Free ACSM-EP Exam Flashcards

The current ACSM algorithm classifies every client using only three questions: (1) current activity status (active vs. inactive), (2) known disease/major signs-symptoms status, and (3) desired exercise intensity (light-to-moderate vs. vigorous). It replaced the older risk-factor-counting/stratification model, which is retired.

Planned, structured physical activity performed at moderate intensity for at least 30 minutes on at least 3 days per week for at least the preceding 3 months. Anything less is classified as 'inactive.'

Any client with major signs or symptoms suggestive of cardiovascular, pulmonary, or metabolic disease (e.g., chest discomfort, syncope, claudication, orthopnea) needs medical clearance before starting or continuing exercise — regardless of current activity status or desired intensity.

Normal: <120/<80 mmHg. Elevated: 120-129/<80. Stage 1 Hypertension: 130-139 systolic OR 80-89 diastolic. Stage 2 Hypertension: ≥140 systolic OR ≥90 diastolic. Classification always uses whichever value (systolic or diastolic) triggers the higher-severity category.

Normal: <100 mg/dL. Prediabetes (impaired fasting glucose): 100-125 mg/dL. Diabetes: ≥126 mg/dL.

Total cholesterol: desirable <200, borderline high 200-239, high ≥240 mg/dL. HDL-C runs opposite the other lipids: <40 mg/dL is a risk factor (low), while ≥60 mg/dL is protective (high).

Claudication: exercise-induced cramping/aching leg pain relieved by rest (from inadequate blood flow). Syncope: temporary loss of consciousness from inadequate cerebral blood flow (fainting). Ischemia: inadequate blood/oxygen supply to a tissue, most often the myocardium during exertion.

Stop immediately for: onset of angina/chest discomfort; a systolic BP drop of ≥10 mmHg with increasing workload; systolic BP >250 mmHg or diastolic >115 mmHg; dizziness, confusion, ataxia, pallor, or cyanosis; a client's request to stop (always honored); or equipment failure.

Seven sequential 3-minute stages that increase speed and grade together, starting at 1.7 mph/10% grade (Stage 1) and ending at 6.0 mph/22% grade (Stage 7). The Modified Bruce protocol adds two lower-intensity stages before Stage 1 for deconditioned or higher-risk clients.

Runs from 6 (no exertion) to 20 (maximal exertion), anchored so that RPE × 10 approximates heart rate in an average adult. Key anchors: 11 = light, 13 = somewhat hard, 15 = hard, 17 = very hard.

Client steps on a 12-inch bench at a fixed cadence of 24 steps/min (metronome 96 beats/min) for exactly 3 minutes, then sits; recovery heart rate is counted for a full 1 minute beginning 5 seconds after stepping stops. A lower recovery HR indicates better cardiorespiratory fitness.

Phase I (first clear tapping sound) marks systolic blood pressure. Phase V (complete disappearance of sounds) marks diastolic blood pressure in standard adult auscultation.

1-RM = weight lifted ÷ (1.0278 − 0.0278 × repetitions completed). Estimates 1-RM from a submaximal set of 2-10 repetitions performed to fatigue, avoiding the injury risk and time cost of a true maximal single-rep attempt. Most accurate at ≤10 reps.

The sit-and-reach test measures hamstring and lower-back flexibility, but reach distance is also influenced by the ratio of limb length to trunk length, not flexibility alone. Results are interpreted against age- and sex-specific normative tables rather than treated as a stand-alone absolute score.

DEXA has the lowest error (~1.5-2% body fat) because it distinguishes fat, lean, and bone via differential X-ray attenuation. Skinfolds and bioelectrical impedance (BIA) carry larger error (~3.5-5%): skinfolds are technician-dependent, BIA is confounded by hydration status.

Increased disease risk: waist circumference >102 cm (40 in) in men, >88 cm (35 in) in women. Substantially increased risk: waist-to-hip ratio ≥0.90 in men, ≥0.85 in women. These add risk information beyond BMI alone because fat distribution matters independently of total body fat.

