ACSM-RCEP Registered Clinical Exercise Physiologist

According to ACSM Guidelines (11th ed.), what is the minimum recommended exercise frequency for cardiac rehabilitation patients in the maintenance phase?

• A1-2 days per week
• B3-5 days per week
• C6-7 days per week
• DEvery other day only

A patient post-myocardial infarction is beginning Phase II cardiac rehab. His peak heart rate on a symptom-limited graded exercise test was 140 bpm and resting HR is 70 bpm. Using the Karvonen (HRR) method at 60%, what is his target HR?

• A98 bpm
• B112 bpm
• C120 bpm
• D132 bpm

Which of the following is an ABSOLUTE contraindication to graded exercise testing per ACSM Guidelines (11th ed.)?

• AResting systolic BP of 160 mmHg
• BAcute myocardial infarction within 2 days
• CModerate stenotic valvular heart disease
• DControlled atrial fibrillation with resting HR 90 bpm

During a graded exercise test, a patient develops 2 mm horizontal ST-segment depression 80 ms after the J-point in leads V4-V6. This finding is MOST consistent with:

• ANormal repolarization
• BMyocardial ischemia
• CLeft bundle branch block
• DDigitalis effect

A patient taking a beta-blocker is preparing for cardiac rehab. Which of the following is the MOST appropriate method to prescribe exercise intensity?

• AAge-predicted maximum HR (220 - age)
• BHeart rate reserve from a medicated graded exercise test
• CResting heart rate + 20 bpm
• DPerceived exertion only, ignoring HR

Per ACSM Guidelines, what is the recommended aerobic exercise prescription intensity for patients with stable heart failure with reduced ejection fraction (HFrEF)?

• A40-80% of heart rate reserve (HRR) or VO2R
• B85-95% of VO2max
• C50-60% of age-predicted HRmax only
• DExercise is contraindicated

Which of the following medications is MOST likely to cause exertional hypotension and blunt heart rate response during exercise?

• AAspirin
• BMetoprolol
• CAtorvastatin
• DFurosemide

According to GOLD criteria, a COPD patient with FEV1 of 45% predicted (post-bronchodilator) is classified as:

• AGOLD 1 (Mild)
• BGOLD 2 (Moderate)
• CGOLD 3 (Severe)
• DGOLD 4 (Very Severe)

A COPD patient in pulmonary rehab reports dyspnea at 5 (severe) on the modified Borg 0-10 scale during exercise. What is the MOST appropriate response?

• AStop exercise immediately
• BReduce intensity to a Borg of 3-4 (moderate to somewhat severe)
• CContinue at current intensity
• DIncrease oxygen flow without modification

What is the PRIMARY physiological benefit of aerobic exercise training for patients with COPD?

• AImproved FEV1
• BReduced ventilatory demand at submaximal workloads
• CIncreased lung diffusion capacity
• DReversal of emphysematous changes

For a patient with Type 2 diabetes, ACSM recommends resistance training at what minimum frequency to improve glycemic control?

• A1 day per week
• B2-3 non-consecutive days per week
• CDaily
• DOnly when blood glucose is elevated

A patient with Type 1 diabetes arrives for exercise with a fasting blood glucose of 260 mg/dL and positive urine ketones. What is the MOST appropriate action?

• AProceed with exercise as scheduled
• BHave the patient eat carbohydrates and begin exercise
• CPostpone exercise and refer to physician
• DAdminister rapid-acting insulin and begin exercise

Which exercise intensity has been shown to produce the greatest improvement in HbA1c in patients with Type 2 diabetes?

• ALow-intensity (<40% VO2R)
• BModerate to vigorous (50-75% VO2R)
• CMaximal effort only
• DIntensity does not matter

A patient with PAD reports leg claudication rated 3/4 (intense pain) during treadmill walking. Per ACSM Guidelines, the MOST appropriate action is:

• AStop exercise immediately and refer
• BContinue until pain reaches 4/4
• CStop, rest until pain subsides, then resume
• DReduce speed but continue walking through pain

Per ACSM, which of the following is an ABSOLUTE indication to terminate a symptom-limited exercise test?

