Safe Engagement in Physical Activity Through Pre-Exercise Risk Assessment: An Observational Study at a Single Facility Over 16 Years

Akihiro Hirata^1,2Yoshifusa Takao³Tomoaki Seto³Satoshi Kurose⁴Yoshinobu Saito^5,6Shinji Sato⁷Shigeki Tsuzuku⁸Yuko Oguma^1,9*

• ¹Sports Medicine Research Center, Keio University, Kanagawa, Japan
• ²Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
• ³LIFE Medical Fitness, Kanagawa, Japan
• ⁴Health Science Center, Kansai Medical University, Osaka, Japan
• ⁵Faculty of Sport Management, Nippon Sport Science University, Kanagawa, Japan
• ⁶Graduate School of Physical Education, Health and Sport Studies, Nippon Sport Science University, Tokyo, Japan
• ⁷Department of Sport and Medical Science, Teikyo University, Tokyo, Japan
• ⁸Center for Student Success Research and Practice, The University of Osaka, Osaka, Japan
• ⁹Graduate School of Health Management, Keio University, Kanagawa, Japan

Background: Regular and appropriate physical activity has health benefits; however, to ensure safety, a pre-exercise medical check based on health information is important. In this study, we aimed to clarify the relationship between risk classification by physicians at a health promotion facility in Japan and the occurrence of adverse events during facility use. Methods: We evaluated 3571 individuals, excluding those with an unknown sex, age, medical assessment of exercise limitations, and facility usage status. Based on the results of the medical checkups conducted by a physician, the participants were divided into an exercise-prohibited group and an exercise-permitted group (exercise-permitted group, subdivided into non-restricted, orthopedic-restricted, internal medical-restricted, and combined-restricted groups). The risk of adverse events was examined. Results: The group in which exercise was prohibited comprised 72 participants, and that in which exercise was permitted comprised 1935, 612, 456, and 496 participants in the non-restricted, orthopedic-restricted, internal medical-restricted, and combined-restricted groups, respectively. Logistic regression analysis was performed on the four subgroups of the exercise-permitted group, and the odds ratios for adverse events adjusted for individual attributes were 1.04 (95% confidence interval [CI], 0.59-1.84; P = 0.89), 0.97 (95% CI, 0.53-1.78; P = 0.93), and 0.80 (95% CI, 0.42-1.54; P = 0.51) for the orthopedic-restricted, internal medical-restricted, and combined-restricted groups, respectively. A power analysis revealed that the study had a high level of power (0.99), based on a Cox-Snell R² of 0.05 and a sample size of 3499, indicating sufficient sensitivity to detect differences between groups. Conclusion: No significant difference in the odds of adverse events was found regardless of the presence or absence of exercise restrictions. Therefore, despite exercise-related risks, pre-exercise screening can help ensure that exercise is performed as safely as it is by individuals without such risks. However, further discussion is required regarding the necessity of screening for all exercise participants.