ACSM-EP Safety & Risk Management — Questions and Answers
Question 1: A client collapses during a session, is unresponsive, and is not breathing normally. What is the exercise physiologist's FIRST priority?
- Check the client's blood pressure
- Activate the emergency response system and begin CPR, using an AED as soon as available (Correct answer)
- Move the client to a cool area and wait for recovery
- Call the client's personal physician
Correct answer: Activate the emergency response system and begin CPR, using an AED as soon as available
Unresponsiveness without normal breathing requires immediate activation of emergency response, CPR, and early AED use.
A collapsed client who is unresponsive and not breathing normally is presumed to be in cardiac arrest. The facility emergency action plan should be activated immediately (call EMS, send someone for the AED) and chest compressions started without delay. Taking blood pressure, waiting for recovery, or calling a personal physician all waste critical minutes. ACSM and AHA stress a written, rehearsed emergency plan and trained staff certified in CPR/AED.
Question 2: A 35-year-old inactive client has no symptoms and no known cardiovascular, metabolic, or renal disease. Under the ACSM preparticipation screening algorithm, what is the recommendation before starting light-to-moderate exercise?
- Graded exercise test with ECG
- Physician clearance letter
- Cardiology referral
- Medical clearance is not necessary; begin gradually and progress (Correct answer)
Correct answer: Medical clearance is not necessary; begin gradually and progress
An asymptomatic person with no known CVD, metabolic, or renal disease may begin light-to-moderate exercise without medical clearance.
The current ACSM algorithm screens first for current exercise habits, known CVD/metabolic/renal disease, and signs or symptoms. This client is inactive but has no disease and no symptoms, so medical clearance is not required for light-to-moderate intensity exercise, and progression should be gradual. A GXT is not required for screening. Medical clearance is recommended when an inactive person with known disease or symptoms wants to start, or when a regular exerciser with disease develops symptoms.
Question 3: Which set of records is MOST important to maintain to limit liability and demonstrate professional standard of care?
- Marketing preferences and social media posts
- Equipment purchase receipts
- Signed informed consent, screening results, and incident reports (Correct answer)
- Staff holiday schedules
Correct answer: Signed informed consent, screening results, and incident reports
Informed consent, screening results, and incident reports document that proper risk management and standard of care were followed.
Signed informed consent shows the client understood the risks, screening and health history documents show appropriate risk assessment, and incident reports record events and responses. Along with emergency plan drills and staff certifications, these form the core legal documentation for exercise professionals. Marketing, receipts, and schedules do not establish standard of care. Records should be stored confidentially in compliance with privacy law such as HIPAA.
Question 4: A client with type 1 diabetes becomes shaky, sweaty, and confused during moderate exercise. What is the best immediate action?
- Give 15 to 20 g of fast-acting carbohydrate and recheck blood glucose after about 15 minutes (Correct answer)
- Encourage the client to continue and cool down slowly
- Give only water and resume exercise
- Have the client inject extra insulin
Correct answer: Give 15 to 20 g of fast-acting carbohydrate and recheck blood glucose after about 15 minutes
These symptoms suggest hypoglycemia, treated by stopping exercise and giving 15 to 20 g of fast-acting carbohydrate, then rechecking glucose.
Shakiness, sweating, and confusion indicate probable hypoglycemia. The standard response is to stop exercise, give 15 to 20 g of fast-acting carbohydrate such as glucose tablets or juice, and recheck glucose in about 15 minutes, repeating if still below 70 mg/dL. Continuing exercise or giving only water would worsen the episode, and extra insulin would lower glucose further and could be dangerous. If the client becomes unresponsive, emergency services should be activated.
Question 5: According to AHA/ACSM recommendations, defibrillation should ideally occur within what time after sudden cardiac arrest in a fitness facility?
- 10 to 15 minutes
- 20 minutes or after EMS arrives
- 3 to 5 minutes (Correct answer)
- Within 1 hour
Correct answer: 3 to 5 minutes
Survival is highest when defibrillation occurs within 3 to 5 minutes of collapse.
AHA/ACSM guidance for health and fitness facilities recommends an emergency plan and AED access that allows defibrillation within 3 to 5 minutes of collapse. Survival from ventricular fibrillation falls by roughly 7 to 10 percent for each minute without defibrillation. Waiting for EMS often takes longer than 5 minutes, so on-site AEDs and trained staff are essential. This is why regular drills of the emergency action plan are important.
Question 6: Which resting blood pressure is a relative contraindication to a graded exercise test?
- 130/85 mmHg
- 140/90 mmHg
- 150/95 mmHg
- Resting systolic above 200 mmHg or diastolic above 110 mmHg (Correct answer)
Correct answer: Resting systolic above 200 mmHg or diastolic above 110 mmHg
Resting SBP above 200 mmHg or DBP above 110 mmHg is a relative contraindication to exercise testing.
ACSM lists resting SBP >200 mmHg or DBP >110 mmHg as a relative contraindication to exercise testing; the test may proceed only if benefits outweigh risks and with physician input. Values of 130/85, 140/90, and 150/95 are elevated or stage 1 to 2 hypertension but do not preclude testing. Absolute contraindications, such as unstable angina, are different and require postponing the test.
