FAQ  –  Update  to  ACSM’s  Recommendations  for  Exercise  
Preparticipation  Health  Screening  
 
 
General  Questions  
 
Q:  What  changed  in  the  recommendations  for  exercise  preparticipation  health  
screening?  
A:  An  expert  panel  proposed  a  new  evidence-­‐informed  model  for  exercise  
preparticipation  health  screening  based  on  three  factors:  
Ø The  individual’s  current  level  of  physical  activity  
Ø Presence  of  signs,  symptoms  and/or  known  cardiovascular,  metabolic  or  renal  
disease  
Ø Desired  exercise  intensity.    
 
The  new  recommendations  no  longer  include  the  cardiovascular  disease  (CVD)  risk  
factor  profile  as  part  of  the  decision-­‐making  for  referral  to  a  health  care  provider  
prior  to  the  initiation  of  a  moderate-­‐to-­‐vigorous  intensity  exercise  program  .    
 
Additionally,  the  recommendations  no  longer  utilize  a  low/moderate/high  risk  
classification  scheme.  It  makes  general  recommendations  for  medical  clearance  
versus  specific  recommendations  for  medical  exams  or  exercise  tests.  The  manner  of  
clearance  is  left  to  the  discretion  of  the  health  care  provider  and  does  not  
automatically  refer  individuals  with  pulmonary  disease  for  medical  clearance  prior  
to  the  initiation  of  an  exercise  program.    
 
Q:  What  didn’t  change?  
A: The  recommendations  continue  to:  
Ø Encourage  preparticipation  screening  for  persons  interested  in  initiating  or  
progressing  exercise  or  other  physical  activity  programs  
Ø Recognize  that  vigorous  intensity  exercise  has  a  small  but  measurable  acute  
risk  of  CVD  complications  and  mitigating  this  risk  in  susceptible  individuals  
is  important  
Ø Continues  to  recommend  that  exercise  professionals  consult  with  health  care  
providers  when  there  are  questions  about  individuals  with  known  disease  or  
signs  and  symptoms  suggestive  of  disease,  or  any  other  concern  about  an  
individual’s  ability  to  safely  participate  in  an  exercise  program.
 
Please  note  the  new  recommendations  pertain  only  to  the  preparticipation  exercise  
screening  portion  of  the  process.  Anything  regarding  the  pre-­‐exercise  evaluation,  
fitness  testing  and  interpretation,  and  exercise  prescription  remains  the  same  once  
clearance  has  been  obtained.        
 
 
 
Q:    What  precipitated  the  change?    
A:  Exercise  is  safe  for  most  people  and  has  many  health/fitness  benefits.  The  
cardiovascular  risks  associated  with  exercise  lessen  as  individuals  become  more  
physically  active,  and  exercise-­‐related  cardiovascular  events  are  rare  and  are  often  
preceded  by  warning  signs  and  symptoms.  The  current  prescreening  risk-­‐based  
algorithms  were  resulting  in  excessive  referrals  to  physicians  for  medical  clearance.    
 
This  caused  a  potential  barrier  to  adopting  exercise,  and  a  financial  burden  on  the  
individual  and  health  care  system.    The  review  of  the  research  ultimately  concluded  
that  the  high  prevalence  of  CVD  risk  factors  among  adults,  combined  with  the  
extreme  rarity  of  exercise-­‐related  sudden-­‐cardiac  death  (SCD)  and  acute  myocardial  
infarction  (AMI),  suggests  that  the  ability  to  predict  these  rare  events  by  assessing  
CVD  risk  factors  is  low.  
 
 
 
Q:  How  did  you  go  about  creating  the  new  recommendations?  
A:  An  expert  panel  was  convened  by  ACSM  in  June  2014  to  establish  best  practices  
in  the  exercise  preparticipation  health  screening  practice.  This  panel  included  
experts  in  risk  assessment,  preventive  cardiology,  public  health,  exercise  
physiology,  and  geriatrics,  practitioners  from  the  field  of  medicine,  clinical  exercise  
physiology,  and  health  fitness/prevention.    The  panel  developed  the  
recommendations  based  on  review  and  examination  of  current  research.  A  writing  
group,  including  several  members  of  the  expert  panel,  was  convened  to  create  a  
paper  reflecting  the  new  recommendations  which  then  went  through  extensive  
reviews.    
 
