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Age Men > 45 years Women > 55 or premature menopause without estrogen replacement therapy Diagnosed Disease Cardiovascular disease Cardiac, peripherial vascular, or cerebrovascular disease Pulmonary disease Chronic obstuctive pulmonary disease, asthma, interstitial lung disease, or cystic fibrosis Metabolic disease Diabetes mellitius (type I or II), thyroid disorders, renal or liver disease Coronary Artery Disease Risk Factors The following risk factors should not be viewed as all inclusive. Hypertension High blood pressure confirmed by measurement on at least two separate occasions Systolic blood pressure: 140 mmHg or greater Diastolic blood pressure: 90 mmHg or greater Using Antihypertensive medication Hypercholesterolemia Low Density lipoprotein: > 130 mg/dL (3.4 mmmol/L) If low density lipoprotein is not available, use total cholestol criteria instead: Total serum cholesterol: >200 mg/dl (5.2 mmol/L) High-density lipoprotein cholesterol: <40 mg/dl (1.03 mmol/L) Using lipid-lower medication High serum HDL cholesterol (negative risk factor) >60 mg/dL (1.6 mmol/L) High serum HDL cholesterol decreases the risk of coronary artery desease Subtracts one risk factor from sum of positive risk factors above Impaired fasting glucose Fasting blood glucose: 100 mg/dL (5.6 mmol/L) or greater confirmed by measurements on at least 2 separate occasions Obesity Exercise professional should use clinical judgment when evaluating this risk factor Professional opinions vary regarding the most appropriate markers and thresholds for obesity Body Mass Index of 30 kg/m2 or greater Waist Hip Ratio greater than 0.95 (men) and 0.86 (women) Waist girth greater than 102 cm (men) and 88 cm (women) Sedentary Lifestyle Not participating in a regular exercise program Not accumulating 30 minutes or more of moderate physical activity on most days of the week Smoking Current cigarette smoker Quit within previous 6 months Family History Myocardial infarction, coronary revascularization, or sudden death before 55 years of age in father or other male first degree relative (ie, brother or son) before 65 years of age in mother or other female first degree relative (ie, sister or daughter) Major Symptoms or Signs Suggestive of Cardiovascular and Pulmonary Disease The following signs and symptoms must be interpreted with in the clinical context in which the appear since they are not all specific for metabolic, pulmonary, or cardiovascular disease. Pain or discomfort in the chest, neck, jaw, arms, or other areas that may be due to myocardial ischemia (lack of adequate circulation) Shortness of breath at rest, during daily activities, or with mild exertion Dizziness or syncope (fainting) Orthopnea (breathing discomfort when not in an upright position) or paroxysmal nocturnal dyspnea (interrupted breathing at night) Ankle edema (swelling) Palpitations (abnormal rapid beating of the heart) or tachycardia (rapid heart beat) Intermittent claudication (cramping pain and weakness in legs, especially calves, during walking due to inadequate blood supply to muscles) Known heart murmur (atypical heart sound indicating a structural or functional abnormality) Unusual or unexplained fatigue Risk Current (within past year) medical examination and exercise testing before participation: Moderate Exercise Vigorous Exercise Physician supervision of exercise tests: Submaximal Test Maximal Test Moderate activity intensity comfortably substainable for about 45 minutes approximately 3-6 METs: equivalent to walking 3-4 mph (4.8-6.5 kmph) 40%-60% of maximal oxygen uptake Vigorous activity produces substantial cardiorespiratory challenge greater than 6 METs: running or walking faster than 4 mph (>6.5 kmph) greater than 60% of maximal oxygen uptake ACSM (2005) ACSM guidelines for exercise testing and prescription, 7th ed. Lippincott, Williams, and Wilkins, 21-30