Abstract: Promoting scientific physical activity to reduce the burden of cardiovascular diseases and all-cause mortality associated with physical inactivity has become a global consensus in public health. However, exercise itself may also induce severe cardiovascular events, highlighting the urgent need to establish a comprehensive exercise risk prevention and control system in China, applicable to both general fitness participants and professional athletes. The system requires international experience and should integrate advanced technologies such as artificial intelligence. This study systematically reviewed six internationally mainstream pre-exercise health risk screening tools: the PAR-Q and PAR-Q＋ questionnaires, the AHA guidelines, the EACPR guidelines, and the 9th and 10th editions of the ACSM guidelines revised around 2015, and found that their evolution has consistently shifted from a restrictive, “exercise-limiting” model toward a more inclusive, “exercise-permitting” approach. Based on an analysis of their target populations, core content, and effectiveness, and considering three key dimensions of“whether the individual has a regular exercise habit”“presence of cardiovascular, metabolic, or renal diseases and any related symptoms” and “risk characteristics of the exercise activity”, three stratified screening recommendations were proposed: 1) For the general healthy population engaging in low-to-moderate intensity exercise, direct participation is acceptable. Individuals with diagnosed cardiovascular disease but no symptoms and no exercise habit should undergo initial screening using PAR-Q＋ to determine appropriate exercise intensity or obtain medical clearance. Exercise should be stopped immediately and assessed if symptoms appear during activity. 2) High-intensity activities like marathons are only recommended for those with a solid training foundation and require prior evaluation. 3) Competitive athletes should adopt a combined screening strategy utilizing the AHA 14-element screening guidelines along with resting electrocardiography and echocardiography. Furthermore, combining the rapid advancements in artificial intelligence, big data, and mobile network technology in China, the study puts forward three key recommendations for constructing a national exercise risk prevention and control system: 1) Enhance public awareness of risk prevention through exercise risk education; 2) Popularize, validate, and standardize the application of existing mature screening tools; 3) Promote the establishment of a new intelligent screening and early-warning model based on AI and big data; and 4) Utilize smart wearable devices to enable dynamic monitoring and real-time intervention for risks during exercise. By integrating pre-participation risk education, precise screening assessment, and real-time risk management during activity, the study ultimately proposes the construction of an integrated “Education-Screening-Control” exercise health risk prevention and control system.