ACSM CEP-Testing and Prescription exam d d d d d
test with mark scheme d d d
Primary Physical Activity Recommendations from 2008 Physical Activity Guidelines
d d d d d d d d d
Advisory Committee Report - d d d d
Everyone should participate in 150 min/week of moderate aerobic activity, 75
d d d d d d d d d d d d d d d d d d d d d d d d d d
min/week of vigorous aerobic activity, or a combo if both. Additional health benefits are
d d d d d d d d d d d d d d
generated with more than 300 min/week of moderate or 150 min/week of vigorous aerobic
d d d d d d d d d d d d d d
activity. Should perform muscle strengthening activities ≥2 days/week.
d d d d d d d
Health Benefits of Improving Muscular Fitness -
d d d d d d d
High levels are associated with significantly better cardiometabolic risk factor
d d d d d d d d d d d d d d d d d d d d d d d d d
profile, lower all-cause mortality risk, fever CVD events, lower risk of developing physical
d d d d d d d d d d d d d
function limitations, and lower risk of nonfatal disease. Also, improved body comp, blood
d d d d d d d d d d d d d
glucose, insulin sensitivity, and BP in people with mild/moderate HTN. Benefits people with
d d d d d d d d d d d d d
T2DM (type II diabetes mellitus) and PAD (peripheral artery disease). Exercises enhancing
d d d d d d d d d d d d
muscle strength and mass also increase bone mass (BMD) and strength, which helps
d d d d d d d d d d d d d
combat/prevent/reverse osteoporosis. d
Benefits of Regular PA and/or Exercise -
d d d d d d d
Cardiovascular/Respiratory Improvements: ↑ VO2 max. ↓minute Ventilation at
d d d d d d d d d d d d d d d d d d d d d d d
given absolute submax intensity. ↓myocardial O2 cost at given absolute submax intensity. ↓
d d d d d d d d d d d d d
HR & BP at submax intensity. ↑ Capillary density in skeletal muscle. ↑ exercise threshold for
d d d d d d d d d d d d d d d d
blood lactate accumulation. ↑ exercise threshold for the onset of disease signs or symptoms
d d d d d d d d d d d d d d
(angina, ischemic ST depression, and claudication).
d d d d d
Benefits of Regular PA and/or Exercise -
d d d d d d d
Reduction in Cardiovascular Disease (CVD) Risk Factors: ↓ Resting SBP/DBP, ↑
d d d d d d d d d d d d d d d d d d d d d d d d d d
serum HDL and ↓ triglycerides, ↓ TBF (total body fat), intra-abdominal fat, insulin needs, ↑
d d d d d d d d d d d d d d d
glucose tolerance, ↓ blood platelet adhesiveness/aggregation, inflammation
d d d d d d
Benefits of Regular PA and/or Exercise -
d d d d d d d
Other benefits of Regular PA and/or Exercise: ↓ anxiety and depression, ↑ cognitive
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
function, enhanced physical function & independent living in older individuals, enhanced
d d d d d d d d d d d
feeling of well-being, enhanced work/recreational/sport performance, ↓risk of falls and
d d d d d d d d d d
injuries in older individuals d d d
Preparticipation health screening: 2 Stage Process - d d d d d d d
1. Need for medical clearance before initiating/progressing exercise programming is
d d d d d d d d d d d d d d d d d d d d d d d d
determined using updated & revised ACSM screening algorithm & the help of a qualified
d d d d d d d d d d d d d d d
exercise/healthcare professional. In absence of professional assistance, individuals may use d d d d d d d d d d
self-guided methods d
2. If indicated during screening, medical clearance should be sought from respective
d d d d d d d d d d d d
healthcare providers (primary care/cardiologist, etc.). Manner of clearance should be
d d d d d d d d d d
determined by clinical judgement and discretion of provider.
