Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening

TLDR

ACSM’s exercise preparticipation screening is designed to identify individuals at risk for sudden cardiac death or myocardial infarction, yet current guidelines may cause excessive referrals, while evidence indicates exercise is generally safe and its benefits increase as fitness improves. A 2014 ACSM scientific roundtable was convened to evaluate and update the exercise preparticipation health screening recommendations. The new model incorporates an individual’s activity level, presence of symptoms or known disease, and desired exercise intensity as key risk modulators. The updated recommendations lower unnecessary barriers to exercise, reinforcing that regular physical activity benefits everyone.

Abstract

The purpose of the American College of Sports Medicine's (ACSM) exercise preparticipation health screening process is to identify individuals who may be at elevated risk for exercise-related sudden cardiac death and/or acute myocardial infarction. Recent studies have suggested that using the current ACSM exercise preparticipation health screening guidelines can result in excessive physician referrals, possibly creating a barrier to exercise participation. In addition, there is considerable evidence that exercise is safe for most people and has many associated health and fitness benefits; exercise-related cardiovascular events are often preceded by warning signs/symptoms; and the cardiovascular risks associated with exercise lessen as individuals become more physically active/fit. Consequently, a scientific roundtable was convened by the ACSM in June 2014 to evaluate the current exercise preparticipation health screening recommendations. The roundtable proposed a new evidence-informed model for exercise preparticipation health screening on the basis of three factors: 1) the individual's current level of physical activity, 2) presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease, and 3) desired exercise intensity, as these variables have been identified as risk modulators of exercise-related cardiovascular events. Identifying cardiovascular disease risk factors remains an important objective of overall disease prevention and management, but risk factor profiling is no longer included in the exercise preparticipation health screening process. The new ACSM exercise preparticipation health screening recommendations reduce possible unnecessary barriers to adopting and maintaining a regular exercise program, a lifestyle of habitual physical activity, or both, and thereby emphasize the important public health message that regular physical activity is important for all individuals.