ACSM[042-082]

44 GUIDELINES FOR EXERCISE TESTING • www.acsm.org
BOX 3.2
Components of the Pre-exercise Test Physical
Examination
Appropriate components of the physical examination may include the
following:
• Body weight; in many instances, determination of body mass index
(BMI), waist girth, and/or body composition (percent body fat) is
desirable
• Apical pulse rate and rhythm
• Resting blood pressure, seated, supine, and standing
• Auscultation of the lungs with specific attention to uniformity of
breath sounds in all areas (absence of rales, wheezes, and other
breathing sounds)
• Palpation of the cardiac apical impulse, point of maximal impulse
(PMI)
• Auscultation of the heart with specific attention to murmurs, gallops,
clicks, and rubs
• Palpation and auscultation of carotid, abdominal, and femoral arteries
• Evaluation of the abdomen for bowel sounds, masses, visceromegaly,
and tenderness
• Palpation and inspection of lower extremities for edema and presence
of arterial pulses
• Absence or presence of tendon xanthoma and skin xanthelasma
• Follow-up examination related to orthopedic or other medical conditions
that would limit exercise testing
• Tests of neurologic function, including reflexes and cognition (as
indicated)
• Inspection of the skin, especially of the lower extremities in known
diabetes patients
Adapted from Bickley LS. Bate’s Pocket Guide to Physical Examination and History Taking. 4th ed.
Philadelphia (PA): Lippincott Williams & Wilkins; 2003.
high-risk subjects (see Fig. 2.4). Appropriate components of the physical examination
specific to subsequent exercise testing are presented in Box 3.2. An
expanded discussion and alternatives can be found in ACSM’S Resource Manual
for Guidelines for Exercise Testing and Prescription.
Identification and risk stratification of persons with CVD and those at high
risk of developing CVD are facilitated by review of previous test results, such as
coronary angiography or exercise nuclear or echocardiography studies (6). Additional
testing may include ambulatory electrocardiogram (ECG) (Holter) monitoring
and pharmacologic stress testing to further clarify the need for and extent
of intervention, assess response to treatment such as medical therapies and revascularization
procedures, or determine the need for additional assessment. As outlined
in Box 3.3, other laboratory tests may be warranted based on the level of
risk and clinical status of the patient. These laboratory tests may include, but are