Prepare for the ACSM Certified Exercise Physiologist (CEP) exam with these practice questions and answers. This guide covers exercise testing, prescription for clinical populations, cardiovascular disease, and metabolic conditions.
Q: Absolute Contraindications to Exercise Testing
Answer: • A recent significant change in the resting ECG suggesting significant ischemia, recent MI (within 2 d), or other acute cardiac event• Unstable angina• Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise• Symptomatic severe aortic stenosis• Uncontrolled symptomatic heart failure• Acute pulmonary embolus or pulmonary infarction• Acute myocarditis or pericarditis• Suspected or known dissecting aneurysm• Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
Q: Relative Contraindications to Exercise Testing
Answer: • Left main coronary stenosis• Moderate stenotic valvular heart disease• Electrolyte abnormalities (hypokalemia or hypomagnesemia)• Severe arterial hypertension (SBP>200 mmHg and/or DBP >110 mmHg) at rest• Tachydysrhythmia or bradydysrhythmia• Hypertrophic cardiomyopathy and other forms of outflow tract obstruction• Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise• High-degree AV block• Ventricular aneurysm• Uncontrolled metabolic disease (diabetes, thyrotoxicosis, or myxedema)• Chronic infectious disease (e.g. HIV)• Mental or physical impairment leading to inability to exercise adequately
Q: General Indications for Stopping an Exercise Test
Answer: • Onset of angina or angina-like symptoms• Drop in SBP of ≥10 mmHg with an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing• Excessive rise in BP: SBP>250 mmHg and/or DBP>115 mmHg• Shortness of breath, wheezing, leg cramps, or claudication• Signs of poor perfusion: light-headedness, confusion, ataxia (loss of full control of bodily movements), (pallor) unhealthy pale appearance, cyanosis (bluish skin color), nausea, or cold and clammy skin• Failure of HR to increase with increased exercise intensity• Noticeable change in heart rhythm by palpation or auscultation• Subject requests to stop• Physical or verbal manifestations of severe fatigue• Failure of the testing equipment
Q: Absolute Indications for stopping an exercise test
Answer: • Drop in SBP ≥10 mmHg with an increase in work rate, or if SBP decreases below the value obtained in the same position prior to testing when accompanied by other evidence of ischemia• Moderately severe angina (defined as 3 on standard scale)• Increasing nervous system symptoms (e.g. ataxia, dizziness, or near syncope)• Signs of poor perfusion (cyanosis or pallor)• Technical difficulties monitoring the ECG or SBP• Subject’s desire to stop• Sustained ventricular tachycardia• ST elevation (+1.0 mm) in leads without diagnostic Q waves (other than V1 or aVR)
Q: Relative Indications for stopping an exercise test
Answer: • Drop in SBP ≥10 mmHg with an increase in work rate, or if SBP below the value obtained in the same position prior to testing• ST or QRS changes such as excessive ST depression (>2 mm horizontal or down sloping ST-segment depression) or marked axis shift• Arrhythmias other than sustained V Tach, including multifocal PVCs, triplets of PVCs, SVT, heart block, or bradyarrhythmias• Fatigue, shortness of breath, wheezing, leg cramps, or claudication• Development of bundle-branch block or intraventricular conduction delay that cannot be distinguished from V Tach• Increasing chest pain• Hypertensive response (SBP>250 mmHg and/or DBP>115 mmHg)
Q: ST segment depression
Answer: ≥1 mm of horizontal or down sloping ST↓ 60-80 ms beyond the J point suggesting myocardial ischemia
Q: Chronotropic incompetence
Answer: 1. Peak exercise HR about 20 BPM below the age predicted HRmax or an inability to achieve > 85% of the age predicted HRmax for subjects limited by volitional fatigue.2. Chronotropic index <.8
Q: Heart Rate Recovery
Answer: less than or equal to 12 BPM at 1 minute for walking, or less than or equal to 22 BPM at 2 mins for supine position
Q: Sensitivity
Answer: % of pts. tested with known CVD who demonstrate significant ST segment changes.Exercise EKG sensitivity usually requires greater than or equal to 70% stenosis
Q: True Positive
Answer: Horizontal or down sloping ST segment depression of ≥1.0 mm and correctly identifies a patient with CVD
Q: False Negative
Answer: test shows no or non-diagnostic ECG changes and fails to identify patients with underlying CVD
Q: Specificity
Answer: % of pts. without CVD who demonstrate non significant ST segment changes
Q: True Negative
Answer: Correctly identifies an individual without CVD
Q: Causes of False Negative Test Results
Answer: • Failure to reach an ischemic threshold• Monitoring an insufficient number of leads to detect ECG changes• Failure to recognize non-ECG signs and symptoms that may be associated with underlying CVD• Angiographically significant CVD compensated by collateral circulation• Musculoskeletal limitations to exercise preceding cardiac abnormalities• Technical or observer error
Q: Predictive Value
Answer: A measure of how accurately a test result (positive or negative) correctly identifies the presence or absence of CVD in tested patients.
