ACSM-EP Exam Flashcards

Q: What is the ACSM-EP exam pass rate?

ACSM's certification pass-rate page reports a 70% first-attempt pass rate for exam administrations from July-December 2025 (following an update to the content outline and professional standards), with a 53% repeat-attempt pass rate. ACSM does not publish an aggregate all-attempts rate.

Q: How many questions are on the ACSM-EP exam?

The ACSM-EP exam has 140 total items: 125 scored questions plus 15 unscored pretest items that don't count toward your score but are randomly interspersed and indistinguishable from scored questions. You have 210 minutes to complete the computer-based exam at a Pearson VUE test center or via online proctoring.

Q: What is the passing score for the ACSM-EP exam?

ACSM reports scores on a scaled 200-800 range, and you need a scaled score of 550 or higher to pass. This scaled-score system is used across all ACSM certification exams, so your practice-test percentage is a directional signal, not a literal predictor of your scaled result.

Q: What are the eligibility requirements for the ACSM-EP exam?

A minimum of a bachelor's degree in exercise science, exercise physiology, kinesiology, or a closely related field, plus current adult CPR/AED certification that includes a live, in-person skills check. Candidates must be at least 18 years old. ACSM has announced a First Aid certification requirement beginning in 2027.

Q: What happens if I fail the ACSM-EP exam?

You may retake the exam after a 15-day waiting period; each retest costs $235. If you fail a fourth attempt, ACSM requires a 12-month waiting period before you can test again.

Question 1

ACSM Preparticipation Screening Algorithm — Three Decision Points

Accepted Answer

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.

Question 2

'Active' — ACSM's Exact Definition

Accepted Answer

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.'

Question 3

Medical Clearance Rule for a Symptomatic Client

Accepted Answer

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.

Question 4

ACC/AHA Blood Pressure Classification

Accepted Answer

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.

Question 5

ADA Fasting Plasma Glucose Classification

Accepted Answer

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

Question 6

NCEP/ATP Cholesterol Classification

Accepted Answer

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).

Question 7

Claudication vs. Syncope vs. Ischemia

Accepted Answer

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.

Question 8

General Indications to Stop a Fitness Assessment

Accepted Answer

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.

Question 9

Standard Bruce Treadmill Protocol

Accepted Answer

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.

Question 10

Borg RPE Scale (6-20)

Accepted Answer

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.

Question 11

YMCA 3-Minute Step Test Protocol

Accepted Answer

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.

Question 12

Korotkoff Phases I and V

Accepted Answer

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

Question 13

Brzycki Equation for Estimated 1-RM

Accepted Answer

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.

Question 14

Sit-and-Reach Test — Why It's Norm-Referenced

Accepted Answer

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.

Question 15

Body Composition Method Accuracy Ranking

Accepted Answer

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.

Question 16

Waist Circumference & Waist-to-Hip Ratio Risk Thresholds

Accepted Answer

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.

Question 17

FITT-VP Framework — Six Components

Accepted Answer

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.

Question 18

ACSM Weekly Cardiorespiratory Exercise Target

Accepted Answer

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.

Question 19

ACSM Resistance Training Frequency for General Fitness

Accepted Answer

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.

Question 20

Reversibility (Detraining) Timeline

Accepted Answer

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.

Question 21

Karvonen (Heart Rate Reserve) Formula

Accepted Answer

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.

Question 22

%HRmax vs. HRR — Which Is More Accurate?

Accepted Answer

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.

Question 23

Prescribing Intensity for Clients on Beta-Blockers

Accepted Answer

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.

Question 24

1 MET — Definition and Value

Accepted Answer

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.

Question 25

ACSM Walking Metabolic Equation

Accepted Answer

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).

Question 26

ACSM Running Metabolic Equation

Accepted Answer

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.

Question 27

Resistance Training Load/Rep Zones by Goal

Accepted Answer

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.

Question 28

Reps-in-Reserve (RIR) to %1-RM Crosswalk

Accepted Answer

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.

Question 29

Valsalva Maneuver — Cardiovascular Risk

Accepted Answer

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.

Question 30

ACSM Flexibility Training FITT

Accepted Answer

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).

Question 31

PNF Stretching — Mechanism

Accepted Answer

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.

Question 32

Type 2 Diabetes — Blood Glucose Exercise Rules

Accepted Answer

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.

Question 33

COPD — Dyspnea-Guided Exercise Prescription

Accepted Answer

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.

Question 34

Osteoporosis — Contraindicated Movements

Accepted Answer

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.

Question 35

Exercise Prescription for Hypertension

Accepted Answer

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.

Question 36

Older Adults — Countering Sarcopenia

Accepted Answer

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.

Question 37

Knowledge of Results (KR) vs. Knowledge of Performance (KP)

Accepted Answer

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').

Question 38

Extrinsic vs. Intrinsic Cueing for Motor Learning

Accepted Answer

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.

Question 39

Transtheoretical Model — Five Stages of Change

Accepted Answer

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.

Question 40

Health Belief Model — Key Constructs

Accepted Answer

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.

Question 41

Social Cognitive Theory — Strongest Source of Self-Efficacy

Accepted Answer

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.

Question 42

Theory of Planned Behavior — What Predicts Intention

Accepted Answer

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.

Question 43

Self-Determination Theory — Three Psychological Needs

Accepted Answer

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.

Question 44

OARS — The Four Core Motivational Interviewing Skills

Accepted Answer

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').

Question 45

SMART Goals

Accepted Answer

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.

Question 46

Abstinence Violation Effect

Accepted Answer

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.

Question 47

Four Elements of a Negligence Claim

Accepted Answer

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.

Question 48

What a Signed Waiver of Liability Does NOT Protect Against

Accepted Answer

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.

Question 49

Adult CPR — Current AHA Compression Standards

Accepted Answer

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.

Question 50

Written Emergency Action Plan (EAP) — Completeness Requirement

Accepted Answer

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.

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