ACSM’S GUIDELINES FOR
EXERCISE TESTING AND
PRESCRIPTION
(9TH ED.)

The first edition of the Guidelines was published in 1975, with updated editions
published approximately every 4 to 6 years.

Founded in 1954, the American College of Sports Medicine (ACSM) promotes
and integrates scientific research, education, and practical applications of
sports medicine and exercise science to maintain and enhance physical
performance, fitness, health, and quality of life. The ACSM national
headquarters moved to Indianapolis in 1984, joining organizations such as
theNational Collegiate Athletic Association, the National Federation of State
High School Associations, and national sport-specific governing bodies.

Members of ACSM work in a wide range of medical specialties, allied health
professions, and scientific disciplines, and are committed to the diagnosis,
treatment, and prevention of sports-related injuries and the advancement of
the science of exercise.
The 11 Chapters
Section I: Health Appraisal and Risk Assessment
1.
Benefits and Risks Associated with Physical Activity
2.
Preparticipation Health Screening
Section II: Exercise Testing
3.
Pre-exercise Evaluation
4.
Health-Related Physical Fitness Testing and Interpretation
5.
Clinical Exercise Testing
6.
Interpretation of Clinical Exercise Test Results
Section III: Exercise Prescription
7.
General Principles of Exercise Prescription
8.
Exercise Prescription for Healthy Populations with Special Considerations and
Environmental Considerations
9.
Exercise Prescription for Patients with Cardiovascular and Cerebrovascular Disease
10. Exercise Prescription for Populations with Other Chronic Diseases and Health
Conditions
11. Behavioral Theories and Strategies for Promoting Exercise
Section I: Health Appraisal and Risk Assessment
Chapter 1: Benefits and Risks Associated with Physical Activity
•
Physical Activity and Fitness Terminology
•
Public Health Perspective for Current Recommendations
•
Benefits of Regular Physical Activity and/or Exercise
•
Risks Associated with Exercise
•
Sudden Cardiac Death Among Young Individuals
•
Exercise-Related Cardiac Events in Adults
•
Exercise Testing and the Risk of Cardiac Events
•
Risk of Cardiac Events During Cardiac Rehabilitation
•
Prevention of Exercise-Related Events
Chapter 2: Preparticipation Health Screening
•
Preparticipation Health Screening
•
Self-Guided Methods
•
Atherosclerotic Cardiovascular Disease Risk Factor Assessment
•
Recommendations for a Medical Examination Prior to Initiating Physical Activity
•
Recommendations for Exercise Testing Prior Initiating Physical Activity
•
Recommendations for Supervision of Exercise Testing
•
Risk Stratification for Patients with Cardiovascular Disease
Chapter 3: Preexercise Evaluation
•
Medical History, Physical Examination, and Laboratory tests
•
Blood Pressure
•
Lipids and Liproteins
•
Blood Profile Analyses
•
Pulmonary Function
•
Contraindications to Exercise Testing
•
Informed Consent
•
Participant Instructions
Section II: Exercise Testing
Chapter 4: Health-Related Physical Fitness testing and Interpretation
•
Purposes of Health-Related Fitness Testing
•
Basic Principles and Guidelines
•
•
Pretest Instructions
•
Test Organization
•
Test Environment
Body Composition
•
Anthropometric Methods
•
Densitometry
•
Other Information
•
Body Composition Norms
•
•
Cardiorespiratory Fitness
•
The Concept of Maximal Oxygen Uptake
•
Maximal versus Submaximal Exercise Testing
•
Modes of Testing
•
Cardiorespiratory Test Sequence and Measures
•
Test Termination Criteria
•
Interpretation Results
Muscular Strength and Muscular Endurance
•
Rationale
•
Principles
•
Muscular Strength
•
Muscular endurance
•
Special Considerations in Muscular Fitness
•
Flexibility
•
A Comprehensive Health Fitness Evaluation
Chapter 5: Clinical Exercise Testing
•
Indications and Purposes
•
Diagnostic Exercise Testing
•
Exercise Testing for Disease Severity and Prognosis
•
Exercise Testing After Myocardial infarction
•
Functional Exercise Testing
•
Exercise Test Modalities
•
Exercise Protocols
•
•
Upper Body Exercise Testing
Testing to Return to Work
•
Measurements During Exercise Testing
•
Heart Rate and Blood Pressure
•
Electrocardiac Monitoring
•
Subjective Ratings and Symptoms
•
Gas Exchange and Ventilatory Responses
•
Arterial Blood Gas Assessment During Exercise
•
Indications for Exercise Test Termination
•
Postexercise Period
•
Imaging Modalities Used in Conjunction with Exercise Testing
•
Exercise Echocardiography
•
Cardiac Radionuclide Imaging
•
•
Imaging Modalities not Used in Conjunction with Exercise Testing
•
Pharmacologic Stress Testing
•
Computed Tomography in the Assessment of Cardiovascular Disease
Supervision of Exercise Testing
Chapter 6: Interpretation of Clinical Exercise Test Results
•
Exercise Testing as a Screening Tool for Coronary Artery Disease
