ACSM Guideline Comparison

Compared to the previous editions of the ACSM Guidelines, the present version of chapter 2 reduces the emphasis on the need for medical evaluation in healthy adults with no symptoms of disease. In addition to the lessened need for medical evaluation, the new version uses the term “risk classification” to group the individuals into groups of low, moderate, or high risk based on the presence or absence of cardiovascular disease risk factors, signs and symptoms, and family history of cardiovascular, pulmonary, renal or metabolic disease.  It is important to identify individuals with known diseases because they are at a greater risk for an exercise related cardiac event.  The previous ACSM exercise preparticipation health screening was based on the number of cardiovascular disease risk factors, the presence of signs/symptoms of known cardiovascular, metabolic, and/or pulmonary disease.  The new ACSM preparticipation health screening is based on the individual’s current level of physical activity, the presence of signs/symptoms and/or known cardiovascular, metabolic, or renal disease, and desired exercise intensity.


            The 9th edition of the book supports the public health message that all people should adopt a physically active lifestyle by reducing the need for medical evaluation as part of the pre-screening process prior to initiating a progressive exercise routine. The reader edition seeks to simplify the screening process in order to remove barriers of adopting an active lifestyle. The new edition introduces the frequency, intensity, time and type principle of exercise prescription. Although a known risk of CV, pulmonary or metabolic disease should be classified as high risk. No known CVD risk factors are treated as low risk, if they have less than 2 symptoms. If they have more than two symptoms, they are considered moderate risk.  The majority of individuals can still complete a light-to-moderate intensity exercise program without consulting a physician.  High-risk individuals should consult a doctor due to their increased risk of an exercise induced cardiac attack. Exercise testing of individuals grouped into the high-risk category should be supervised in a clinical exercise testing facility.

            The new edition of the ACSM Preparticipation Health Screening recommends that all individuals wishing to start a physical activity program should at least be screened by a self-reported medical history or health risk appraisal questionnaire. If the individual has concerning, high-risk factors, they should follow up with a physician. Individuals that are at a moderate risk, with two or more CVD risk factors, they are encouraged to consult a professional before initiating vigorous intensity exercise, otherwise, a low intensity work out such as walking can be started without approval from a doctor.