Frequency (sessions/week), Intensity (how hard), Time (duration/session), Type (mode), Volume (total dose = frequency × intensity × time), and Progression (how variables advance as the client adapts). Organizes every ACSM exercise prescription.

At least 150 minutes/week of moderate-intensity exercise (40-59% HRR/VO2R), OR 75 minutes/week of vigorous-intensity exercise (60-89% HRR/VO2R), or an equivalent combination, for apparently healthy adults.

Train each major muscle group on at least 2 non-consecutive days per week, using 1-3 sets of 8-12 repetitions per exercise as the general novice-to-intermediate guideline.

Cardiorespiratory fitness (VO2max) begins measurably declining within roughly 2-3 weeks of inactivity; measurable strength loss typically emerges closer to 4 weeks. A returning client should resume training at reduced intensity/volume, not at the prior program level.

Target HR = [(HRmax − HRrest) × %intensity] + HRrest. Correlates ~1:1 with %VO2R, making it ACSM's preferred intensity-prescription method when an accurate HRmax and resting HR are available.

HRR (Karvonen) is more accurate because it accounts for resting heart rate. %HRmax (Target HR = HRmax × %intensity) is simpler but systematically overestimates true relative exercise intensity, especially at lower intensities, because it ignores resting HR.

Beta-blockers (and non-dihydropyridine calcium channel blockers) blunt the heart-rate response to exercise, invalidating HRR- and %HRmax-based methods. RPE becomes the preferred — sometimes the only valid — intensity-prescription method for these clients.

1 MET = 3.5 mL O2 · kg⁻¹ · min⁻¹, the approximate oxygen cost of resting metabolism. METs = relative VO2 (mL·kg⁻¹·min⁻¹) ÷ 3.5.

VO2 (mL·kg⁻¹·min⁻¹) = (0.1 × speed) + (1.8 × speed × grade) + 3.5, with speed converted from mph to m·min⁻¹ (× 26.8) before use. Valid for 1.9-3.7 mph. The +3.5 term is resting VO2 (1 MET).

VO2 (mL·kg⁻¹·min⁻¹) = (0.2 × speed) + (0.9 × speed × grade) + 3.5, with speed in m·min⁻¹. Valid above 5.0 mph (or above roughly 3.0 mph if jogging). Larger coefficients than the walking equation reflect running's higher oxygen cost per unit of speed.

Strength: 60-100% 1-RM, 3-8 reps, 2-4 sets, 2-3 min rest. Hypertrophy: 70-85% 1-RM, 8-12 reps, 3-4 sets, 1-2 min rest. Muscular endurance: <50-70% 1-RM, 15-25+ reps, 2-3 sets, <1 min rest.

RIR = how many more reps could be performed before failure (0 RIR = failure). An RIR of 1-2 corresponds to roughly 85-90% of 1-RM; an RIR of 4-5 corresponds to roughly 70-75% of 1-RM.

Forced exhalation against a closed glottis during heavy lifting causes an acute BP spike, then a fall in venous return/cardiac output, then a rebound overshoot on release — risking dizziness, syncope, or arrhythmia. A specific caution for clients with hypertension or cardiovascular disease; coach exhaling on exertion instead of breath-holding.

At least 2-3 days/week (daily is optimal). Stretch to the point of tightness or mild discomfort, never pain. Hold static stretches 10-30 seconds for 2-4 repetitions per muscle group (~60 seconds total stretch time).

Uses a contract-relax technique: an isometric contraction of the target muscle triggers the Golgi tendon organ, producing autogenic inhibition (reflexive relaxation) that allows a deeper stretch immediately afterward. Typically produces the greatest single-session range-of-motion gain of any stretching method.

Pre-exercise glucose >250 mg/dL with moderate-to-high ketones: do not exercise, treat first. Glucose <70 mg/dL (hypoglycemia): Rule of 15 — 15 g fast-acting carbohydrate, wait 15 minutes, recheck. Clients should not go more than 2 consecutive days without activity, since insulin-sensitivity gains fade within 24-72 hours.