d d d d d d d
1|Page
,Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Shortness of breath (dyspnea) @ rest or with mild exertion
d d d d d d d d d d d d d d d d d d d d d d d d
Dyspnea (abnormally uncomfortable awareness of breathing). Commonly occurs during
d d d d d d d d d
strenuous exercise in healthy/well-trained people & in moderate exercise in healthy/untrained
d d d d d d d d d d
people. *should be regarded as abnormal if experienced at level of exertion not expected to
d d d d d d d d d d d d d d d d
evoke symptom* d d
Abnormal exertional dyspnea suggests presence of Cardiopulmonary. disorders, in particular
d d d d d d d d d d
left ventricular (LV) dysfunction (LVD) or COPD
d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Pain; discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
areas typical of myocardial ischemia
d d d d d
Key features favoring ischemic origin:
d d d d
Character: constricting, squeezing, burning, "heaviness" or "heavy feeling"
d d d d d d d d
Location: substernal, across midthorax, anteriorly; one/both arms, shoulders; in neck, cheeks,
d d d d d d d d d d d
teeth; in forearms, fingers
d d d d
Provoking factors: exercise/exertion, excitement, stress, cold weather, post-meals
d d d d d d d d
Key features against ischemic origin:
d d d d
Character: dull ache; "knife-like", "sharp, stabbing pain"; "jabs" aggravated by respiration
d d d d d d d d d d d
Location: left submammary area; left hemithorax
d d d d d d
Provoking factors: post-exercise, provoked by a specific body motion
d d d d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Dizziness/Syncope
d d d d d d d d d d d d d d d
Syncope (loss of consciousness). Dizziness or Syncope during exercise may result from
d d d d d d d d d d d d
cardiac disorders that prevent normal rise of CO. Potentially life-threatening & include severe
d d d d d d d d d d d d
CAD, Hypertrophic Cardiomyopathy (HCM), Aortic Stenosis (AS) [narrowing/aortic valve
d d d d d d d d d d
doesn't open fully], & Ventricular Dysrhythmias (Ven DysRhyth)
d d d d d d d d
Post Exercise: dizziness/syncope should not be ignored, but these symptoms may occur even
d d d d d d d d d d d d d
in healthy individuals due to ↓ venous return to heart
d d d d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Orthopnea/Paroxysmal Nocturnal Dyspnea (PND)
d d d d d d d d d d d d d d d d d d
Orthopnea (dyspnea at rest in recumbent position.) Usually relived by standing/sitting
d d d d d d d d d d d
upright. PND begins 2-5 hours after onset of sleep (relieved by sitting on side of bed/getting
d d d d d d d d d d d d d d d d
out of bed). Both are symptoms of LVD. Nocturnal Dyspnea may occur in patient's w/
d d d d d d d d d d d d d d d
COPD, it differs because it is relieved after a bowl movement rather than sitting up.
d d d d d d d d d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Ankle Edema (AE)
d d d d d d d d d d d d d d d d d
Bilateral AE most evident at night is *a characteristic sign of heart failure (HF) or bilateral
d d d d d d d d d d d d d d d d
chronic venous insufficiency. Unilateral AE of limb often results from venous thrombosis
d d d d d d d d d d d d
2|Page
,(clot) or lymphatic blockage in limb. Generalized edema (anasarca) occurs in individuals w/
d d d d d d d d d d d d d
nephrotic syndrome (kidney disorder; too much protein in urine), severe HF, or hepatic
d d d d d d d d d d d d d
(liver) cirrhosis. d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Palpitations/Tachycardia
d d d d d d d d d d d d d d d
Palpitations (unpleasant awareness of forceful/rapid beating of the heart). Can be induced by
d d d d d d d d d d d d d
various disorders of cardiac rhythm. I.E. Tachycardia (Tachy [HR >100 bpm]), Sudden onset
d d d d d d d d d d d d d
Bradycardia (Brady [HR <60 bpm]), Ectopic beats (disturbance of the cardiac rhythm related
d d d d d d d d d d d d d
to electrical conduction of heart) [PAC or PVC], compensatory pauses, & accentuated (more
d d d d d d d d d d d d d
prominent) SV from valvular regurgitation. d d d d d
Can also see palpitations anxiety, ↑ CO states (such as anemia, fever, thyrotoxicosis
d d d d d d d d d d d d d
[overactive thyroid], arteriovenous fistula [abnormal connection between artery and vein],
d d d d d d d d d d
and idiopathic hyperkinetic heart syndrome [hyperactivity of the heart])
d d d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Intermittent Claudication (IC)
d d d d d d d d d d d d d d d d d
IC refers to pain occurring in lower extremities (LE) w/ an inadequate blood supply (typically
d d d d d d d d d d d d d d
dfrom atherosclerosis [hardening/narrowing of arteries]) that is brought on by exercise. Pain
d d d d d d d d d d d d
doesn't occur w/ sitting or standing, reproducible from day to day, more severe when walking
d d d d d d d d d d d d d d d
@ incline (stairs, hill) & is described as a cramp, which disappears 1-2 min after exercise.