•
Interpretation of Responses to graded Exercise Testing
•
•
Heart Rate Response
•
Blood Pressure Response
•
Electrocardiograph Waveforms
•
Limiting Signs and Symptoms
•
Ventilatory Expired Gas Responses in Exercise
Diagnostic Value of Exercise Testing
•
Sensitivity
•
Specificity
•
Predictive Value
•
Comparison with Imaging Stress Tests
•
Prognostic Applications of the Exercise Test
Section III: Exercise Prescription
Chapter 7: General Principles of Exercise Prescription
•
An Introduction to the Principles of Exercise Prescription
•
General Considerations for Exercise Prescription
•
Components of the Exercise Training Session
•
Aerobic (Cardiorespiratory Endurance) Exercise
•
Frequency of Exercise
•
Intensity of Exercise
•
Exercise Time (Duration)
•
Exercise Volume (Quantity)
•
Type (Mode)
•
Rate of Progression
•
•
Muscular Fitness
•
Frequency of Resistance Exercise
•
Types of Resistance Exercise
•
Volume of Resistance Exercise (Sets and Repetitions)
•
Resistance Exercise Technique
•
Progression/Maintenance
Flexibility Exercise (Stretching)
•
Types of Flexibility Exercises
•
Volume of Flexibility Exercise (Time, Repetitions, and Frequency)
•
Neuromotor Exercise
•
Exercise Program Supervision
Chapter 8: Exercise Prescription for Healthy populations with
Special Considerations and Environmental Considerations
•
•
•
•
Pregnancy
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Children and Adolescents
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Low Back Pain
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Environmental Considerations
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Chapter 9: Exercise Prescription for Patients with Cardiovascular
and Cerebrovascular Disease
•
Inpatient Rehabilitation Programs
•
Outpatient Exercise programs
•
Exercise Prescription
•
Types of Outpatient Exercise Programs
•
Special Considerations
•
Resistance Training for Cardiac patients
•
Exercise Training for Return to Work
•
Exercise Prescription for Patients with Cerebrovascular Disease (Stroke)
Chapter 10: Exercise Prescription for Populations with Other
Chronic Diseases and Health Conditions
•
•
•
Arthritis
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Cancer
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Cerebral Palsy
•
Exercise Testing
•
Exercise Prescription/Special Considerations
•
•
•
Diabetes Mellitus
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Dyslipidemia
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Fibromyalgia
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
•
•
•
Human Immunodeficiency Virus
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Hypertension
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Intellectual disability and Down Syndrome
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
•
•
•
Kidney Disease
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Metabolic Syndrome
•
Exercise Testing
•
Exercise Prescription/Special Considerations
Multiple Sclerosis
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
•
•
Osteoporosis
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Overweight and Obesity
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
•
Weight Loss Program Recommendations
•
Bariatric Surgery
•
•
Parkinson Disease
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Pulmonary Diseases
•
Asthma
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
•
Chronic Obstructive Pulmonary Disease
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
•
•
Spinal Cord Injury
•
Exercise Testing
•
Exercise Prescription/Special Considerations
Individuals with Multiple Chronic Diseases and Health Concerns
•
Preparticipation Health Screening
•
Exercise Testing
•
Exercise Prescription
•
Special Considerations
Chapter 11: Behavioral Theories and Strategies for Planning
Exercise
•
•
Exercise Prescription
•
Frequency/Time
•
Intensity
•
Type
Theoretical Foundations for Understanding Exercise Behavior
•
Social Cognitive Theory and Self-Efficacy
•
Transtheoretical Model
•
Health Belief Model
•
Self-Determination Theory
•
Theory of Planned Behavior
•
Social Ecological
•
Theoretical Strategies and Approaches to Change
•
Behavior/Increase Adherence
•
Building Self-Efficacy
•
Brief Counseling and Motivational Interviewing
•
Stage of Change Tailored Interviewing
•
Group Leader interactions
•
Cognitive-Behavioral Approaches
•
Social Support
•
Association versus Disassociation
•
Affect Regulation
•
Relapse Prevention
•
Special Populations
•
Cultural Diversity
•
Older Adults
•
Children
•
Individuals with Obesity
•
Individuals with Chronic Diseases and Health Concerns
Appendices

A
Common Medications

B
Emergency Risk Management

C
Electrocardiogram Interpretation

D
American College of Sports Medicine Certifications

E
Contributing Authors to the Previous Two Editions