ACSM's Guidelines for Exercise Testing and Prescription

Contents
1 Benefits and Risks Associated with Physical Activity 1
Introduction 1
Physical Activity and Fitness Terminology 1
Public Health Perspective for Current Recommendations 4
Sedentary Behavior and Health 7
Health Benefits of Regular Physical Activity and Exercise 9
Health Benefits of Improving Muscular Fitness 10
Risks Associated with Physical Activity and Exercise 10
Exercise-Related Musculoskeletal Injury 12
Sudden Cardiac Death among Young Individuals 12
Exercise-Related Cardiac Events in Adults 14
Exercise Testing and the Risk of Cardiac Events 16
Risks of Cardiac Events during Cardiac Rehabilitation 16
Prevention of Exercise-Related Cardiac Events 16
Online Resources 19
References 19
2 Pre-exercise Evaluation 27
Introduction 27
Informed Consent 28
Exercise Preparticipation Health Screening 28
American College of Sports Medicine Preparticipation
Screening Process 31
American College of Sports Medicine Preparticipation
Screening Algorithm 32
Algorithm Components 32
Using the Algorithm 37
Alternative Self-Guided Method 40
Exercise Testing 45
Risk Stratification for Individuals with Clinical
Conditions and Medical Fitness Facilities 45
Pre-exercise Evaluation 45
Medical History and Cardiovascular Disease Risk
Factor Assessment 47
Additional Recommendations 48
Online Resources 55
References 55xxiv ACSM’s Guidelines for Exercise Testing • www.acsm.org
3 Health-Related Physical Fitness Testing and Interpretation 58
Introduction 58
Purposes of Health-Related Physical Fitness Testing 58
Basic Principles and Guidelines 59
Pretest Instructions for Fitness Testing 59
Organizing the Fitness Test 59
Test Environment 60
A Comprehensive Health Fitness Evaluation 60
Measurement of Resting Heart Rate and Blood Pressure 61
Body Composition 61
Anthropometric Methods 63
Densitometry 70
Other Techniques 72
Body Composition Norms 72
Cardiorespiratory Fitness 73
The Concept of Maximal Oxygen Uptake 75
Maximal versus Submaximal Exercise Testing 76
Cardiorespiratory Test Sequence and Measures 77
Test Termination Criteria 79
Modes of Testing 79
Submaximal Exercise Tests 87
Interpretation of Results 87
Muscular Fitness 90
Rationale 92
Principles 93
Muscular Strength 93
Muscular Endurance 97
Muscular Power 100
Flexibility 100
Balance 103
Online Resources 105
References 106
4 Clinical Exercise Testing and Interpretation 113
Introduction 113
Indications for a Clinical Exercise Test 113
Conducting the Clinical Exercise Test 115
Testing Staff 117
Testing Mode and Protocol 119
Monitoring and Test Termination 121
Post-exercise 124
Safety 124
Interpreting the Clinical Exercise Test 126
Heart Rate Response 126
Blood Pressure Response 126
Rate-Pressure Product 127
Electrocardiogram 128
Symptoms 129xxv Contents
Exercise Capacity 130
Cardiopulmonary Exercise Testing 131
Maximal versus Peak Cardiorespiratory Stress 131
Diagnostic Value of Exercise Testing for the Detection of
Ischemic Heart Disease 133
Sensitivity, Specificity, and Predictive Value 133
Clinical Exercise Test Data and Prognosis 135
Clinical Exercise Tests with Imaging 135
Field Walking Tests 137
Online Resources 138
References 138
5 General Principles of Exercise Prescription 142
An Introduction to the Principles of Exercise Prescription 142
General Considerations for Exercise Prescription 143
Components of the Exercise Training Session 143
Cardiorespiratory Fitness 144
Frequency of Aerobic Exercise 145
Intensity of Aerobic Exercise 146
Time (Duration) of Aerobic Exercise 150
Type (Mode) 151
Volume (Quantity) of Aerobic Exercise 151
Progression of Aerobic Exercise 153
Resistance Training 153
Frequency of Resistance Training Exercise 155
Intensity of Resistance Training Exercise 155
