ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 2 Health Screening & Risk Stratification


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ACSM’s Guidelines For Exercise Testing And Prescription : Chapter 2 Health Screening & Risk Stratification

Reasons To Screen Your Exercising Population

Identify individuals with significant disease who should only exercise in a medically supervised environment.

Physical Activity Readiness Questionnaire - The PAR-Q


Questions On The PAR-Q To Ask Potential Exercising Persons

3. Do you often feel faint or have spells of severe dizziness?

5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise?

6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?

If the person filling out the PAR-Q answers YES to any of the questions, they are advised to see their physician and find out if they are able to exercise safely in a community exercise program.

If the person filling out the PAR-Q answers NO truthfully to all of the questions, they are reasonably assured that they can have a fitness appraisal evaluation and begin an exercise program as long as they start out slowly and gradually advance the intensity of their exercise.

Coronary Risk Factors To Be Used With ACSM’s Risk Stratification

Cigarette Smoking - current use or those who have quit within the last 6 months (other tobacco use - pipe, cigars, etc.)

Hypertension - Blood pressure on two separate occassions > 140/90 or an individual who is on medications for hypertension


Impaired Fasting Glucose - > 110 mg/dl measured on 2 separate occassions.

Obesity - Body mass Index > 30 Kg/m2 or waist girth > 100 cm.

Sedentary Lifestyle - Persons who are not involved with a regular exercise program†.

Additional Concerns …...

Ankle Edema

ACSM Risk Stratification

Moderate Risk - Men > 45 yrs and women > 55 yrs or if these persons have two or more risk factors.

High Risk - Persons with one or more signs or symptoms (ankle edema, orthopnea, SOB, angina, etc.) or known cardiovascular, pulmonary (COPD) or metabolic disease (DM).

Now that the patient has been screened and evaluated as to their potential risk, there are other decisions that the exercise leader must make.


Vigorous Exercise : Activities > 6 METs

The Two Golden Questions

Does The Patient Need A Physical, An Exercise Test & Does The Physician Need To Be Present ?

What If They Are Already Cardiac Patients ?

Moderate Risk

High Risk

Risk factor stratification can be modified with :

With cardiac patients, do I have an algorhythm to determine if they need a physical exam and an exercise test with a physician present prior to undertaking an exercise program ?

Author: David Alan Arnall

Email: David.Arnall@NAU.EDU

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