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PDF Acsm S Health Fitness Facility Standards and Guidelines Fifth Edition American College of Sports Medicine Ebook Full Chapter
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Fifth Edition
ACSM’s
Health/Fitness
Facility
Standards
and Guidelines
American College of Sports Medicine
Senior Editor
▶ v
vi ◀ Contents
APPENDIX D Trade and Professional Associations Involved in the Health/Fitness Facility Industry . . . . 187
Index 209
Senior Editor
and Contributing Editors
▶ vii
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Preface
Time and place. The time: the late 1980s. The place: three additional editions of this one-of-a-kind
ACSM national headquarters in Indianapolis, resource have been published—in 1997, 2004,
Indiana. Lyle Micheli, MD, FACSM, president of and 2012, respectively. Each subsequent edition
ACSM at the time, spearheads an effort to have was designed to reflect changing market forces,
ACSM establish a blueprint that specifies what relevant developments, and new factors brought
health/fitness facilities must do to establish and to light in the health/fitness facility industry.
maintain the standards of care that they offer This fifth edition of ACSM’s Health/Fitness
members and users, as well as what health/fit- Facility Standards and Guidelines continues to
ness facilities should do in order to enhance the ensure that the latest edition of this exceptional
experience that members and users can achieve resource offers the most up-to-date information,
by engaging in the activities and programs ideas, and insights available on the standard of
offered by a particular facility. care for health/fitness facilities, wherever and in
Before the call to action by ACSM, no such whatever format they might exist. As with previ-
blueprint existed to help ensure that the experi- ous editions, the fifth edition features a team of
ences of members and users in health/fitness professionals who provided their expertise in a
facilities (e.g., commercial health or fitness clubs, variety of subject areas, including architecture,
corporate fitness centers, Jewish community health and wellness, law, safety-related practices
centers, medical fitness centers, YMCAs) were and policies, and the health/fitness club industry.
safe, efficient, and effective. In response to the Arguably, this group of well-respected individu-
leadership of Dr. Micheli, ACSM initiated the als has produced a very helpful and authoritative
process of assembling a team of experts in the book on the standard of care for health/fitness
academic, club industry, health/wellness, and facilities.
medical fields to develop and write a manual on There is an old African proverb that states, it
facility standards and guidelines for delivering takes a village to raise a child. To put this saying
quality physical activity programs and activities into the context of the fifth edition of ACSM’s
to consumers. Health/Fitness Facility Standards and Guidelines, it
The result. In 1992, the first edition of ACSM’s took a team to make this extraordinary book a
Health/Fitness Facility Standards and Guidelines reality. Collectively, their energy, efforts, passion,
was published. Over the intervening 25 years, and expertise made it happen.
Mary E. Sanders, PhD, FACSM, CDE,
ACSM-CEP, ACSM-RCEP
Senior Editor
James A. Peterson, PhD, FACSM
Editor Emeritus
▶ ix
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Acknowledgments
The American College of Sports Medicine (ACSM) •• Fourth edition—Stephen J. Tharrett, MS,
and the editors of this fifth edition of ACSM’s and James A. Peterson, PhD
Health/Fitness Facility Standards and Guidelines
would like to extend their thanks to the members The editors would also like to extend a special
of the editorial board who committed their time thanks to the ACSM board of trustees for their
and expertise to the writing of this book. Addi- contributions to and involvement in the estab-
tional thanks are extended to the editors of the four lishment of this book and its predecessors. For
previous editions of this book for their foresight more than 50 years, ACSM has played a leading
in helping establish the legacy of this publication: role in the growth in the level of professionalism
exhibited by the industry.
•• First edition—Carl Foster, PhD, FACSM, Finally, special thanks are extended to Darren
and Neil Sol, PhD Warburton, PhD, and JoAnn Eickhoff-Shemek,
•• Second edition—James A. Peterson, PhD, PhD, FACSM, for their contributions and to all the
FACSM, and Stephen J. Tharrett, MS organizations and professionals who reviewed
the draft manuscript for this book and provided
•• Third edition—Stephen J. Tharrett, MS; the editors with feedback on its content.
