Does Insistence on Medical Clearance Inhibit Adoption of Physical Activity in the Elderly?

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Abstract
During the 1970s, the U.S. policy of requiring a negative exercise stress test for all adults >35 years old proved expensive. It also discouraged exercise adoption, was ineffective in detecting high-risk individuals, and led to much iatrogenic disease. In the age range of 15–69 years, a better alternative is triage, based on responses to the revised Physical Activity Readiness Questionnaire (PAR-Q), supplemented by considerations of age and cardiac risk factors. But most people older than 70 years have one or more clinical conditions; in this age group, any potential system of triage excludes an excessive proportion of potential exercisers and thus does not appear warranted. An increase in habitual physical activity increases quality-adjusted life span, and it might also enhance total longevity. Restriction of physical activity remains advisable in a few individuals, but they are already under medical care. The one small group who need medical clearance includes those who decide to prepare themselves for some high-performance event. They are highly motivated, and their activity will not be discouraged by the need for a careful clinical examination.

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