Because COPD clients are limited by ventilatory capacity rather than cardiac output, intensity is guided by a dyspnea scale (modified Borg CR-10 or mMRC) rather than a fixed %HRR. Pursed-lip breathing — inhale through the nose, then exhale through pursed lips for about twice the inhalation time — splints the airways open and reduces air trapping and dyspnea.

Avoid unsupported spinal flexion (sit-ups, crunches, toe touches), combined flexion + rotation (twisting), and high-impact loading (running, jumping) in clients at high fracture risk — these load the vertebrae in ways associated with compression fracture. Weight-bearing aerobic activity plus progressive resistance training instead builds bone mineral density.

Aerobic exercise is the first-line modality: regular aerobic training lowers resting BP by roughly 5-7 mmHg, with lower-to-moderate intensity as effective as higher intensity. Resistance training should avoid heavy loads and sustained isometric holds, and clients must avoid the Valsalva maneuver. Refer back to the physician at resting BP ≥180/110 mmHg.

Sarcopenia reduces muscle mass by roughly 1-2% per year beginning in the fourth decade, with strength loss outpacing mass loss. Resistance training at least 2 days/week is the single most effective countermeasure, improving strength, cross-sectional area, and functional task performance even when begun late in life.

KR is feedback about the outcome of an attempt (e.g., 'you held that plank for 45 seconds'). KP is feedback about the quality or mechanics of the movement itself (e.g., 'your hips dropped at the 30-second mark').

Extrinsic (external-focus) cues direct attention to the movement's effect or an external target (e.g., 'push the floor away'). Intrinsic (internal-focus) cues direct attention to the body itself (e.g., 'squeeze your glutes'). Motor-learning research generally favors extrinsic cueing for skill acquisition and movement efficiency.

Precontemplation (no intention to change in 6 months) → Contemplation (intends to change within 6 months) → Preparation (intends to act within 30 days) → Action (changed behavior <6 months) → Maintenance (sustained behavior 6+ months). Clients can move backward (relapse) as well as forward.

Predicts health behavior from perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. A client is most likely to act when perceived benefits and self-efficacy are high and perceived barriers are low.

Bandura's Social Cognitive Theory centers on self-efficacy, built from four sources in descending order of strength: mastery experiences (past personal success), vicarious experiences (watching similar others succeed), verbal persuasion, and physiological/emotional states.

Intention — the strongest single predictor of actual behavior — is predicted by three factors: attitude toward the behavior, subjective norm (do important others approve?), and perceived behavioral control.

Autonomy, competence, and relatedness are the three psychological needs that sustain intrinsic motivation (engaging in exercise for its own inherent satisfaction) and long-term adherence.

Open-ended questions, Affirmations, Reflective listening, and Summaries. Motivational interviewing is a client-centered counseling style that elicits the client's own 'change talk' rather than arguing the client into change (avoiding the 'righting reflex').

Specific, Measurable, Attainable, Relevant, Time-bound. Short-term process goals (behaviors within the client's control) build self-efficacy through frequent mastery experiences and should be emphasized early in a program, alongside longer-term outcome goals.

A single missed session escalates into full relapse when the client reframes the lapse as total failure rather than a normal, expected setback. Relapse-prevention planning identifies high-risk situations in advance and builds coping plans to prevent this spiral.

Duty (the EP-C owed the client a professional duty of care), Breach (conduct fell below the accepted standard of care), Causation (the breach directly caused the injury), and Damages (the client suffered actual, measurable harm). All four must be proven together.

A waiver documents that a client voluntarily accepted the inherent risks of exercise, but it does not protect an EP-C from claims of gross negligence or reckless conduct, and it does not replace the informed-consent process.

Rate: 100-120 compressions/minute. Depth: at least 2 in (5 cm), avoiding depths greater than 2.4 in (6 cm). Compression-to-ventilation ratio: 30:2 for single-rescuer or two-rescuer CPR without an advanced airway. Allow complete chest recoil between compressions.

An EAP is only considered complete when it is posted in visible locations throughout the facility AND physically rehearsed through periodic drills — not simply written and filed away. An untested plan functions like no plan at all in an actual emergency.