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Pre-exercise glucose <90 mg/dL requires carbohydrate intake before starting to prevent hypoglycemia. Insulin would worsen glucose decline. Canceling is unnecessary if corrected. ACSM provides glucose thresholds for safe exercise initiation.

Voluntary fatigue or patient request is a valid ACSM termination criterion. Forcing continuation compromises safety and autonomy. Respecting the patient’s decision while documenting ensures ethical and professional responsibility.

Severe dyspnea and cyanosis indicate hypoxemia and possible cardiopulmonary compromise. ACSM lists this as an absolute indication for test termination and emergency response if unresolved.

For individuals with insulin-treated diabetes, pre-exercise glucose below ~90 mg/dL (5.0 mmol/L) is low for sustained aerobic activity and increases hypoglycemia risk, particularly if insulin on board is present. The leader should delay exercise, provide 15–20 g fast-acting carbohydrate (e.g., glucose tablets), and recheck glucose after ~15 minutes. If still below target, repeat treatment until ≥90–100 mg/dL before starting. Once exercise begins, encourage carrying carbohydrates, monitor symptoms, and consider reducing intensity or adding brief rest periods. Avoid administering insulin pre-exercise in this scenario, which would worsen hypoglycemia risk. While outright cancellation is rarely necessary, safety dictates correction before activity. Post-exercise monitoring is also important due to late-onset hypoglycemia, especially after prolonged or evening sessions. Leadership responsibilities include establishing clear glucose thresholds, ensuring supplies are available, training staff in recognition and treatment, and documenting actions taken to support safe participation for people with diabetes.

CPR/AED certification ensures emergency readiness and is required for CEPs. Prescribing medications, diagnosing, or providing supplements are outside scope. ACSM emphasizes clear scope boundaries and emergency competency.