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Well, after managing to complete several publication deadlines, summer projects and getting ready for a new semester “a week” has turned into more than a month since my last post. I have to get better at this!!

On the bright side, and among one of my “summer projects”, I’ve started to publish a new daily digest of health & fitness information. Check it out, and subscribe; you’ll get new health & fitness information in your mailbox everyday!

Okay, so let’s get to the post.  As I mentioned, I wanted to discuss one of most significant changes to the American College of Sports Medicine’s (ACSM) Guidelines for Exercise Testing & Prescription.

As described in my last post, ACSM completed several changes to the new edition of the Guidelines; however, their most significant change occurred in the screening of individuals participating in exercise programs.  Specially those who are considered to be high risk!

I realize this is not a very ‘easy read’ as it is more on the academic side, but keep reading — there may be something to learn after all!  Until next time. BeActive!

Blog-RFsPerhaps we should start with delineating what we consider risk factors for cardiovascular disease (Table 1).  At this time, these are the only risk factors considered during a health screening.  This is not to say there aren’t other factors that may influence an individual’s health screening; however, these are most commonly known to have a direct relationship with someone having a cardiac event during exercise participation.  So, ask questions carefully and thoroughly to make the best decision possible for your client/patient.

Blog-S&S'sIn addition to the risk factors above, there are a number of signs & symptoms that are suggestive of cardiovascular disease and must be considered during the health appraisal (Table 2; greater detailed is outline in the Guidelines).  An individual exhibiting ANY of these signs & symptoms is automatically considered High Risk regardless of how many other positive risk factors they may have.

THINGS TO CONSIDER (Not in any specific order):

  1. In the event a risk factor is omitted, say the individual does not know their cholesterol level, that risk factor should not be counted as a positive risk factor in the total tally.  However, if the person is older than 45 years and has a Body Mass Index (BMI) ≥ 25 kg/m^2; or they are younger than 45 years with a BMI ≥ 25 kg/m^2, prediabetes should be counted as a positive risk factor for these individuals, as age and overweight/obesity are highly correlation with diabetes.
  2. In addition, if a participant has a HDL cholesterol of 60 mg/dl or higher, this should be counted as a negative risk factor (-1 in the total tally).
  3. Use the Total Cholesterol (TC) value if LDL and/or HDL are NOT available.


Therefore, the risk factor classification is as follows:

  • Low Risk: An individual without signs or symptoms of CVD with less than two risk factors.
  • Moderate Risk: An individual without signs or symptoms of CVD with two or more risk factors.
  • High Risk: An individual with signs or symptoms of CVD, or with documented cardiovascular, pulmonary, or metabolic disease.


Let’s take a look at several examples and determine what risk factor category they fall under:

RiskFactorExampleCase 1: Low-risk.
In this example, her only risk factor is smoking.  Even though her fasting blood glucose (FBG) is unknown, we DO NOT consider prediabetes a risk factor as her BMI is normal.

Case 2: High Risk
This female would be considered high-risk because of her Type 1 diabetes.  The fact she is active is good, but from a risk stratification stand point she is at high-risk of CVD considering her long history of diabetes.

Case 3: Moderate Risk
This participant will be considered moderate-risk considering his three risk factors (physical inactivity, taking medication for blood pressure and cholesterol). His BMI is less than 30 kg/m^2, his waist is less than 40 cm and his FBG is normal.


Risk factor classification is an important component of any pre-participation health screening, as it provides valuable information of the health status of a participant.  Based on findings from this pre-participation screening, the health care professional should be able to determine if: (1) medical clearance is necessary before starting and exercise program; (2) the individual should perform an exercise test prior to starting to exercise; and/or (3) what level of supervision would be most beneficial for this person while exercising (high risk individuals requiring higher levels of supervision).

What does YOUR risk profile look like?  Are you at low, moderate or high risk for cardiovascular disease?