Signs & Symptoms Suggestive of Cardiovascular/Metabolic/Renal Disease
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The red-flag list — chest pain, breathlessness, dizziness, swelling, palpitations, and a few others — that, if present, means stop and get medical clearance before exercising.
Detail
ACSM's preparticipation screening recommendations (Riebe et al., 2015) list a set of major signs or symptoms that may indicate underlying cardiovascular, metabolic, or renal (CMR) disease. Their presence (at rest or with exertion) is the strongest trigger in the screening algorithm: someone already exercising should stop and get medical clearance before continuing, and someone not yet exercising should get medical clearance before starting. None is diagnostic alone, but each warrants professional interpretation.
The classic list:
- Pain/discomfort in the chest, neck, jaw, arms, or other areas that may be ischemic in origin.
- Shortness of breath at rest or with mild exertion (dyspnea).
- Dizziness or syncope (fainting).
- Orthopnea or paroxysmal nocturnal dyspnea — breathlessness lying flat / waking at night short of breath.
- Ankle edema — bilateral ankle swelling.
- Palpitations or tachycardia — awareness of rapid/irregular heartbeat.
- Intermittent claudication — leg pain/cramping on walking, relieved by rest.
- Known heart murmur.
- Unusual fatigue or shortness of breath with usual activities.
Context matters: chest discomfort clearly reproduced by a strained pec is different from exertional chest pressure radiating to the jaw. When in doubt, refer.
Key facts
- Nine major signs/symptoms of CMR disease in ACSM's 2015 screening algorithm.
- Presence of any → discontinue exercise, seek medical clearance before (re)starting.
- Ischemic-pattern chest pain, exertional dyspnea, syncope, claudication, edema are the highest-concern flags.
- Not diagnostic individually — they trigger referral, not a diagnosis.
Connections
- ACSM Pre-Exercise Screening Algorithm — these flags override activity status and intensity.
- Contraindications to Exercise Testing — overlapping list for halting/deferring a test.
- Medical Clearance — When to Seek It — the destination when a flag is present.
Sources
- GuidelineRiebe D et al. Updating ACSM's recommendations for exercise preparticipation health screening. Med Sci Sports Exerc 2015;47(11):2473–2479 Published 2015 · DOI 10.1249/MSS.0000000000000664 · Accessed 2026-10-13
- SurveyWhitfield GP, Riebe D, Magal M, Liguori G. Applying the ACSM preparticipation screening algorithm to U.S. adults: National Health and Nutrition Examination Survey 2001–2004. Med Sci Sports Exerc 2017;49(10):2056–2063 (reproduces the 2015 algorithm and its signs/symptoms list) Published 2017 · DOI 10.1249/MSS.0000000000001331 · Accessed 2026-10-13
Corrections (1)
- 2026-10-13 — Reconciled against ACSM's current preparticipation screening recommendations (Riebe et al. 2015), whose algorithm lists the same nine signs/symptoms; wording checked against the algorithm as reproduced by Whitfield et al. 2017. Added how the 2015 algorithm uses them (already exercising: stop and get medical clearance; not exercising: get clearance before starting). Removed the unverified GETP 10th/11th-edition citation.
Keep this lesson, or ask how it applies to you.
Educational content only — not medical advice. Always consult a qualified professional for individualized guidance, especially around injury, pregnancy, or medical conditions.