Assertive screening: health checks prior to exercise programmes in older people

Assertive screening, as opposed to defensive screening, is done for the participant’s benefit not the provider’s protection. It is used to identify and manage chronic health conditions and functional limitation. It is neither risk averse nor protective but an “enabling, pre-exercise medical review that will facilitate safe and effective recreational participation”.1 Such screening asserts the right of older and functionally very limited people to participate in exercise programmes.

Unnecessary safety screening, medical clearance and detailed questionnaires may be a disincentive for an older person already ambivalent about commencing an exercise programme. Such screening may be an unjustified barrier to participation and presage an unwarranted encroachment of medical services into normal human activities. In a review of safety monitoring before an exercise programme in older persons, Gill and colleagues …