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ACSM CEP EXAM 2025 QUESTIONS AND ANSWERS, Exams of Medical Genetics

University of CumbriaMedical Genetics

ACSM CEP EXAM 2025 QUESTIONS AND ANSWERS 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

Typology: Exams

2024/2025

Available from 07/15/2025

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ACSM CEP EXAM 2025 QUESTIONS AND ANSWERS
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
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
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
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ACSM CEP EXAM 2025 QUESTIONS AND ANSWERS

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 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 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

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) 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) ST segment depression - ANSWER ≥1 mm of horizontal or down sloping ST↓ 60-80 ms beyond the J point suggesting myocardial ischemia 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.
  1. Chronotropic index <. 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 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 True Positive - ANSWER Horizontal or down sloping ST segment depression of ≥1.0 mm and correctly identifies a patient with CVD False Negative - ANSWER test shows no or non-diagnostic ECG changes and fails to identify patients with underlying CVD

During: Continuously, Last 15 s of each minute After: Continuously, Last 5 s of each minute When to monitor BP during an exercise test - ANSWER Before: supine position and posture of exercise During: 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 Signs/ Symps during an exercise test - ANSWER Monitored continuously and recorded as observed RPE During an exercise test - ANSWER Before: Explain the scale During: last 15 s of each stage or every 2 mins with ramp protocols After: Obtain peak exercise value then don't measure during recovery Pregnancy Special Considerations - ANSWER 1. Sedentary women should gradually increase PA to recommended levels

  1. Severely obese, GDM, HTN see Dr. before exercise 3. No contact sports
  2. 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 leakage
  3. Don't exss in a supine position after 16 weeks of pregnancy to avoid venous obstruction.
  4. Avoid valsalva
  5. Avoid hot and humid weather
  6. Metabolic demand increases by about 300 kcal/day 9. Submax weight training allowed
  7. Postpartum exss- about 4-6 wks after normal vaginal delivery and about 8-10 weeks after C section Children Special Considerations - ANSWER 1. Proper instruction provided for strength training.
  8. B/c of immature thermoregulatory systems, avoid hot weather and stay hydrated
  9. OW and physically inactive kids should gradually increase frequency and time of PA 4. Children with disabilities or disease should have their Ex Rx tailored to them
  10. Decrease sedentary activity Older Adults Special Considerations - ANSWER 1. Intensity and duration should be light at first
  11. Progression tailored to tolerance and preference 3. Muscular strength is more important with age
  12. Supervise strength training
  13. Muscle strengthening activities may need to precede aerobic training 6. Gradually exceed the recommended minimum amounts of PA
  1. If chronic conditions preclude activity at the recommended min. amount, activities should be performed as tolerated to avoid being sedentary
  2. Exceed min amount of PA to improve chronic conditions
  3. Mod. intensity PA should be encouraged for individuals with cognitive decline 10. Structured PA sessions should end with an appropriate cool down
  4. Incorporate behavior strategies to enhance participation
  5. Regular feedback and positive reinforcement to increase adherence Low Back Pain Special Considerations - ANSWER 1. Promote spinal stabilization 2. Certain exercises and positions may aggravate symps (walking downhill)
  6. Encourage exercises that result in a centralization of symps 4. Encourage flexibility Arthritis Special Considerations - ANSWER 1. Avoid strenuous exercises during acute flare ups and periods of inflammation
  7. Long warm up and cool down
  8. Individuals with significant pain and functional limitations should perform as much PA as they can
  9. Exss during times of the day where pain is less severe and/ or in conjunction with peak activity of pain meds
  10. Appropriate shoes
  11. Functional exercises help improve neuromotor control 7. Water exercise temp- 83- Cancer Special Considerations - ANSWER 1. Up to 90% of all cancer survivors will experience cancer related fatigue
  12. Bone is a common site of metastases in many cancers 3. Cachexia prevalent in pts. with advanced GI cancers
  13. Identify when a pt. is in an immune surpressed state --> exercise at home or a medical setting
  14. Avoid swimming with catheters
  15. Pts. receiving chemo may experience sickness and fatigue Cerebral Palsy Special Considerations - ANSWER 1. FITT principle is unclear
  16. B/c of lack of movement control, energy expenditure is high at low power output 3. If balance is a problem use the bike
  17. Fatigue easily because of poor economy of movement
  18. Resistance training increases strength without an adverse effect on muscle tone
  19. Resistance exercises designed to target weak muscle groups that oppose hypertonic muscle groups improve the strength and normalize the tone
  20. Hypertonic muscles should be stretched slowly throughout the workout program 8. 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 10. Good positioning of the head, trunk, and proximal joints of extremities to control persistent primitive reflexes is preferred to strapping
  1. 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 6. BP lowering effects of aerobic exercise is immediate
  2. Exss intensity should be set ≥10 BPM below the ischemic threshold Intellectual Disability and Down Syndrome Special Considerations - ANSWER 1. ID- Require more encouragement
  3. ID-Motor control problems and poor coordination 3. ID-Short attention span
  4. Familiarize and practice before testing 5. Maximize enjoyment and adherence
  5. DS- very low levels of aerobic capacity and muscle strength 7. DS- often obese
  6. DS- likely to have a low HR max caused by reduced catecholamine response 9. DS- Might have atlantoaxial instability
  7. DS- may experience skeletal muscle hypotonia coupled with excessive joint laxity Kidney Disease Special Considerations - ANSWER 1. Progress to greater exercise volume over time
  8. Might not be able to do continuous exercise
  9. Resistance- 1 set of 10 reps 70% 1 RM 2x/week
  10. 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 5. Peritoneal Dialysis: -May attempt exss with fluid in the abdomen, if it is uncomfy then drain fluid before exss 6. Kidney Transplant: -During periods of rejection, FITT principle should be reduced but still exss Metabolic Syndrome Special Considerations - ANSWER 1. Will likely have multiple CVD risk factors
  11. Initial exss at moderate intensity
  12. To reduce body weight, increase PA levels to 300 min/week MS Special Considerations - ANSWER 1. In spastic muscles, increase the frequency and time of flexibility exercises
  13. Incorporate functional activities
  14. USE RPE
  15. During acute exacerbation of symps, decrease exss
  16. Commonly used disease modifying meds can have transient side effects 6. Systemic fatigue is common but can be improved
  17. Heat sensitivity is common 8. HR and BP my be blunted
  18. Some pts. may restrict their daily fluid intake
  1. Might have trouble understanding testing and training instructions 11. Watch for signs and symps of Uhthoff Phenomenon Osteoporosis Special Considerations - ANSWER 1. Difficult to quantify exercise intensity in terms of bone loading forces
  2. No guidelines for contraindications to exss
  3. 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 osteo
  4. Increased risk for falls OW and OB special considerations - ANSWER 1. For long term weight loss maintenance exercise greater than 250 min/week
  5. PA 5-7 days/week
  6. Moderate to vigorous PA start at 30 min/day then progress Parkinson Disease Special Considerations - ANSWER 1. Incorporate functional exercises
  7. Suffer from ANS dysfunction
  8. Some meds further impair ANS functions
  9. Cognitive decline and dementia are common neuro symps and can burden training 5. Emphasize fall prevention
  10. Avoid dual tasking 7.Pay attention to the development and management of fatigue when performing resistive exercise Pulmonary Disease Special Considerations - ANSWER 1. Resistance training (upper body) important in COPD
  11. Train inspiratory muscles
  12. Dyspnea rating 4-6 on a 1-10 scale is the recommended exss intensity 4. Measure O2 during exercise to avoid desaturation
  13. Supplemental O2 for pts PaO2 ≤55 mmHg or a %SaO2≤88% while breathing room air
  14. In severe COPD, using noninvasive positive pressure ventilation to help with exercise Spinal Cord Injury Special Considerations - ANSWER 1. Empty bowels and bladder before exss
  15. Skin pressure sores should be avoided at all times
  16. Decrease cardio. performance in complete spinal cord injuries
  17. During exss, autonomic dysreflexia results in an increased release of catecholamines that increases HR, VO2, BP, and exercise capacity
  18. Short bouts of 5-10 mins with 5 min recovery
  19. Tetraplegia will experience muscle fatigue before exhausting central cardio. capacity 7. High SCI may benefit from lower body positive pressure
  20. Stabilize all trunk muscles by completing strength training in and out of a wheelchair 9. Endure higher core temp during endurance exercise. Despite the enhanced thermoregulatory drive, they generally have lower sweat rates