d d d d d d d d d d d d d d d d
CAD is more prevalent in individuals with IC. Patients w/ Diabetes Mellitus (DM) are more
d d d d d d d d d d d d d d d
at risk for IC.
d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Known Heart Murmur
d d d d d d d d d d d d d d d d d
Some may be innocent, but heart murmurs (HM) may indicate valvular or other types of
d d d d d d d d d d d d d d d
CVD. From an exercise safety standpoint, it's important to exclude hypertrophic
d d d d d d d d d d d
cardiomyopathy (HCM) and aortic stenosis (AO) [narrowing of aortic valve] as underlying d d d d d d d d d d d d
causes because these are among the more common causes or exertion-related Sudden Cardiac
d d d d d d d d d d d d
Death (SCD).
d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Unusual Fatigue or Dyspnea with usual activities
d d d d d d d d d d d d d d d d d d d d d
May be benign origins for symptoms, they may also signal the onset/or change in status of
d d d d d d d d d d d d d d d d
CVD or Metabolic Disease d d d
ACSM Preparticipation Screening Algorithm - Doesn't Participate in Regular Exercise -
d d d d d d d d d d d
No CV, Metabolic, or Renal Disease AND no S/S suggestive of CV, Metabolic, or
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
Renal disease d
Medical Clearance Not Necessary d d d
Light - Moderate Intensity Exercise Recommended May gradually ↑ to Vigorous Intensity
d d d d d d d d d d d d
Exercise following ACSM Guidelines d d d
3|Page
, ACSM Preparticipation Screening Algorithm - Doesn't Participate in Regular Exercise -
d d d d d d d d d d d
Known CV, Metabolic, or Renal Disease AND Asymptomatic (showing no
d d d d d d d d d d d d d d d d d d d d d d d d d
signs/symptoms)
Medical Clearance Recommended d d
Following Medical Clearance, Light - Moderate Intensity Exercise Recommended May
d d d d d d d d d d
gradually ↑ as tolerated following ACSM Guidelines
d d d d d d
ACSM Preparticipation Screening Algorithm - Doesn't Participate in Regular Exercise -
d d d d d d d d d d d
Any S/S or Symptoms Suggestive of CV, Metabolic, or Renal Disease * Regardless
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
of disease status
d d
Medical Clearance Recommended d d
Following Medical Clearance, Light - Moderate Intensity Exercise Recommended May
d d d d d d d d d d
gradually ↑ as tolerated following ACSM Guidelines
d d d d d d
ACSM Preparticipation Screening Algorithm - Participates in Regular Exercise (structured
d d d d d d d d d d
PA @ moderate intensity for at least 30/min *3-4 days/week* past 3 months) -
d d d d d d d d d d d d d d
No CV, Metabolic, or Renal Disease AND No S/S suggestive of CV, Metabolic, or
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
Renal disease d
Medical Clearance Not Necessaryd d d
Continue Moderate - Vigorous Intensity Exercise May gradually progress following ACSM
d d d d d d d d d d d
Guidelines
ACSM Preparticipation Screening Algorithm - Participates in Regular Exercise (structured
d d d d d d d d d d
PA @ moderate intensity for at least 30/min *3-4 days/week* past 3 months) -
d d d d d d d d d d d d d d
Known CV, Metabolic, or Renal Disease AND Asymptomatic
d d d d d d d d d d d d d d d d d d d d d d
Medical Clearance for Moderate Intensity Exercise Not Necessary Medical Clearance (w/in
d d d d d d d d d d d
last 12 months if no change in S/S) Recommended before engaging in Vigorous Intensity
d d d d d d d d d d d d d d
Exercise
Continue w/ Moderate Intensity Exercise Following Medical Clearance, may gradually
d d d d d d d d d d
progress as tolerated following ACSM Guideline
d d d d d
ACSM Preparticipation Screening Algorithm - Participates in Regular Exercise (structured
d d d d d d d d d d
PA @ moderate intensity for at least 30/min *3-4 days/week* past 3 months) -
d d d d d d d d d d d d d d
Any S/S or Symptoms suggestive of CV, Metabolic, or Renal Disease *Regardless
d d d d d d d d d d d d d d d d d d d d d d d d d d d
of disease status
d d
Discontinue Exercise & Seek Medical Clearance d d d d d
May Return to Exercise following Medical Clearance Gradually progress as tolerated
d d d d d d d d d d d
following ACSM Guidelines d d
4|Page
test with mark scheme d d d
Primary Physical Activity Recommendations from 2008 Physical Activity Guidelines
d d d d d d d d d
Advisory Committee Report - d d d d
Everyone should participate in 150 min/week of moderate aerobic activity, 75
d d d d d d d d d d d d d d d d d d d d d d d d d d
min/week of vigorous aerobic activity, or a combo if both. Additional health benefits are
d d d d d d d d d d d d d d
generated with more than 300 min/week of moderate or 150 min/week of vigorous aerobic
d d d d d d d d d d d d d d
activity. Should perform muscle strengthening activities ≥2 days/week.
