ACSM's Guidelines for Exercise Testing and Prescription

482 Pages·2013·11.96 MB·English

ACSM’S
Guidelines for
Exercise Testing and Prescription
NINTH EDITION
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ii GUIDELINES FOR EXERCISE TESTING (cid:129) www.acsm.org
SENIOR EDITOR
Linda S. Pescatello, PhD, FACSM, FAHA, ACSM-PD, ACSM-ETT
Professor
Department of Kinesiology & Human Performance Laboratory
Neag School of Education
University of Connecticut
Storrs, Connecticut
ASSOCIATE EDITORS
Ross Arena, PhD, PT, FACSM, FAACVPR, FAHA, ACSM-CES
Director and Professor
Physical Therapy Program
Department of Orthopaedics & Rehabilitation
University of New Mexico Health Sciences Center
Albuquerque, New Mexico
Deborah Riebe, PhD, FACSM, ACSM-HFS
Chair and Professor
Department of Kinesiology
University of Rhode Island
Kingston, Rhode Island
Paul D. Thompson, MD, FACSM, FACC
Chief of Cardiology
Hartford Hospital
Hartford, Connecticut
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ACSM’
S
Guidelines for
Exercise Testing and Prescription
NINTH EDITION
AMERICAN COLLEGE
OF SPORTS MEDICINE
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Acquisitions Editor: Emily Lupash
Product Manager: Meredith L. Brittain
Marketing Manager: Sarah Schuessler
Vendor Manager: Marian Bellus
Creative Director: Doug Smock
Compositor: Absolute Service, Inc.
ACSM Committee on Certification and Registry Boards Chair: Deborah Riebe, PhD, FACSM, ACSM-HFS
ACSM Publications Committee Chair: Walter R. Thompson, PhD, FACSM, FAACVPR
ACSM Group Publisher: Kerry O’Rourke
Umbrella Editor: Jonathan K. Ehrman, PhD, FACSM
Ninth Edition
Copyright © 2014, 2010, 2006, 2001 American College of Sports Medicine
351 West Camden Street Two Commerce Square / 2001 Market Street
Baltimore, MD 21201 Philadelphia, PA 19103
Printed in China
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in
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9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
ACSM’s guidelines for exercise testing and prescription / American College of Sports Medicine ; senior editor,
Linda S. Pescatello ; associate editors, Ross Arena, Deborah Riebe, Paul D. Thompson. — 9th ed.
p. ; cm.
Guidelines for exercise testing and prescription
Includes bibliographical references and index.
ISBN 978-1-60913-605-5
I. Pescatello, Linda S. II. American College of Sports Medicine. III. Title: Guidelines for exercise testing and
prescription.
[DNLM: 1. Physical Exertion—Guideline. 2. Exercise Test—standards—Guideline. 3. Exercise Therapy—
standards—Guideline. WE 103]
615.8'2—dc23
2012038784
DISCLAIMER
Care has been taken to confirm the accuracy of the information present and to describe generally
accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions
or for any consequences from application of the information in this book and make no w arranty, expressed
or implied, with respect to the currency, completeness, or accuracy of the c ontents of the publication.
Application of this information in a particular situation remains the p rofessional responsibility of the
practitioner; the clinical treatments described and recommended may not be considered absolute and
universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and d osage
set forth in this text are in accordance with the current recommendations and practice at the time of
publication. However, in view of ongoing research, changes in government regulations, and the constant flow
of information relating to drug therapy and drug reactions, the reader is urged to check the package insert
for each drug for any change in indications and dosage and for added w arnings and precautions. This is
particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA)
clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain
the FDA status of each drug or device planned for use in their clinical practice.
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This book is dedicated to the hundreds of volunteer professionals who have,
since 1975, contributed their valuable time and expertise to develop and update
the Guidelines. Now in its ninth edition, it is the most widely circulated set of
guidelines used by professionals performing exercise testing or exercise programs.
