3. Systems review¶

Filled by Client · Questions 45 · Time ~12 min · Prefix sys_*

A symptom sweep by body system, adapted from the practitioner intake sheet (דף תשאול). It exists to catch things the PAR-Q+ in section 2 does not ask about — and to catch them before a training programme starts, not after a client mentions them in passing eight weeks in.

Screening tool, not a diagnostic one

This section identifies when to refer out. It does not identify what is wrong, and nothing here should be interpreted, treated or "supported" by a coach. A cluster of symptoms is a reason to say please see your doctor about this and to note the modification it forces on the programme — nothing more.

Several blocks below (sys_endocrine, sys_pancreas, sys_adrenal) sit inside a licensed practitioner's scope — dietitian, naturopath, doctor. If your registration doesn't cover them, delete those blocks rather than collecting answers you cannot act on. Collecting health data you have no lawful basis to process is a problem in its own right.

3.1 How to answer¶

Each block lists symptoms as prompts. The client ticks what applies and adds detail only where something is present — the prompt list is deliberately long so that nothing is missed, not so that every line gets an answer.

For anything ticked, the follow-up asks the same four things: since when, how often, what makes it worse, what makes it better.

3.2 Head & neurological¶

Refer before training

Fainting, seizures, tremors, or numbness and weakness in a limb are Refer & stop — see Screening red flags. Dizziness is already captured as parq_3_dizziness; if it appears here but not there, go back and resolve the contradiction with the client.

3.3 Cardiorespiratory¶

A client who reports Breathlessness at rest has already fired a stop, so this question is never reached down that branch.

Overlaps the PAR-Q+ deliberately

Breathlessness is asked twice — here and as parq_2a_breathlessness in 2.1. That redundancy is intentional: clients under-report on a form headed "screening" and report more freely on a symptom checklist. Any disagreement between the two is resolved in the client's favour, meaning the more serious answer stands and clearance is required.

Chest pain is not asked twice. sys_cardio is the only field on the questionnaire that asks about it, so this page carries its stop entry alone — see 3.10.

3.4 Musculoskeletal¶

Joint and spine symptoms are covered in depth in section 4. This block only catches the systemic pattern — symmetrical, migratory or inflammatory joint pain that suggests something other than a training injury.

Inflammatory versus mechanical

Morning stiffness over 30 minutes, symmetrical joint involvement, or swelling with heat point away from a mechanical problem you can program around. Refer, and don't load the affected joints until someone qualified has looked.

3.5 Digestive¶

The three that are referrals, not notes

Blood in the stool, black or tarry stools, and unexplained vomiting were on the source sheet as matrix rows. They are not matrix rows — they are urgent referrals, and burying them in a grid makes them easy to skim past. They are asked separately below and they are not something a coach manages.

Stop rule

Any tick in sys_gi_urgent other than None of these means Refer & stop: no assessment, no programme, direct the client to their doctor today. Unintentional weight loss in particular is often mistaken for progress — it is not.

3.6 Urinary & pelvic¶

Blood in urine is a referral.

3.7 Menstrual & hormonal¶

Every question is optional.

Ask sys_menses_status of every client — it is the gate, and its Not applicable option is how a client for whom this block is irrelevant says so in one turn. Do not decide in advance who to skip it for: client_gender in section 1 is not a reliable proxy for whether someone menstruates, and pre-judging it is both wrong often enough to matter and unpleasant when it is wrong.

If sys_menses_status is Not applicable or Prefer not to say, skip the rest of the block and record those fields as skipped — not triggered. Any other answer opens the block. Enforced as visibleIf on each field in survey/sections/03-systems-review.json, keyed off sys_menses_status.

sys_menses_age, sys_menses_length, sys_menses_duration, sys_menses_flow, sys_menses_symptoms, sys_menses_training and

Why the detail earns its place

Cycle length, flow and symptom load are the difference between periodising training around a client's cycle and ignoring it. Heavy bleeding with fatigue is also worth an iron-status conversation with their doctor — sys_menses_flow = Very heavy alongside sys_endocrine fatigue is a common and very fixable pattern.

