ACSM-EP Exam Questions

Correct answer: What resources are nearby?

According to the transactional model of stress and coping, there are two major components that largely account for the impact of a stressor:

1. Event threat: Individuals gauge both their susceptibility and severity of the threat (e.g., Will I be in trouble if I don't do this workout?)
2. Availability of resources: Individuals evaluate the available resources to control and cope with the stressor (e.g., Is there water nearby?)

When a client is evaluating a stressor, appropriate questions to ask include:

• What does this mean to me?
• How is this going to impact me?
• Will I get in trouble?

Asking about resources would be more appropriate for the secondary appraisal stage.

Correct answer: Maximal functional capacity of at least 7.0 METs 

The greatest challenge of ACSM preparticipation physical screening is potentially overlooking a sign or symptom of ongoing cardiovascular disease, and this mistake leads to a client experiencing a cardiac event. This is why it's best to err on the side of caution, obtain as much medical history as possible, and make an educated decision based on minimizing risk.

If a client has any one or more of the following factors present, they are considered at moderate risk for a cardiac event:

• Left ventricular ejection fraction = 40% - 50%
• Signs and symptoms of angina at moderate levels of exercise
• Mild to moderate silent ischemia

Maximal functional capacity of at least 7.0 METs would classify the client as low risk.

Correct answer: 16.25 inches

The Queens College Step Test is a type of cardiorespiratory fitness test. You should instruct the client to step up and down on a standardized step height of 16.25 inches. 

Adult females should step at a rate of 22 steps per minute. Adult males should step at a rate of 24 steps per minute.

After three minutes, instruct the client to stop. Within the first five seconds, palpate the pulse while the client stands. A 15-second pulse count is then taken and multiplied by four.

The subject's VO2 max is determined from the recovery heart rate by the following formulas:

If you have a female participating in the assessment, you should use the following formula to determine the subject's VO2 max:

• VO2 max (mL x kg-1 x min-1) = 65.81 - (0.1847 x HR)

If you have a male performing the test, use the following formula:

• VO2 max (mL x kg-1 x min-1) = 111.33 - (0.42 x HR)

Correct answer: 80% to 100% 1-RM for 1 to 6 reps

The use of Repetition Maximum (RM) loads is a relatively common method to prescribe resistance training intensity. RM loads of 80% to 100% for 1 to 6 repetitions are best for increasing muscular strength. It should be noted that muscular strength training tends to be a higher intensity type of training and usually requires longer rest breaks of 90 to 270 seconds.

As an example, if the one-repetition maximum (the maximum amount of weight someone can lift once with perfect form) on the leg press is 100 pounds, a training intensity of 80% to 100% would be between 80 and 100 pounds.

Correct answer: Having a resting blood pressure of > 130 mm Hg systolic and/or > 80 mm Hg diastolic 

When performing an atherosclerotic cardiovascular disease risk factor assessment, there are multiple defining criteria that the exercise physiologist should review. One of those factors is hypertension. Hypertension is best defined as having a resting blood pressure of > 130 mm Hg systolic and/or > 80 mm Hg diastolic.

Another way to verify if a client is hypertensive is to confirm whether or not they are taking anti-hypertensive medications.

Correct answer: Theory of planned behavior

The theory of planned behavior is an intention-based model to explain physical activity behavior and is an extension of the theory of reasoned action, which proposes and identifies intention as the primary influence in determining behavior. Intention directly reflects an individual's level of motivation to perform the desired behavior.

Correct answer: Goniometer

The most useful method for measuring joint flexibility is using a goniometer. Similar to a protractor, a goniometer expresses the range of motion in degrees. When performing a flexibility assessment with a goniometer, be sure to follow these steps:

1. Have the client perform a short warm-up.
2. Place the goniometer at the center of the joint being measured. The fixed arm of the goniometer should be aligned with the appropriate bony landmark of the stationary body part.
3. The moveable arm of the goniometer should be aligned with the specific bony landmark that is going to be moving.
4. Record the range of motion in degrees.
5. It is recommended that you perform three measurements.