Specifically, this edition is dedicated to the editors, contributing authors, and
reviewers of this and previous editions, who have not only provided their collective
expertise but also their valuable time to ensure the Guidelines meet the highest
standards in exercise science and practice.
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The American College of Sports Medicine (ACSM) Guidelines origins are within the
ACSM Committee on Certification and Registry Boards (CCRB, formerly known as
the Certification and Education Committee and the Preventive and Rehabilitative
Exercise Committee). Today, the Guidelines remain under the auspices of the CCRB,
and have become the primary resource for anyone conducting exercise testing or
exercise programs. The Guidelines provide the foundation of content for its sup-
porting companion texts produced by ACSM, which include the seventh edition of
ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, fourth
edition of ACSM’s Certification Review, fourth edition of ACSM’s Resources for the
Personal Trainer, first edition of ACSM’s Resources for the Health Fitness Specialist,
fourth edition of ACSM’s Health-Related Physical Fitness Assessment Manual, and
second edition of ACSM’s Resources for Clinical Exercise Physiology: Musculoskeletal,
Neuromuscular, Neoplastic, Immunologic, and Hematologic Conditions.
The first edition of the Guidelines was published in 1975, with updated edi-
tions published approximately every 4 to 6 years. The outstanding scientists and
clinicians who have served in leadership positions as chairs and editors of the
Guidelines since 1975 are:
First Edition, 1975 Edward T. Howley, PhD, FACSM,
Associate Editor Fitness
Karl G. Stoedefalke, PhD, FACSM,
Cochair Seventh Edition, 2005
John A. Faulkner, PhD, FACSM, Mitchell H. Whaley, PhD, FACSM,
Cochair Senior Editor
Second Edition, 1980 Peter H. Brubaker, PhD, FACSM,
Associate Editor Clinical
Anne R. Abbott, PhD, FACSM, Chair
Robert M. Otto, PhD, FACSM,
Third Edition, 1986 Associate Editor Fitness
Steven N. Blair, PED, FACSM, Chair Eighth Edition, 2009
Fourth Edition, 1991 Walter R. Thompson, PhD, FACSM,
Senior Editor
Russell R. Pate, PhD, FACSM, Chair
Neil F. Gordon, MD, PhD, FACSM,
Fifth Edition, 1995 Associate Editor
Larry W. Kenney, PhD, FACSM, Linda S. Pescatello, PhD, FACSM,
Senior Editor Associate Editor
Reed H. Humphrey, PhD, PT, FACSM,
Ninth Edition, 2013
Associate Editor Clinical
Linda S. Pescatello, PhD, FACSM,
Cedric X. Bryant, PhD, FACSM,
Senior Editor
Associate Editor Fitness
Ross Arena, PhD, PT, FACSM,
Sixth Edition, 2000 Associate Editor
Barry A. Franklin, PhD, FACSM, Deborah Riebe, PhD, FACSM,
Senior Editor Associate Editor
Mitchell H. Whaley, PhD, FACSM, Paul D. Thompson, MD, FACSM,
Associate Editor Clinical Associate Editor
vi
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IPnrdeefxace
This edition of ACSM’s Guidelines for Exercise Testing and Prescription will con-
tinue the efforts of the editors and contributing authors of the eighth edition to
make the ninth edition a true guidelines book rather than a sole and inclusive
resource. For it was the original intent of the Guidelines to be user friendly, easily
accessible, and a current primary resource for professionals that conduct exer-
cise testing and exercise programs. To this effect, in this edition, text descrip-
tions have been minimized; more tables, boxes, and figures have been included;
summary boxes have been added throughout to highlight important information;
and take home messages and key Web sites now conclude each chapter.
