Starting exercise safely

1. Health checks before you start

These are the items in the MHLW pre-exercise health checklist, which was developed with reference to PAR-Q+. The action to take after a “yes” depends on the item.

1. A doctor has told you that you have heart disease or high blood pressure.
2. You have a chronic condition other than heart disease or high blood pressure, or have had one in the past.
3. You have had surgery.
4. You take medication for a chronic condition or another illness.
5. You sometimes feel chest pain at rest, in daily life or during exercise.
6. You lose your balance because of dizziness, or have lost consciousness within the past year.
7. You have a bone, joint, muscle, ligament or tendon problem that exercise could worsen, or have had one within the past year.
8. A doctor has told you to exercise under medical supervision.

• “Yes” to 1–3: Check whether you have any exercise restrictions and follow them if you do. If you cannot establish this, consult a medical provider.
• “Yes” to 4: Check medication-related exercise precautions and take the necessary measures. If you cannot establish these, consult a medical provider.
• “Yes” to 5–8: Consult a medical provider. If the issue has already been resolved, follow the exercise instructions you received afterward.

When starting a new exercise routine, consider (1) any diseases and their current status, (2) what you want to do, and (3) your usual physical activity. Obtain a pre-exercise health assessment (medical clearance) when needed.

2. Signs that warrant medical advice

If you have any of the following signs or symptoms at rest or during activity, consult a medical provider before starting exercise.

• Pain or discomfort in the chest, neck, head or arms that may be related to insufficient blood flow to the heart.
• Dizziness or fainting.
• Breathlessness when lying down that improves when you sit up, or waking at night because of breathlessness.
• Swelling around the ankles.
• Palpitations or a fast pulse.
• Pain in the calves or similar areas when walking that eases with rest (intermittent claudication).
• You have been told that you have a heart murmur.
• Unusual tiredness or shortness of breath during everyday activities.

3. Blood pressure guidance

• Exercise raises blood pressure, so people who already have high blood pressure need care. The Japanese guidance recommends medical consultation for grade III hypertension—180/110 mmHg or above in a clinic, or 160/100 mmHg or above at home—and states that blood pressure should be controlled with medication before exercise begins.
• If your blood pressure tends to be high, make a habit of measuring and recording it, along with your pulse, before exercise. Rest for at least 5 minutes before measuring.
• If your pre-exercise blood pressure is 160/100 mmHg or above, limit activity to light exercise such as a gentle walk. At 180/110 mmHg or above, avoid exercise and rest.

4. If you take medication

• Beta blockers, some calcium-channel blockers, alpha blockers and similar blood-pressure medicines: These affect heart rate, so heart rate is not a suitable guide to exercise intensity. Use perceived effort, such as “somewhat hard,” as a guide. The heart-rate estimates on this website do not apply either.
• Insulin and medicines that stimulate insulin secretion (diabetes medication): Exercise can cause low blood sugar.
• Diuretics: Dehydration is more likely. Pay attention to heatstroke and lightheadedness on standing, and drink fluids.
• Anticoagulants and antiplatelet medicines: These increase the tendency to bleed. Take care with falls, impacts and contact activities.
• Statins (medicines for abnormal blood lipids): Muscle weakness or muscle pain can occur.

Review your exercise routine when medication is changed or added.

5. Check how you feel before every session

Check before leaving home on an exercise day. If even one answer is “yes,” do not push yourself to exercise. Rest and seek medical attention if needed.

1. Severe pain in your legs or lower back.
2. A fever.
3. Feeling sluggish or generally unwell.
4. Nausea or feeling sick.
5. A headache or dizziness.
6. Ringing in your ears.
7. Feeling unwell from overwork.
8. Feeling unwell from lack of sleep.
9. Loss of appetite.
10. Feeling unwell from a hangover.
11. Abdominal pain with diarrhea or constipation.
12. Shortness of breath or palpitations after only a little activity.
13. A cough or phlegm and symptoms of a cold.
14. Chest pain.
15. In summer: a heatstroke alert has been issued.

6. Symptoms that mean you should stop immediately

Stop exercising immediately if you notice unusual symptoms, including the following.

• Chest pain
• Intense hunger or trembling
• Cold sweats
• Palpitations
• Unusually severe tiredness
• Dizziness or unsteadiness
• Severe joint or muscle pain

7. Precautions for every session

• Warm up: Always warm up before exercise of a certain intensity. It helps prevent injuries and medical events and lets you assess how you feel.
• Cool down: After exercise of a certain intensity, cool down for 5–10 minutes. Stopping abruptly can lower blood pressure and cause dizziness, fainting or an irregular heartbeat.
• Fluids: During exercise, take fluids and salt approximately once every 15 minutes. Pay attention to temperature and humidity too.
• Next-day tiredness: If tiredness interferes with daily life the next day, the intensity or amount was excessive. Rest and do less next time.
• For people with obesity: Take care, as exercise-related joint injuries and similar problems are more likely.

Sources

1. Japan's Ministry of Health, Labour and Welfare: Physical Activity and Exercise Guide for Health Promotion 2023, INFORMATION 4, Points for safe physical activity and exercise. (in Japanese; title translated) https://www.mhlw.go.jp/content/001195872.pdf