercise professional and the requisite core competencies required by those working with various chronic conditions; and the risks associated with physical activity during pregnancy. The risks associated with being physically inactive are markedly higher than transient risks during and following an acute bout of exercise in both asymptomatic and symptomatic populations across the lifespan. Further refinements of the PAR-Q and the PARmed-X (including online versions of the forms) are required to address the unique limitations imposed by various chronic health conditions, and to allow the inclusion of individuals across their entire lifespan. A probing decision-tree process is proposed to assist in risk stratification and to reduce barriers to physical activity. Qualified exercise professionals will play an essential role in this revised physical activity clearance process. [ABSTRACT FROM AUTHOR]

For many individuals, pre-participation clearance using the PAR-Q and the PARmed-X has become a barrier to adopting a physically active lifestyle. An extensive project is therefore planned to reduce the number of medical referrals from the PAR-Q and to revise the PARmed-X so that it becomes more effective, user friendly, and evidence based. The entire process will likely require 3 years to complete; therefore, as an interim solution, we propose giving greater pre-participation screening responsibility to qualified university-educated fitness professionals. The highest level of professional fitness qualification in Canada is the Canadian Society for Exercise Physiology Certified Exercise Physiologist; the requirements for this certification are such that it could serve as a model allowing other countries that use the PAR-Q to develop similarly qualified university-educated fitness professionals who could also be entrusted with greater pre-participation screening responsibility. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the degree of familial resemblance in baseline and 7-year changes in musculoskeletal fitness. Data from the 1981 Canada Fitness Survey and the Campbell's Survey 7-year follow-up were used. The sample consisted of 1264 people (635 males and 629 females) between the ages of 7 and 69 years for whom measurements of musculoskeletal fitness were available at baseline. A subsample of 834 people had measurements at both baseline and 7-year follow-up. Sit-and-reach trunk flexibility, number of push-ups without time limit, number of sit-ups in 60 seconds, and hand-grip strength were used as indicators of musculoskeletal fitness. The data were adjusted for the effects of age and body mass index (and baseline level of the variable for changes) by using regression procedures, and they were standardized to zero mean and unit variance within each of the four sex-by-generation groups (fathers, mothers, sons, and daughters). Familial correlation models were fitted to the data by using the computer software SEGPATH. The results indicate significant familial resemblance for all indicators of musculoskeletal fitness for baseline measures and 7-year changes. The heritabilities, or the percentages of the total variance attributable to heredity, were 64% for trunk flexibility, 37% for push-ups, 59% for sit-ups, and 48% for grip strength. Similarly, heritabilities for the change scores were 48% for trunk flexibility, 52% for push-ups, 41% for sit-ups, and 32% for grip strength. The results suggest that familial, and perhaps genetic, factors are important in explaining the variance in musculoskeletal fitness not only cross-sectionally but also for changes over time. [ABSTRACT FROM AUTHOR]

Presents a study on the economic burden of physical inactivity in Canada. Background; Methods; Results; Interpretation that physical inactivity represents an important public health burden in Canada; How modest reductions in inactivity levels could result in substantial cost savings.

Purpose: Graded exercise tests (GXTs) are commonly used to determine the maximal oxygen consumption (VO2max) of firefighter applicants. However, the criteria used to confirm VO2max are inconsistent and have a high inter-subject variability, which can compromise the reliability of the results. To address this, a verification phase (VP) after the GXT has been proposed as a "gold standard" protocol for measuring VO2max. Methods: 4179 male and 283 female firefighter applicants completed a GXT and a VP to measure their VO2max. VO2peak values measured during the GXT were compared to the VO2 values measured during the VP. The proportion of participants who met the job-related aerobic fitness standard during the GXT was compared to that of those who met the required standard during the VP. Results: For male and female participants that required the VP to attain their VO2max, the VO2peak values measured during the GXT (47.3 ± 6.0 and 41.6 ± 5.3 mL kg−1 min−1) were, respectively, 10.1% and 10.3% lower than the VO2 values measured during the VP (52.1 ± 6.7 and 45.9 ± 6.4 mL kg−1 min−1), p < 0.001. Furthermore, the proportion of male and female participants who met the job-related aerobic fitness standard significantly increased from the GXT to the VP by 11.6% and 29.9%, respectively, p < 0.001. Conclusion: These results strongly support the use of a VP to confirm VO2max, especially for females, older and overweight individuals. These findings are applicable to other physically demanding public safety occupations and when examining the efficacy of training interventions on VO2max. [ABSTRACT FROM AUTHOR]