Q: Absolute Contraindications to Resistance training
Answer: • Unstable CHD• Decompensated HF• Uncontrolled arrhythmias• Severe pulmonary HTN• Severe and symptomatic aortic stenosis• Acute myocarditis, endocarditis, or pericarditis• Uncontrolled HTN (>180/110 mmHg)• Aortic dissection• Marfan syndrome• High intensity RT (80-100% of 1-RM) in patients with active proliferative retinopathy or moderate or worse non-proliferative diabetic retinopathy
Q: Relative Contraindications to Resistance Training
Answer: • Major risk factors for CHD• Diabetes at any age• Uncontrolled HTN (>160/100 mmHg)• Low functional capacity (<4 METs)• Musculoskeletal limitations• Individuals who have implanted pacemakers or defibrillators
Q: When to monitor EKG for an Exercise Test
Answer: Before: Continuously, supine position and posture of exerciseDuring: Continuously; last 15 s of each stage or the last 15 s of each 2 min period (ramp protocols)After: continuously, immediate postexercise, last 15 s of the 1st minute of recovery and every 2 minutes after
Q: When to monitor HR for an exercise test
Answer: Before: Continuously; supine position, and posture of exerciseDuring: Continuously, Last 15 s of each minuteAfter: Continuously, Last 5 s of each minute
Q: When to monitor BP during an exercise test
Answer: Before: supine position and posture of exerciseDuring: Last 45 s of each stage or the last 45 s of each 2 min period (ramp protocols)After: recorded immediately postexercise and then 2 mins after
Q: Signs/ Symps during an exercise test
Answer: Monitored continuously and recorded as observed
Q: RPE During an exercise test
Answer: Before: Explain the scaleDuring: last 15 s of each stage or every 2 mins with ramp protocolsAfter: Obtain peak exercise value then don’t measure during recovery
Q: Pregnancy Special Considerations
Answer: 1. Sedentary women should gradually increase PA to recommended levels2. Severely obese, GDM, HTN see Dr. before exercise3. No contact sports4. Terminate Exss for vaginal bleeding, dyspnea before exertion, dizziness, headache, chest pain, muscle weakness, calf pain/swelling, preterm labor, decreased fetal movement, and amniotic fluid leakage5. Don’t exss in a supine position after 16 weeks of pregnancy to avoid venous obstruction.6. Avoid valsalva7. Avoid hot and humid weather8. Metabolic demand increases by about 300 kcal/day9. Submax weight training allowed10. Postpartum exss- about 4-6 wks after normal vaginal delivery and about 8-10 weeks after C section
Q: Children Special Considerations
Answer: 1. Proper instruction provided for strength training.2. B/c of immature thermoregulatory systems, avoid hot weather and stay hydrated3. OW and physically inactive kids should gradually increase frequency and time of PA4. Children with disabilities or disease should have their Ex Rx tailored to them5. Decrease sedentary activity
Q: Older Adults Special Considerations
Answer: 1. Intensity and duration should be light at first2. Progression tailored to tolerance and preference3. Muscular strength is more important with age4. Supervise strength training5. Muscle strengthening activities may need to precede aerobic training6. Gradually exceed the recommended minimum amounts of PA7. If chronic conditions preclude activity at the recommended min. amount, activities should be performed as tolerated to avoid being sedentary8. Exceed min amount of PA to improve chronic conditions9. Mod. intensity PA should be encouraged for individuals with cognitive decline10. Structured PA sessions should end with an appropriate cool down11. Incorporate behavior strategies to enhance participation12. Regular feedback and positive reinforcement to increase adherence
Q: Low Back Pain Special Considerations
Answer: 1. Promote spinal stabilization2. Certain exercises and positions may aggravate symps (walking downhill)3. Encourage exercises that result in a centralization of symps4. Encourage flexibility
