Study guide
Pre-Participation Screening
CSCS Certified Strength and Conditioning Specialist
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1 Introduction
About the CSCS Exam Structure and Content Breakdown Pass Rates and Scoring How to Use This Guide
2 Exercise Science
Muscular and Neuromuscular Systems Skeletal and Cardiovascular Systems Bioenergetics and Metabolism Biomechanics Physiological Adaptations to Training
3 Sport Psychology & Nutrition
Motivation and Goal Setting Arousal, Anxiety, and Performance Mental Skills and Team Dynamics Macronutrients and Energy Hydration, Timing, and Supplements
4 Exercise Technique
Resistance Training Technique Olympic Lifting Technique Plyometric and Speed Training Flexibility and Warm-up Spotting and Equipment Safety
5 Program Design
Needs Analysis and Training Goals Training Variables Periodization Models Resistance Training Program Design Speed, Agility, and Conditioning Programs
6 Testing, Evaluation & Administration
Pre-Participation Screening Cardiovascular and Body Composition Testing Strength, Power, and Speed Testing Flexibility Assessment Facility Management and Legal Issues
Pre-Participation Screening
Key Takeaways Explain This Topic AI
The PAR-Q+ is a self-administered screening tool that identifies individuals who need medical clearance before exercise testing.
Risk stratification categorizes athletes as low, moderate, or high risk based on CVD risk factors.
Health history questionnaires should include cardiovascular, pulmonary, metabolic, musculoskeletal, and medication information.
Athletes with two or more CVD risk factors require physician clearance before maximal exercise testing.
Injury history assessment identifies previous injuries, surgeries, and chronic conditions that may affect training.
Last updated: January 2026
Quick Answer: Pre-participation screening uses the PAR-Q+, health history questionnaires, and CVD risk factor assessment to identify athletes who need medical clearance before exercise testing. Athletes with 2+ CVD risk factors or known cardiovascular, pulmonary, or metabolic disease require physician clearance for maximal testing.
Pre-participation screening is the first step in any testing or training program. It identifies potential health risks and ensures athlete safety before beginning exercise testing.
Physical Activity Readiness Questionnaire (PAR-Q+)
The PAR-Q+ is a self-administered screening tool that helps identify individuals who may need medical clearance.
PAR-Q+ General Health Questions
- Question If YES
- Has a doctor ever said you have a heart condition? Medical clearance needed
- Do you feel pain in your chest during physical activity? Medical clearance needed
- Have you had chest pain in the past month when not active? Medical clearance needed
- Do you lose balance due to dizziness or lose consciousness? Medical clearance needed
- Do you have bone/joint problems that could worsen with exercise? Medical clearance needed
- Are you taking medications for blood pressure or heart condition? Medical clearance needed
- Do you know of any other reason you should not exercise? Medical clearance needed
Key Point: If an athlete answers YES to ANY PAR-Q+ question, they should seek physician clearance before maximal exercise testing.
Health History Questionnaire Components
A comprehensive health history should include:
Medical History Categories
- Category Information Collected
- Cardiovascular Heart disease, hypertension, murmurs, arrhythmias
- Pulmonary Asthma, COPD, exercise-induced bronchospasm
- Metabolic Diabetes, thyroid disorders, kidney disease
- Musculoskeletal Previous injuries, surgeries, chronic conditions
- Medications Current prescriptions, OTC drugs, supplements
- Family History CVD, sudden death, metabolic conditions
- Lifestyle Smoking, alcohol, exercise habits
- Cardiovascular Disease Risk Factors
The ACSM identifies the following CVD risk factors for risk stratification:
Positive Risk Factors
- Risk Factor Defining Criteria
- Age Men ≥45 years; Women ≥55 years
- Family History MI, revascularization, or sudden death before age 55 (father/son) or 65 (mother/daughter)
- Cigarette Smoking Current smoker or quit within past 6 months
- Sedentary Lifestyle Not meeting minimum physical activity guidelines
- Obesity BMI ≥30 kg/m² or waist circumference >102 cm (men), >88 cm (women)
- Hypertension SBP ≥140 mmHg or DBP ≥90 mmHg, or on antihypertensive medication
- Dyslipidemia LDL ≥130 mg/dL, HDL <40 mg/dL, or on lipid-lowering medication
- Prediabetes Fasting glucose 100-125 mg/dL or impaired glucose tolerance
- Negative Risk Factor (Subtract One)
- Risk Factor Defining Criteria
- High HDL Cholesterol HDL ≥60 mg/dL
- Risk Stratification Categories
- Category Criteria Medical Clearance
- Low Risk Asymptomatic with 0-1 positive risk factors Not required for maximal testing
- Moderate Risk Asymptomatic with ≥2 positive risk factors Recommended for maximal testing
- High Risk Known CVD, pulmonary, or metabolic disease OR signs/symptoms Required for any testing
- Signs and Symptoms of Disease
The following signs/symptoms automatically classify an individual as HIGH RISK:
- Pain or discomfort in chest, neck, jaw, or arms
- Shortness of breath at rest or with mild exertion
- Dizziness or syncope
- Orthopnea or paroxysmal nocturnal dyspnea
- Ankle edema
- Palpitations or tachycardia
- Intermittent claudication
- Known heart murmur
- Unusual fatigue or shortness of breath with usual activities
- Injury Assessment
- Key Components of Injury History
- Component Information to Gather
- Previous Injuries Type, location, mechanism, treatment, recovery time
- Current Pain/Discomfort Location, intensity, aggravating factors
- Surgeries Type, date, complications, physician restrictions
- Chronic Conditions Arthritis, tendinopathy, recurring injuries
- Current Limitations ROM restrictions, activity modifications
- Clearance Procedures
- Medical Clearance Protocol
- Identify risk category using screening tools
- Refer high-risk individuals to physician
Obtain written clearance specifying:
- Approved activities
- Exercise intensity restrictions
- Monitoring requirements
- Emergency protocols
- Document all clearances in athlete files
- Re-screen annually or after significant health changes