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Ensuring safe exercise participation in clinical populations: who is responsible?

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An overview of recent advances and ongoing challenges in exercise participation-related risk

The benefits of regular physical activity are well established, and the advice to “move more” can be offered to most individuals with little risk. Exercise, where there is a structured movement and activity plan, is recommended as cornerstone management for people with many chronic conditions, but it carries inherent risks that must be considered.1 The responsibility for managing this risk should be shared between primary health providers, patients and exercise professionals, but how well does this work in practice?

The best available evidence suggests the absolute risk of adverse events during exercise in an apparently healthy individual is very low at 0.1–1 adverse events for every 10 000 hours of exercise.2 However, this risk is higher in people with many common chronic conditions.1 In a study of commercial fitness centres, 52% of new members were identified as “higher risk” and 17% as “moderate risk” and in need of a modified exercise prescription,3 yet there is an alarming lack of capacity and effective processes within the fitness industry to manage the increased risk in clients who present with chronic diseases. The highest level of fitness or exercise qualification commonly found in…