ACSM-EP Exercise Testing & Prescription 4 — Questions and Answers
Question 1: A client with type 2 diabetes wishes to begin a vigorous aerobic program. Beyond standard pre-participation screening, the EP should specifically monitor for:
- Elevated HDL cholesterol during exercise
- Hypoglycemia and peripheral neuropathy-related foot injuries (Correct answer)
- Hyper-hydration from excessive fluid intake
- Rhabdomyolysis from moderate cycling
Correct answer: Hypoglycemia and peripheral neuropathy-related foot injuries
People with T2D are at risk for exercise-induced hypoglycemia (especially if on insulin/secretagogues) and foot injuries due to peripheral neuropathy reducing protective sensation.
Question 2: Which parameter is calculated by dividing oxygen consumption by the work rate (W) and represents the mechanical efficiency of the cardiovascular-pulmonary system?
- Ventilatory equivalent (VE/VO2)
- O2 pulse (VO2/HR) (Correct answer)
- Respiratory exchange ratio (RER)
- Oxygen uptake efficiency slope (OUES)
Correct answer: O2 pulse (VO2/HR)
O2 pulse (VO2 ÷ HR) reflects stroke volume × arteriovenous O2 difference and is a surrogate for cardiac stroke volume during exercise testing.
Question 3: A 40-year-old female client has a resting BP of 138/88 mmHg. According to the 2017 ACC/AHA guidelines adopted by ACSM, she is classified as:
- Normal
- Elevated
- Stage 1 hypertension (Correct answer)
- Stage 2 hypertension
Correct answer: Stage 1 hypertension
Under the 2017 ACC/AHA classification, a BP of 130–139/80–89 mmHg is Stage 1 hypertension; 138/88 falls squarely in this category.
Question 4: During maximal exercise testing, the respiratory exchange ratio (RER) value that typically confirms maximal effort has been achieved is:
- ≥ 0.85
- ≥ 0.90
- ≥ 1.00
- ≥ 1.10 (Correct answer)
Correct answer: ≥ 1.10
An RER ≥ 1.10 at peak exercise is a strong indicator of maximal effort, as excess CO2 production from bicarbonate buffering drives RER above 1.0.
Question 5: For a client performing aquatic exercise, which adjustment should the EP make when prescribing intensity using heart rate?
- Add 10–15 bpm to land-based targets to account for increased buoyancy
- Subtract 10–17 bpm from land-based targets due to hydrostatic pressure and cooling (Correct answer)
- Use the same HR targets as land-based exercise without adjustment
- Double the RPE target because water resistance overestimates effort
Correct answer: Subtract 10–17 bpm from land-based targets due to hydrostatic pressure and cooling
Aquatic exercise HR is typically 10–17 bpm lower than equivalent land-based exercise due to hydrostatic pressure increasing venous return, horizontal position, and water's cooling effect.
Question 6: The ACSM recommends that neuromotor (functional fitness) exercise be performed on how many days per week for older adults?
- 1 day/week
- 2–3 days/week (Correct answer)
- 4–5 days/week
- Every day
Correct answer: 2–3 days/week
ACSM recommends neuromotor/functional fitness exercises (balance, agility, coordination, proprioception) ≥2–3 days/week for older adults.
Question 7: During a graded exercise test, ST-segment depression is most clinically significant when it is:
- Upsloping and ≥ 0.5 mm at the J-point
- Horizontal or downsloping and ≥ 1 mm at 60–80 ms post J-point (Correct answer)
- Upsloping and ≥ 2 mm at 80 ms post J-point
- Horizontal and < 0.5 mm at the J-point
Correct answer: Horizontal or downsloping and ≥ 1 mm at 60–80 ms post J-point
Horizontal or downsloping ST depression ≥1 mm measured 60–80 ms after the J-point is the classic positive ischemic response during GXT.
ACSM-EP Exercise Testing & Prescription 4
A client with type 2 diabetes wishes to begin a vigorous aerobic program.
Beyond standard pre-participation screening, the EP should specifically monitor for: