Does insistence on medical clearance inhibit adoption of physical activityin the elderly?

During the 1970s, the U.S. policy of requiring a negative exercise stress t est for all adults >35 years old proved expensive. It also discouraged exer cise adoption, was ineffective in detecting high-risk individuals, and led to much iatrogenic disease. In the age range of 15-69 years, abetter altern ative is triage, based on responses to the revised Physical Activity Readin ess Questionnaire (PAR-Q), supplemented by considerations of age and cardia c risk factors. But most people older than 70 years have one or more clinic al conditions; in this age group, any potential system of triage excludes a n excessive proportion of potential exercisers and thus does not appear war ranted. An increase in habitual physical activity increases quality-adjuste d life span, and it might also enhance total longevity. Restriction of phys ical 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. Th ey are highly motivated, and their activity will not be discouraged by the need for a careful clinical examination.