Purpose: Prediabetes is linked to several modifiable risk factors, in particular, physical activity participation. The optimal prescription for physical activity remains uncertain. This pilot study aimed to investigate the effectiveness of continuous moderate intensity (CON) versus high-intensity interval training (HIIT) in persons with prediabetes. Outcome measures included glycated hemoglobin (A1C), body composition, musculoskeletal and aerobic fitness. Methods: Participants (n = 35) were recruited and screened using a questionnaire plus capillary blood point-of-care A1C analysis. After baseline screening/exclusions, 21 participants were randomly assigned to either HIIT or CON training three times per week for 12 wk. All participants also undertook resistance training two times per week. A1C, an oral glucose tolerance test, select measures of physical and physiological fitness were assessed at baseline and follow-up. Results: There were no significant differences in improvements in select metabolic indicators to training between CON and HIT groups. Pooled participant data showed a mean reduction in A1C of 0.5% (95% confidence interval [CI] = 0.3%-0.7%), whereas β-cell function (%β) improved by 28.9% (95% CI = 16.5%-39.2%) and insulin sensitivity (%S) decreased by 34.8 (95% CI = 57.8%-11.8), as assessed by the Homeostatic Model Assessment. Significant reductions in waist circumference of 4.5 cm (P < 0.001) and a 20% (P < 0.001) improvement in aerobic fitness were also observed in both training groups. Conclusion: The completion of a 12-wk exercise program involving both resistance training and either HIIT or CON training results in improved glycemic control, visceral adiposity, and aerobic fitness in persons with prediabetes. [ABSTRACT FROM AUTHOR]

The article reports on research conducted to provide descriptions of prominent job-specific physical fitness protocols (JSPFPs) that were used to satisfy the legal obligations to qualify as a bona fide occupational requirement for physically demanding public safety jobs in Canada. Researchers found that prospective JSPFP participants and professionals who require the information can fully inform themselves about the specific protocol requirements and associated fitness training implications.

A letter to the editor is presented in response to the article "Is this the new smoking? An expert panel review of the York University OHV health benefits study," by G. Bissix is presented.

The aims of this study were: (1) to characterize selected fitness and health attributes of two types of habitual recreational off-road vehicle riders - off-road motorcyclists and all-terrain vehicle riders; (2) to explore differences among riders in terms of vehicle type, age, and gender; and (3) to compare the fitness and health of riders to population norms and clinical health standards. Canadian off-road riders (n = 141) of both sexes aged 16 years and over were recruited through local and national off-road riding organizations. Anthropometry, fitness, and health measures of off-road motorcycle and all-terrain vehicle riders were compared with population norms, health standards, and physical activity guidelines. Off-road motorcycle riders had above average aerobic fitness (79th percentile), while all-terrain vehicle riders were lower than average (40th percentile). All riders had a healthy blood lipid profile and a low incidence of the metabolic syndrome (12.9%) compared with members of the general population. Off-road motorcycle riders had healthier body composition and fitness than all-terrain vehicle riders; however, the body composition of off-road motorcycle riders was no healthier than that of the general population and all-terrain vehicle riders were worse than the general population. Off-road motorcycle riders had healthier anthropometry and fitness than all-terrain vehicle riders and thus fewer health risk factors for future disease, demonstrating that the physiological profiles of off-road riders are dependent on vehicle type. [ABSTRACT FROM AUTHOR]

The fitness test for correctional officer applicants (FITCO) was constructed a priori to conform to requirements established by the Meiorin Decision of the Supreme Court of Canada. A critical obligation from this decision is to determine whether the FITCO has the potential of adverse impact on any subpopulation of applicants and, if so, whether it is possible to provide accommodation. The FITCO pass rate was 28.6% for 56 women and 72.7% for 22 men, which indicates adverse impact on the female applicants. There was no specific adverse impact on minority applicants. To evaluate training as accommodation for adverse impact, a subgroup of 40 females and 8 males engaged in a 6-week FITCO-specific training program with pre-FITCO and post-FITCO performance evaluations. Over the 6 weeks, the overall FITCO pass rate of the females improved to 82.5%, whereas the pass rate of the males improved to 100%, indicating that the training program removed the adverse impact that the FITCO had on the females. We conclude that although the FITCO is likely to have an adverse impact on female correctional officer applicants, a 6-week FITCO-specific training program can provide the accommodation necessary to overcome the potential adverse impact, and the FITCO meets all the requirements established by the Supreme Court of Canada’s Meiorin Decision. [ABSTRACT FROM AUTHOR]

