Health Clubs Failing to Flag Heart Trouble

WASHINGTON — At many health clubs, the condition of a new member’s heart is a great unknown, a study finds.

These clubs don’t even ask prospective members if they have symptoms of heart disease, the report said.

Although exercise in general is safe as well as healthy, these clubs are raising risks they ought to be lowering, said researcher Kyle J. McInnis, a professor of exercise physiology at Boston University Medical Center.

“They don’t know if [new members] have heart disease if they don’t ask the questions,” McInnis said. Would-be exercisers should ask about health issues when they join, and should check with their doctors if they have heart problems, he said.

McInnis and his colleagues analyzed survey data gathered in the spring of 1996 from 110 health clubs in Massachusetts. The clubs were asked if they gave prospective members questionnaires on heart disease symptoms.

Thirty-eight percent of all clubs did not do pre-entry screening consistently, and 10% never screened, the study found. The results were presented recently at a meeting of the American Heart Assn.

This is contrary to guidelines from the AHA, the American College of Sports Medicine, and a health club trade group--IHRSA, the International Health, Racquet and Sportsclub Assn., McInnis said. “All agree that at least a basic form of written health history questionnaire be administered to all clients,” he said.

Of clubs offering special programs for the elderly and for people with heart disease, 25% did not screen consistently, the survey found. That’s especially worrisome because the risk of a cardiac event during exercise is about 10 times greater for someone with heart disease than for someone without heart disease, McInnis said.

Of all clubs that do screen, 25% would let people with known heart disease exercise without a physician’s consent. Twenty-two percent of clubs with special programs would do the same, the survey said. “Even if they do screen, what do they do with the data?” McInnis said. At many clubs, he said, the answer apparently is nothing.

The study has some limitations, McInnis noted.

The researchers did not attempt a national sample, so the percentages might be different in other areas, McInnis said. He added, however, “I can’t think of any reasons why.”

Also, the 110 clubs that responded were only 54% of those to which the questionnaire was sent. But non-responders would probably be less likely to pretest prospective members, McInnis said. “You wouldn’t want to admit it,” he said. “So we think this is probably a best-case scenario.”

McInnis and other experts caution that people should not take the study as an excuse not to exercise. Controlled exercise is commonly prescribed for people with heart trouble. And the risk of early death from causes including heart disease is higher among the sedentary than among exercisers.

“That’s what we don’t want to see happen,” said Cathy McNeil, IHRSA’s spokeswoman. “They are at greater risk for not exercising than they are for exercising.”

Other experts find that the risk that a person will die during exercise is very low overall. “I don’t think this is an enormously major problem,” said cardiologist Paul D. Thompson of the University of Pittsburgh Heart Institute, in an interview.

An article Thompson wrote for the journal Archives of Internal Medicine said that, although the risk of a cardiac event does rise a bit during exercise, only six middle-aged men per 100,000 die each year from any cause during exertion. The risk is even lower for younger people, he said.

Just the same, 20 million people exercise at health clubs, McInnis and his colleagues said. “The promotion of physical activity to the public must coincide with better screening at fitness clubs to minimize potential cardiovascular risks,” their report said.