Assessing the Risks of an Exercise Program

Ready to start an exercise program? That’s great, but before you begin, I strongly suggest you get a health screening. An effective screening will help you identify any medical conditions or factors that place you at risk during exercise. The simplest and most effective way to do this is to work with your physician to review your risk factors for coronary artery disease (CAD), the number one killer in the U.S. The eight positive risk factors (i.e., increases the risk for CAD) identified by the American College of Sports Medicine (ACSM) are as follows:

1. Age. Men e 45 years and women e 55 years.

2. Cigarette Smoking. A current cigarette smoker or those who quit within the previous 6 months; or exposure to environmental tobacco smoke (i.e., second-hand smoke).

3. Family History. Heart attack or sudden death before 55 in father or first degree male relative (e.g., brother) or before 65 in mother or first degree female relative (e.g., sister).

4. High Blood Pressure. Systolic blood pressure (SBP) e 140 mmHg or diastolic blood pressure (DBP) e 90 mmHg confirmed by measurements on at least two separate occasions; or on antihypertensive medication.

5. High Cholesterol. LDL cholesterol > 130 mg/dL or HDL cholesterol < 40 mg/dL; or on lipid lowering medication. If total serum cholesterol is all that is available use > 200 mg/dL.

6. Fasting Blood Glucose. A fasting blood glucose e 100 mg/dL but < 126 mg/dL confirmed on at least two separate occasions.

7. Obesity. Body Mass Index > 30. Also, waist girth > 40 inches (102 cm) in men and > 35 inches (88 cm) in women.

8. Sedentary Lifestyle. Persons not getting 30 minutes of moderate-intensity physical activity on most days of the week.

There is also one negative risk factor. A high serum HDL > 60 mg/dL reduces the risk of cardiovascular disease. ACSM provides a risk stratification to determine if you fall within a Low, Moderate or High Risk category. If you are low risk, you are ready to get started with your exercise regimen. However, if you are either moderate risk or high risk, I strongly recommend you receive a full physical examination from your physician before beginning an exercise program. This is particularly important if you plan on doing high-intensity exercise. Your physician may have specific guidelines for exercises you can and cannot do, and he or she may want to facilitate an exercise test (e.g., stress test) before clearing you to begin your program:

* Low Risk – Men and women who are asymptomatic (no existing disease or symptoms of disease) and have no more than one positive risk factor.

* Moderate Risk – Men and women who are asymptomatic but have two or more positive risk factors.

* High Risk – Anyone with an existing disease or symptoms of disease (e.g., diabetes, asthma, renal or liver disease, lung disease, cardiovascular disease, cystic fibrosis, angina, heart murmur, dizziness, shortness of breath).