The reader of this edition of ACSM’s Guidelines for Exercise Testing and
Prescription will notice several new themes. First and foremost, the ninth edi-
tion supports the public health message that all people should adopt a physically
active lifestyle by reducing the emphasis on the need for medical evaluation
(i.e., medical examination and exercise testing) as part of the preparticipation
health screening process prior to initiating a progressive exercise regimen among
healthy, asymptomatic persons. This edition of the Guidelines seeks to simplify
the preparticipaton health screening process in order to remove unnecessary and
unproven barriers to adopting a physically active lifestyle. Secondly, we have
instituted an automated referencing system that is the beginning of an ACSM
evidence-based library that will become available to the membership at some
time in the future. We have integrated the most recent guidelines and recom-
mendations available from ACSM position stands and other relevant professional
organization’s scientific statements so that the Guidelines are the most current,
primary resource for professionals that conduct exercise testing and exercise pro-
grams in academic, corporate, health/fitness, health care, and research settings. It
is important for the readership to know these new themes and the more specific
innovations of the ninth edition that follow were developed with input from the
ACSM membership prior to the initiation of this project via an electronic survey
and in-house focus group that asked respondents and participants, respectively,
for their suggestions regarding the content of the ninth edition.
More specific, noteworthy innovations of the ninth edition include the
following:
(cid:129) The introduction of the Frequency, Intensity, Time, Type — Volume, and
Progression or FITT-VP principle of exercise prescription in Chapter 7.
(cid:129) An expanded number of special populations in Chapter 10 because more
information related to exercise testing, prescription, and special consider-
ations of these new populations has become available since the publication of
the eighth edition.
(cid:129) Inclusion of Chapter 11, a new chapter on behavioral change strategies
addressing the challenges of exercise adherence.
vii
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viii Preface
Several of the appendices have undergone significant changes. Appendix A,
Common Medications, is now authored by registered pharmacists in academic
settings with clinical expertise in the pharmacology of medications likely to
be used by patients and clients in exercise testing and programmatic settings.
The content of Appendix B, Medical Emergency Management, is now based
primarily on the fourth edition of ACSM’s Health/Fitness Facility Standards and
Guidelines. The learning objectives have been removed from Appendix D, ACSM
Certifications, b ecause these are now available via the ACSM Certification link
www.acsmcertification.org/exam-content-outlines. Appendix E, which lists the
contributing authors to the two previous editions of the Guidelines, has been
added.
Any updates made in this edition of the Guidelines after their publication and
prior to the publication of the next edition of the Guidelines, can be accessed
from the ACSM Certification link (www.acsmcertification.org/getp9-updates).
Furthermore, the reader is referred to the ACSM Access Public Information
Books and Media link for a list of ACSM books (www.acsm.org/access-public-
information/books-multimedia), and to the ACSM Get Certified link for a listing
of ACSM certifications (www.acsmcertification.org/get-certified).
ACKNOWLEDGMENTS
It is in this preface that the editors of the ninth edition have the opportunity
to thank the many people who helped to see this project to completion. To be
consistent with the theme of the Guidelines, our thanks will remain short, to the
point, and without great elaboration.
We thank our families and friends for their understanding of the extensive
time commitment we made to this project that encompassed over three years.
We thank our publisher, and in particular Emily Lupash, senior acquisitions
editor; Meredith Brittain, senior product manager; Christen Murphy and Sarah
Schuessler, marketing managers; and Zachary Shapiro, editorial assistant.
We thank Richard T. Cotton, ACSM National Director of Certification; Traci
Sue Rush, ACSM Assistant Director of Certification Programs; Kela Webster,
ACSM Certification Coordinator; Robin Ashman and Dru Romanini, ACSM
Certification Department Assistants; Angela Chastain, ACSM Editorial Services
Office; Kerry O’Rourke, ACSM Director of Publishing; Walter R. Thompson,
ACSM Publications Committee Chair; and the extraordinarily hardworking
Publications Committee.
We thank the ACSM CCRB for their valuable insights into the content of
this edition of the Guidelines and counsel on administrative issues related to
seeing this project to completion. The ACSM CCRB tirelessly reviewed manu-
script drafts to ensure the content of this edition of the Guidelines meets the
highest standards in exercise science and practice. We thank Dr. David Swain,
senior editor of the seventh edition of ACSM’s Resource Manual for Guidelines
for Exercise Testing and Prescription, for his very careful and insightful review of
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