Q: Arthritis Special Considerations
Answer: 1. Avoid strenuous exercises during acute flare ups and periods of inflammation2. Long warm up and cool down3. Individuals with significant pain and functional limitations should perform as much PA as they can4. Exss during times of the day where pain is less severe and/ or in conjunction with peak activity of pain meds5. Appropriate shoes6. Functional exercises help improve neuromotor control7. Water exercise temp- 83-88
Q: Cancer Special Considerations
Answer: 1. Up to 90% of all cancer survivors will experience cancer related fatigue2. Bone is a common site of metastases in many cancers3. Cachexia prevalent in pts. with advanced GI cancers4. Identify when a pt. is in an immune surpressed state –> exercise at home or a medical setting5. Avoid swimming with catheters6. Pts. receiving chemo may experience sickness and fatigue
Q: Cerebral Palsy Special Considerations
Answer: 1. FITT principle is unclear2. B/c of lack of movement control, energy expenditure is high at low power output3. If balance is a problem use the bike4. Fatigue easily because of poor economy of movement5. Resistance training increases strength without an adverse effect on muscle tone6. Resistance exercises designed to target weak muscle groups that oppose hypertonic muscle groups improve the strength and normalize the tone7. Hypertonic muscles should be stretched slowly throughout the workout program8. Children- inhibit abnormal reflex activity, normalize muscle tone, and develop reactions to increase equilibrium9.Athletes- sport specific fitness testing to determine fitness areas for improvement10. Good positioning of the head, trunk, and proximal joints of extremities to control persistent primitive reflexes is preferred to strapping11. More prone to overuse injuries b/c of their higher incidence of inactivity
Q: Diabetes Special Considerations
Answer: 1. Hypoglycemia- most serious problem2. Blood glucose monitoring before and after exercise is important3. Timing of insulin should be considered4. PA with oral hypoglycemic agents has not been studied well5. Adjust carb intake and meds before and after exss6. People with insulin pumps can disconnect depending on intensity and duration of exss7. Continuous glucose monitoring can be useful to determine immediate and delayed effects of exercise8. Exercise with a friend9. Hyperglycemia with or without ketosis is a concern for individuals with Type 1 who are not in glycemic control10. Dehydration resulting from polyuria may compromise thermoregulatory response11. Retinopathy at risk for retinal detachment and hemorrhage associated with vigorous exercise12. During exss, autonomic neuropathy may cause chronotropic incompetence, attenuated VO2 kinetics and anhydrosis13. Peripheral neuropathy- foot care
Q: Dyslipidemia Special Considerations
Answer: Individuals taking lipid lowering meds that have the potential to cause muscle damage (statins and fibric acid) may experience soreness
Q: Fibromyalgia Special Considerations
Answer: 1. Teach the correct form for exercises to reduce injury2. Avoid improper form and exercising when excessively fatigued3. Consider less exercise if symps increase during or after exss4. Avoid free weights when fatigued or have excessive pain5. Exercise in a room with temp and humidity control6. Consider group exercises7. Consider yoga and tai chi
Q: HIV Special Considerations
Answer: 1. No contraindications for exercise2. Supervised exercises for symptomatic people3. Should report increased general feelings of fatigue or perceived effort during activity, lower GI distress, and shortness of breath4. Minor feelings of fatigue should not end exercise
Q: HTN Special Considerations