Correct answer: Lateral band walks

Knee valgus is caused by excessive femoral internal rotation and potentially adduction of the femur, usually caused by weakness in the external rotators and abductors of the hip. As a part of the trainer's duty to appraise the quality of movement during an exercise session, it will be necessary to observe any alignment faults that might present themselves. 

When a client has knee valgus, the trainer should incorporate the lateral band walk exercise into the client's program until the alignment issue is corrected. The trainer can also utilize the clam shell exercise. From there, the client can be re-evaluated and progressed to the next exercise that is in line with their fitness goals.

Correct answer: Developing a list of potential solutions

Exercise physiologists can use the IDEA method as a practical framework to facilitate an action plan for problem solving barriers to physical exercise. The second step of the IDEA method is to develop a list of potential solutions. It's important that you encourage creative brainstorming with the client.

The remaining steps include the following:

• Identify the barrier—Be specific and thorough when describing the challenge and the effect that it has on physical fitness.
• Develop a list of potential solutions—Brainstorm in a creative way.
• Evaluate the solutions—Select one that seems to be appropriate and works the best.
• Act on the solution—Assess how well the plan works and decide what can be done differently or if another potential solution should be tried.

It's crucial that the client directs this process. Giving advice can backfire and increase resistance. More importantly, your client will learn the skill of problem solving on their own, reducing the chance of barriers in the future.

Correct answer: Stabilizers 

Some experts have classified muscles as two distinct yet interdependent systems: a muscle is either a stabilizer or a mobilizer. Stabilizing muscles are more centrally located and largely function to create stiffness across joints. Mobilizers, on the other hand, are considered global muscles, as they comprise long lever arms and allow for greater force production, torque, and gross multiplanar movements.

Characteristics of stabilizers include the following:

• Slow-twitch
• Resistance to fatigue
• Deep
• Major contributor to proprioception
• Low force production
• Prone to inhibition/weakness
• Isometric/eccentric
• Joint stabilization

Correct answer: Three times

The most useful method for measuring joint flexibility is using a goniometer. When using a goniometer to measure flexibility, it's recommended to take the measurements three times.

Similar to a protractor, a goniometer expresses the range of motion in degrees. When performing a flexibility assessment with a goniometer, be sure to follow these steps:

1. Have the client perform a short warm-up.
2. Place the goniometer at the center of the joint being measured. The fixed arm of the goniometer should be aligned with the appropriate bony landmark of the stationary body part.
3. The moveable arm of the goniometer should be aligned with the specific bony landmark that is going to be moving.
4. Record the range of motion in degrees.
5. It is recommended that you perform three measurements.

Correct answer: Companionship

Behavioral change is challenging, but studies show that support from others can enhance the opportunity for success. Here are the four types of social support:

• Instrumental: Providing tangible, practical assistance for goal achievement, such as driving a spouse to a cardiac rehabilitation appointment
• Emotional: Expressing encouragement, empathy, and concern, such as praising a client for their efforts and demonstrating compassion for sore muscles
• Informational: Giving instructions, advice, and feedback, such as providing exercise tips and giving valuable health-related information
• Companionship: Providing a sense of belonging and connectedness, such as making oneself available as an experience partner

These types of social support can be provided by a variety of sources, including family, partners, friends, and exercise physiologists. 

When a friend of your client offers to be their accountability buddy for workouts and meal planning, this is an example of companionship in social support.

Correct answer: Trainer assessments 

Self-monitoring involves observing and recording behavior and has been shown to be important in exercise behavior change. It's important to select tasks that don't require a lot of time to reduce the burden and increase the likelihood of use. One way to encourage this and make it easier for the client is with passive or automated monitoring via physical activity devices. Some great examples of physical activity monitors include a smart watch, pedometer, and accelerometer.

Correct answer: Suggesting they seek out additional support

Exercise professionals can quickly become a confidant to a client, especially during stressful situations. Clients might deal with these stressors poorly and in an unhealthy manner. If you notice that your client is displaying symptoms of extreme stress or directly displaying a need for help, it is advisable to refer them to a mental health professional.

There are steps for discussing a referral to a mental health professional:

1. Broach the topic with a general observation
2. Normalize the context
3. Emphasize strengths
4. Suggest that they seek out additional support
5. Obtain permission to make a referral
6. If they deny the need for additional help, keep the option available in the future

When you mention how other clients have found a mental health professional helpful, you are suggesting they seek out additional support.

