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Hypertensive responses are relative—testing may continue or be stopped depending on context. Chest pain with ischemia, SBP drop, and ST elevation are absolute termination criteria. ACSM requires distinguishing between relative vs absolute termination.

Accurate, complete documentation ensures continuity of care, legal protection, and patient safety. Minimal or absent records expose liability. ACSM requires thorough records for all sessions.

For older adults with OA and metabolic goals, low-impact aerobic modes such as cycling or swimming reduce joint loading while improving cardiorespiratory fitness and insulin sensitivity. Prescribing moderate intensity (e.g., 40–60% HRR or RPE 11–13) across most days of the week supports caloric expenditure and glycemic control. Complementary resistance training 2–3 days/week (1–3 sets of 8–12 reps for major muscle groups) enhances muscle mass, joint stability, and functional capacity; start with machines or bands, emphasizing pain-free ROM. Progress duration before intensity, and integrate flexibility and neuromotor exercises for balance. Avoid high-impact or ballistic activities initially due to joint stress and fall risk. Monitor pain (e.g., ≤2 points increase acceptable, resolving within 24 hours) and use warm-up/cool-down to protect joints. This combined, joint-friendly approach balances metabolic benefits and musculoskeletal safety, fostering adherence and long-term functional improvements.

Unstable angina is an absolute contraindication to exercise. Stable obesity, mild hypertension, or normal HR are not immediate contraindications. ACSM emphasizes identifying unstable cardiac conditions before exercise.

Cardiac arrest requires immediate CPR and AED use. Delays decrease survival. ACSM mandates ERP readiness, AED accessibility, and staff training for emergencies.