Answer: 1. Pts. with uncontrolled severe HTN (SBP ≥180 mmHg and/or DBP ≥110 mmHg) should add exercise training to their treatment plan only after first being evaluated by their physician2. B blockers and diuretics may adversely affect thermoregulatory function3. B blockers may reduce submax and max exercise capacity4. Alpha blockers, CA channels blockers, and vasodilators may lead to sudden excessive reductions in postexss BP5.OW and OB pts should focus on increasing caloric expenditure6. BP lowering effects of aerobic exercise is immediate7. Exss intensity should be set ≥10 BPM below the ischemic threshold
Q: Intellectual Disability and Down Syndrome Special Considerations
Answer: 1. ID-Require more encouragement2. ID-Motor control problems and poor coordination3. ID-Short attention span4. Familiarize and practice before testing5. Maximize enjoyment and adherence6. DS- very low levels of aerobic capacity and muscle strength7. DS- often obese8. DS- likely to have a low HR max caused by reduced catecholamine response9. DS- Might have atlantoaxial instability10. DS- may experience skeletal muscle hypotonia coupled with excessive joint laxity
Q: Kidney Disease Special Considerations
Answer: 1. Progress to greater exercise volume over time2. Might not be able to do continuous exercise3. Resistance- 1 set of 10 reps 70% 1 RM 2x/week4. Hemodialysis- exss on non dialysis days and not immediately post-if done during do it during the first half-Use RPE-Measure BP in arm without fistula5. Peritoneal Dialysis:-May attempt exss with fluid in the abdomen, if it is uncomfy then drain fluid before exss6. Kidney Transplant:-During periods of rejection, FITT principle should be reduced but still exss
Q: Metabolic Syndrome Special Considerations
Answer: 1. Will likely have multiple CVD risk factors2. Initial exss at moderate intensity3. To reduce body weight, increase PA levels to 300 min/week
Q: MS Special Considerations
Answer: 1. In spastic muscles, increase the frequency and time of flexibility exercises2. Incorporate functional activities3. USE RPE4. During acute exacerbation of symps, decrease exss5. Commonly used disease modifying meds can have transient side effects6. Systemic fatigue is common but can be improved7. Heat sensitivity is common8. HR and BP my be blunted9. Some pts. may restrict their daily fluid intake10. Might have trouble understanding testing and training instructions11. Watch for signs and symps of Uhthoff Phenomenon
Q: Osteoporosis Special Considerations
Answer: 1. Difficult to quantify exercise intensity in terms of bone loading forces2. No guidelines for contraindications to exss3. BMD of the spine may appear normal or increased after compression fractures or in pts with osteo of the spine. Hip BMD is a more reliable indicator for osteo4. Increased risk for falls
Q: OW and OB special considerations
Answer: 1. For long term weight loss maintenance exercise greater than 250 min/week2. PA 5-7 days/week3. Moderate to vigorous PA start at 30 min/day then progress
Q: Parkinson Disease Special Considerations
Answer: 1. Incorporate functional exercises2. Suffer from ANS dysfunction3. Some meds further impair ANS functions4. Cognitive decline and dementia are common neuro symps and can burden training5. Emphasize fall prevention6. Avoid dual tasking7.Pay attention to the development and management of fatigue when performing resistive exercise
Q: Pulmonary Disease Special Considerations
Answer: 1. Resistance training (upper body) important in COPD2. Train inspiratory muscles3. Dyspnea rating 4-6 on a 1-10 scale is the recommended exss intensity4. Measure O2 during exercise to avoid desaturation5. Supplemental O2 for pts PaO2 ≤55 mmHg or a %SaO2≤88% while breathing room air6. In severe COPD, using noninvasive positive pressure ventilation to help with exercise
Q: Spinal Cord Injury Special Considerations