d d d d d d d
Health Benefits of Improving Muscular Fitness -
d d d d d d d
High levels are associated with significantly better cardiometabolic risk factor
d d d d d d d d d d d d d d d d d d d d d d d d d
profile, lower all-cause mortality risk, fever CVD events, lower risk of developing physical
d d d d d d d d d d d d d
function limitations, and lower risk of nonfatal disease. Also, improved body comp, blood
d d d d d d d d d d d d d
glucose, insulin sensitivity, and BP in people with mild/moderate HTN. Benefits people with
d d d d d d d d d d d d d
T2DM (type II diabetes mellitus) and PAD (peripheral artery disease). Exercises enhancing
d d d d d d d d d d d d
muscle strength and mass also increase bone mass (BMD) and strength, which helps
d d d d d d d d d d d d d
combat/prevent/reverse osteoporosis. d
Benefits of Regular PA and/or Exercise -
d d d d d d d
Cardiovascular/Respiratory Improvements: ↑ VO2 max. ↓minute Ventilation at
d d d d d d d d d d d d d d d d d d d d d d d
given absolute submax intensity. ↓myocardial O2 cost at given absolute submax intensity. ↓
d d d d d d d d d d d d d
HR & BP at submax intensity. ↑ Capillary density in skeletal muscle. ↑ exercise threshold for
d d d d d d d d d d d d d d d d
blood lactate accumulation. ↑ exercise threshold for the onset of disease signs or symptoms
d d d d d d d d d d d d d d
(angina, ischemic ST depression, and claudication).
d d d d d
Benefits of Regular PA and/or Exercise -
d d d d d d d
Reduction in Cardiovascular Disease (CVD) Risk Factors: ↓ Resting SBP/DBP, ↑
d d d d d d d d d d d d d d d d d d d d d d d d d d
serum HDL and ↓ triglycerides, ↓ TBF (total body fat), intra-abdominal fat, insulin needs, ↑
d d d d d d d d d d d d d d d
glucose tolerance, ↓ blood platelet adhesiveness/aggregation, inflammation
d d d d d d
Benefits of Regular PA and/or Exercise -
d d d d d d d
Other benefits of Regular PA and/or Exercise: ↓ anxiety and depression, ↑ cognitive
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
function, enhanced physical function & independent living in older individuals, enhanced
d d d d d d d d d d d
feeling of well-being, enhanced work/recreational/sport performance, ↓risk of falls and
d d d d d d d d d d
injuries in older individuals d d d
Preparticipation health screening: 2 Stage Process - d d d d d d d
1. Need for medical clearance before initiating/progressing exercise programming is
d d d d d d d d d d d d d d d d d d d d d d d d
determined using updated & revised ACSM screening algorithm & the help of a qualified
d d d d d d d d d d d d d d d
exercise/healthcare professional. In absence of professional assistance, individuals may use d d d d d d d d d d
self-guided methods d
2. If indicated during screening, medical clearance should be sought from respective
d d d d d d d d d d d d
healthcare providers (primary care/cardiologist, etc.). Manner of clearance should be
d d d d d d d d d d
determined by clinical judgement and discretion of provider.
