Q. If you’re new to exercise, do you need to see a doctor before you start?

A: Maybe. If you have certain health conditions, it’s advised you see a doctor first.

We’re always being told to exercise – and if you’ve not been active for a while, you often hear that you should see a doctor before you start.

But finding the motivation to get moving can be tough enough on its own. Add to that the need to get yourself checked over first, and there’s a risk some of us might decide it’s all too hard.

So if you’re new to exercise, do you really need to bother getting medical clearance first?
In some cases, it’s definitely advised, says Jeff Coombes, professor of exercise science at the University of Queensland.

“It’s a balancing act. We don’t want to put up barriers to stop people from starting exercise programs. But at the same we want it to be safe.”

Managing the risk of a cardiac event

While in general exercise is one of the best things you can do for your mind and body, there are certain health conditions that can make being active more risky, he says.

“The major event we’re trying to avoid is a cardiovascular event – a heart attack or stroke.”

So if you’ve had a heart attack or stroke in the past, been diagnosed with a heart condition, or have symptoms suggesting one, seeing a doctor first is recommended. Examples of heart conditions include heart rhythm problems, heart infections and heart defects you’re born with.

Unexplained chest pains, dizziness or loss of balance may indicate undiagnosed problems relating to heart attack and stroke risk, so these indicate the need for a checkup too.

And recent asthma attacks requiring a GP or hospital visit, trouble controlling diabetes, and problems with muscles, bones and joints, may also be “red flags” that require further investigation, Coombes says.

While the risk of a heart attack or stroke during exercise is low for the population as a whole – about one in 15,000 – it might go up to one in 2000 if you have coronary artery disease (where the arteries supplying your heart muscle are narrowed or blocked).

Having untreated high blood pressure or cholesterol in turn raises the odds of these narrowed or blocked arteries.

Says Coombes: “The more risk factors you have, the more the risk goes up. But the risk of developing narrowed or blocked vessels in the first place is around one half for those who are physically active. Therefore, we need to be doing everything to encourage and support people to exercise”

Almost always, whatever your health problem, some type of exercise will still be possible but advice may have to be tailored to your particular needs.

Try this quick quiz about your exercise readiness

The risk of injury or death from exercise can never be completely ruled out, but it can be minimised. And Coombes is part of a team that recently finalised a screening tool designed to do just that.
Known as the Australian Pre-exercise Screening System (APSS), the first stage of the system is a simple seven point questionnaire you can do yourself to work out if getting medical advice before you start exercise is likely to be necessary or useful. Exercise physiologists, exercise scientists and personal trainers can also use this with clients.

You might expect age or obesity to be the subject of points in the questionnaire. But by themselves, they aren’t significant factors affecting the safety of starting exercise.

Around 10 per cent of obese people have no other cardiovascular risk factors, and for them, starting a gradual program of light to moderate exercise is considered relatively safe.

Whether obese or not, he says the safest way to start getting active is with bouts of 10 minutes at a light to moderate intensity. This means walking (or some other activity) at a level where you can still have a conversation.

“You could then try to build that up to maybe two bouts of 10 minutes or 10 minutes plus five. Start trying to do this every second day – so three times a week – and work your way up. Your goal is to eventually complete 150 minutes each week at a moderate intensity.”

You can find the questionnaire (stage 1 of the screening tool) here along with a handy table (scroll down to page 2 of the above pdf document) that describes how to tell if activity you’re doing is at a light, moderate or intense level.

If you answer yes to any of the seven questions in the questionnaire, you’re advised to seek more help before starting exercise.

Note: If you have a chronic health condition, you may be eligible for a Medicare rebate for visits to an exercise physiologist, who can help you set up and maintain a regular exercise program. Check with your GP.

Jeff Coombes, professor of exercise science at the University of Queensland, spoke to Cathy Johnson.

This is a transcript from a recent interview on ABC radio.