When to Consult a Health-Care Provider Before Engaging in Physical Activities

Physical activity (PA) is beneficial for health, but the transition from a sedentary lifestyle to PA or a change in the level of habitual PA may be associated with risks, especially in subjects with preexisting heart disease. The position paper of the European Association of Cardiovascular Prevention and Rehabilitation provides in-depth guidelines for preparticipation evaluation that is useful for recreational scuba divers, too. According to the classification of PA levels referred to in this article, scuba diving  falls under moderate-intensity PA, while some situations can emerge in diving that would correspond to high-intensity PA.

Classification of PA levels

  1. Low intensity intended PA, corresponding to 1.8-2.9 METS
  2. Moderate intensity intended PA, corresponding to 3-6 METS
  3. High intensity intended PA, including individuals participating/willing to participate in masters events such as long-distance cycling, city marathons, long-distance cross-country skiing and triathlons, corresponding to greater than 6 METS.

For more details about METS, take a moment to review the Compendium of Physical Activities page.

For a quick orientation to assess your need for medical evaluation, use the Preparticipation Screening Questionnaire below. It is of utmost importance to be honest with yourself when it comes to conditions and symptoms asked in the questionnaire. Remember, you keep the keys to your safe participation in PA and in scuba diving.

American Heart Association/American College of Sport Medicine Health/Fitness Facility Preparticipation Screening Questionnaire:

Section I: History

You have had:

  • A heart attack
  • Heart surgery
  • Cardiac catherization
  • Coronary angioplasty (PCI)
  • Pacemaker/implantable cardiac defibrillator/rhythm disturbance
  • Heart valve disease
  • Heart failure
  • Heart transplantation
  • Congenital heart disease


  • You experience chest discomfort with exertion
  • You experience unreasonable breathlessness
  • You experience dizziness, fainting, blackouts
  • You take heart medications

Other health issues:

  • You have musculoskeletal problems
  • You have concerns about the safety of exercise
  • You take prescription medication(s)
  • You are pregnant

If you have marked any of the statements in Section I, consult your healthcare provider before engaging in exercise. You may need to use a facility with a medically qualified staff.

Section II: Cardiovascular risk factors

  • You are a man older than 45 years
  • You are a woman older than 55 years or you have had a hysterectomy or you are postmenopausal
  • You smoke
  • Your blood pressure is>140/90 or you do not know your blood pressure
  • You take blood pressure medication
  • Your cholesterol level is >240mg/dl or you do not know your cholesterol level
  • You have a close relative who had a heart attack before the age of 55 (father or brother) or 65 years (mother or sister)
  • You are diabetic or take medicine to control your blood sugar
  • You are physically inactive (i.e. you get <30min of physical activity at least 3 days/week)
  • You are >20 pounds overweight

If you have marked two or more of the statements in Section 2, consult your health-care provider before engaging in exercise. You might benefit from using a facility with a professionally qualified exercise staff to guide your exercise program.

If none of the above statements in Sections 1 and 2 were true, you should be able to exercise safely without consulting your health-care provider in almost any facility that meets your exercise program needs

Adopted from Balady. Circulation 1998; 97:2283-2293. PCI, percutaneous coronary intervention.


Borjesson M, Urhausen A, Kouidi E, et al. Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2010; June 19 (http://cpr.sagepub.com/content/early/2011/01/14/HJR.0b013e32833bo969.full.pdf)