ACSM[042-082]

CHAPTER 3 Pre-Exercise Evaluations 45
BOX 3.3
Recommended Laboratory Tests by Level of Risk
and Clinical Assessment
Apparently healthy (low risk) or individuals at increased risk, but without
known disease (moderate risk)
• Fasting serum total cholesterol, LDL cholesterol, HDL cholesterol, and
triglycerides
• Fasting plasma glucose, especially in individuals 45 years old and
younger individuals who are overweight (BMI 25 kgm 2 ) and have
one or more of the following risk factors for type 2 diabetes: a firstdegree
relative with diabetes, member of a high-risk ethnic population
(e.g., African American, Latino, Native American, Asian American, and
Pacific Islander), delivered a baby weighing 9 lbs (4.08 kg) or
history of gestational diabetes, hypertension (BP 140/90 mm Hg in
adults), HDL cholesterol of 40 mgdL 1 (1.04 mmolL 1 ) and/or
triglyceride level 150 mgdL 1 (1.69 mmolL 1 ), previously identified
impaired glucose tolerance or impaired fasting glucose (fasting
glucose 100 mgdL 1 ; 5.55 mmolL 1 ), habitual physical inactivity,
polycystic ovary disease, and history of vascular disease
• Thyroid function, as a screening evaluation especially if dyslipidemia is
present
Patients with known or suspected cardiovascular disease (high risk)
• Preceding tests plus pertinent previous cardiovascular laboratory tests
(e.g., resting 12-lead ECG, Holter monitoring, coronary angiography,
radionuclide or echocardiography studies, previous exercise tests)
• Carotid ultrasound and other peripheral vascular studies
• Consider measures of Lp(a), high-sensitivity C-reactive protein, LDL
particle size and number, and HDL subspecies (especially in young
persons with a strong family history of premature CVD and in those
persons without traditional coronary risk factors)
• Chest radiograph, if heart failure is present or suspected
• Comprehensive blood chemistry panel and complete blood count as
indicated by history and physical examination (Table 3.3)
Patients with pulmonary disease
• Chest radiograph
• Pulmonary function tests (Table 3.4)
• Other specialized pulmonary studies (e.g., oximetry or blood gas analysis)
not limited to, serum chemistries, complete blood count, serum lipids and
lipoproteins, fasting plasma glucose, and pulmonary function. Detailed guidelines
for several chronic diseases can be found in other chapters within this text.
Although a detailed description of all the physical examination procedures
listed in Box 3.2 and the recommended laboratory tests listed in Box 3.3 are
beyond the scope of this text, additional basic information related to assessment
of blood pressure, lipids and lipoproteins, other blood chemistries, and