When proctoring the AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire to a new client, you learn that he may need to use a facility with a medically qualified staff or need a…

A total cholesterol of 250 mg/dL (6.5 mmol/L) is a CVD risk factor but not a symptom, and the AHA/ACSM screening framework reserves the highest-level referral requirement for symptomatic individuals, not those with risk factors alone.

Blood pressure of 160/90 mm Hg represents stage 2 hypertension and is a notable risk factor, but as an asymptomatic finding it does not by itself meet the criterion for requiring medically qualified staff or a physician referral.

Chest discomfort with exertion is a major sign or symptom suggestive of ischemic heart disease or other serious cardiovascular pathology. Under the AHA/ACSM screening framework, any cardiovascular symptom - regardless of other findings - automatically places a client in the category requiring physician clearance or access to medically qualified staff. Risk factors alone do not meet this threshold; only symptoms do.

Smoking one pack per day is a significant CVD risk factor but is not a symptom of cardiovascular disease, so it does not trigger the physician referral or medically qualified staff requirement under this screening tool.