This chapter is designed to provide a summary of the current consensus on evidence-based, best practice guidelines for safe and effective preparticipation screening and risk stratification. We summarize briefly the irrefutable body of evidence supporting the health benefits of routine physical activity/exercise (particularly in the elderly and at-risk populations). We also highlight the benefit-to-risk paradox, wherein routine physical activity decreases the long-term risk for premature mortality and at least 25 chronic medical conditions, while acute bouts of activity (particularly vigorous-intensity exercise) increase transiently the risk for adverse potentially life-threatening events (such as sudden cardiac death). We examine the various risk factors associated with the transient risks after exercise testing or training, identifying how low the risks are and how regular physical activity participation reduces these transient risks. We highlight current advances in preparticipation-screening and risk stratification strategies and the implications for the elderly (including those living with chronic medical conditions). These advances have resulted in very few participants being sent to see a physician prior to participating in a physical activity program. As such, innovations in preparticipation screening and risk stratification have significantly reduced the barriers for physical activity participation so that the vast majority of society can reap the health benefits of routine physical activity. [ABSTRACT FROM AUTHOR]

The article presents the Functional Movement Screen (FMS) of fundamental movement patterns that involves athletes movements and sport performances. Primary goal of the FMS which comprises of 7 different movements that are scored on a scale of 0-3 and two of these were specific pain clearance tests is to evaluate the efficiency of exercise training programs and to identify injury risk. The result of FMS conducted on 101 players before all fitness assessments is also presented.

Background: Amidst the growing health care burden created by diabetes, this study aimed to assess the utility of a prediabetes/type 2 diabetes risk questionnaire in high risk ethnic communities in Toronto Canada. Methods: Participants (n = 691) provided questionnaire responses and capillary blood tests collected via fingerstick and results were analysed for HbA1c using the Bio-Rad in2it point-of-care device. The Bland-Altman method was used to compare point-of-care HbA1c analysis (Bio-Rad, boronate affinity chromatography) to that using high performance liquid chromatography. ANOVA and linear regression were performed to investigate the relationship between questionnaire and blood data. Results: Mean (±SD) HbA1c was 5.99% ± 0.84 and the Bland-Altman analysis revealed no significant biases HbA1c (bias = 0.039, 95% limits of agreement = -1.14 to 1.22). ANOVA showed that with increasing risk classification based on questionnaire answers (with the exception of "moderate"-to-"high"), there was a significant increase in mean HbA1c (Welch Statistic 30.449, p < 0.001). Linear regression revealed that the number of high risk parents, age category, BMI, physical activity participation and previous diagnosis of high blood sugar were significant contributors (p < 0.05) to the variance in HbA1c. Conclusions: Though not a substitute for established diagnostic protocols, the use of a risk questionnaire can be an accurate, low cost, educational and time efficient method for assessment of type 2 diabetes risk. The early detection of prediabetes and type 2 diabetes is vital to increased awareness and opportunity for intervention with the goal of preventing or delaying the progression of type 2 diabetes and the known associated complications. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article on the role of exercise professionals in the management and treatment of obesity in the 2006 issue is presented.

