The promotion of physical activity is at the top of our national public health agenda. Although regular exercise reduces subsequent cardiovascular morbidity and mortality, the incidence of a cardiovascular event during exercise in patients with cardiac disease is estimated to be 10 times that of otherwise healthy persons. Adequate screening and evaluation are important to identify and counsel persons with underlying cardiovascular disease before they begin exercising at moderate to vigorous levels. This statement provides recommendations for cardiovascular screening of all persons (children, adolescents, and adults) before enrollment or participation in activities at health/fitness facilities. Staff qualifications and emergency policies related to cardiovascular safety are also discussed.