Who should obtain a physician's clearance before starting an exercise program?

ACSM guidelines use a stratified, risk-based approach to clearance; requiring every new exerciser to obtain physician clearance is not supported and creates unnecessary barriers to physical activity.

ACSM pre-participation screening guidelines identify sedentary individuals beginning vigorous-intensity exercise as a high-concern group because the physiological demands of vigorous activity are superimposed on a deconditioned cardiovascular and musculoskeletal baseline. This combination creates a clinically elevated risk that warrants medical evaluation before participation. Moderate-intensity exercise in sedentary individuals or vigorous exercise in already-active individuals represents a meaningfully different risk profile that may not require clearance.

Low risk individuals beginning moderate exercise are generally not required to obtain physician clearance under ACSM pre-participation screening recommendations.

Age thresholds such as men under 45 or women under 55 are components within risk factor counting, not standalone criteria that independently determine physician clearance requirements.