Kyle McInnis, ScD, FACSM; and James A.
Peterson, PhD
▶ xi
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Notice and Disclaimer
ACSM developed the previous and current the experience they provide to users. Such guide-
editions of this book to enhance the safety and lines are not standards, nor are they applicable in
effectiveness of physical activity conducted in every situation or circumstance; rather, they are
health/fitness facilities, with the goal of increas- tools that ACSM believes should be considered
ing global participation rates in physical activity. for adoption by health/fitness operators.
To this end, the book will address pre-activity
screening practices; orientation, education, ACSM and its senior co-editors and editorial
and supervision issues; risk management and board have designed this book as a resource for
emergency-procedure practices; staffing issues; those who operate all types of health/fitness
operational practices; design issues; equipment facilities, whether they be fully staffed facilities
issues; and signage issues that affect the safety or unstaffed and unsupervised facilities, such
and effectiveness of physical activity, as engaged as some hotel fitness centers, worksite centers,
in by the general population in health/fitness and commercial 24-hour facilities. Some of the
facilities. standards and guidelines detailed in this book,
ACSM and its senior co-editors and editorial in particular those that apply to issues of staffing
board, in setting forth standards and guidelines and supervision or the execution of a practice
in this book, have done so based on the following requiring staffing, may not be applicable to
definitions for standards and guidelines: those facilities whose operational model does not
include facility staffing.
•• Standards. These are base performance Despite the development and publication of
criteria or minimum requirements that ACSM this book, the responsibility for the design and
believes each health/fitness facility must meet delivery of services and procedures remains
to provide a relatively safe environment in with the facility operator and with others who
which physical activities and programs can be are providing services. Individual circumstances
conducted. These standards are not intended may necessitate deviation from these standards
to create or confirm a legal duty or standard of and guidelines, such as for an unstaffed facility.
care for purposes of litigation; rather, they are Facility personnel must exercise professionally
performance criteria derived from a consensus derived decisions concerning what is appropri-
of both ACSM leaders and leaders from the ate for individuals or groups under particular
health/fitness facility industry. The standards circumstances. These standards and guidelines
are not intended to be restrictive or to supersede represent ACSM’s opinion regarding best prac-
international, national, regional, or local laws and tices. Responsibility for service provision is a
regulations. They are intended to be qualitative matter of personal and professional experience.
in nature. Finally, as base performance criteria, Any activity, including those undertaken
these standards are steps designed to promote within a health/fitness facility, carries with it
quality. They are intended to accommodate rea- some risk of harm, no matter how prudently
sonable variations based on local conditions and and carefully services may be provided. Health/
circumstances. fitness facilities are not insurers against all risks
•• Guidelines. These are recommendations of untoward events; rather, their mission should
that ACSM believes health/fitness operators be directed at providing facilities and services
should consider using to improve the quality of in accordance with applicable standards. The
▶ xiii
xiv ◀ Notice and Disclaimer
standard of care that is owed by facilities is ever training services, or the practice of law or risk
changing and emerging. As a consequence, facili- management. Rather, facilities and profession-
ties must stay abreast of relevant professional als must engage the services of appropriately
developments in this regard. trained and/or licensed individuals to obtain
By reason of authorship and publication of this those services.
document, neither the editors, the contributors, The words safe and safety are frequently used
nor the publisher are or shall be deemed to be throughout this publication. Readers should rec-
engaged in the practice of medicine or any allied ognize that the use of these terms is relative and
health field, the practice of delivering fitness that no activity is completely safe.
Definitions
This section of the text provides readers with of applying chest compressions and, if needed,
definitions for the most frequently used words, breaths to assist an individual who is experienc-
phrases, and acronyms found throughout the ing cardiac arrest.
book. health care professional—Refers to a profes-
ADA—The Americans With Disabilities Act sional who has education, training, and experi-
(ADA) prohibits discrimination against people ence in the provision of health care services. In
with disabilities, including in the areas of em- the context of this book, it refers primarily to
ployment, transportation, public accommoda- physicians, nurse practitioners, physician as-
tions, communications, and access to state and sistants, registered nurses, emergency medical
local government programs and services. While technicians, or others who have received the
many of the ADA issues in health/fitness facili- proper licensing to deliver health care services
ties are equipment- or facility-related, the ADA in their respective fields of expertise.