 
Q:  I  don’t  understand  the  change  or  difference  between  medical  clearance  
versus  a  medical  exam  or  exercise  test  and  how  that  works  with  the  new  
recommendations.    
A:  Medical  clearance  (a  doctor  advising  a  patient  that  it  is  ok  to  exercise)  has  
replaced  specific  recommendations  for  a  medical  exam  or  exercise  test  because  it  
should  be  the  health  care  provider  that  decides  what  evaluation,  if  any,  is  
appropriate  prior  to  the  initiation  of  exercise.  The  current  recommendations  
indicate  the  need  for  a  medical  exam  or  an  exercise  test  based  on  the  results  of  a  
CVD  risk-­‐factor  assessment  and  classification  as  low,  moderate  or  high  risk.  In  the  
update,  medical  clearance  has  replaced  these  specific  recommendations  as  we  
believe  it  should  be  the  health  care  provider’s  decision  as  to  what  further  
evaluation,  if  any,  is  appropriate  prior  to  the  initiation  of  exercise.  For  example,  a  
doctor  may  simply  review  the  patient’s  chart  and  deem  the  patient  cleared  to  
exercise,  and  the  need  for  a  full  medical  exam  may  not  be  necessary.  In  addition,  
there  is  a  lack  of  evidence  that  medical  exams  and  exercise  testing  are  effective  in  
mitigating  the  risk  of  exercise-­‐related  cardiovascular  deaths.  Thus,  acquiring  
medical  clearance  (rather  than  requiring  medical  exams  or  exercise  testing)  leaves  
the  decision-­‐making  to  the  physician.  
 
Q:  Where  can  I  find  the  new  recommendations?  What  documents  or  
publications  are  being  updated  as  ACSM’s  official  recommendation?    
A:  The  new  recommendations  are  published  as  an  ACSM  roundtable  consensus  
statement  in  the  November  2015  issue  of  Medicine  &  Science  in  Sports  &  Exercise.  
This  information  will  also  be  found  within  many  ACSM  publications  including  
ACSM’s  Guidelines  for  Exercise  Testing  and  Prescription  10th  Edition  (GETP10),  all  of  
which  will  be  updated  over  the  course  of  the  next  18  months.  New  resources  that  
incorporate  this  update  are  also  being  created.      
 
Q:.  Where  do  I  go  to  find  the  consensus  statement  paper  and  detailed  
specifics?  
A:  http://journals.lww.com/acsm-­‐
msse/Fulltext/2015/11000/Updating_ACSM_s_Recommendations_for_Exercise.28.a
spx  
 
 
Job-­‐Specific  Questions  
 
Q:  How  will  this  affect  my  job  if  I  am  working  directly  with  clients  on  exercise  
programming?  
A:  The  new  recommendations  will  change  how  you  go  about  determining  whether  
or  not  a  client  needs  a  referral  to  a  health  care  provider  prior  to  commencing  an  
exercise  program.    The  new  exercise  preparticipation  health  screening  
recommendations  are  not  a  replacement  for  sound  clinical  judgment,  and  decisions  
about  referral  to  a  health  care  provider  for  medical  clearance  prior  to  the  initiation  
of  an  exercise  program  should  continue  to  be  made  on  an  individual  basis.    
 
 
 
Q:  When  should  I  integrate  the  recommendations  of  the  paper  and  GETP10  
into  my  exercise  professional  practice?  
A:  You  may  incorporate  the  new  recommendations  as  described  in  the  consensus  
statement  paper  now.  GETP10,  which  will  contain  many  updates  (including  the  new  
recommendations  referenced  here),  will  be  available  in  March  of  2017.    
 