Types of Resistance Training Exercises 156
Rest Intervals for Resistance Training Exercises 157
Volume (Number of Sets per Week) of Resistance
Training Exercise 157
Progression of Resistance Training Exercise 157
Flexibility 158
Types of Flexibility Exercises 160
Volume of Flexibility Exercise
(Time, Repetitions, and Frequency) 160
References 161
6 Exercise Prescription for Healthy Populations with
Special Considerations 167
Children and Adolescents 167
Exercise Testing 168
Exercise Prescription 169
Special Considerations 171
Online Resources 172
Low Back Pain 172
Exercise Testing 174
Exercise Prescription 175
Special Considerations 176
Online Resources 177xxvi ACSM’s Guidelines for Exercise Testing • www.acsm.org
Older Adults 177
Exercise Testing 178
Exercise Prescription 181
Special Considerations for Exercise Programming 185
Online Resources 186
Pregnancy 186
Exercise Testing 188
Exercise Prescription 188
Special Considerations 193
Online Resources 193
References 194
7 Environmental Considerations for Exercise Prescription 202
Introduction 202
Exercise in High-Altitude Environments 202
Altitude Acclimatization 203
Rapid Ascent 204
Assessing Individual Altitude Acclimatization Status 205
Medical Considerations: Altitude Illnesses and
Preexisting Conditions 205
Prevention and Treatment of Altitude Sickness 207
Exercise Prescription 207
Special Considerations 208
Organizational Planning 209
Exercise in Cold Environments 209
Medical Considerations: Cold Injuries 209
Cardiac and Respiratory Considerations 212
Clothing Considerations 214
Exercise Prescription 214
Exercise in Hot Environments 215
Counteracting Dehydration 215
Medical Considerations: Exertional Heat Illnesses 217
Exercise Prescription 220
Special Considerations 220
References 222
8 Exercise Prescription for Individuals with Cardiovascular
and Pulmonary Diseases 226
Introduction 226
Cardiovascular, Peripheral Arterial, and Pulmonary Diseases 226
Inpatient Cardiac Rehabilitation Programs 227
Outpatient Cardiac Rehabilitation 232
Individuals with Heart Failure 237
Individuals with a Sternotomy 240
Pacemaker and Implantable Cardioverter De? brillator 241
Individuals after Cardiac Transplantation 243
Individuals with Peripheral Artery Disease 245
Exercise Testing 246
FITT Recommendations for Individuals with xxvii Contents
Peripheral Artery Disease 247
Exercise Training Considerations 248
Individuals with a Cerebrovascular Accident (Stroke) 248
Exercise Testing 248
Exercise Prescription 249
Exercise Training Considerations 249
Other Considerations 250
Exercise Training for Return to Work 251
Pulmonary Diseases 251
Asthma 252
Chronic Obstructive Pulmonary Disease 255
Exercise Training for Pulmonary Diseases Other
than Chronic Obstructive Pulmonary Disease 261
Online Resources 265
References 266
9 Exercise Prescription for Individuals with
Metabolic Disease and Cardiovascular Disease
Risk Factors 276
Introduction 276
Diabetes Mellitus 276
Benefits of Regular Physical Activity for Diabetes 278
Exercise Testing 279
Exercise Prescription 279
Special Considerations 282
Online Resources 285
Dyslipidemia 285
Exercise Testing 286
Exercise Prescription 286
Special Consideration 288
Online Resources 288
Hypertension 288
Exercise Testing 289
Exercise Prescription 290
Special Considerations 292
Online Resources 293
Metabolic Syndrome 293
Exercise Testing 293
Exercise Prescription/Special Considerations 295
Online Resources 296
Overweight and Obesity 296
Exercise Testing 297
Exercise Prescription 298
Special Considerations 299
Bariatric Surgery 299
Online Resources 300
References 300xxviii ACSM’s Guidelines for Exercise Testing • www.acsm.org
10 Exercise Testing and Prescription for Populations with