Frostbite - ANSWER 1. Most common in exposed skin (nose, ears, cheeks) 2. Contact frostbite may occur by touching cold objects with bare skin

  1. 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 wetness
  2. Wind exacerbates heat loss
  3. Wind does NOT cause an exposed object to become colder than the ambient temp 7. Wet skin exposed to wind cools faster
  4. Can occur in 30 min or less when the WDT falls below -27 Celsius (-8 F) 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 Acute Mountain Sickness - ANSWER Most common Symps: headache, nausea, fatigue, decreased appetite, poor sleep, poor balance Can progress to HACE High Altitude Cerebral Edema - ANSWER Exacerbation of unresolved AMS Occurs in <2% of individuals ascending >12,000 ft 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 Social Cognitive Theory - ANSWER Triadic reciprocation: The individual (emotion, personality, cognition, biology), behavior, and environment all interact to influence future behavior Self Efficacy - ANSWER One's belief in their capacity to successfully complete a course of action such as exercise Task Self Efficacy - ANSWER Belief in capability to physically complete the task; the measure must be specific to the task Barriers Self Efficacy - ANSWER Belief in the capability to exercise regularly in the face of common barriers Outcome Expectations - ANSWER Anticipatory results of a behavior; if specific outcomes are valued, then behavior change is more likely to occur Transtheoretical Model - ANSWER Developed as a framework for understanding behavior change.

5 stages: Precontemplation, contemplation, preparation, action, maintenance Precontemplation to contemplation - ANSWER Processes Focus: Consciousness raising, environmental reevaluation, dramatic relief Decisional Balance: Pros < Cons Self Efficacy: Low Contemplation to Preparation - ANSWER Processes Focus: Consciousness raising, environmental reevaluation, self reevaluation, dramatic relief Decision Balance: Pros>Cons Self Efficacy: increasing Preparation to Action - ANSWER Processes Focus: Self Liberation Decision balance: Pros>>Cons Self Efficacy: high Action to Maintenance - ANSWER Processes Focus: stimulus control, reinforcement management, counterconditioning, helping relationships Decision balance: Pros >>Cons Self Efficacy: high 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 Self Determination Theory - ANSWER 3 primary psycho social needs that need to be satisfied: relatedness, competence (mastery) , and autonomy (self determination) 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 Perceived behavioral control - ANSWER individual's belief about how easy or difficult performance of the behavior is likely to be Social Ecological - ANSWER Considers the impact of and connections between individuals and their environment How to build Self Efficacy - ANSWER Mastery experiences, social modeling., social persuasion, reduction of stress and physical/emotional arousal Client Centered PA Counseling (Five A's Model) - ANSWER 1. Address agenda 2. Assess

  1. Advise
  2. Assist