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Applying the ACSM Preparticipation Screening Algorithm to U.S. Adults: National Health and Nutrition Examination Survey 2001–2004


Medicine & Science in Sports & Exercise: October 2017 - Volume 49 - Issue 10 - p 2056–2063
doi: 10.1249/MSS.0000000000001331

Purpose For most people, the benefits of physical activity far outweigh the risks. Research has suggested that exercise preparticipation questionnaires might refer an unwarranted number of adults for medical evaluation before exercise initiation, creating a potential barrier to adoption. The new American College of Sports Medicine (ACSM) prescreening algorithm relies on current exercise participation; history and symptoms of cardiovascular, metabolic, or renal disease; and desired exercise intensity to determine referral status. Our purpose was to compare the referral proportion of the ACSM algorithm to that of previous screening tools using a representative sample of U.S. adults.

Methods On the basis of responses to health questionnaires from the 2001–2004 National Health and Nutrition Examination Survey, we calculated the proportion of adults 40 yr or older who would be referred for medical clearance before exercise participation based on the ACSM algorithm. Results were stratified by age and sex and compared with previous results for the ACSM/American Heart Association Preparticipation Questionnaire and the Physical Activity Readiness Questionnaire.

Results On the basis of the ACSM algorithm, 2.6% of adults would be referred only before beginning vigorous exercise and 54.2% of respondents would be referred before beginning any exercise. Men were more frequently referred before vigorous exercise, and women were more frequently referred before any exercise. Referral was more common with increasing age. The ACSM algorithm referred a smaller proportion of adults for preparticipation medical clearance than the previously examined questionnaires.

Conclusions Although additional validation is needed to determine whether the algorithm correctly identifies those at risk for cardiovascular complications, the revised ACSM algorithm referred fewer respondents than other screening tools. A lower referral proportion may mitigate an important barrier of medical clearance from exercise participation.

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1Centers for Disease Control and Prevention, Atlanta, GA; 2University of Rhode Island, Kingston, RI; and 3North Carolina Wesleyan College, Rocky Mount, NC

Address for correspondence: Geoffrey P. Whitfield, Ph.D., M.Ed., Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-77, Atlanta, GA 30341; E-mail:;

Submitted for publication March 2017.

Accepted for publication May 2017.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2017 American College of Sports Medicine