Answer: 1. Empty bowels and bladder before exss2. Skin pressure sores should be avoided at all times3. Decrease cardio. performance in complete spinal cord injuries4. During exss, autonomic dysreflexia results in an increased release of catecholamines that increases HR, VO2, BP, and exercise capacity5. Short bouts of 5-10 mins with 5 min recovery6. Tetraplegia will experience muscle fatigue before exhausting central cardio. capacity7. High SCI may benefit from lower body positive pressure8. Stabilize all trunk muscles by completing strength training in and out of a wheelchair9. Endure higher core temp during endurance exercise. Despite the enhanced thermoregulatory drive, they generally have lower sweat rates
Q: Hot Environment Considerations
Answer: 1. Hyperthermia- metabolic heat > heat loss2. Heat acclimatization= higher and more sustained sweating rates3. Active individuals should drink at least 1 pt of fluid for each pound of body weight lost during exss4. Decreased sweating rate and decreased cutaneous BF responsible for greater heat storage
Q: Exertional Heatstroke
Answer: Signs and symps: disorientation, dizziness, irrational behavior, apathy, headache, nausea, vomiting, hyperventialtion, wet skinMental Status: disoriented, unresponsiveCore temp elevation: >40° C
Q: Exertional Heat Exhaustion
Answer: Signs and Symps: Low BP, elevated HR and respiratory rates, skin is wet and pale, headache, weakness, dizziness, decreased muscle coordination, chills, nausea, vomiting, diarrheaMental Status: AgitatedCore Temp Elevation:None to moderate (37°-40° C)
Q: Heat Syncope
Answer: Signs/symps: HR and breathing rates are slow; skin is pale; patient may experience sensations of weakness, tunnel vision, vertigo, or nausea before syncopeMental Status: Brief fainting episodeCore temp elevation: little to none
Q: Exertional Heat Cramps
Answer: Signs/ symps: Begins as feeble, localized, wandering spasms that may progress to debilitating crampsCore temp elevation: Moderate (37°-40° C)
Q: THR in the heat
Answer: Will be achieved at a lower workload
Q: Heat Acclimatization
Answer: Improved heat transfer from the body’s core to the external environment, improved CV function, more effective sweating, improved heat tolerance
Q: WBGT Children <75.0
Answer: All activities are allowed
Q: WBGT Children 75- 78.6
Answer: Longer rest periods in the shade; enforce drinking every 15 mins
Q: WBGT Children 79-84
Answer: Stop activity of unacclimitized individuals and those in high risk categories; limit activities of all other
Q: WBGT Children >85.0
Answer: Cancel all athletic activities
Q: Frostbite
Answer: 1. Most common in exposed skin (nose, ears, cheeks)2. Contact frostbite may occur by touching cold objects with bare skin3. Frostbite risk is <5% when the ambient temperature is greater than -15° C (5° F)4. Principal cold stress determinants are air temp, wind speed, and wetness5. Wind exacerbates heat loss6. Wind does NOT cause an exposed object to become colder than the ambient temp7. Wet skin exposed to wind cools faster8. Can occur in 30 min or less when the WDT falls below -27 Celsius (-8 F)
Q: High Altitude
Answer: o Ascent to higher altitudes reduces the partial pressure of oxygen in the inspired air, resulting in decreased arterial oxygen levels. Immediate compensatory responses include increased ventilation and cardiac output (usually through elevated HR)o Acclimatization occurs at ≥1 week
Q: Acute Mountain Sickness
Answer: Most commonSymps: headache, nausea, fatigue, decreased appetite, poor sleep, poor balanceCan progress to HACE
Q: High Altitude Cerebral Edema
Answer: Exacerbation of unresolved AMSOccurs in <2% of individuals ascending >12,000 ft
Q: High Altitude Pulmonary Edema
Answer: -Occurs in <10% of individuals ascending >12,000 ft-Individuals making repeated ascents and descents >12,000 ft and who exercise strenuously early in exposure have an increased susceptibility to HAPE-Blue lips and nail beds may be present
Q: Social Cognitive Theory
Answer: Triadic reciprocation: The individual (emotion, personality, cognition, biology), behavior, and environment all interact to influence future behavior
Q: Self Efficacy
Answer: One’s belief in their capacity to successfully complete a course of action such as exercise