is quite comprehensive and covers several other health/fitness facility—A facility that offers ex-
areas that affect health/fitness facilities, includ- ercise-based health and fitness programs and ser-
ing employment. vices. May include government-based facilities,
AED—An acronym for automated external defi- commercial facilities, corporate-based facilities,
brillator, an automated device that can detect the hospital-based facilities, and private facilities.
presence and absence of certain cardiac rhythms health/fitness facility member—A health/fit-
and deliver a potentially lifesaving electrical ness facility user who pays for the regular privi-
shock that may restore a normal heart rhythm. lege of engaging in the activities, programs, and
ASTM International—Originally known as services of the facility.
the American Society for Testing and Materials health/fitness facility operator—The owner or
(ASTM), this term refers to a worldwide volun- management group responsible for the financial
tary standards development organization for and operating activities of a health/fitness facil-
technical standards for materials, products, sys- ity.
tems, and services. health/fitness facility user—An individual
barrier protection apparel—Gowns, protective (who is not a member) who accesses a facility on
clothing, gloves, masks, and eye shields worn to one or more than one occasion without purchas-
help protect the staff person from bodily fluids ing a membership to the facility.
and chemicals. HHQ—An acronym for health history question-
cardio equipment—Machines that allow an in- naire, which is a pre-activity screening instru-
dividual to perform whole or partial body move- ment that is used to collect general health and
ments intended to stimulate the cardiorespirato- medical history information about an individu-
ry system of the individual engaged in using the al.
equipment. Examples of this equipment include HIPAA—An acronym for the U.S. government
treadmills, elliptical machines, mechanical stair Health Insurance Portability and Accountability
climbers, and indoor cycles. Act of 1996, which provides certain privacy pro-
CPR—An acronym that stands for cardiopulmo- tections for health information of individuals,
nary resuscitation, which involves the process including the dissemination of personal health
▶ xv
xvi ◀ Definitions
information without the written permission of cise for members and users as well as to coach,
the individual. guide, and supervise members and users while
independent contractor—An individual work- they engage in exercise at a health/fitness facil-
ing at a health/fitness facility but not employed ity.
by the operator of the facility. professional staff—Refers to staff who are edu-
MSDS—An acronym for material safety data cated and trained in a professional field, such as
sheets. These sheets specify data about products fitness or health care.
and materials, per U.S. Occupational Safety and selectorized resistance equipment—Resis-
Health Administration laws. tance training equipment composed of stacks
OSHA—An acronym for the Occupational of weight plates that are attached to a cable and
Safety and Health Administration of the U.S. moved over a pulley, allowing users to adjust
government. It oversees the implementation of the amount of weight lifted by selecting the
health and safety regulations required by the number of plates they desire to lift.
government, as well as the adherence to these staff—The employees of a health/fitness facil-
regulations by businesses. ity.
PAD—An acronym for public access defibril- staffed health/fitness facility—A health/fit-
lation; a system involving giving the public at ness facility that has employees or independent
large access to AEDs in public and private set- contractors who work in the facility during all
tings in an effort to bring lifesaving defibrilla- operating hours.
tion to as large a segment of the public as pos-
sible. unstaffed health/fitness facility—A health/
fitness facility that does not have employees or
PAR-Q+—An acronym for Physical Activity
independent contractors working in the facility
Readiness Questionnaire for Everyone, which is
during operating hours. This situation can ap-
a self-guided pre-activity screening instrument
ply for all operating hours or a portion of the
that helps an individual identify certain health
facility’s operating hours.
conditions and risk factors that might affect the
ability to exercise safely. variable-resistance equipment—Often the
same as selectorized resistance equipment, with
PASQ—An acronym for the Pre-Activity Screen-
the only difference being that instead of a cable
ing Questionnaire, a questionnaire that should
run over a standard circular pulley, the pulley
be reviewed by a qualified health/fitness pro-
is run over a cam-shaped pulley that varies the
fessional prior to initiating an exercise program.
torque (and hence the level of resistance) of
personal trainer—An employee or independent the weight lifted, without requiring the actual
contractor of a health/fitness facility whose weight to be changed.
primary responsibilities are to prescribe exer-
CHAPTER 1
Exercise
Preparticipation
Health Screening
2. Exercise preparticipation health screening tools shall provide an authenticated means for
new members and/or users to identify whether a level of risk exists that indicates that they
should seek consultation from a qualified health care professional prior to engaging in a
program of physical activity.