d d d d d d d
1|Page
,Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Shortness of breath (dyspnea) @ rest or with mild exertion
d d d d d d d d d d d d d d d d d d d d d d d d
Dyspnea (abnormally uncomfortable awareness of breathing). Commonly occurs during
d d d d d d d d d
strenuous exercise in healthy/well-trained people & in moderate exercise in healthy/untrained
d d d d d d d d d d
people. *should be regarded as abnormal if experienced at level of exertion not expected to
d d d d d d d d d d d d d d d d
evoke symptom* d d
Abnormal exertional dyspnea suggests presence of Cardiopulmonary. disorders, in particular
d d d d d d d d d d
left ventricular (LV) dysfunction (LVD) or COPD
d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Pain; discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
areas typical of myocardial ischemia
d d d d d
Key features favoring ischemic origin:
d d d d
Character: constricting, squeezing, burning, "heaviness" or "heavy feeling"
d d d d d d d d
Location: substernal, across midthorax, anteriorly; one/both arms, shoulders; in neck, cheeks,
d d d d d d d d d d d
teeth; in forearms, fingers
d d d d
Provoking factors: exercise/exertion, excitement, stress, cold weather, post-meals
d d d d d d d d
Key features against ischemic origin:
d d d d
Character: dull ache; "knife-like", "sharp, stabbing pain"; "jabs" aggravated by respiration
d d d d d d d d d d d
Location: left submammary area; left hemithorax
d d d d d d
Provoking factors: post-exercise, provoked by a specific body motion
d d d d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Dizziness/Syncope
d d d d d d d d d d d d d d d
Syncope (loss of consciousness). Dizziness or Syncope during exercise may result from
d d d d d d d d d d d d
cardiac disorders that prevent normal rise of CO. Potentially life-threatening & include severe
d d d d d d d d d d d d
CAD, Hypertrophic Cardiomyopathy (HCM), Aortic Stenosis (AS) [narrowing/aortic valve
d d d d d d d d d d
doesn't open fully], & Ventricular Dysrhythmias (Ven DysRhyth)
d d d d d d d d
Post Exercise: dizziness/syncope should not be ignored, but these symptoms may occur even
d d d d d d d d d d d d d
in healthy individuals due to ↓ venous return to heart
d d d d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Orthopnea/Paroxysmal Nocturnal Dyspnea (PND)
d d d d d d d d d d d d d d d d d d
Orthopnea (dyspnea at rest in recumbent position.) Usually relived by standing/sitting
d d d d d d d d d d d
upright. PND begins 2-5 hours after onset of sleep (relieved by sitting on side of bed/getting
d d d d d d d d d d d d d d d d
out of bed). Both are symptoms of LVD. Nocturnal Dyspnea may occur in patient's w/
d d d d d d d d d d d d d d d
COPD, it differs because it is relieved after a bowl movement rather than sitting up.
d d d d d d d d d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Ankle Edema (AE)
d d d d d d d d d d d d d d d d d
Bilateral AE most evident at night is *a characteristic sign of heart failure (HF) or bilateral
d d d d d d d d d d d d d d d d
chronic venous insufficiency. Unilateral AE of limb often results from venous thrombosis
d d d d d d d d d d d d
2|Page
,(clot) or lymphatic blockage in limb. Generalized edema (anasarca) occurs in individuals w/
d d d d d d d d d d d d d
nephrotic syndrome (kidney disorder; too much protein in urine), severe HF, or hepatic
d d d d d d d d d d d d d
(liver) cirrhosis. d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Palpitations/Tachycardia
d d d d d d d d d d d d d d d
Palpitations (unpleasant awareness of forceful/rapid beating of the heart). Can be induced by
d d d d d d d d d d d d d
various disorders of cardiac rhythm. I.E. Tachycardia (Tachy [HR >100 bpm]), Sudden onset
d d d d d d d d d d d d d
Bradycardia (Brady [HR <60 bpm]), Ectopic beats (disturbance of the cardiac rhythm related
d d d d d d d d d d d d d
to electrical conduction of heart) [PAC or PVC], compensatory pauses, & accentuated (more
d d d d d d d d d d d d d
prominent) SV from valvular regurgitation. d d d d d
Can also see palpitations anxiety, ↑ CO states (such as anemia, fever, thyrotoxicosis
d d d d d d d d d d d d d
[overactive thyroid], arteriovenous fistula [abnormal connection between artery and vein],
d d d d d d d d d d
and idiopathic hyperkinetic heart syndrome [hyperactivity of the heart])
d d d d d d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Intermittent Claudication (IC)
d d d d d d d d d d d d d d d d d
IC refers to pain occurring in lower extremities (LE) w/ an inadequate blood supply (typically
d d d d d d d d d d d d d d
dfrom atherosclerosis [hardening/narrowing of arteries]) that is brought on by exercise. Pain
d d d d d d d d d d d d
doesn't occur w/ sitting or standing, reproducible from day to day, more severe when walking
d d d d d d d d d d d d d d d
@ incline (stairs, hill) & is described as a cramp, which disappears 1-2 min after exercise.