Q: Task Self Efficacy
Answer: Belief in capability to physically complete the task; the measure must be specific to the task
Q: Barriers Self Efficacy
Answer: Belief in the capability to exercise regularly in the face of common barriers
Q: Outcome Expectations
Answer: Anticipatory results of a behavior; if specific outcomes are valued, then behavior change is more likely to occur
Q: Transtheoretical Model
Answer: Developed as a framework for understanding behavior change.5 stages: Precontemplation, contemplation, preparation, action, maintenance
Q: Precontemplation to contemplation
Answer: Processes Focus: Consciousness raising, environmental reevaluation, dramatic reliefDecisional Balance: Pros < ConsSelf Efficacy: Low
Q: Contemplation to Preparation
Answer: Processes Focus: Consciousness raising, environmental reevaluation, self reevaluation, dramatic reliefDecision Balance: Pros>ConsSelf Efficacy: increasing
Q: Preparation to Action
Answer: Processes Focus: Self LiberationDecision balance: Pros>>ConsSelf Efficacy: high
Q: Action to Maintenance
Answer: Processes Focus: stimulus control, reinforcement management, counterconditioning, helping relationshipsDecision balance: Pros >>ConsSelf Efficacy: high
Q: Health Belief Model
Answer: An individual’s beliefs about whether or not he/she is susceptible to disease, and his/her perceptions of the benefits of trying to avoid it, influence his/her readiness to act
Q: Self Determination Theory
Answer: 3 primary psycho social needs that need to be satisfied: relatedness, competence (mastery) , and autonomy (self determination)
Q: Theory of Planned Behavior
Answer: -Intention to perform a behavior is the primary determinant of behavior.-Intentions are determined by an individual’s attitude, subjective norms, and predictive behavioral control
Q: Perceived behavioral control
Answer: individual’s belief about how easy or difficult performance of the behavior is likely to be
Q: Social Ecological
Answer: Considers the impact of and connections between individuals and their environment
Q: How to build Self Efficacy
Answer: Mastery experiences, social modeling., social persuasion, reduction of stress and physical/emotional arousal
Q: Client Centered PA Counseling (Five A’s Model)
Answer: 1. Address agenda2. Assess3. Advise4. Assist5. Arrange Follow up
Q: Cognitive Behavioral Approaches
Answer: 1. Reinforcement2. Goal Setting3. Social Support4. Association vs disassociation5. Affect Regulation6. Relapse Prevention
Q: Reinforcement
Answer: Extrinsic: helps increase short term adherenceIntrinsic: More likely to adhere long term
Q: Goal Setting
Answer: – Must be a part of an ongoing process- SMART goals (Specific, measurable, action oriented, realistic, timely)
Q: Social Supoport
Answer: 1. Guidance- advice and info2. Reliable alliance- assurance that others can be counted on in times of stress3. Reassurance of worth- recognition of one’s competence that individuals in the exercise group or personal trainer believe in their abilities4. Attachment- emotional closeness5. Social integration- sense of belonging6. Opportunity for nurturance- providing assistance to others in the exercise group
Q: Disassociation Strategies
Answer: Encourage the individual to block out feelings associated with exertion such as fatigue, sweating, or discomfort, usually by focusing on positive thoughts
Q: Association Strategies
Answer: Focus on bodily sensations such as respiration, temperature, and enjoyment
Q: Affect Regulation
Answer: -Key component to intrinsic motivation- Positive affective responses to moderate intensity exercise can be predictive of PA participation 6 and 12 months later
Q: Relapse Prevention
Answer: -Having individuals brainstorm ways and create plans to stay active when they are outside of their traditional routine-Varying their exercise routine to avoid boredom-Creating new exercise goals to enhance and maintain motivation