3. Exercise preparticipation health screening tools shall be reviewed by qualified staff (e.g.,
a qualified health/fitness professional or health care professional), and the results of the
review shall be retained on file by the facility for a period of at least one year from the time
the tool was reviewed. All health data and related communications shall be kept in such a
manner that it is private, confidential, and secure.
4. If a facility operator is told that a member, user, or prospective user has known cardiovas-
cular, metabolic, or renal disease, or any other self-disclosed medical concern that may
affect the individual’s ability to exercise safely, medical clearance is recommended before
beginning a physical activity program.
5. Facilities shall provide a means for communicating to existing members the value of com-
pleting an exercise preparticipation health screening tool on a regular basis (e.g., preferably
once annually) during the course of membership, or if they experience a significant change
in health status. Such communication can be done through a variety of mechanisms,
including, but not limited to, the facility membership agreement, online communications,
personal correspondence, and/or signage.
Medical Clearance
(within the last 12 Discontinue
Medical Medical Months if no
Medical Medical Exercise and
Clearance‡‡‡‡ Clearance‡‡‡‡ change in
Clearance‡‡‡‡ Clearance‡‡‡‡ seek
Not Not signs/symptoms)
Recommended Recommended Medical
Necessary Necessary Recommended Clearance
Before Engaging in
vigorous***
Intensity Exercise
§Exercise participation, performing planned, structured physical activity at least 30 min at moderate intensity on at least 3 d·wk for at least the last 3 months.
*Light-intensity exercise, 30% to <40% HRR or V˙O2R, 2 to <3 METs, 9–11 RPE, an intensity that causes slight increases in HR and breathing.
**Moderate-intensity exercise, 40% to <60% HRR or V˙O2R, 3 to <6 METs, 12–13 RPE, an intensity that causes noticeable increases in HR and breathing.
***Vigorous-intensity exercise ≥60% HRR or V˙O2R, ≥6 METs, ≥14 RPE, an intensity that causes substantial increases in HR and breathing.
‡CVD, cardiac, peripheral vascular, or cerebrovascular disease.
‡‡Metabolic disease, type 1 and 2 diabetes mellitus.
‡‡‡Signs and symptoms, at rest or during activity; includes pain, discomfort in the chest, neck, jaw, arms, or other areas that may result from ischemia;
shortness of breath at rest or with mild exertion; dizziness or syncope; orthopnea or paroxysmal nocturnal dyspnea; ankle edema; palpitations or tachycardia;
intermittent claudication; known heart murmur; or unusual fatigue or shortness of breath with usual activities.
‡‡‡‡Medical clearance, approval from a health care professional to engage in exercise.
ФACSM Guidelines, see ACSM’s Guidelines for Exercise Testing and Prescription, 10th edition, 2018.
Figure 1.1 The American College of Sports Medicine preparticipation screening algorithm.
Reprinted by permission from D. Riebe et al., “Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening,” Medicine and Science in Sports and Exercise
47, no. 11 (2015): 2473-249. E7303/ACSM/F01.01/606907/KH/R3
6 ■ ACSM’s Health/Fitness Facility Standards and Guidelines • www.acsm.org
Instructions: First, save this form to your computer. Then, please complete this form by
clicking the respective boxes in sections 1-3 and sign/date electronically in section 4. Upon
completion, save it again to your computer and return as instructed.
Edema (swelling) in both ankles that is most evident at night or swelling in a limb
An unpleasant awareness of forceful or rapid beating of the heart
Pain in the legs or elsewhere while walking; often more severe when walking upstairs/
uphill
Known heart murmur
Unusual fatigue or shortness of breath with usual activities
Signature: _____________________________________________________________________
Step 1
Step 2
Current Activity
Has your client performed planned, structured physical activity for at least 30 minutes at
moderate intensity on at least 3 days per week for at least the last 3 months?