• APatient requests to stop
• BDrop in systolic BP >10 mmHg with ischemic signs
• CModerate fatigue (RPE 14)
• DHeart rate 85% of age-predicted max

The Bruce treadmill protocol increases workload every:

• A1 minute
• B2 minutes
• C3 minutes
• D5 minutes

What is the approximate MET equivalent of Stage 3 of the standard Bruce protocol (3.4 mph, 14% grade)?

• A5 METs
• B7 METs
• C10 METs
• D13 METs

A patient recovering from a recent stroke begins outpatient exercise training. What is the PRIMARY resistance training goal in the early rehabilitation phase?

• AMaximize 1RM strength
• BImprove functional ADL performance and postural control
• CBuild hypertrophy
• DTrain for competitive sport

Which of the following is TRUE regarding exercise and cancer-related fatigue?

• ARest is the best treatment for cancer-related fatigue
• BExercise is contraindicated during chemotherapy
• CModerate aerobic and resistance exercise reduces cancer-related fatigue
• DExercise worsens fatigue in cancer survivors

A breast cancer survivor with stable lymphedema wants to begin resistance training. Per ACSM Guidelines, the recommended approach is:

• AAvoid upper body resistance training entirely
• BStart with low loads and progress slowly while monitoring symptoms
• COnly perform bodyweight exercises
• DMaintain a 10-pound upper body lifting limit indefinitely

Which of the following metabolic equations is used by ACSM to estimate VO2 for LEVEL walking between 1.9 and 3.7 mph?

• AVO2 = 3.5 + (0.1 x speed) + (1.8 x speed x grade)
• BVO2 = (0.2 x speed) + (0.9 x speed x grade) + 3.5
• CVO2 = 0.2 x speed + 3.5
• DVO2 = 1.8 x work rate / body mass + 7

A patient walks at 3.0 mph (80.4 m/min) on a treadmill at 5% grade. Using the ACSM walking equation, approximately what is their VO2?

• A11 mL/kg/min
• B18 mL/kg/min
• C25 mL/kg/min
• D32 mL/kg/min

For a CABG patient entering Phase II cardiac rehab, when can resistance training typically be initiated per ACSM Guidelines?

• AImmediately post-surgery
• B2-3 weeks post-surgery, light upper body only
• C5 weeks post-sternotomy with physician clearance
• DNever

Which sternal precaution is LEAST appropriate during the healing phase (first 6-8 weeks) after median sternotomy?

• AAvoid lifting >10 lb
• BAvoid pushing up from a chair using arms
• CAvoid overhead pressing
• DEncourage maximal shoulder flexion and abduction

What defines a hypertensive response during exercise testing per ACSM?

• ASBP > 180 mmHg at peak
• BSBP > 250 mmHg or DBP > 115 mmHg
• CSBP > 140 mmHg at rest
• DDBP > 90 mmHg at peak

Which chronic condition is associated with CHRONOTROPIC INCOMPETENCE during exercise?

• AWell-trained marathon runner
• BHeart failure and sick sinus syndrome
• CHealthy sedentary adult
• DUncontrolled hyperthyroidism

A patient with osteoporosis and a history of vertebral fracture asks about exercise. Which activity should be AVOIDED?

• AWeight-bearing walking
• BResistance training with proper form
• CSpinal flexion exercises (e.g., sit-ups)
• DBalance training

According to ACSM, the MINIMUM amount of moderate-intensity aerobic activity recommended for most adults is:

• A75 minutes per week
• B150 minutes per week
• C300 minutes per week
• D500 minutes per week

When using the FITT-VP principle for exercise prescription, what does the 'V' represent?

• AVelocity
• BVolume
• CVigor
• DVariability

For healthy adults, ACSM recommends resistance training at what percentage of 1RM to develop muscular strength?

• A20-40% 1RM
• B40-60% 1RM
• C60-80% 1RM (novice) / 80-100% (advanced)
• DOver 100% 1RM

What is the appropriate action if a cardiac rehab patient develops new 3 mm ST elevation during exercise?

