Adult Pre-Exercise Information 2022

1 ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS) V2 (2018)
7. Describe your current physical activity/exercise levels in a typical week
by stating the frequency and duration at the different intensities.
For intensity guidelines consult figure 2.
Intensity Light Moderate Vigorous/High
Frequency
(number of sessions per week) _________ _________ _________
Duration
(total minutes per week) _________ _________ _________
Weighted physical activity/exercise per week
Total minutes = (minutes of light + moderate) +
(2 x minutes of vigorous/high)
TOTAL = _________ minutes per week
I believe that to the best of my knowledge, all of the information I have supplied within this screening tool is correct.
• If your total is less than 150 minutes per week then light to moderate intensity exercise is recommended. Increase your volume and
intensity slowly.
• If your total is more than or equal to 150 minutes per week then continue with your current physical activity/exercise intensity levels.
• It is advised that you discuss any progression (volume, intensity, duration, modality) with an exercise professional to optimise your results.
1
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS)
This screening tool is part of the Adult Pre-Exercise Screening System (APSS) that also includes guidelines (see User Guide) on how
to use the information collected and to address the aims of each stage. No warranty of safety should result from its use. The screening
system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by Exercise & Sport
Science Australia, Fitness Australia, Sports Medicine Australia or Exercise is Medicine for any loss, damage, or injury that may arise from
any person acting on any statement or information contained in this system.
Full Name:
Date of Birth: Male: Female: Other:
To identify individuals with known disease, and/or signs or symptoms of disease, who may be at a higher risk of an
adverse event due to exercise. An adverse event refers to an unexpected event that occurs as a consequence of an
exercise session, resulting in ill health, physical harm or death to an individual.
This stage may be self-administered and self-evaluated by the client. Please complete the questions below and refer to
the figures on page 2. Should you have any questions about the screening form please contact your exercise professional
for clarification.
STAGE 1 (COMPULSORY)
AIM:
1. Has your medical practitioner ever told you that you have a heart condition or have you ever
suffered a stroke?
2. Do you ever experience unexplained pains or discomfort in your chest at rest or during physical
activity/exercise?
3. Do you ever feel faint, dizzy or lose balance during physical activity/exercise?
4. Have you had an asthma attack requiring immediate medical attention at any time over the
last 12 months?
5. If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose)
in the last 3 months?
6. Do you have any other conditions that may require special consideration for you to exercise?
IF YOU ANSWERED ‘YES’ to any of the 6 questions, please seek guidance from an appropriate
allied health professional or medical practitioner prior to undertaking exercise.
IF YOU ANSWERED ‘NO’ to all of the 6 questions, please proceed to question 7 and calculate your typical weighted physical activity/
exercise per week.
Client signature: ______________________________ Date: ___________________
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS) V2 (2019)
NOYESPlease tick your response

2
ADULT PRE-EXERCISE
SCREENING SYSTEM (APSS) V2 (2019)
NO
CURRENT PHYSICAL ACTIVITY/EXERCISE
YES
EXERCISE PROGRESSION:
It is advised that you discuss any progression (volume, intensity, duration, modality) with an exercise professional to optimise your results.
FIGURE 1: Stage 1 Screening Steps
FIGURE 2: Exercise Intensity Guidelines
40 to <55% HRmax* VERY LIGHT TO
LIGHT RPE# 1-2
• An aerobic activity that does
not cause a noticeable change
in breathing rate
• An intensity that can be
sustained for at least 60
minutes
LIGHT
55 to <70% HRmax*
MODERATE TO
SOMEWHAT
HARD RPE# 3-4
• An aerobic activity that is
able to be conducted whilst
maintaining a conversation
uninterrupted
• An intensity that may last
between 30 and 60 minutes
MODERATE
70 to <90% HRmax* HARD
RPE# 5-6
• An aerobic activity in which
a conversation generally
cannot be maintained
uninterrupted
• An intensity that may last up
to 30 minutes
VIGOROUS
≥ 90% HRmax* VERY HARD
RPE# 7
• An aerobic activity in which
it is difficult to talk at all
• An intensity that generally
cannot be sustained for longer
than about 10 minutes
HIGH
* HRmax = estimated heart rate maximum. Calculated by subtracting age in years from 220 (e.g. for a 50 year old person = 220 - 50 = 170 beats per minute).
# = Borg’s Rating of Perceived Exertion (RPE) scale, category scale 0-10.
Modified from Norton K, L. Norton & D. Sadgrove. (2010). Position statement on physical activity and exercise intensity terminology.
J Sci Med Sport 13, 496-502.
Did you answer yes to any question in stage 1?
STAGE 1 (COMPULSORY)
INTENSITY CATEGORY HEART RATE MEASURES PERCEIVED EXERTION
MEASURES DESCRIPTIVE MEASURES
TOTAL WEIGHTED PHYSICAL
ACTIVITY/EXERCISE <150 MIN
Light to moderate intensity exercise is
recommended. Increase your volume
and intensity slowly.
TOTAL WEIGHTED PHYSICAL
ACTIVITY/EXERCISE ≥ 150 MIN
Continue with your current physical
activity/exercise levels.
Please seek guidance from an
appropriate allied health professional
or medical practitioner prior to
undertaking exercise.