“Do I need doctor clearance to be physically active?”

Summary of article

• Being physically active is overwhelmingly safe

• The risks that do exist can be managed by

  • Starting out slowly and building the volume and intensity of activity over time

  • Seeking out medical guidance in the following scenarios:

    • Dramatic increase in breathlessness

    • New or worsening chest pain and/or increasing glyceryl trinitrate (medication) requirement

    • Sudden onset of rapid palpitations or irregular heartbeat

    • Dizziness

    • Sudden change in vision

    • Sudden reduction in activity capacity

• Following the guidance for pregnancy and physical activity, if relevant

Article

Do you need to go to the doctor in order to receive clearance to be physically active? In most cases, no.

As outlined here, being physically active is amazing for your health. People who meet the physical activity guidelines live longer, are more mobile, and more mentally and cognitively fit than those who are not. However, there is a popular view that a significant minority of people cannot be physically active due to the risk of exacerbating other health conditions. This view is not supported by evidence, or by the World Health Organisation physical activity guidelines.

“… the benefits of doing physical activity and limiting sedentary behaviour outweighed the potential harms. Any potential harms may be managed by a gradual increase in the amount and intensity of physical activity.”

– World Health Organisation Physical Activity Guideline Development Group (1)

Getting Started with New Physical Activity

In reality, even if you are not completing structured physical activity, you are likely physically active. Even if your activity is as limited as walking around the supermarket, getting up and down from a chair, or carrying a suitcase to the car. This is physical activity. For a person like this, increasing their levels of activity towards meeting the recommended minimums would likely include increasing their walking distance, performing some sit to stands, and trialling some other low level strength exercises such as wall pushups. Over several weeks, they might progress to a walk/jog, doing some split squats, and doing knee pushups.

Considerations for People with Long-Term Conditions

But what about people with cardiac chest pain, diabetes, chronic obstructive pulmonary disease, or other long-term conditions? As with the general population, the benefits outweigh the risks (2). Consulting with a doctor before initiating new physical activity is not a blanket requirement. Instead, advice should be sought out if any of the following occur:

• A dramatic increase in breathlessness (2)

• New or worsening chest pain and/or increasing glyceryl trinitrate requirement (2)

• Sudden onset of rapid palpitations or irregular heartbeat (2)

• Dizziness (2)

• Sudden change in vision (2)

• Sudden reduction in activity capacity (2)

For people with chronic obstructive pulmonary disease (COPD), asthma, and heart failure, health outcomes are improved in those who are physically active. Although increased effort with breathing is normal when increasing levels of physical activity, this can feel uncomfortable for people with these conditions. When beginning or increasing physical activity levels, monitor symptoms, and seek medical guidance if your breathlessness is alarming (2).

Angina (chest pain) caused by ischemic heart disease can be improved with physical activity. However, where frequency or severity of chest pain are increasing as a result of increased physical activity, medical guidance should be sought. For people who have had cardiac events (such as heart attack) or cardiac surgery in the past six weeks, all physical activity should be monitored by cardiac specialists (2).

Increased awareness of your heart beat while exercising is normal. However, people with untreated arrhythmia (abnormal heartbeat), should obtain medical advice before increasing their levels of physical activity. For those who have already established control of their arrhythmia, being physically active beneficial, and can help to reduce the symptoms of arrhythmia (2).

People with Type 1 Diabetes (T1D) and Type 2 Diabetes should monitor their blood glucose, and carry carbohydrates with them, during and after physical activity. While rare, hypoglycaemic (low blood sugar) events do occur. Additionally, for people with T1D, any abnormal ketone levels should delay physical activity, and the underlying causes should be addressed (2).

Being Physically Active During Pregnancy

Being active during pregnancy carries a number of specific benefits including:

• Reduced risk of preterm birth and low birth weight (3)

• Reduced risk of gestational diabetes, gestational hypertension, and preeclampsia (3)

• Reduced requirement for surgical delivery (3)

• Healthy gestational weight gain (3)

However, for some people being physically active during pregnancy does carry additional risks. No activity more intense than required for completion of day-to-day tasks should be undertaken in cases of:

• Ruptured membranes (4)

• Premature labour (4)

• Unexplained persistent vaginal bleeding (4)

• Pre-eclampsia (4)

• Incompetent cervix (4)

• Intrauterine growth restriction (4)

• High order multiple pregnancy (eg. triplets) (4)

• Uncontrolled type 1 diabetes (4)

• Uncontrolled hypertension (4)

• Uncontrolled thyroid disease (4)

• Other serious cardiovascular, respiratory, or systemic disorder (4)

Where any of the following are relevant, the benefits and risks of physical activity should be discussed with an obstetric care provider:

• Recurrent pregnancy loss (4)

• Gestational hypertension (4)

• A history of spontaneous pre-term birth (4)

• Mild/moderate cardiovascular or respiratory disease (4)

• Symptomatic anaemia (4)

• Malnutrition (4)

• Eating disorder (4)

• Twin pregnancy after the 28th week (4)

• Other significant medical conditions (4)

In Summary

For most people, a visit to their doctor before increasing their levels of physical activity is not required. The health benefits of being active are clear, and the risks are very low. However, where new symptoms occur, and during pregnancy, there are occasions that seeking medical advice is recommended.

References

1. Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., ... & Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine, 54(24), 1451-1462.

2. Reid, H., Ridout, A. J., Tomaz, S. A., Kelly, P., & Jones, N. (2022). Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. British journal of sports medicine, 56(8), 427-438.

3. Artal, R., & O'Toole, M. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British journal of sports medicine, 37(1), 6-12.

4. Mottola, M. F., Davenport, M. H., Ruchat, S. M., Davies, G. A., Poitras, V. J., Gray, C. E., ... & Zehr, L. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British journal of sports medicine, 52(21), 1339-1346.