ACSM-EP Exam Questions

Correct answer: Client maintains optimal alignment without significant swaying for 30 seconds

If you are progressing a client through an instability training program and they are currently performing a wide staggered stance with eyes closed, the demonstration of mastery would be if the client maintains optimal alignment without significant swaying for 30 seconds.

Once mastery is reached, the progression will be a narrow staggered stance and eyes open.

Correct answer: 3-5 x week / Intensity: Moderate to vigorous / 150 minutes moderate intensity or 75 minutes high intensity each week / Walking, rowing, etc.

For clients with rheumatoid arthritis, exercise is highly encouraged as it can help to reduce pain, joint stiffness, and fatigue, but only when the training program is within the client's ability and does not push past the pain threshold. The following best captures the acute variables for an aerobic training program for a client with rheumatoid arthritis:

• Frequency: 3-5 x week
• Intensity: Moderate to vigorous - 40% - 50% HRR / 60% - 80% HRR
• Time: 150 minutes moderate intensity or 75 minutes high intensity each week
• Type: Walking, rowing, cycling, swimming

A special note of consideration is that clients should avoid high-intensity, high-impact exercise to minimize pain. Those clients with significant damage to large joints should limit high-intensity weight-bearing exercises to avoid further damage and complications.

Correct answer: Basketball

As an exercise physiologist, you'll be expected to perform a thorough fitness assessment to determine which type of exercises are ideal for your client. In general, there are four modes of aerobic exercise to improve physical fitness:

1. Low- to moderate-intensity endurance activities requiring no/minimal skill
2. Vigorous-intensity endurance activities requiring minimal skill
3. Endurance activities requiring skill to perform
4. Recreational sports

If you want to select a vigorous-intensity endurance activity that requires minimal skill, you should choose from the following examples:

• Jogging
• Running
• Rowing
• Aerobics
• Spinning
• Elliptical
• Stepping exercise
• Fast dancing

Basketball is a vigorous activity, but it requires skill to perform.

Correct answer: Preparation 

The TransTheoretical Model (TTM) is used to explain a variety of health behaviors, understand physical acitivity behaviors, and create appropriate interventions. According to this model, behaviors and cognitive processes occur as individuals move through these stages of change. Here are the five stages of change of the TTM:

1. Precontemplation: Currently inactive and not intending to take action in the next 6 months
2. Contemplation: Currently inactive but intending to take action within six months
3. Preparation: Slightly physically active but not meeting ACSM guidelines—wants to increase physical activity
4. Action: Does enough physical activity to meet ACSM guidelines—less than 6 months at this stage
5. Maintenance: Maintains physical activity level—exercises for more than 6 months

If your client is slightly physically active but isn't meeting ACSM guidelines, they are in the preparation stage of change. This means that the client will need to increase their overall physical activity to meet ACSM guidelines.

Correct answer: Do you believe that exercise can improve many different health conditions? 

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.

The following are the foundation of the PAR-Q+ and the most important questions that determine which course of action to take next:

1. Has your doctor ever said that you have a heart condition or high blood pressure?
2. Do you feel pain in your chest at rest, during daily activities, or when you do physical activity?
3. Do you lose balance because of dizziness, or have you lost consciousness in the last 12 months?
4. Have you ever been diagnosed with another chronic medical condition?
5. Are you currently taking prescribed medications for a chronic medical condition?
6. Do you currently have a bone, joint, or soft tissue problem that could be made worse by becoming more physically active?
7. Has your doctor ever said that you should only do medically supervised physical activity?

Correct answer: The point at which the first of two or more Korotkoff sounds is heard

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, you have to listen to Korotkoff sounds to determine both diastolic and systolic blood pressure. You know that you are listening to systolic blood pressure at the point when you hear the first of two or more Korotkoff sounds.

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: Encourage exploration of likely outcomes in life with and without change

Motivational interviewing is a person-centered approach focused on facilitating autonomy and strengthening motivation for change. This is a crucial approach for an exercise physiologist to engage in with the client as they begin to work together to establish a strong rapport. It also helps to build an understanding of client goals, concerns, and life situation.

The basic premise of motivational interviewing is that behavior change is more successful when the client takes the lead in discovering and fully considering all the factors that impact action and inaction toward a specific behavior.

To demonstrate discrepancies, the exercise physiologist can do the following:

• Clarify the difference between current and preferred behavior
• Encourage exploration of likely outcomes in life with and without change

Correct answer: Proactive

There are many differences between having a leadership role and a management role in a fitness facility. The tendencies of a management role include the following:

• Predictable
• Vision implementer
• Maintains status quo
• Motivated to analyze risks
• Solves problems with policy and procedure
• Reactive
• Focus on the short term
• Identifies obstacles

Correct answer: Headache

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 for 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

Although headache may not be a common symptom related to a musculoskeletal injury, it is a reason to temporarily stop the session and check in with the client to determine appropriate actions.

Correct answer: To design a program with appropriate parameters

Interactions with clients can serve as the cornerstone of incorporating behavior change into your practice. It cannot always be about the work that happens in fitness and health settings. These important interactions with your client must be a part of the work you do.

For example, it's important to discover what is relevant to your client as it pertains to their fitness goals, because knowing this deeper layer of information will help the exercise physiologist understand what the client may value (e.g., family).