Other Chronic Diseases and Health Conditions 307
Introduction 307
Arthritis 307
Exercise Testing 309
Exercise Prescription 309
Special Considerations 312
Online Resources 312
Cancer 312
Overview of Importance of Physical Activity in
Cancer Survivors 313
Preparticipation Evaluation 314
Exercise Prescription 318
Summary 324
Online Resources 324
Fibromyalgia 324
Exercise Testing 327
Exercise Prescription 328
Special Considerations 331
Online Sources 332
Human Immunodeficiency Virus 332
Exercise Testing 333
Exercise Prescription 334
Special Considerations 335
Online Resources 336
Kidney Disease 336
Exercise Testing 336
Exercise Prescription 338
Special Considerations 340
Online Resources 341
Multiple Sclerosis 341
Exercise Testing 344
Exercise Testing Considerations 345
Exercise Prescription 346
Special Considerations 347
Online Resources 348
Osteoporosis 348
Exercise Testing 349
Exercise Prescription 349
Special Considerations 349
Online Resources 351
Spinal Cord Injury 351
Exercise Testing 352
Exercise Prescription 354
Special Considerations 358
Online Resources 361xxix Contents
Multiple Chronic Diseases and Health Conditions 361
Exercise Testing 361
Exercise Prescription 362
Special Considerations 362
References 362
11 Brain Health and Brain-Related Disorders 378
Introduction 378
Attention-Deficit/Hyperactivity Disorder 379
Exercise Testing 380
Exercise Prescription 380
Future Directions 381
Online Resources 382
Alzheimer’s Disease 382
Exercise Testing 384
Exercise Prescription 385
Future Directions 387
Online Resources 387
Anxiety and Depression 387
Exercise Testing 388
Exercise Prescription 388
Exercise Considerations 390
Special Considerations 391
Online Resources 391
Autism Spectrum Disorder 392
Exercise Testing 393
Exercise Prescription 393
Exercise Training Considerations 395
Future Directions 395
Online Resources 396
Cerebral Palsy 397
Exercise Testing 398
Exercise Prescription 400
Online Resources 403
Intellectual Disability and Down Syndrome 403
Exercise Testing 404
Exercise Prescription 407
Special Considerations for Individuals with
Intellectual Disability 409
Special Considerations for Individuals with
Down Syndrome 410
Online Resources 411
Parkinson’s Disease 412
Exercise Testing 416
Exercise Programming 418
Special Considerations 422
Future Directions 423xxx ACSM’s Guidelines for Exercise Testing • www.acsm.org
Online Resources 424
References 424
12 Behavioral Theories and Strategies for Promoting Exercise 441
Introduction 441
Modifying the Exercise Prescription 441
Frequency/Time 442
Intensity 442
Type 442
Theoretical Foundations for Understanding Exercise Behavior 443
Social Cognitive Theory 443
Transtheoretical Model 446
Health Belief Model 447
Self-Determination Theory 447
Theory of Planned Behavior 449
Social Ecological Models 449
Dual Processing Theories 450
Strategies and Approaches for Increasing Physical Activity 452
Enhancing Self-Efficacy 452
Self-Monitoring 452
Goal Setting 453
Implementation Intentions 453
Reinforcement 453
Social Support 454
Problem Solving 455
Affect Regulation 455
Relapse Prevention 457
Brief Counseling and Motivational Interviewing 457
Stage of Change Tailored Counseling 458
Group Leader Effectiveness 458
Special Populations 460
Cultural Diversity 461
Older Adults 461
Individuals with Mental Illness 462
Youth 462
Individuals with Obesity 463
Individuals with Chronic Diseases and Health Conditions 463
Online Resources 464
References 464
Appendix A Common Medications 470
Appendix B Electrocardiogram Interpretation 477
Appendix C American College of Sports Medicine Certifications 482
Appendix D Metabolic Calculations and Methods for
Prescribing Exercise Intensity 487
Appendix E Contributing Authors to the Previous Two Editions 495
Index 501