Recent feedback from physical activity (PA) participants, fitness professionals, and physicians has indicated that there are limitations to the utility and effectiveness of the existing PAR-Q and PARmed-X screening tools for PA participation. The aim of this study was to have authorities in exercise and chronic disease management to work with an expert panel to increase the effectiveness of clearance for PA participation using an evidence-based consensus approach and the well-established Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Systematic reviews were conducted to develop a new PA clearance protocol involving risk stratification and a decision-tree process. Evidence-based support was sought for enabling qualified exercise professionals to have a direct role in the PA participation clearance process. The PAR-Q+ was developed to use formalized probes to clarify problematic responses and to explore issues arising from currently diagnosed chronic disease or condition. The original PARmed-X tool is replaced with an interactive computer program (ePARmed-X+) to clear prospective PA participants for either unrestricted or supervised PA or to direct them to obtain medical clearance. Evidence-based validation was also provided for the direct role of highly qualified university-educated exercise professionals in the PA clearance process. The risks associated with exercise during pregnancy were also evaluated. The systematic review and consensus process, conforming to the AGREE Instrument, has provided a sound evidence base for enhanced effectiveness of the clearance process for PA participation of both asymptomatic populations and persons with chronic diseases or conditions. [ABSTRACT FROM AUTHOR]

The article presents a study that characterized the physiological demands of off-road vehicle riding. It states that the physical requirement for all-terrain vehicle (ATV) and off-road motorcycle (ORM) riders are compared. The riders went through strength assessments before and after a trail ride and their ambulatory oxygen consumption (VO2) were measured after one lap. The result of the temporal analysis showed about 14% VO2 for ATV and 38% VO2 for ORM and that the activity could lead to upperbody muscular fatigue. It concludes that the activity demands muscular strength and caloric expenditures and could benefit to health and fitness.

The purpose of this investigation was to develop and validate a fitness test for correctional officer (CO) applicants (FITCO) and to establish associated standards of acceptability. The FITCO incorporated the most important, physically demanding, and frequently occurring tasks of a CO. It consists of (i) a simulated cell search; (ii) an emergency response circuit (ERC), involving a 60-m run while scaling 4 sets of stairs, followed by simulations of an inmate control, wrist restraint, arm retraction, and 40-m mannequin drag; and (iii) a test of aerobic fitness. The validity of the FITCO was established by very high congruence between the oxygen consumption, heart rate, and rating of perceived exertion of incumbent COs while performing the ERC with the same measurements while COs were performing the on-the-job tasks on which the ERC was based. The content validity of the FITCO was confirmed by very high Likert ratings (>6 on a 7-point scale) by both male and female incumbent COs of all ages concerning the importance, relatedness, physical demands, and overall appropriateness of the FITCO for evaluating CO applicants. We conclude that because the forces built into the ERC and the FITCO standards were both derived from the performance of safe and efficient incumbent female COs of all ages, and both the validity and test-retest reliability (intraclass correllation coefficient = 0.977) of the FITCO are very high, the FITCO was properly constructed to meet the requirements of the Supreme Court of Canada’s Meiorin Decision. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to identify the critical tasks encountered by correctional officers (COs) on the job and to conduct a comprehensive assessment and characterization of the physical demands of these tasks. These are the first steps in developing a fitness screening test for COs in compliance with recent legislation. The most important, physically demanding, and frequently occurring tasks were identified using Delphi methodology, focus groups, and questionnaire responses from 190 experienced front-line COs. These tasks were structured into emergency response scenarios for which a physical and physiological characterization was conducted to verify their relative physical demands analysis. Oxygen consumption and the forces exerted by COs were quantified while they were responding and then controlling and restraining inmates. The female COs used less force than the male COs did to control and restrain the same inmates (body control = 46 vs. 60 kg, wrist hold = 32 vs. 49 kg, and arm retraction = 37 vs. 47 kg) and did not exert their maximal strength during their control and restraint activities. The mean oxygen consumption of the female and male COs while performing the on-the-job tasks was similar (39.5 vs. 38.5 mL·kg-1·min-1). We concluded that the essential components of a fitness screening protocol for CO applicants are cell search, expeditious response, body control, arm restraint, inmate relocation, and an assessment of aerobic fitness. The criterion performance standards for completing these tasks in a circuit were set at the job performance level of safe and efficient female COs. [ABSTRACT FROM AUTHOR]

The article reports on research conducted to determine whether aggregate fitness indicators could be used to predict a hockey player's potential for playing in the National Hockey League. Researchers evaluated 345 athletes. They found that by taking into account the shared variance on standard tests of fitness, it is possible to use an athlete's results to gauge his potential for playing in the National Hockey League.

The article reports on the study that determines that fitness variables with the highest capability for predicting hockey playing potential at the elite-level ice hockey players. The study indicates that standing long jump is a significant predictor variable for forwards and defends and is useful for assessing overall hockey potential. It also reveals that physical fitness measures and anthropometric data are valuable in predicting hockey playing potential.

