ACSM-EP Clinical Exercise Testing 2 — Questions and Answers
Question 1: Which absolute contraindication requires immediate termination of a graded exercise test?
- Systolic BP drop >10 mmHg from baseline with increasing workload (Correct answer)
- Subject requests to stop
- HR exceeds 85% of age-predicted maximum
- Rating of perceived exertion reaches 17
Correct answer: Systolic BP drop >10 mmHg from baseline with increasing workload
A drop in systolic BP of >10 mmHg from baseline despite increasing workload is an absolute indication to stop the test due to risk of cardiovascular collapse.
Question 2: During a maximal GXT, a patient develops ST-segment depression of 3 mm at 70% of predicted max HR. What is the most appropriate action?
- Increase workload as planned
- Slow the treadmill belt only
- Terminate the test immediately (Correct answer)
- Continue and recheck ECG in 2 minutes
Correct answer: Terminate the test immediately
ST depression ≥2 mm is an absolute indication to stop the test because it suggests significant myocardial ischemia.
Question 3: What is the primary purpose of a cool-down period following a maximal exercise test?
- To allow lactic acid to fully clear before discharge
- To prevent venous pooling and reduce risk of post-exercise hypotension (Correct answer)
- To normalize respiratory rate before ECG interpretation
- To obtain a final RPE measurement
Correct answer: To prevent venous pooling and reduce risk of post-exercise hypotension
Active cool-down maintains venous return via muscle pump action, preventing the venous pooling that can cause orthostatic hypotension after exercise ceases.
Question 4: In the Bruce treadmill protocol, how do workload increments change between stages?
- Speed increases by 0.5 mph each stage while grade stays constant
- Both speed and grade increase simultaneously every 3 minutes (Correct answer)
- Grade increases by 2% each stage while speed stays constant
- Speed increases by 1 mph every 2 minutes
Correct answer: Both speed and grade increase simultaneously every 3 minutes
The Bruce protocol increases both treadmill speed and percent grade simultaneously at each 3-minute stage.
Question 5: Which spirometry value is most useful for detecting obstructive pulmonary disease before an exercise test?
- Total lung capacity (TLC)
- FEV1/FVC ratio (Correct answer)
- Tidal volume at rest
- Peak expiratory flow rate during exercise
Correct answer: FEV1/FVC ratio
A reduced FEV1/FVC ratio (<0.70) is the hallmark diagnostic criterion for airflow obstruction in conditions like COPD and asthma.
Question 6: A patient's VO2 at ventilatory threshold is 22 mL/kg/min. This value is best used to:
- Estimate maximal cardiac output
- Set upper intensity boundary for aerobic exercise prescription (Correct answer)
- Determine anaerobic enzyme capacity
- Calculate resting metabolic rate
Correct answer: Set upper intensity boundary for aerobic exercise prescription
The ventilatory threshold (VT) represents the upper limit of sustainable aerobic exercise and is used to set the top of the target training zone.
Question 7: During a submaximal cycle ergometer test, heart rate is 148 bpm at 150 W. The next stage raises power to 200 W, and HR climbs to 163 bpm. Which assumption underlies VO2max extrapolation from these data?
- VO2 and HR increase linearly with workload up to maximum (Correct answer)
- Oxygen pulse remains constant across intensities
- Mechanical efficiency decreases at higher wattages
- Respiratory exchange ratio equals 1.0 at all submaximal stages
Correct answer: VO2 and HR increase linearly with workload up to maximum
Submaximal extrapolation methods assume a linear HR–VO2 relationship that continues to predicted maximum heart rate.
ACSM-EP Clinical Exercise Testing 2
Which absolute contraindication requires immediate termination of a graded exercise test?