ACSM-EP Exam Questions

Correct answer: Quit smoking 12 months ago

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 smoking.

If a client is currently smoking, quit smoking within the last 6 months, or lives in an environment with second-hand smoke, they are at risk for a cardiovascular event.

Correct answer: Fitness professionals who create programs only need current certification in CPR, not AED

The American College of Sports Medicine has identified 35 fundamental standards relating to risk management and emergency procedures. As an exercise physiologist, you will be training clients in a variety of locations, and therefore, it's important to take basic precautions that these fundamental standards lay out.

As it pertains to staff credentials, the following are required:

• Fitness professionals with supervisory responsibility must have appropriate levels of education and experience.
• Fitness professionals with counseling responsibilities must have appropriate levels of education and experience.
• At least one staff member who is trained in CPR and AED must be on the gym floor at all times.

Fitness professionals who create programs must have current certifications in both CPR and AED.

Correct answer: Specific, Measurable, Attainable, Relevant, Time-Bound

Goals have an important and significant impact on a client's thoughts and behavioral choices. Helping your client to create and achieve new, healthy goals is an important part of the responsibility of an exercise physiologist. The acronym "S.M.A.R.T." can help you and your client create effective and realistic goals. S.M.A.R.T. stands for the following:

• Specific: Identify the what, where, and how aspects of the goal
• Measurable: Ensure the change and progress can be clearly noted
• Attainable: Set up goals that are challenging but within reach
• Relevant: Focus energy on goals that help achieve outcomes that are highly valued
• Time-Bound: Explicitly state deadlines for goal completion

Those fitness goals that state the desired outcome, reducing the ambiguity of the task, are more likely to be accomplished within a realistic amount of time.

Correct answer: Joint position sense

Proprioception can best be described as the sense of knowing where one's body is in space. It is composed of two senses:

• Static: Joint position sense, where the joints or connective tissue are at a given point in time during exercise
• Dynamic: Kinesthetic movement sense, sensing the body's position while it is in motion

Proprioception allows the client to do many things even with their eyes closed, including the following:

• Postural control
• Precise calibration of limb position in space
• Maintenance of steady muscle force production/movement amplitudes
• Discrimination of object weight
• Production of coordinated gait patterns
• Controlling the timing of muscular contraction for dynamic stabilization and multisegmental movement
• Feedback and feed-forward motor control

Correct answer: VO2 max

As an ACSM exercise physiologist, you should have multiple options at your disposal to determine the appropriate exercise intensity when prescribing physical activity to improve a client's cardiorespiratory fitness.

One of those methods is the Peak VO2 Method. This method requires the trainer to first measure or estimate the VO2 max of the client in a laboratory or field setting. Once the trainer has that, they can use the following formula:

• Target VO2 = VO2 max x % intensity desired

For example, if your client has a measured VO2 max of 60 mL x kg-1 x min-1 with an exercise prescription of 90% maximum, here's what the formula would look like:

• 60 x 90% = Target VO2 max of 54 mL x kg-1 x min-1

Correct answer: Right side

Skinfolds are always measured at standardized sites on the body, and these sites must be precisely located to ensure accuracy. What's more, all of the measurements should take place on the right side of the body with the client standing upright.

Try to let the client know ahead of time to avoid putting on lotions or skin creams as this can impact the measurements.

Correct answer: In both arms

It is critical to assess a new client's resting blood pressure, as this is the first step to determining whether the client is at risk for a cardiac event. When performing this exam for the first time, be sure to assess both arms.

Here are the correct steps to follow when assessing resting blood pressure:

1. No smoking or caffeine 30 minutes before the assessment.
2. Have your client sit quietly for five minutes before the assessment with their feet on the floor.
3. Wrap the cuff firmly around the upper arm at heart level.
4. Place the sthethscope chest piece below the antecubital space over the brachial artery.
5. Quickly inflate cuff pressure 20 mm Hg above first Korotkoff sound.
6. Slowly release pressure at a rate equal to 2 to 5 mm Hg x s-1.
7. Systolic blood pressure is the point at which the first of two or more Korotkoff sounds is heard (phase 1).
8. Diastolic blood pressure is the point before the disappearance of Korotkoff sounds (phase 5).