 
 
Q:  Do  the  changes  affect  my  liability  when  working  with  clients  in  any  way?  
A:    The  liability  for  fitness  professionals  who  rely  on  ACSM  recommendations  has  
not  changed-­‐fitness  professionals  must  continue  to  exercise  reasonable  care  in  
training  a  client.  As  has  been  the  case,  there  is  recognition  that  there  is  some  
assumption  of  risk  with  regard  to  fitness  training  under  the  guidance  
of  a  fitness  professional,  and  waivers  and  releases  can  limit  future  liability.  As  stated  
in  the  paper,  the  new  exercise  preparticipation  health  screening  recommendations  
are  not  a  replacement  for  sound  clinical  judgment,  and  decisions  about  referral  to  a  
health  care  provider  for  medical  clearance  prior  to  the  initiation  of  an  exercise  
program  should  continue  to  be  made  on  an  individual  basis.    
 
Q:  How  will  this  impact  me  if  I  am  teaching  as  a  faculty  member?  Do  I  need  to  
change  what  I  teach  if  my  students  are  preparing  to  take  an  ACSM  certification  
exam?  
A:  We  encourage  you  to  teach  using  the  new  recommendations.  However,  if  you  
have  students  preparing  to  take  an  ACSM  certification  exam,  this  content  will  not  be  
incorporated  into  the  exams  until  the  new  exams  release  in  June  2017.  
 
 
Certification-­‐Related  Questions  
 
Q:  How  does  this  impact  me  if  I  am  planning  to  take  a  certification  test  in  the  
next  18  months?  
A:  If  you  are  taking  the  exam  prior  to  2017,  this  new  information  does  not  impact  
you.  The  content  covered  in  the  current  exams,  as  well  as  the  preparatory  materials  
and  workshops  will  not  include  this  update  related  to  preparticipation  health  
screening.  
   
The  new  exam  changes  specific  to  the  updated  information  on  the  exercise  
preparticipation  health  screening  will  not  be  incorporated  until  the  new  exams  
release  in  June  2017.  ACSM  does  major  updates  to  exam  content  and  supporting  
materials  on  a  4-­‐year  cycle  –  that  has  not  changed.  Prior  to  that  date,  exam  
preparatory  materials  including  books,  job  task  analyses,  webinars  and  seminars  
will  all  be  updated  with  the  new  information  starting  in  late  Q1  of  2017.    
 
Q:  When  will  ACSM’s  Certification  workshops  include  the  new  content  
provided  in  GETP10?  
A:  The  new  content  will  begin  to  be  introduced  into  the  workshop  content  in  the  
fourth  quarter  of  2016.  Students  will  also  be  informed  within  the  workshops  as  to  
when  the  ACSM  certification  examinations  will  be  changed  to  reflect  the  new  
content.  
 
 
 
 
Q:  When  will  ACSM’s  certification  exams  be  changed  to  reflect  the  content  of    
GETP10?  
A:  The  ACSM  certification  exams  reflecting  the  changes  in  GETP10  will  first  be  
administered  three  months  after  GETP10  is  available  for  purchase,  which  will  be  in  
June  2017.  
 
 
 
Content  and  Education-­‐Related  Questions  
 
 
Q:  Normally  I  rely  on  ACSM’s  Guidelines  for  Exercise  Testing  and  Prescription  
(GETP)  as  the  industry-­‐standard  guide  for  my  exercise  professional  practice.  
How  is  this  consensus  statement  paper  different?  How  do  the  updated  
recommendations  work  with  GETP?  Does  this  mean  my  current  copy  of  ACSM’s  
Guidelines  for  Exercise  Testing  and  Prescription  9th  Edition  (GETP9)  is  outdated?    
A:  ACSM  publishes  a  new  edition  of  GETP  every  four  years  that  serves  as  the  
industry  standard  guide  for  exercise  testing  and  prescription.  Each  new  edition  has  
numerous  key  updates.  During  the  four  years  in  between  the  new  editions,  
guidelines,  standards  and  recommendations  from  ACSM  and  other  organizations  
will  likely  change.  Any  updated  guidelines  need  to  be  used  in  conjunction  with  GETP  
as  they  become  available.  It  does  not  mean  GETP9  is  outdated,  or  that  you  won’t  
need  to  obtain  the  new  edition  of  GETP10  when  it  becomes  available.    This  
consensus  statement  paper  reflects  just  one  change  in  ACSM’s  recommendations  
regarding  the  exercise  preparticipation  health  screening.          
 
