Changes in the ACSM Risk Factor Stratification Guidelines
Proper screening of your clients is key in beginning a safe exercise program. Screening allows us to determine which clients need a physician’s clearance before they can start working out, and which clients can start exercising right away with no red tape.
The standard screening tool for the fitness industry is the ACSM Risk Factor Stratification Guidelines. You can find info about ACSM Risk Factor Guidelines in the following places in your material:
ACE Group Fitness Instructor Manual 2nd ed.: Chapter 5, starting pg. 149
ACE Personal Trainer Manual 4th ed.: Chapter 6, starting pg. 109
Every so many years, the people at ACSM review the scientific literature, have a huddle, and make any necessary changes to the guidelines. Those changes happened in the 8th edition of the ACSM’s Guidelines for Exercise Testing and Prescription (published 2010). The biggest change this time around? Age is now officially a risk factor.
But before you start panicking, let’s take a step back. Don't forget that the three step process for determining what to do with a client still applies.
The first step is to look at the risk factors and add up how many your client has (family history, smoking, obesity, etc).
The second step is to look at the Initial ACSM Risk Factor Stratification and decide what the client’s risk level is (low, moderate, high) based on their total score from the first step.
The third step is to look at the ACSM Recommendations for Medical Exam & GXT Before Exericse and Doctor Supervision of Exercise Test and decide what you are “doing” with your client. Are you performing an exercise test? Are you programming an exercise plan? Moderate or vigorous? Submaximal or maximal? These decisions determine if you need a doctor’s clearance.
For example…You have a moderate risk client (top row, middle column) you would like to perform a sub-maximal test on. According to the chart, a doctor’s recommendation is ‘not necessary’ before you proceed.
But…if you have a moderate risk client and you wish to set them up with vigorous exercise, then a doctor’s recommendation/clearance is ‘recommended’ before you proceed.
Remember that earlier blog post on ACSM Risk Factor Stratification? The three step structure discussed there still applies. As a reminder…you first determine the number of risk factors for your client. Second, you determine their risk level (low, moderate, high). Third, you decide what you want to do with your client (moderate or vigorous exercise/max or submax test) and if it requires physician’s clearance.
The ACE Personal Trainer Manual 4th ed. materials have a great ‘decision tree’ that describes how steps two and three of the stratification work together. You can see the new guidelines here. A new term you may see on this decision tree is ‘asymptomatic’ versus symptomatic. What symptomatic is referring to is if someone is showing signs and symptoms of disease (see pg. 107 in 4th ed.) – chest pain, dyspnea, ankle edema, known heart murmur, etc. Asymptomatic would mean no signs or symptoms.
So how does this change in ACSM Risk Factor Stratification Guidelines impact your studies? If you are studying the Personal Trainer 4th ed. materials, the updated ACSM guidelines are in there – nothing to worry about. Questions? Confusion? Contact an ACE Education Consultant at 1-888-825-3636 x782.