Clinical Assessment and Risk Stratification
Screening is a decision pathway, not a checklist
The core skill is deciding whether a client can begin exercise now, needs medical clearance, or needs a supervised test first. ACSM's preparticipation framework rests on three inputs: current exercise participation, signs or symptoms of cardiovascular, metabolic, or renal disease, and the intensity the client intends to perform.
Risk factors to know cold
Age (men ≥45, women ≥55), family history (first-degree male relative <55 or female <65), cigarette smoking or quit within 6 months, sedentary lifestyle (under 30 min moderate activity, 3 days/week, for 3 months), obesity (BMI ≥30 or waist >102 cm men / >88 cm women), hypertension (≥130/85 or on medication), dyslipidemia (LDL ≥130, HDL <40, or on medication), prediabetes (fasting glucose 100-125 mg/dL). Two or more flags elevated risk in the classic model.
Traps
Questions love the family-history thresholds and substituting total cholesterol for LDL. Note that the newer algorithm does not ask you to count risk factors at all; it asks about symptoms and current activity. Separate absolute contraindications (acute MI within 2 days, unstable angina, uncontrolled arrhythmia, severe symptomatic aortic stenosis, decompensated heart failure, acute pulmonary embolism or myocarditis) from relative ones.
Rule of thumb
Asymptomatic and already exercising at moderate intensity: proceed. Symptoms at any intensity: clearance plus a supervised test. Sedentary with known disease planning vigorous work: clearance. If you cannot justify the decision in a chart note, the screening was incomplete.