ACSM[042-082]

Recommendations

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CHAPTER 3 Pre-Exercise Evaluations 45BOX 3.3Recommended Laboratory Tests by Level of Riskand Clinical AssessmentApparently healthy (low risk) or individuals at increased risk, but withoutknown disease (moderate risk)• Fasting serum total cholesterol, LDL cholesterol, HDL cholesterol, andtriglycerides• Fasting plasma glucose, especially in individuals 45 years old andyounger individuals who are overweight (BMI 25 kgm 2 ) and haveone or more of the following risk factors for type 2 diabetes: a firstdegreerelative with diabetes, member of a high-risk ethnic population(e.g., African American, Latino, Native American, Asian American, andPacific Islander), delivered a baby weighing 9 lbs (4.08 kg) orhistory of gestational diabetes, hypertension (BP 140/90 mm Hg inadults), HDL cholesterol of 40 mgdL 1 (1.04 mmolL 1 ) and/ortriglyceride level 150 mgdL 1 (1.69 mmolL 1 ), previously identifiedimpaired glucose tolerance or impaired fasting glucose (fastingglucose 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 ispresentPatients 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, LDLparticle size and number, and HDL subspecies (especially in youngpersons with a strong family history of premature CVD and in thosepersons without traditional coronary risk factors)• Chest radiograph, if heart failure is present or suspected• Comprehensive blood chemistry panel and complete blood count asindicated 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 andlipoproteins, fasting plasma glucose, and pulmonary function. Detailed guidelinesfor several chronic diseases can be found in other chapters within this text.Although a detailed description of all the physical examination procedureslisted in Box 3.2 and the recommended laboratory tests listed in Box 3.3 arebeyond the scope of this text, additional basic information related to assessmentof blood pressure, lipids and lipoproteins, other blood chemistries, and
46 GUIDELINES FOR EXERCISE TESTING • www.acsm.orgpulmonary function are provided in the following section. For more detaileddescriptions of these assessments, the reader is referred to the work of Bickley (3).BLOOD PRESSUREMeasurement of resting blood pressure (BP) is an integral component of the preexercisetest evaluation. Subsequent decisions should be based on the average of twoor more properly measured, seated BP readings recorded during each of two or moreoffice visits (11,14). Specific techniques for measuring BP are critical to accuracyand detection of high BP and are presented in Box 3.4. In addition to high BPreadings, unusually low readings also should be evaluated for clinical significance.The Seventh Report of the Joint National Committee on Prevention, Detection,Evaluation, and Treatment of High Blood Pressure (JNC7) provides guidelines forBOX 3.4Procedures for Assessment of RestingBlood Pressure1. Patients should be seated quietly for at least 5 minutes in a chairwith back support (rather than on an examination table) with theirfeet on the floor and their arm supported at heart level. Patientsshould refrain from smoking cigarettes or ingesting caffeine duringthe 30 minutes preceding the measurement.2. Measuring supine and standing values may be indicated underspecial circumstances.3. Wrap cuff firmly around upper arm at heart level; align cuff withbrachial artery.4. The appropriate cuff size must be used to ensure accurate measurement.The bladder within the cuff should encircle at least 80% of theupper arm. Many adults require a large adult cuff.5. Place stethoscope bell below the antecubital space over the brachialartery.6. Quickly inflate cuff pressure to 20 mm Hg above first Korotkoffsound.7. Slowly release pressure at rate equal to 2 to 5 mm Hg per second.8. Systolic BP is the point at which the first of two or more Korotkoffsounds is heard (phase 1) and diastolic BP is the point before thedisappearance of Korotkoff sounds (phase 5).9. At least two measurements should be made (minimum of 1 minuteapart).10. Provide to patients, verbally and in writing, their specific BP numbersand BP goals.Modified from National High Blood Pressure Education Program. The Seventh Report of the JointNational Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).Washington, DC: 2003; 03-5233. For additional, more detailed recommendations, see PickeringTG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humansand experimental animals. Hypertension. 2005;45:142–61.
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