The assessment should never begin as soon as the client arrives, as this will produce inaccurate test results. Let the client sit down quietly for five minutes before the assessment. On the day of, remind your client not to ingest caffeine or smoke until after the assessment.

Correct answer: Dizziness during exercise and/or fainting

Clients with any of the CMR diseases are at a higher risk for an untoward event during exercise testing and/or participation. The major CMR diseases that the trainer should be aware of include heart attack, heart surgery, pacemaker, heart valve disease, heart failure, heart transplantation, congenital heart disease, diabetes, and renal failure. 

One of the nine signs and symptoms of CMR disease is syncope. If a client has any of these signs or symptoms, they are considered a higher risk and should get medical clearance before continuing with the test and physical activity.

In regard to CMR diseases, syncope is dizziness during exercise and/or fainting.

Ankle swelling is a specific form of edema. Trouble breathing is known as dyspnea. Orthostatic dyspnea refers to the position in which one experiences the condition, such as while lying down. 

Correct answer: Orthopnea

Clients with any of the CMR diseases are at a higher risk for an untoward event during exercise testing and/or participation. The major CMR diseases that the trainer should be aware of include heart attack, heart surgery, pacemaker, heart valve disease, heart failure, heart transplantation, congenital heart disease, diabetes, and renal failure. 

One of the nine signs and symptoms of CMR disease is syncope. If a client has any of these signs or symptoms, they are considered a higher risk and should get medical clearance before continuing with the test and physical activity.

In regard to CMR diseases, syncope is dizziness during exercise and/or fainting. This could be caused by poor blood flow to the brain due to inadequate cardiac output. Serious disorders that are associated with syncope include severe coronary artery disease, hypertrophic cardiomyopathy, aortic stenosis, and malignant ventricular dysrhythmias.

Orthopnea refers to a condition in which the patient experiences difficulty breathing while lying down but the symptoms are relieved upon changing positions. 

Correct answer: Chest

When conducting a three-site skinfold measurement on a woman, the triceps, suprailiac, and thigh are used. Alternatively, the triceps, suprailiac, and abdominal folds can be used. 

The chest fold is not used for the three-site measurement for a woman.

Correct answer: "While tucking your chin, stand or sit as tall as possible."

For postural deviations, it is suggested to provide verbal cues for postural correction. When a client has increased thoracic curvature, you will want to tell the client, "While tucking your chin, stand or sit as tall as possible."

It's also recommended to focus on stretching the pectoralis major and minor, latisimus dorsi, and abdominals.

Correct answer: Taking a heart rate for 1 minute

Heart rate is measured in beats per minute. Therefore, the most accurate way to determine heart rate is to take it for a minute. This also allows the clinician or trainer to determine if the rate is irregular. 

Taking heart rates for 30, 20, and 15 seconds are efficient ways to measure heart rate, and they are reliable. However, they are not as reliable as taking the measurement for the full minute.

Correct answer: Dynamic stretching

While exercise is a proven and effective way to reduce stress, it should not be the only option in the toolkit of the exercise physiologist. It's important to know and recommend non-exercise options such as mind-body techniques for reducing stress. These include the following:

• Diaphramagmatic breathing and body scans
• Progressive muscle relaxation
• Biofeedback
• Massage
• Meditation and prayer
• Mindfulness
• Yoga and martial arts
• Referring a client to a psychologist

Dynamic stretching is not a type of mind-body technique for reducing stress. Rather, it would be categorized under exercise alongside warming up, strength training, cardio, etc.

Mind-body techniques have been shown to help people cope with stress and anxiety while promoting relaxation. Aspects of each can be worked into your client's weekly training program.

