A rapid review on the utility of physical activity pre-participation questionnaires

Citation

Hall ECR, Ridout A & Reid H (2025) A rapid review on the utility of physical activity pre-participation questionnaires. Cold Spring Harbor Laboratory. https://doi.org/10.1101/2025.09.19.25336065

Abstract
Background: Exercise brings multiple health benefits and removing barriers to participation is important. Fears around adverse events during exercise, particularly those of cardiovascular nature, have traditionally underpinned conservative approaches to pre-participation clearance. Concerns exist that existing pre-participation screening questionnaires create false positives and unnecessarily inhibit people from exercising. The aims of this rapid review were (i) to describe the utility, and (ii) to assess the impact, of pre-participation screening questionnaires. Methods: A literature search of the PubMed, Web of Science, Scopus, and Google Scholar databases was conducted from inception to February 2024. Included articles reported (a) background, justification, and/or commentary on development/revision/implementation of pre-participation questionnaires, (b) sensitivity, specificity, or other metrics of pre-participation questionnaires, and/or (c) stakeholder opinions regarding pre-participation questionnaire utility. Results: Sixty-three reports were included, comprising original research, pre-prints, meeting abstracts, conference proceedings, literature reviews, and editorial materials. Thirteen different questionnaires were identified, and versions of the Physical Activity Readiness Questionnaire (PAR-Q, revised PAR-Q, PAR-Q+) and related follow-up tools (PARmed-X, ePARmed-X) were investigated most (61.4%). Original estimates suggested 1 in 5 respondents would be referred for medical clearance before increasing their exercise. Subsequent studies suggest this is an underestimation, especially for older individuals, and there is limited evidence supporting pre-participation questionnaires in reducing mortality and adverse events. Conclusions: Pre-participation questionnaires have several limitations. False positives create unnecessary barriers to exercise, particularly in older adults, and sub-optimal test sensitivity increases the risk of at-risk individuals being placed at undue risk. Further work is needed to improve this process.

• Rapid Review MedRxiv 19092025