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ACSM CEP Examination practices questions and answers 2025
Absolute Contraindications to Exercise Testing - Correct 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
Relative Contraindications to Exercise Testing - Correct 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
General Indications for Stopping an Exercise Test - Correct 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
Absolute Indications for stopping an exercise test - Correct 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)
Relative Indications for stopping an exercise test - Correct 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)
ST segment depression - Correct Answer ≥1 mm of horizontal or down sloping ST↓ 60-80 ms beyond the J point suggesting myocardial ischemia
Chronotropic incompetence - Correct 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.
- Chronotropic index <.
Heart Rate Recovery - Correct 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
Sensitivity - Correct 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
True Positive - Correct Answer Horizontal or down sloping ST segment depression of ≥1.0 mm and correctly identifies a patient with CVD
False Negative - Correct Answer test shows no or non-diagnostic ECG changes and fails to identify patients with underlying CVD
Specificity - Correct Answer % of pts. without CVD who demonstrate non significant ST segment changes
True Negative - Correct Answer Correctly identifies an individual without CVD
Causes of False Negative Test Results - Correct 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
Predictive Value - Correct Answer A measure of how accurately a test result (positive or negative) correctly identifies the presence or absence of CVD in tested patients.
Absolute Contraindications to Resistance training - Correct 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
- If chronic conditions preclude activity at the recommended min. amount, activities should be performed as tolerated to avoid being sedentary
- Exceed min amount of PA to improve chronic conditions
- Mod. intensity PA should be encouraged for individuals with cognitive decline
- Structured PA sessions should end with an appropriate cool down
- Incorporate behavior strategies to enhance participation
- Regular feedback and positive reinforcement to increase adherence
Low Back Pain Special Considerations - Correct Answer 1. Promote spinal stabilization
- Certain exercises and positions may aggravate symps (walking downhill)
- Encourage exercises that result in a centralization of symps
- Encourage flexibility
Arthritis Special Considerations - Correct Answer 1. Avoid strenuous exercises during acute flare ups and periods of inflammation
- Long warm up and cool down
- Individuals with significant pain and functional limitations should perform as much PA as they can
- Exss during times of the day where pain is less severe and/ or in conjunction with peak activity of pain meds
- Appropriate shoes
- Functional exercises help improve neuromotor control
- Water exercise temp- 83-
Cancer Special Considerations - Correct Answer 1. Up to 90% of all cancer survivors will experience cancer related fatigue
- Bone is a common site of metastases in many cancers
- Cachexia prevalent in pts. with advanced GI cancers
- Identify when a pt. is in an immune surpressed state --> exercise at home or a medical setting
- Avoid swimming with catheters
- Pts. receiving chemo may experience sickness and fatigue
Cerebral Palsy Special Considerations - Correct Answer 1. FITT principle is unclear
- B/c of lack of movement control, energy expenditure is high at low power output
- If balance is a problem use the bike
- Fatigue easily because of poor economy of movement
- Resistance training increases strength without an adverse effect on muscle tone
- Resistance exercises designed to target weak muscle groups that oppose hypertonic muscle groups improve the strength and normalize the tone
- Hypertonic muscles should be stretched slowly throughout the workout program
- Children- inhibit abnormal reflex activity, normalize muscle tone, and develop reactions to increase equilibrium 9.Athletes- sport specific fitness testing to determine fitness areas for improvement
- Good positioning of the head, trunk, and proximal joints of extremities to control persistent primitive reflexes is preferred to strapping
- More prone to overuse injuries b/c of their higher incidence of inactivity
Diabetes Special Considerations - Correct Answer 1. Hypoglycemia- most serious problem
- Blood glucose monitoring before and after exercise is important
- Timing of insulin should be considered
- PA with oral hypoglycemic agents has not been studied well
- Adjust carb intake and meds before and after exss
- People with insulin pumps can disconnect depending on intensity and duration of exss
- Continuous glucose monitoring can be useful to determine immediate and delayed effects of exercise
- Exercise with a friend
- Hyperglycemia with or without ketosis is a concern for individuals with Type 1 who are not in glycemic control
- Dehydration resulting from polyuria may compromise thermoregulatory response
- Retinopathy at risk for retinal detachment and hemorrhage associated with vigorous exercise
- During exss, autonomic neuropathy may cause chronotropic incompetence, attenuated VO2 kinetics and anhydrosis
- Peripheral neuropathy- foot care
Dyslipidemia Special Considerations - Correct Answer Individuals taking lipid lowering meds that have the potential to cause muscle damage (statins and fibric acid) may experience soreness
Fibromyalgia Special Considerations - Correct Answer 1. Teach the correct form for exercises to reduce injury
- Avoid improper form and exercising when excessively fatigued
- Consider less exercise if symps increase during or after exss
- Avoid free weights when fatigued or have excessive pain
- Exercise in a room with temp and humidity control
- Consider group exercises
- Consider yoga and tai chi
HIV Special Considerations - Correct Answer 1. No contraindications for exercise
- Supervised exercises for symptomatic people
- Should report increased general feelings of fatigue or perceived effort during activity, lower GI distress, and shortness of breath
- Minor feelings of fatigue should not end exercise