Correct answer: ePARmed-X

A 2021 PAR-Q+ would be ideal as a self-guided screening, or a screening not involving an exercise professional supervising the screening. If the individual answers "yes" to one of the seven questions on the PAR-Q+, they will then be directed to use the ePARmed-X, which includes a physician follow-up to obtain permission to engage in a physical activity program.

A preparticipation physical activity screening is recommended for new clients for the following reasons:

• To identify those with medical contraindications for performing physical activity
• To identify those who should receive a medical/physical evaluation exam and clearance prior to performing a physical activity program
• To identify those who should participate in a medically supervised physical activity program
• To identify those with other health/medical concerns such as orthopedic injuries

There are two basic approaches to a preparticipation physical activity screening:

• Self-guided: This approach can be performed by an individual wishing to become more physically active without direct input from an exercise professional.
• Professionally supervised: This approach involves interaction with an exercise professional.

These approaches are not mutually exclusive, and one may follow the other.

Correct answer: Stop the session

If a client tells you that they are experiencing pain in their leg even after warming up and there is swelling, you should stop the session as your client more than likely has a musculoskeletal injury. Once you stop the session, inquire as to when the pain started, the activities the client was doing, etc. Once you know this, you'll be able to recommend a proper course of action, usually rest, ice, and follow-up with a doctor.

A properly designed cardiorespiratory fitness program is meant to minimize the risk of injury while maximizing the benefits associated with exercise and physical activity. With that said, you should be very familiar with signs and symptoms of common musculoskeletal injuries associated with cardiorespiratory exercise:

• Exquisite tenderness
• Pain that persists even when the body is at rest
• Joint pain
• Pain that does not go away after warming up
• Swelling or discoloration
• Increased pain with weight-bearing activities
• Changes in normal bodily functions

Correct answer: A martial artist 

Ballistic stretching focuses on rapid and bounce-like movements. The momentum from the bouncing helps to push the joint through the full range of motion. Ballistic stretching is ideal for athletes who are well conditioned for this type of exercise, but it is not recommended for general fitness clients, older adults, or pregnant clients due to the technical difficulty and high risk of performing it incorrectly.

Correct answer: Internal obliques

The global stabilization system is comprised of muscles referred to as global stabilizers that attach from the pelvis to the spine. These muscles provide stability by moving stress from a load between the upper and lower extremities. During functional movements, these muscles contribute to stabilization.

The global stabilization system includes the following muscle groups:

• Quadratus lumborum
• External obliques
• Erector spinae
• Rectus abdominis

The internal obliques are considered a part of the local stabilization system (local stabilizers).

Correct answer: Relative

There are certain clinical characteristics of an individual that make physical activity risky, or contraindicated. Most are related to cardiovascular health. Absolute contraindications refer to conditions that will absolutely not allow for exercise testing, while relative contradictions refer to conditions that might allow for testing, depending on the client's doctor's recommendations.

The following are relative contraindications:

• Tachyarrhythmias with uncontrolled ventricular rates
• Recent stroke or transient ischemia attack
• Known obstructive left main coronary artery stenosis
• Moderate to severe aortic stenosis
• Acquired advanced or complete heart block
• Mental impairment with limited ability to cooperate
• Resting hypertension with systolic > 200 mmHg or diastolic > 110 mm Hg
• Uncorrected medical conditions, such as significant anemia, significant electrolyte imbalance, and hyperthyroidism

This is a relative contraindication and testing would be appropriate as long as the trainer focused on low intensity tests and constantly checked in with the client.

Correct answer: Recumbent bike riding 

Riding a bike is a low impact activity. Walking, stepping, and skipping rope are all medium to high impact activities which would not be appropriate for this client. 

Correct answer: To measure normal lumbar curvature and forward head posture by standing against the wall

The wall test can measure normal lumbar curvature and forward head posture, an important part of functional movement.

Have the client stand with their back to a wall. Have them place their feet 6 inches from the wall. The head should be against the wall, and the client should be able to fit their own hands between the wall and their lumbar spine. If this isn't possible, you've identified an issue in functional movement and proper posture.