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ACSM Pre-Participation Screening

To reduce the occurrence of any unwanted event during exercise program, it is wise to conduct some form of pre-activity screening. Follow steps one through three to determine the risk level.

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
    • 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
Total Number Of Diagnosed Diseases  

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%