Medical history, questionnaires and physical examination

Abstract

Negative cardiovascular events represent the main risks associated with exercise. Also in healthy individuals, such risks increase during high-intensity exercise compared to rest, but still the absolute risk of a cardiac event remains low. Of course, high-intensity exercise increases significantly the risk of such events in subjects with cardiovascular diseases. Instead, respiratory diseases are rarely a contraindication for physical or sport activities but may condition their practice and therefore should be diagnosed. A lack of consensus still exists on the extent of medical investigations required before prescribing any exercise programme, even if it is of high intensity. Medical history and physical examination are mandatory to detect subjects at moderate to high risk of cardiovascular events. Questionnaires can only contribute marginally to this evaluation process, whereas they surely represent a useful tool for measuring physical activity. The medical history should be sufficiently detailed and tailored to include past and current informations, including those regarding daily physical activity. For this last aspect, questionnaires, besides being inexpensive and easy to apply, are also sensitive and suitable to detect relevant characteristics of patients’ daily life physical activities and related limitations. However, there is still an insufficient knowledge about reliability, validity and sensitivity of such questionnaires for older adults or patients with chronic diseases. The physical examination should allow to detect signs that in combination with the medical history and characteristics of symptoms may be suggestive of some specific disease.