 
 
Q:  When  will  I  be  able  to  purchase  my  copy  of  the  new  edition  of  the  
Guidelines?  
A:    The  10th  edition  of  ACSM’s  Guidelines  for  Exercise  Testing  and  Prescription  
(GETP10)  is  scheduled  to  be  available  for  purchase  in  March  of  2017.  
 
 
Q:.  What  is  ACSM  doing  to  educate  members,  certification  candidates  and  
others  on  the  new  information?  
A:  ACSM  will  be  providing  a  series  of  resources  including  the  consensus  statement  
paper,  a  webinar,  an  infographic,  PowerPoint,  presentations,  updated  publications  
and  more.      Please  visit  http://www.acsm.org/public-­‐information/acsm-­‐
journals/guidelines  to  find  more  information  about  these  resources.    
 
 
Q:  What  is  the  timeline  for  educational  events  related  to  the  new  
recommendations?  Where  will  I  have  additional  opportunities  to  learn  more?    
A:  ACSM  will  be  providing  a  host  of  educational  opportunities  surrounding  the  new  
recommendations.    A  timeline  of  key  milestone  events  can  be  found  below.    
Resources  available  at  http://www.acsm.org/public-­‐information/acsm-­‐
journals/guidelines.will  be  updated  regularly,  so  check  back  often  for  new  
information  regarding  events,  publications,  educational  opportunities  and  FAQ  
updates.    
 
November  2015  –  ACSM’s  Recommendations  for  Exercise  Preparticipation  Health  
Screening  paper  published  in  Medicine  &  Science  in  Sports  &  Exercise.    
 
November  2015  –  Information  kit  posted  at  http://www.acsm.org/public-­‐
information/acsm-­‐journals/guidelines.  
 
Wednesday  January  13th,  2015,  1pm  eastern  time  -­‐  Informational  webinar  
hosted  by  ACSM,  Deborah  Riebe,  Ph.D.,  FACSM,  Carol  Garber,  Ph.D.,  FACSM,  Linda  
Pescatello,  Ph.D.,  FACSM.    Register  for  the  January  2016  Informational  Webinar  at:  
https://attendee.gotowebinar.com/register/8549211250565520130  
   
March  2016  –  Meet  the  authors  and  ask  questions  at  ACSM’s  Health  and  Fitness  
Summit.  
 
April  2016  –  Feature  article  in  ACSM’s  Health  and  Fitness  Journal.  
 
Fourth  Quarter  2016-­‐  New  content  will  begin  to  be  introduced  into  certification  
workshops.  Students  will  also  be  informed  within  the  workshops  as  to  when  the  
ACSM  certification  examinations  will  be  changed  to  reflect  the  new  content.  
 
Spring  2017  -­‐  Release  of  10th  edition  of  ACSM’s  Guidelines  for  Exercise  Testing  and  
Prescription  and  related  books.    
 
June  2017  –  Release  of  new  ACSM  certification  exams.  
 
 
Q:  What  do  I  do  if  I  have  a  question  not  answered  here?  
A:  For  questions  not  addressed  on  the  FAQ  please  contact  the  following  individuals:  
-­‐For  media,  press  and  communications-­‐related  inquiries,  please  contact  Paul  Branks  
at  Paul  Branks.  
-­‐For  publications  or  content-­‐related  questions,  please  contact  Katie  Feltman  at  Katie  
Feltman.  
-­‐For  questions  related  to  certification,  please  contact  ACSM’s  certification  
department  at  Certification.  
 
 
 
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