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Q.I heard ACSM has recently issued a new edition of its exercise guidelines. Were any changes made regarding risk-factor assessment?



A.It can be difficult to keep up with the latest guidelines and standards. This is particularly true this year, which has seen new USDA Food Guidelines in January, a revised Food Pyramid in May and, most recently, the release of the 7th edition of ACSM’s Guidelines for Exercise Testing and Prescription. The good news is that the ACSM risk factors have been minimally revised. For your reference, here is a summary of what has and has not changed for the 2006 edition.

Positive Risk Factors

1. Family History
  • Myocardial infarction (heart attack), coronary revascularization (heart bypass or angioplasty) or sudden death (attributed to a stroke or cardiovascular disease) before 55 years of age in men considered immediate family (father, brother, son) or before 65 in women considered immediate family (mother, sister, daughter)
  • This has not changed for 2006.
2. Smoking
  • Current smoking or those who quit within the previous six months
  • This has not changed for 2006.
3. Hypertension
  • Systolic blood pressure >140mm or diastolic blood pressure >90mm, confirmed by measurements on at least two separate occasions or on antihypertensive medications
  • This has not changed for 2006.
4. Dyslipidemia (name changed for 2006 from hypercholesterolemia)
  • LDL >130 mg/dL, HDL <40 mg/dL or on lipid-lowering medication
  • If serum cholesterol is all that is available, use serum cholesterol >200mg/dL
  • The HDL score has changed from 35 mg/dL to 40 mg/dL for 2006. Additionally, total cholesterol score is de-emphasized in favor of HDL and LDL scores, unless those two scores are unavailable.
5. Impaired Fasting Glucose
  • Fasting blood sugar >100 mg/dl, confirmed on at least two separate occasions
  • The score has changed from 110 mg/dL to 100 mg/dL for 2006.
6. Obesity
  • BMI >30 kg/m2 or
  • Waist girth >102 cm (40”) for men and >88 cm (35”) for women or
  • Waist/hip ratio >0.95 for men and >0.86 for women
  • Due to varying opinions, use additional valid markers of obesity to evaluate obesity
  • The waist-girth measurement has changed from one previous score of 100 cm (39.4”) to individual scores of 102 cm (40”) for men and 88 cm (35”) for women.
  • Additionally, waist/hip ratio has been added for 2006.
7. Physical Inactivity
  • Persons not participating in a regular exercise program or not meeting the minimal recommendations of the 1996 Surgeon General’s Report
  • This has not changed for 2006.

Negative Risk Factors

1. HDL
  • HDL >60 mg/dL
  • This has not changed for 2005. The objective with risk assessment is to quantify the number of risk factors as follows:
  • Assign a positive numerical score of one (1) to each positive risk factor category that the client possesses. This implies a maximal score of seven if the client demonstrates all seven positive risk factors.
  • Assign a negative numerical score of one (1) to the negative risk factor if applicable.
  • Sum the total of all numbers for a final score.
  • Risk stratification (see below) is determined primarily by the number of positive risk factors held.

ACSM Initial Risk Stratification

1. Low Risk
  • Younger individuals (men <45 9 years, women <55 years) who are asymptomatic and meet no more than one risk factor
2. Moderate Risk
  • Men >45 years, women >55 years or individuals who meet the threshold for two or more risk factors and are asymptomatic
3. High Risk
  • Individuals with one or more signs and symptoms for cardiovascular disease, individuals with known cardiovascular (including peripheral vascular disease, cerebral vascular disease), pulmonary (chronic obstructive pulmonary disease, asthma, cystic fibrosis) or metabolic (renal, liver or thyroid disorder) disease.
  • The risk stratification criteria has not changed for 2006.
Fabio Comana, an exercise physiologist, is ACE’s Certification and Exam Development Manager. Prior to joining ACE, he served as a wellness and general manager for Club One Professional Services and as a strength and conditioning coach at San Diego State University. He currently teaches at the University of California, San Diego, and San Diego State University.


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