Absent periods in a client who trains hard or eats little is a referral, not a training variable. Read it with nut_disordered_history in section 7.

3.8 Endocrine & metabolic¶

Scope

Delete 3.8 unless a licensed practitioner is reading the answers. For a coach, the only actionable output is refer to a doctor, which section 2 already achieves.

On the last two blocks

sys_pancreas symptoms are worth flagging because they change when a client should eat relative to training, and because they may indicate undiagnosed glucose dysregulation — which is a doctor's question.

sys_adrenal describes a real and common fatigue pattern, and the answers usefully shape session timing. But "adrenal fatigue" is not a recognised medical diagnosis, and these symptoms overlap heavily with poor sleep, under-eating, depression, anaemia and thyroid disease — all of which are diagnosable and treatable. Treat a positive cluster as a prompt to check section 8 and to refer, never as a finding.

3.9 Anything else¶

sys_worst is the one clients answer honestly

It routinely surfaces the thing they came in for but didn't put under "goals" — a knee that stops them playing with their kids, reflux that makes evening training miserable. Read it against goal_primary in section 6.

3.10 Red flags¶

A symptom sweep is exactly where the largest share of the stop-and-refer list surfaces. Full outcome definitions are in Screening red flags.

Stop and refer immediately — no assessment, no session, today:

Chest pain, pressure or tightness (sys_cardio includes Chest pain). Stop whether it comes on at rest or only on exertion — the distinction changes the urgency for the doctor, not whether you stop. Record whatever the client already said in sys_cardio_detail; do not ask a follow-up first. This is the trigger the whole stop-and-refer path was built for.
Breathlessness at rest or on minimal exertion (sys_cardio_exertion = At rest or Walking slowly, or sys_cardio includes Breathlessness at rest). Walking slowly is in the trigger deliberately: someone who is breathless crossing a room is not a training candidate today.
New, unexplained swelling in one leg with pain or warmth (sys_cardio includes Swelling in the ankles or feet, reported with pain or warmth)
Blood in the stool, black or tarry stools, or unexplained vomiting (sys_gi_urgent)
Unintentional weight loss (sys_gi_urgent) — easily mistaken for progress, and never treated as it
Difficulty swallowing that is new or getting worse (sys_gi_urgent)
Blood in the urine (sys_urinary)
Seizures, fainting or unexplained tremor (sys_head, sys_neuro)
New numbness or weakness in a limb (sys_neuro) — if it's pain-related rather than a standalone neurological symptom, see 4.2 too

Clearance required before training:

Epilepsy with seizures in the last 12 months (sys_head or sys_neuro includes Seizures — cross-check against health_conditions in 2.9)
A concussion in the last 3 months without a return-to-activity clearance — there is no dedicated field yet; treat a head injury reported under sys_head as this trigger until one exists

Proceed with caution:

Flag	Source field	Typical modification
Pelvic floor symptoms	`sys_urinary`	Avoid impact and heavy intra-abdominal pressure; refer to a pelvic health physio
Inflammatory joint pattern — several joints, migratory, morning stiffness over 30 min	`sys_msk`	Don't load affected joints; refer for a rheumatology opinion
Symptoms of glucose dysregulation — shakiness when meals are delayed, excessive thirst	`sys_pancreas`	Fixed session timing, carbohydrate available, refer for blood glucose testing
Absent periods in a client training hard or eating little	`sys_menses_status`	Reduce training load, refer; do not treat as a training variable
Very heavy menstrual bleeding with fatigue	`sys_menses_flow`, `sys_endocrine`	Refer for iron studies; expect endurance work to feel disproportionately hard

If a stop condition fires here, use the wording in Stop conditions and hand off immediately — do not finish this section first.

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