HTN Special Considerations - Correct 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 physician
- B blockers and diuretics may adversely affect thermoregulatory function
- B blockers may reduce submax and max exercise capacity
- Alpha blockers, CA channels blockers, and vasodilators may lead to sudden excessive reductions in postexss BP 5.OW and OB pts should focus on increasing caloric expenditure
- BP lowering effects of aerobic exercise is immediate
- Exss intensity should be set ≥10 BPM below the ischemic threshold
Intellectual Disability and Down Syndrome Special Considerations - Correct Answer 1. ID-Require more encouragement
- ID-Motor control problems and poor coordination
- ID-Short attention span
- Familiarize and practice before testing
- Maximize enjoyment and adherence
- DS- very low levels of aerobic capacity and muscle strength
- DS- often obese
- DS- likely to have a low HR max caused by reduced catecholamine response
- DS- Might have atlantoaxial instability
- DS- may experience skeletal muscle hypotonia coupled with excessive joint laxity
Kidney Disease Special Considerations - Correct Answer 1. Progress to greater exercise volume over time
- Might not be able to do continuous exercise
- Resistance- 1 set of 10 reps 70% 1 RM 2x/week
- 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 fistula
- Peritoneal Dialysis: -May attempt exss with fluid in the abdomen, if it is uncomfy then drain fluid before exss
- Stabilize all trunk muscles by completing strength training in and out of a wheelchair
- Endure higher core temp during endurance exercise. Despite the enhanced thermoregulatory drive, they generally have lower sweat rates
Hot Environment Considerations - Correct Answer 1. Hyperthermia- metabolic heat > heat loss
- Heat acclimatization= higher and more sustained sweating rates
- Active individuals should drink at least 1 pt of fluid for each pound of body weight lost during exss
- Decreased sweating rate and decreased cutaneous BF responsible for greater heat storage
Exertional Heatstroke - Correct Answer Signs and symps: disorientation, dizziness, irrational behavior, apathy, headache, nausea, vomiting, hyperventialtion, wet skin Mental Status: disoriented, unresponsive Core temp elevation: >40° C
Exertional Heat Exhaustion - Correct 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, diarrhea Mental Status: Agitated Core Temp Elevation:None to moderate (37°-40° C)
Heat Syncope - Correct Answer Signs/symps: HR and breathing rates are slow; skin is pale; patient may experience sensations of weakness, tunnel vision, vertigo, or nausea before syncope Mental Status: Brief fainting episode Core temp elevation: little to none
Exertional Heat Cramps - Correct Answer Signs/ symps: Begins as feeble, localized, wandering spasms that may progress to debilitating cramps Core temp elevation: Moderate (37°-40° C)
THR in the heat - Correct Answer Will be achieved at a lower workload
Heat Acclimatization - Correct Answer Improved heat transfer from the body's core to the external environment, improved CV function, more effective sweating, improved heat tolerance
WBGT Children <75.0 - Correct Answer All activities are allowed
WBGT Children 75- 78.6 - Correct Answer Longer rest periods in the shade; enforce drinking every 15 mins
WBGT Children 79-84 - Correct Answer Stop activity of unacclimitized individuals and those in high risk categories; limit activities of all other
WBGT Children >85.0 - Correct Answer Cancel all athletic activities
Frostbite - Correct Answer 1. Most common in exposed skin (nose, ears, cheeks)
- Contact frostbite may occur by touching cold objects with bare skin
- Frostbite risk is <5% when the ambient temperature is greater than -15° C (5° F)
- Principal cold stress determinants are air temp, wind speed, and wetness
- Wind exacerbates heat loss
- Wind does NOT cause an exposed object to become colder than the ambient temp
- Wet skin exposed to wind cools faster
- Can occur in 30 min or less when the WDT falls below -27 Celsius (-8 F)
High Altitude - Correct 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
Acute Mountain Sickness - Correct Answer Most common Symps: headache, nausea, fatigue, decreased appetite, poor sleep, poor balance Can progress to HACE
High Altitude Cerebral Edema - Correct Answer Exacerbation of unresolved AMS Occurs in <2% of individuals ascending >12,000 ft
High Altitude Pulmonary Edema - Correct 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
Social Cognitive Theory - Correct Answer Triadic reciprocation: The individual (emotion, personality, cognition, biology), behavior, and environment all interact to influence future behavior
Self Efficacy - Correct Answer One's belief in their capacity to successfully complete a course of action such as exercise
Task Self Efficacy - Correct Answer Belief in capability to physically complete the task; the measure must be specific to the task
Barriers Self Efficacy - Correct Answer Belief in the capability to exercise regularly in the face of common barriers
Outcome Expectations - Correct Answer Anticipatory results of a behavior; if specific outcomes are valued, then behavior change is more likely to occur
Transtheoretical Model - Correct Answer Developed as a framework for understanding behavior change. 5 stages: Precontemplation, contemplation, preparation, action, maintenance
Precontemplation to contemplation - Correct Answer Processes Focus: Consciousness raising, environmental reevaluation, dramatic relief Decisional Balance: Pros < Cons Self Efficacy: Low
Contemplation to Preparation - Correct Answer Processes Focus: Consciousness raising, environmental reevaluation, self reevaluation, dramatic relief Decision Balance: Pros>Cons Self Efficacy: increasing
Preparation to Action - Correct Answer Processes Focus: Self Liberation Decision balance: Pros>>Cons Self Efficacy: high
Action to Maintenance - Correct Answer Processes Focus: stimulus control, reinforcement management, counterconditioning, helping relationships Decision balance: Pros >>Cons Self Efficacy: high
Health Belief Model - Correct 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
Self Determination Theory - Correct Answer 3 primary psycho social needs that need to be satisfied: relatedness, competence (mastery) , and autonomy (self determination)
