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Copyright 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Table. Recommendations for Exercise Testing Prior to Initiating
New ACSM GETP9 recommendations for exercise testing in asymp- Physical Activity
tomatic people prior to exercise for individuals at high risk (10). & Routine exercise testing before initiating a vigorous-
Diagnosed CVD intensity physical activity program is recommended
only for individuals at high risk of exercise-related
Unstable or new or possible symptoms of CVD
complications (Table and Figure).
Diabetes mellitus and at least one of the following: & Exercise testing is warranted also whenever the health/
Age 935 yr or fitness and clinical exercise professional has concerns
about an individuals CVD risk or requires additional
Type 2 diabetes mellitus 910 yr duration or
information to design an Ex Rx, or when the exercise
Type 1 diabetes mellitus 915 yr duration or participant has concerns about starting an exercise
Hypercholesterolemia (total cholesterol Q240 mgILj1) or program of any intensity without such testing.
Hypertension (systolic blood pressure Q140 or diastolic
Q90 mm Hg) or Recommendations for Supervision of Exercise Testing
Smoking or & Exercise testing of individuals at high risk can be su-
pervised by nonphysician health care professionals if
Family history of coronary artery disease (CAD)
in first-degree relative G60 yr or
Presence of microvascular disease or
Peripheral vascular disease or
Autonomic neuropathy
End-stage renal disease
Patients with symptomatic or diagnosed pulmonary disease
including chronic obstructive pulmonary disease, asthma,
interstitial lung disease, or cystic fibrosis
Copyright 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
the professional is specially trained in clinical exer- 6. Gordon SMBS. Health appraisal in the non-medical setting. In: Durstine JL,
editor. ACSMs Resource Manual for Guidelines for Exercise Testing
cise testing with a physician immediately available if and Prescription. 2nd ed. Philadelphia (PA): Williams & Wilkins; 1993.
needed. p. 219Y28.
& Exercise testing of individuals at moderate risk can be 7. Lahav D, Leshno M, Brezis M. Is an exercise tolerance test indicated
before beginning regular exercise? A decision analysis. J. Gen. Intern.
supervised by nonphysician health care professionals Med. 2009; 24:934Y8.
if the professional is trained specifically in clinical 8. Maron BJ, Araujo CG, Thompson PD, et al. World Heart Federation, In-
exercise testing, but whether or not a physician must ternational Federation of Sports Medicine, American Heart Association
Committee on Exercise, Cardiac Rehabilitation, and Prevention. Recom-
be immediately available for exercise testing is de- mendations for preparticipation screening and the assessment of cardiovas-
pendent on local policies and circumstances, the cular disease in masters athletes: an advisory for healthcare professionals
health status of the patients, and the training and ex- from the working groups of the World Heart Federation, the International
Federation of Sports Medicine, and the American Heart Association Com-
perience of the laboratory staff. mittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation.
2001; 103:327Y34.
In conclusion, the new ACSM preparticipation health
9. Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation
screening recommendations are made to reduce barriers screening of competitive athletes. A statement for health professionals from
to the adoption of a physically active lifestyle because of the Sudden Death Committee (clinical cardiology) and Congenital Cardiac
Defects Committee (cardiovascular disease in the young), American Heart
the following: 1) Much of the risk associated with exercise Association. Circulation. 1996; 94:850Y6.
can be mitigated by adopting a progressive exercise training
10. Pescatello LS, Riebe D, Arena R, American College of Sports Medicine.
regimen, and 2) there is an overall low risk of participation ACSMs Guidelines for Exercise Testing and Prescription. 9th ed. Baltimore
in physical activity programs (1). (MD): Lippincott Williams & Wilkins; 2014.
11. Physical Activity Guidelines Advisory Committee Report, 2008 [Internet].
Washington (DC): U.S. Department of Health and Human Services [cited 2011
The authors declare no conflicts of interest and do not January 6]. Available from: http://www.health.gov/paguidelines/Report/pdf/
have any financial disclosures. CommitteeReport.pdf.
12. Thompson PD, Buchner D, Pina IL, et al. American Heart Association
Council on Clinical Cardiology Subcommittee on Exercise, Rehabilitation,
and Prevention, American Heart Association Council on Nutrition, Physical
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Copyright 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.