The purposes of this study were (a) to determine the measurement device and jumping protocol most appropriate for testing the leg power of elite hockey players and (b) to assess the relationship of leg power measurements to hockey playing ability as indicated by draft selection order. Comparisons were made of leg power measurements from the top 95 players entering the National Hockey League Entry Draft using 2 devices (Vertec and Just Jump) and 2 jump protocols (countermovement and squat). Players' leg powers were ranked from highest to lowest power using each device and protocol and were correlated with draft selection order. Vertec leg power measurements were highest (5,511-5,631 W), but there were no significant differences in power between the 2 jumping protocols on either device. Vertec squat jump provided the highest correlation (0.47) between leg power ranking and selection order and was judged to most closely approximate the full-body coordinated movements involved in hockey. The Vertec device using a squat jump protocol is most appropriate for coaches and fitness specialists to use when evaluating hockey potential based on the off-ice leg power measurements of elite hockey players. [ABSTRACT FROM AUTHOR]

Heart transplantation patients generally demonstrate exercise capacities that are below the minimal standards for firefighting. Therefore, it is unlikely that heart transplantation patients will receive medical and/or employer clearance for active duty. We report a case of a firefighter who sought to return to full-time active duty following heart transplantation. We examined his physiological readiness to return to work during occupation-specific testing. Remarkably, the patient was able to meet the minimal requirements for full active firefighting. This finding provides direct evidence to support the potential of transplant patients returning to active duty in physiologically demanding occupations. [ABSTRACT FROM AUTHOR]

The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally renowned and extensively used preparticipation screening tools. However, recent feedback from end-users has identified limitations to the existing PAR-Q and PARmed-X screening process. As such, a systematic evaluation of the PAR-Q and PARmed-X forms was conducted, adhering to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Recognized experts in physical activity (PA) and prominent health conditions worked with an expert consensus panel to increase the effectiveness of the PAR-Q and PARmed-X PA participation clearance process. The systematic review process established that the health benefits of PA participation far outweigh the risks in the vast majority of asymptomatic and symptomatic individuals. A new risk continuum and decision tree process was created to allow for the effective risk stratification of prominent health conditions, reducing greatly the barriers to PA participation for the majority of individuals. The new PA participation clearance process is available in new paper and online versions (PAR-Q+) and the PARmed-X was replaced with an online interactive computer programme (ePARmed-X+). It is anticipated that this new risk stratification and PA clearance process will reduce markedly the barriers for PA participation for both asymptomatic and symptomatic individuals. [ABSTRACT FROM AUTHOR]

Background: Amidst the growing health care burden created by diabetes, this study aimed to assess the utility of a prediabetes/type 2 diabetes risk questionnaire in high risk ethnic communities in Toronto Canada.Methods: Participants (n = 691) provided questionnaire responses and capillary blood tests collected via fingerstick and results were analysed for HbA1c using the Bio-Rad in2it point-of-care device. The Bland-Altman method was used to compare point-of-care HbA1c analysis (Bio-Rad, boronate affinity chromatography) to that using high performance liquid chromatography. ANOVA and linear regression were performed to investigate the relationship between questionnaire and blood data.Results: Mean (± SD) HbA1c was 5.99% ± 0.84 and the Bland-Altman analysis revealed no significant biases HbA1c (bias = 0.039, 95% limits of agreement = -1.14 to 1.22). ANOVA showed that with increasing risk classification based on questionnaire answers (with the exception of "moderate"-to-"high"), there was a significant increase in mean HbA1c (Welch Statistic 30.449, p < 0.001). Linear regression revealed that the number of high risk parents, age category, BMI, physical activity participation and previous diagnosis of high blood sugar were significant contributors (p < 0.05) to the variance in HbA1c.Conclusions: Though not a substitute for established diagnostic protocols, the use of a risk questionnaire can be an accurate, low cost, educational and time efficient method for assessment of type 2 diabetes risk. The early detection of prediabetes and type 2 diabetes is vital to increased awareness and opportunity for intervention with the goal of preventing or delaying the progression of type 2 diabetes and the known associated complications. [ABSTRACT FROM AUTHOR]