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ACSM’s Guidelines For
Exercise Testing And
Prescription : Chapter 3
Pretest Clinical Evaluation
David Arnall, Ph.D., P.T., FACSM, ES
What is Necessary ?

Medical History
Medical diagnosis
 Previous medical history
 Hx of presenting symptoms
 Recent illnesses, hospitalizations, etc.
 Orthopedic problems
 Medication history

Review of habits - tobacco use,
ETOH, caffeine use, illicit drugs
 Exercise history
 Work history
 Family history of sudden death,
stroke, metabolic disease, COPD,
and presence of cardiac problems

Components Of The
Physical Exam

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Body weight
BP - rest, supine, sitting, standing
Heart & lung auscultation
Palpation of pulses
Palpation of BLE’s for edema & staining
Inspection for xanthomas
Neurological tests - balance, cognition,
etc.
Recommended Lab Tests
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Total serum cholesterol and HDL
Fasting triglycerides
Fasting blood glucose
EKG, PFT, Chest X-Ray
Complete panel & blood count
Thyroid function
What are the Desirable
Lipoprotein Values ?
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Cholesterol : < 200 mg/dl
HDL : > 35 mg/dl
LDL : < 130 mg/dl
Triglycerides : < 200 mg/dl
Some Important Blood Values

RBC :
 4.5 - 6.5 x 1012/L
12
  3.9 - 5.6 x 10 /L
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Hematocrit :
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 40% - 52% :  36% - 48%
Hemaglobin :
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 14 - 17 g/dl :  11 - 15 g/dl
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WBC : 4 - 11 x 109/L
Platelets : 150 - 450 x 109/L
Fasting Glucose : 60 -110 mg/dl
Blood Urea Nitrogen : 4 - 24 mg/dl
Creatinine : 0.3 - 1.4 mg/dl
Contraindications To Exercise

Absolute Contraindications
Unstable angina
 Uncontrolled dysrhythmias
 Recent EKG changes & cardiac events
 Acute myocarditis/pericarditis

Acute pulmonary
embolism/infarction
 Severe aortic stenosis
 Dissecting aneurysm
 Acute infections
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Contraindications To Exercise
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Relative Contraindications
Left main coronary stenosis
 Severe hypertension (>200/110)
 Tachycardias/bradycardias
 Uncontrolled metabolic disease
 High-degree AV blocks
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Chronic infectious diseases
 Cardiomyopathy & outflow obstructions
 Stenotic valve disease
 ventricular aneurysm
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Informed Consent
Purpose & benefits of the testing
 Risks associated with the test
 A statement indicating that the
patient can ask questions
 A statement saying the patient can
stop the test whenever they want
 Emergency equipment is available
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Patient Preparation For Testing
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Refrain from food & alcohol before
test
Patient should be well rested
Patient wears loose fitting clothing
Patient should have a family
member to take them home
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Patient may need to alter current
medication use if this effects the test
(antianginal drugs alter EKG
responses)
Patient may need to continue their
medications to guarantee consistent
outcomes (beta-blockers)
Patient should bring all of their
medications to the test site