Applying the ACSM Preparticipation Screening Algorithm to U.S. Adults: National Health and Nutrition Examination Survey 2001-2004

Abstract

Purpose: For most people, the benefits of physical activity far outweigh the risks. Research has suggested that exercise preparticipation questionnaires might refer an unwarranted number of adults for medical evaluation before exercise initiation, creating a potential barrier to adoption. The new American College of Sports Medicine (ACSM) prescreening algorithm relies on current exercise participation; history and symptoms of cardiovascular, metabolic, or renal disease; and desired exercise intensity to determine referral status. Our purpose was to compare the referral proportion of the ACSM algorithm to that of previous screening tools using a representative sample of U.S. adults.

Methods: On the basis of responses to health questionnaires from the 2001-2004 National Health and Nutrition Examination Survey, we calculated the proportion of adults 40 yr or older who would be referred for medical clearance before exercise participation based on the ACSM algorithm. Results were stratified by age and sex and compared with previous results for the ACSM/American Heart Association Preparticipation Questionnaire and the Physical Activity Readiness Questionnaire.

Results: On the basis of the ACSM algorithm, 2.6% of adults would be referred only before beginning vigorous exercise and 54.2% of respondents would be referred before beginning any exercise. Men were more frequently referred before vigorous exercise, and women were more frequently referred before any exercise. Referral was more common with increasing age. The ACSM algorithm referred a smaller proportion of adults for preparticipation medical clearance than the previously examined questionnaires.

Conclusions: Although additional validation is needed to determine whether the algorithm correctly identifies those at risk for cardiovascular complications, the revised ACSM algorithm referred fewer respondents than other screening tools. A lower referral proportion may mitigate an important barrier of medical clearance from exercise participation.

Figure 1:. 2015 ACSM Preparticipation Screening Algorithm, reproduced with permission from Riebe, et al (11)

^§Exercise Participation Performing planned, structured physical activity at least 30 min at moderate intensity on at least 3 d∙wk⁻¹ for at least the last 3 months. *Light Intensity Exercise: 30% to <40% HRR or VO₂R, 2 to <3 METs, 9–11 RPE, an intensity that causes slight increases in HR and breathing **Moderate Intensity Exercise 40% to <60% HRR or VO₂R, 3 to <6 METs, 12–13 RPE, an intensity that causes noticeable increases in HR and breathing ***Vigorous Intensity Exercise ≥60% HRR or VO₂R, ≥6 METs, ≥14 RPE, an intensity that causes substantial increases in HR and breathing ^‡ Cardiovascular (CV) Disease Cardiac, peripheral vascular, or cerebrovascular disease. ^‡‡Metabolic Disease Type 1 and 2 diabetes mellitus. ^‡‡‡Signs and Symptoms At rest or during activity; includes pain, discomfort in the chest, neck, jaw, arms, or other areas that may result from ischemia; shortness of breath at rest or with mild exertion; dizziness or syncope; orthopnea or paroxysmal nocturnal dyspnea; ankle edema; palpitations or tachycardia; intermittent claudication; known heart murmur; or unusual fatigue or shortness of breath with usual activities. ^‡‡‡‡Medical Clearance Approval from a healthcare professional to engage in exercise. ^ɸACSM Guidelines See ACSM’s Guidelines for Exercise Testing and Prescription, 9^th edition, 2014

Figure 2:. Comparison of predicted referral proportions for the 2015 ACSM algorithm, AAPQ, and PAR-Q

Results for the AAPQ and PAR-Q have been previously published (15) Abbreviations: ACSM: American College of Sports Medicine; AAPQ: ACSM/American Heart Association Preparticipation Questionnaire; PAR-Q: Physical Activity Readiness Questionnaire; PA: Physical Activity