ACSM Pre-Participation Screening

STEP 1
Identify the presence of major positive (and one negative) coronary artery disease risk factors.

• Age
  • Men ≥ 45 years of age
  • Women ≥ 55 years of age
• Family History
  • Myocardial infarction, coronary revascularization, or sudden death
    • Before 55 years of age in father or other male first degree relative (ie, brother or son
    • Before 65 years of age in mother or other female first degree relative (ie, sister or daughter)
• Cigarette Smoking
  • Current cigarette smoker or those who quit within the previous six month 
• Hypertension
  • Confirmed by measurement on at least two separate occasions
    • Systolic blood pressure: 140 mmHg or greater
    • Diastolic blood pressure: 90 mmHg or greater
  • Using Antihypertensive medication
• Dyslipidemia
  • Low Density lipoprotein (LDL, aka: bad cholesterol): > 130 mg/dL (3.4 mmmol/L)
  • High-density lipoprotein (HDL, aka: good cholesterol): <40 mg/dl (1.03 mmol/L)
  • Using lipid-lower medication
  • If total serum cholesterol is all that is available use >200 mg/dl (5.2 mmol/L)
• Prediabetes
  • Fasting plasma glucose ≥ 100 but < 126 mg/dl
  • Oral glucose tolerance test (OGTT) ≥ 140 mg/dl but < 200 mg/dl on at least two seperate occasions
• Obesity
  • Body Mass Index ≥ 30 kg×m^-2
    • Use BMI Tool
  • Waist girth > 102 cm (40.2 in) for men and > 88 cm (34.6 in) for women.
• Sedentary lifestyle
  • Not participating in at least 30 minutes of moderate intensity physical activity on at least 3 days of the week for at least 3 months
• High serum HDL cholesterol
  • ≥60 mg/dL (1.6 mmol/L)

Total Number Of Risk Factors :

STEP 2
Identify the presence of major signs or symptoms suggestive of cardiovascular, pulmonary, and/or metabolic disease.

• Pain or discomfort in the chest, neck, jaw, arms, or other areas that may be due to myocardial ischemia.
  • Chest pain associated with reduction in blood supply to the heart muscle
• Shortness of breath
  • Rest, during daily activities, or with mild exertion
• Dizziness or syncope
  • Fainting sensation
• Orthopnea or paroxysmal nocturnal dyspnea
  • breathing discomfort when not in an upright position
  • interrupted breathing at night
• Ankle edema
  • Swelling at the lower leg
• Palpitations
  • abnormal rapid  heart rate
• Intermittent claudication
  • Leg pain (during movement) that is associated with reduction in blood supply to the lower leg
• Known heart murmur
  • atypical heart sound
• Unusual or unexplained fatigue

Total Number Of Signs Or Symptoms :

STEP 3
Identify the presence of any diagnosed disease.

• Cardiovascular disease
  • Cardiac, peripheral vascular, or cerebrovascular disease
• Pulmonary disease
  • Chronic obstructive pulmonary disease, asthma, interstitial lung disease, or cystic fibrosis
• Metabolic disease
  • Diabetes mellitus (type I or II), thyroid disorders, renal or liver disease

RISK STRATIFICATION

1.    Number of major coronary artery disease risk factors

2.   Number of major signs or symptoms suggestive of cardiovascular, pulmonary, and/or metabolic disease

3.    Number of known diagnosed diseases

RISK LEVEL  

LOW RISK

• Further medical examination and exercise testing not necessary prior to initiation of exercise testing.
• Medical supervision for submaximal or maximal exercise testing not necessary.

MODERATE RISK

• Medical examination and exercise testing recommended prior to the initiation of vigorous exercise training.
• Medical supervision recommended for maximal exercise testing.

HIGH RISK

• Medical examination and exercise testing recommended prior to the initiation of moderate or vigorous exercise training.
• Medical supervision recommended for submaximal or maximal exercise testing.

Moderate exercise intensity = 40-59% Heart Rate Reserve (HRR); Vigorous exercise intensity = >60%