Risk Factors For Atherosclerotic Cardiovascular Disease (CVD)

Risk factors for coronary disease should be determined from the medical history prior to a fitness assessment or the beginning of an exercise program.  

Risk factors have a synergistic effect or the evidence of two such factors magnifies the effect of the one. Risk factors are defined as positive or negative which is not to be interpreted as good or bad. However, positive risk factors are considered to be those that place the individual at greater risk for a coronary event while negative factors decrease the risk for such.

There are 8 positive risk factors while only one negative factor. If a client demonstrates the one negative risk factor, then a positive risk factor can be deleted.

Positive risk factors include:

A. Family history – count this risk factor IF the client demonstrates the following:

1. has a relative (see below) that has suffered a heart attack (myocardial infarction), coronary revascularization (such as angioplasty) or sudden death AND:

a. is a daughter, sister, mother younger than 65

b. OR a son, brother, father younger than 55

B. Cigarette smoking – count this as a risk factor IF the client is currently smoking or has quit within that last six months

C. Hypertension – count this as a risk factor IF the client has a

1. systolic blood pressure ≥ to 140 mm Hg

2. OR a diastolic blood pressure of ≥ to 90 mm Hg

3. OR is on antihypertensive medication

D. Hypercholesterolemia – count this as a risk factor IF one of the following conditions is met:

1. total cholesterol > 200 mg/dL desirable

2. LDL (low density lipoprotein or “bad” cholesterol) level > 130 mg/dL

3. HDL (high density lipoprotein or “good” cholesterol) level 102 cm for â(TM),; >88 cm for â(TM)EUR

G. Sedentary lifestyle – count this as a risk factor IF the client doesn’t meet the CDC-ACSM recommendation of 30 minutes of moderate physical activity on most days of the week.

H. Age – men at/younger than 45; women at/younger than 55

Negative risk factors include:

A. High HDL cholesterol – negate a previous positive risk factor IF the client has an HDL of ≥ 60 mg/dL

Use the number of risk factors to determine if a person is a low risk or a moderate risk.

IF the client has no risk factors or one, then s/he is a low risk.

IF the client has two or more risk factors, then s/he is a moderate risk.

Using the following ACSM recommendations, determine whether a current medical examination, presence of medical personnel, or exercise testing prior to participation is necessary. Note: Necessity is based on how you will be testing the individual (submaximal vs. maximal) as well as how you will be training the individual (moderate vs. vigorous exercise program).

Low Risk Individuals can be assessed and/or trained without an exam or medical personnel present. It is NOT necessary to meet these conditions.

High Risk Individuals should always have a medical exam or medical personnel involved in testing them BEFORE any tests or training from the personal trainer. It is HIGHLY recommended that these conditions be met BEFORE working with him/her.

Moderate Risk Individuals can be given a moderate exercise program or a submaximal test WITHOUT a medical exam or medical supervision. HOWEVER, if you are training this individual vigorously (greater than 69% MaxHR) OR you are performing a maximal field test, then it is HIGHLY recommended that you have a physician present or have a medical exam PRIOR to assessment and/or training.

Client safety is paramount.  When working with new clients, it is prudent on the part of the personal trainer to discuss the client’s medical history for anything that might preclude exercise prior to a physician’s release.