d d d d d d d d d d d d d d d d
CAD is more prevalent in individuals with IC. Patients w/ Diabetes Mellitus (DM) are more
d d d d d d d d d d d d d d d
at risk for IC.
d d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Known Heart Murmur
d d d d d d d d d d d d d d d d d
Some may be innocent, but heart murmurs (HM) may indicate valvular or other types of
d d d d d d d d d d d d d d d
CVD. From an exercise safety standpoint, it's important to exclude hypertrophic
d d d d d d d d d d d
cardiomyopathy (HCM) and aortic stenosis (AO) [narrowing of aortic valve] as underlying d d d d d d d d d d d d
causes because these are among the more common causes or exertion-related Sudden Cardiac
d d d d d d d d d d d d
Death (SCD).
d d
Signs/Symptoms Suggestive of CVD, Metabolic, and Renal Disease - d d d d d d d d d
Unusual Fatigue or Dyspnea with usual activities
d d d d d d d d d d d d d d d d d d d d d
May be benign origins for symptoms, they may also signal the onset/or change in status of
d d d d d d d d d d d d d d d d
CVD or Metabolic Disease d d d
ACSM Preparticipation Screening Algorithm - Doesn't Participate in Regular Exercise -
d d d d d d d d d d d
No CV, Metabolic, or Renal Disease AND no S/S suggestive of CV, Metabolic, or
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
Renal disease d
Medical Clearance Not Necessary d d d
Light - Moderate Intensity Exercise Recommended May gradually ↑ to Vigorous Intensity
d d d d d d d d d d d d
Exercise following ACSM Guidelines d d d
3|Page
, ACSM Preparticipation Screening Algorithm - Doesn't Participate in Regular Exercise -
d d d d d d d d d d d
Known CV, Metabolic, or Renal Disease AND Asymptomatic (showing no
d d d d d d d d d d d d d d d d d d d d d d d d d
signs/symptoms)
Medical Clearance Recommended d d
Following Medical Clearance, Light - Moderate Intensity Exercise Recommended May
d d d d d d d d d d
gradually ↑ as tolerated following ACSM Guidelines
d d d d d d
ACSM Preparticipation Screening Algorithm - Doesn't Participate in Regular Exercise -
d d d d d d d d d d d
Any S/S or Symptoms Suggestive of CV, Metabolic, or Renal Disease * Regardless
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of disease status
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Medical Clearance Recommended d d
Following Medical Clearance, Light - Moderate Intensity Exercise Recommended May
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gradually ↑ as tolerated following ACSM Guidelines
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ACSM Preparticipation Screening Algorithm - Participates in Regular Exercise (structured
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PA @ moderate intensity for at least 30/min *3-4 days/week* past 3 months) -
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No CV, Metabolic, or Renal Disease AND No S/S suggestive of CV, Metabolic, or
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Renal disease d
Medical Clearance Not Necessaryd d d
Continue Moderate - Vigorous Intensity Exercise May gradually progress following ACSM
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Guidelines
ACSM Preparticipation Screening Algorithm - Participates in Regular Exercise (structured
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PA @ moderate intensity for at least 30/min *3-4 days/week* past 3 months) -
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Known CV, Metabolic, or Renal Disease AND Asymptomatic
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Medical Clearance for Moderate Intensity Exercise Not Necessary Medical Clearance (w/in
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last 12 months if no change in S/S) Recommended before engaging in Vigorous Intensity
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Exercise
Continue w/ Moderate Intensity Exercise Following Medical Clearance, may gradually
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progress as tolerated following ACSM Guideline
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ACSM Preparticipation Screening Algorithm - Participates in Regular Exercise (structured
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PA @ moderate intensity for at least 30/min *3-4 days/week* past 3 months) -
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Any S/S or Symptoms suggestive of CV, Metabolic, or Renal Disease *Regardless
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of disease status
d d
Discontinue Exercise & Seek Medical Clearance d d d d d
May Return to Exercise following Medical Clearance Gradually progress as tolerated
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following ACSM Guidelines d d
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