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SCREENING RECOMMENDATIONS
What Exercise Professionals Need to Know
by Meir Magal, Ph.D., ACSM CEP, FACSM and Deborah Riebe, Ph.D., ACSM EP-C, FACSM
Learning Objectives
From this article, the readers should
understand the following:
The rationale for updating the
ACSM exercise preparticipation
screening procedures
How to use the updated ACSM
exercise preparticipation screening recommendations
How to use the newly developed
exercise preparticipation health
screening questionnaire for exercise professionals tool
INTRODUCTION
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Copyright 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
May/June 2016
WHAT IS NEW?
The current preparticipation health screening recommendations outlined in the ninth edition of ACSM's Guidelines for Exercise
Testing and Prescription require the exercise professional to 1) complete a CVD risk factor profile; 2) determine if the client/patient
has known CV, pulmonary, and/or metabolic diseases; and
3) identify major signs or symptoms suggestive of CV, pulmonary,
and/or metabolic diseases. Using this information, the client/
patient is classified as low, moderate, or high risk (13). Based on
the risk classification and the intensity of the intended exercise
training or exercise test, a decision is made concerning 1) the need
for a medical examination, 2) the need for an exercise test, and
3) the need for a physician to be present during the exercise test (13).
1 AMI incident per 184,000 runners and 1 SCD incident per 256,000 runners, which translate to 0.20
AMIs and 0.14 SCDs per 100,000 estimated runner-hours
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are no longer automatically required to receive medical clearance. Although CVD and pulmonary diseases share smoking
as a common risk factor, the presence of pulmonary disease does
not increase the risk of experiencing an adverse CVD event per se
(15). In fact, the increased risk of an adverse CVD event is associated with the inactive and sedentary lifestyle of many individuals with pulmonary disease (8).
Finally, the recommendation for medical examination and/or
diagnostic exercise test before the commencement of an exercise
program was replaced with a recommendation for medical clearance (Figure 1). The term medical clearance was chosen to suggest
that, after referral, the health care provider is in the best position
to decide what the next step is in respect to the evaluation of a
patient before approving the initiation of any exercise program
(15). It is important to point out that although there are some
substantial changes to the recommendations, the objectives of
the process have remained the same as stated in the current
guidelines (13):
1. To identify those who should receive medical clearance
before starting a new program or increasing the frequency,
intensity, and/or volume of an existing exercise program.
2. To identify those who present with CV, metabolic,
and/or renal diseases and will benefit from participating
in a medically supervised exercise program.
3. To identify those with CV, metabolic, and/or renal diseases who must wait until their medical condition(s) have
improved to proceed with an exercise program.
TABLE 2: Keeping Participants Safe During Exercise Tips for the Exercise Professional
Design an appropriate and effective program using the FITT principles of exercise prescription.
Include an adequate warm-up and cool-down in the exercise prescription and confirm that the client/patient does not skip this step.
Incorporate a 2- to 3-month transitional phase where the intensity and duration of exercise are increased gradually.
Educate your client/patient about the warning signs and symptoms of CVD.
Encourage sedentary individuals to start low and go slow. Remind them to avoid unaccustomed vigorous physical activity.
FITT indicates frequency, intensity, time, and type.
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Copyright 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
May/June 2016
Figure 1. The American College of Sports Medicine preparticipation screening algorithm. (Reprinted from: Riebe D,
et al. Updating ACSM's recommendations for exercise preparticipation health screening. Med. Sci. Sports Exerc. 2015;
47(11):24732479. Copyright 2015 Lippincott, Williams & Wilkins. Used with permission.)
2. If asymptomatic with known CV, metabolic, or renal diseases, one may continue the exercise program
as long as one remains symptom free and as long
as medical clearance was given within the last
12 months.
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Copyright 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
May/June 2016
13. Pescatello LS. American College of Sports Medicine. ACSM's Guidelines for
Exercise Testing and Prescription. 9th ed. Philadelphia (PA): Wolters
Kluwer/Lippincott Williams & Wilkins Health; 2014. xxiv, 456 p.
14. Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the
incidence of coronary heart disease. Annu Rev Public Health. 1987;8:25387.
15. Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM's recommendations for
exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47(11):
24739.
16. Thompson PD, Franklin BA, Balady GJ, et al. Exercise and acute cardiovascular
events placing the risks into perspective: a scientific statement from the
American Heart Association Council on Nutrition, Physical Activity, and
Metabolism and the Council on Clinical Cardiology. Circulation. 2007;115(17):
235868.
17. Thompson PD, Funk EJ, Carleton RA, Sturner WQ. Incidence of death during
jogging in Rhode Island from 1975 through 1980. JAMA. 1982;247(18):25358.
18. Whang W, Manson JE, Hu FB, et al. Physical exertion, exercise, and sudden
cardiac death in women. JAMA. 2006;295(12):1399403.
2) is physically active; and 3) has a known CV, metabolic, or renal disease. The information gathered with the checklist will
guide the exercise professional in making a decision about the
need for medical clearance.
19. Whitfield GP, Pettee Gabriel KK, Rahbar MH, Kohl HW III. Application of the
American Heart Association/American College of Sports Medicine Adult
Preparticipation Screening Checklist to a nationally representative sample of US
adults aged >=40 years from the National Health and Nutrition Examination
Survey 2001 to 2004. Circulation. 2014;129(10):111320.
Acknowledgment
Disclosure: The authors declare no conflict of interest and do not have any
financial disclosures.
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