• AContinue monitoring
• BStop exercise immediately, obtain 12-lead ECG, activate emergency protocol
• CReduce intensity by 20%
• DAdminister aspirin

A patient with a pacemaker has a programmed upper rate limit of 130 bpm. During exercise, the HR reaches 130 and plateaus. What is the MOST likely explanation?

• AThe pacemaker is malfunctioning
• BThe upper rate limit is limiting HR response
• CThe patient has atrial fibrillation
• DBeta-blocker effect

Which is the MOST appropriate method to prescribe exercise intensity for a patient with an implantable cardioverter-defibrillator (ICD)?

• AAge-predicted HRmax x 0.85
• BTarget HR at least 10 bpm below ICD detection threshold, using RPE
• CIgnore HR entirely
• DMaximum tolerated effort

Which of the following exercise modalities is MOST appropriate for a severely obese patient (BMI >40) with knee osteoarthritis?

• ATreadmill running
• BAquatic exercise and stationary cycling
• CStair-climbing
• DPlyometric training

What is the target range for weight loss through exercise plus caloric restriction per ACSM?

• A5-10% of initial body weight over 3-6 months
• B50% of initial body weight in 6 months
• C1% per week indefinitely
• DUnlimited rate is acceptable

Which of the following is CORRECT regarding RPE on the original Borg 6-20 scale during moderate-intensity exercise?

• ARPE 6-8 (very, very light)
• BRPE 12-13 (somewhat hard)
• CRPE 17-18 (very hard)
• DRPE 19-20 (maximal)

A patient with hypertrophic cardiomyopathy (HCM) asks about exercise. Per ACSM, the MOST appropriate recommendation is:

• ACompetitive sports are permitted at all levels
• BModerate low-intensity recreational exercise with individualized assessment by a cardiolo…
• CStrict bed rest
• DHigh-intensity interval training is recommended

During resistance exercise, a Valsalva maneuver causes which acute hemodynamic response?

• ADecreased intrathoracic pressure and decreased BP
• BIncreased intrathoracic pressure, transient BP spike, then reduced venous return
• CNo change in BP
• DImmediate sustained hypotension

For a patient with end-stage renal disease on hemodialysis, the BEST time to exercise is generally:

• AImmediately after dialysis
• BDuring the first 2 hours of dialysis
• CNot at all; exercise is contraindicated
• DOnly on non-dialysis days, morning

A patient reports experiencing a near-syncopal episode during yesterday's exercise session. What is the MOST appropriate clinical action today?

• AHave the patient exercise at reduced intensity
• BComplete a thorough evaluation (vitals, symptoms, medication review) and consult physicia…
• CDismiss as dehydration
• DIncrease intensity to test reserve

A patient's peak VO2 on a graded exercise test is 14 mL/kg/min. This is equivalent to approximately how many METs?

• A2 METs
• B4 METs
• C6 METs
• D10 METs

A patient with peripheral artery disease has an Ankle-Brachial Index (ABI) of 0.60. This is consistent with:

• ANormal
• BMild PAD
• CModerate PAD
• DSevere PAD

Which heart sound is MOST commonly associated with heart failure and LV dysfunction?

• AS1
• BS2
• CS3 gallop
• DS4 gallop

What is the recommended aerobic exercise training intensity (in terms of percent VO2R or HRR) for low-risk cardiac patients entering Phase II cardiac rehab?

• A10-20%
• B40-80%
• C85-100%
• DOnly use RPE, no percentage

The cold pressor test can be used during exercise testing to evaluate:

• AVO2 max
• BVasospastic angina
• CPulmonary function
• DLactate threshold

Which pre-exercise screening tool is most commonly used for health/fitness settings per ACSM Guidelines (11th ed.)?

• ABruce treadmill protocol
• BACSM pre-participation health screening algorithm
• C24-hour Holter monitor
• DEchocardiogram

What is the recommended intensity (as % of 1RM) for resistance training in older adults beginning a program?

• A10-20% 1RM
• B40-50% 1RM progressing to 60-80% 1RM
• C90-100% 1RM
• DAvoid resistance training in older adults