Correct answer: Bursitis

Bursitis is best described as the inflammation of a small, fluid-filled sac called the bursa, which acts like a cushion to reduce friction between muscles, tendons, and joints. Clients will usually describe symptoms occurring with bursitis as pain and swelling in the shoulders, hips, knees, and elbows.

Arthritis refers to inflammation of a joint. Meningitis refers to inflammation of the tissue surrounding the brain and spinal cord. Fasciitis is inflammation of the fascia surrounding muscles and other tissues.

Correct answer: 50 rpm

CardioRespiratory Fitness (CRF) can be assessed through a variety of step tests, field tests, and submaximal VO2 prediction tests. The advantage of having a wide variety of available tests is that it allows you as the trainer to select an appropriate assessment that provides the desired physiological information while adhering to the needs of the client.

The Astrand-Rhyming Cycle Ergometer test is one of the most recommended methods for fitness trainers to measure an adult client's cardiorespiratory fitness level. When the testing portion begins, you'll have your client pedal at 50 rpm.

Before that, you'll want to focus on the following:

After you set the seat on the cycle ergometer to ACSM guidelines, you will select the appropriate work rate based on the sex and self-reported fitness level of the client:

• Females, unconditioned: 300 or 450 kg-m x min-1 (50 or 75 w)
• Females, conditioned: 450 or 600 kg-m x min-1 (75 or 100 w)
• Males, unconditioned: 300 or 600 kg-m x min-1 (50 or 100 w)
• Males, conditioned: 600 or 900 kg-m x min-1 (100 or 150 w)

While you should have access to these formulas during the assessment through the ACSM textbook, it's still useful to memorize them as you progress in your field. Here is the rest of the process for the Astrand-Rhyming Cycle Ergometer test:

1. After a proper warm-up, instruct your client to pedal at 50 rpm for six minutes at the work rate selected above.
2. Assess heart rate two times during minute 5-6 and average the values.
3. Estimate VO2 max from a nomogram.
4. Because HR max decreases with age, the value from the monogram must be adjusted for age by multiplying VO2 max value by the following correction factors:

         Age / Correction Factor

         15 / 1.10

         25 / 1.00

         35 / 0.87

         40 / 0.83

         45 / 0.78

         50 / 0.75

         55 / 0.71

         60 / 0.68

         65 / 0.65

Correct muscle: Obliques

When a client has a forward head posture deviation, the trainer should implement a stretching program to loosen up the tight muscles contributing to the issue. These muscles will include the pectoralis major, pectoralis minor, latissimus dorsi, and rectus abdominis.

While the abdominals are a target muscle, the obliques are not.

Correct answer: Low-volume interval training

Similar to its high-intensity counterpart, LVIT or Low-Volume Interval Training focuses on physical activity that is very high in intensity but only lasts 15 minutes or less. The idea is to cycle through bouts of all-out effort and rest breaks.

Two to three bouts of all-out 20-second efforts with two to three minutes of rest in between would be a great example of this type of training. Another example would be eight bouts of all-out 20-second efforts with 10 seconds of rest in between. This would take place four days per week.

Correct answer: 2-3 sessions per week / 2-4 repetitions / Hold: 10-30 seconds

To improve a client's range of motion, it is generally recommended to hold two to three flexibility training sessions per week. Daily stretching can be implemented, but this might be better reserved for more experienced clients.

Make sure your client is performing two to four repetitions with each one lasting 10 to 30 seconds. For older adults, it might be more beneficial to have them hold it for up to 60 seconds, but only if they are in good shape.

Correct answer: Stop the session

It is normal for blood pressure to increase when the work rate increases. However, if there is an excessive increase in blood pressure, such as a client's diastolic blood pressure reaching > 115 mm Hg, it is necessary to stop the test or exercise session. Allow the client to rest and monitor their blood pressure. A medical follow-up may be required.

Other reasons to stop an exercise session include the following:

• Onset of angina
• Excessive rise in blood pressure
• Shortness of breath
• Signs of poor perfusion
• Heart rate won't increase with increased intensity
• Participant requests to stop
• Severe fatigue
• Failure of testing equipment