Correct answer: Reduced impact

As an exercise physiologist, you'll be expected to perform a thorough fitness assessment to determine which type of exercises are ideal for your client. In general, there are four modes of aerobic exercise to improve physical fitness:

1. Low- to moderate-intensity endurance activities requiring no/minimal skill
2. Vigorous-intensity endurance activities requiring minimal skill
3. Endurance activities requiring skill to perform
4. Recreational sports

Cycling is a moderate- to vigorous-intensity physical activity that requires minimal skill for your client and offers the benefits of having low impact on bones and joints.

The potential disadvantages of cycling include the following:

• Cost of bicycle
• Weather
• Safety of cycling environment

Correct answer: Helping a client brainstorm possible solutions to a problem

One of the components of healthy stress management is enhancing social support. The following four categories are related to social support:

• Emotional support: Includes empathy, love, trust, and caring
• Instrumental support: Includes tangible aid and services that directly meet a need
• Informational support: Includes advice and information concerning the problem
• Appraisal support: Includes information that is useful for self-evaluation purposes such as constructive feedback and affirmation

Helping a client brainstorm possible solutions to a problem and providing feedback for problem-solving are forms of appraisal support.

While the exercise physiologist should be able and ready to offer all of these forms of social support, it is best to match the solution to the specific needs of the client. Don't offer a form of social support without just cause.

Correct answer: Informational

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. 

Providing feedback to a client is a form of informational support. 

Correct answer: Three years

The purpose of ACSM recertification is to ensure that ACSM-certified professionals enhance skills and knowledge above and beyond minimum competence. Periodic recertification occurs through the documentation of required continuing education activities within the three-year period following successful passing of an ACSM certification exam.

Correct answer: Counterconditioning

Processes of change can be broken down into experiential processes and behavioral processes. Both are recommended to help increase self-efficacy and facilitate the required transition from precontemplation to action to maintenance.

When a client substitutes a healthy behavior for an unhealthy one, this is an example of counterconditioning. For example, when a client starts to ride their bike to work instead of taking their car, this is counterconditioning.

Other types of behavioral processes include the following:

• Self-liberation
• Helping relationships
• Stimulus control
• Reinforcement management

Correct answer: I see a lot of people dealing with stress.

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.

By saying something like "I see a lot of people dealing with stress," you are normalizing the context for a conversation.

"You seem to have a lot of stress" is an example of an observation.

"Would you like me to make a recommendation?" is an example of a request for permission to make a referral.

"I am happy to be a resource for you" is an example of keeping options available for the future. 

Correct answer: Encourage the client to compare results with someone in the same weight class

If you have an overweight or obese client who is new to exercise, it's important to find ways to increase positive feelings surrounding exercise as this will increase the likelihood that they will start and maintain an exercise program. Here are several effective ways to do just that:

• Exercise in a context that is enjoyable
• Try new activities
• Introduce variety into the exercises you have them perform
• Allow the client to self-select the intensity level, ensuring they choose one that feels good
• Establish a reward system
• Help clients understand their emotions as they relate to exercise

Correct answer: Spinning

As an exercise physiologist, you'll be expected to perform a thorough fitness assessment to determine which type of exercises are ideal for your client. In general, there are four modes of aerobic exercise to improve physical fitness:

1. Low- to moderate-intensity endurance activities requiring no/minimal skill
2. Vigorous-intensity endurance activities requiring minimal skill
3. Endurance activities requiring skill to perform
4. Recreational sports

If you want to select an endurance activity that requires skill to perform, you should choose a similar exercise to the following:

• Swimming
• Cross-country skiing
• Skating
• Jumping rope or other similar skill-based movements

Spinning is a vigorous-intensity activity that does not require skill to perform.

Correct answer: Avoid discrepancies

Motivational interviewing is a person-centered approach focused on facilitating autonomy and strengthening motivation for change. This is a crucial approach for an exercise physiologist to engage in with the client as they begin to work together to establish a strong rapport. It also helps to build an understanding of client goals, concerns, and life situation.

The basic premise of motivational interviewing is that behavior change is more successful when the client takes the lead in discovering and fully considering all the factors that impact action and inaction toward a specific behavior.

There are four general principles of motivational interviewing:

• Express empathy: Be sure to express an attitude of understanding, use skillful listening, and demonstrate understanding
• Develop discrepancies: Clarify the difference between current and preferred behavior; encourage exploration of likely outcomes in life with and without change
• Roll with resistance: Avoid arguing, offer new perspectives, demonstrate patience and flexibility
• Support self-efficacy: Instill confidence in the ability to change, limit, and redirect negativity; affirm appropriate goals

Correct answer: 2-3 days per week / Stretch to the point of tightness, slight discomfort / Hold for 10-30 seconds, 2-4 reps / Static, dynamic, and/or PNF

For clients who are overweight or obese and new to fitness, the focus on the flexibility side of their program should reflect the following:

• Frequency: 2-3 days per week
• Intensity: Stretch to the point of tightness, slight discomfort
• Time: Hold for 10-30 seconds, 2-4 reps
• Type: Static, dynamic, and/or PNF stretching

After several weeks, the trainer can consider progressing the program to a higher frequency, time, and type.