_____ yes _____ no
Continue to Step 3.
Step 3
Medical Conditions
Has your client had or do they currently have:
_____ a heart attack _____ heart valve disease
_____ heart surgery, cardiac catheteri- _____ pacemaker/implantable cardiac defibril-
zation, or coronary angioplasty lator/rhythm disturbance
_____ heart failure _____ congenital heart disease
_____ heart transplantation _____ renal disease
_____ diabetes
•• If you did not mark any of the statements in Step 3, medical clearance is not necessary.
•• If you marked Step 2 “yes” and marked any of the statements in Step 3, your client
may continue to exercise at light to moderate intensity without medical clearance.
Medical clearance is recommended before engaging in vigorous exercise.
•• If you marked Step 2 “no” and marked any of the statements in Step 3, medical
clearance is recommended. Your client may need to use a facility with a medically
qualified staff.
Figure 1.3 Exercise preparticipation health screening questionnaire for exercise professionals.
Reprinted by permission from M. Magal and D. Riebe, “New Participation Health Screening Recommendations: What Exercise Professionals Need to Know,”
ACSM’s Health Fitness Journal 20, no. 3 (2016): 22-27.
10 ■ ACSM’s Health/Fitness Facility Standards and Guidelines • www.acsm.org
An HHQ (figure 1.4) may also be used to determine whether an individual has
cardiovascular, metabolic, or renal disease, or signs and symptoms of it, or other
medical conditions that should be medically evaluated. Each individual facility may
opt to develop its own HHQ, incorporating questions from the PASQ or the PAR-Q,
as well as additional questions that target specific health concerns or member groups.
Because of the greater detail generally associated with these questionnaires, they can
provide a more comprehensive evaluation of an individual’s risk for an adverse event
during exercise. For example, an HHQ could include a question about the sickle cell
trait, which is associated with a higher risk of exertional rhabdomyolysis (severe
Standards for Exercise Preparticipation Health Screening
General Information
Medications
Please list any medications you are currently taking:
_________________________________________________________________________________
_________________________________________________________________________________
Exercise History
On average, how many days per week do you exercise or do physical activity?
Days per week: __________
On average, how many minutes of physical activity or exercise do you perform each of
those days?
Minutes per day: __________
Le 28. — J’ai failli avoir un chagrin : mon petit linot était sous la
griffe de la chatte, comme j’entrai dans ma chambre. Je l’ai sauvé en
donnant un grand coup de poing à la chatte, qui a lâché prise.
L’oiseau n’a eu que peur, puis il s’est trouvé si content qu’il s’est mis
à chanter de toutes ses forces comme pour me remercier et
m’assurer que la frayeur ne lui avait pas ôté la voix. Un bouvier qui
passe au chemin de Cordes chante aussi menant sa charrette, mais
un air si insouciant, si mou, que j’aime mieux le gazouillement du
linot. Quand je suis seule ici, je me plais à écouter ce qui remue au
dehors, j’ouvre l’oreille à tout bruit : un chant de poule, les branches
tombant, un bourdonnement de mouche, quoi que ce soit
m’intéresse et me donne à penser. Que de fois je me prends à
considérer, à suivre des yeux de tout petits insectes que j’aperçois
dans les feuillets d’un livre ou sur les briques ou sur la table ! Je ne
sais pas leur nom, mais nous sommes en connaissances comme
des passants qui se considèrent le long du chemin. Nous nous
perdons de vue, puis nous nous rencontrons par hasard, et la
rencontre me fait plaisir ; mais les petites bêtes me fuient, car elles
ont peur de moi, quoique je ne leur aie jamais fait mal. C’est
qu’apparemment je suis bien effrayante pour elles. En serait-il de
même au paradis ? Il n’est pas dit qu’Ève y fit jamais peur à rien. Ce
n’est qu’après le péché que la frayeur s’est mise entre les créatures.
Il faut que j’écrive à Philibert.