ACSM-EP Health Appraisal & Risk Assessment 5 — Questions and Answers
Question 1: Which of the following absolute contraindications to exercise testing would require postponing a graded exercise test?
- Controlled hypertension (BP 140/90 mmHg)
- Unstable angina with recent change in symptom pattern (Correct answer)
- Mild aortic stenosis with no symptoms
- Controlled type 2 diabetes mellitus
Correct answer: Unstable angina with recent change in symptom pattern
Unstable angina is an absolute contraindication to exercise testing per ACSM, as it indicates an active ischemic event with unpredictable risk.
Question 2: A client's LDL cholesterol is reported as 145 mg/dL. According to ACSM CVD risk factor thresholds, how is this classified?
- A negative (protective) risk factor
- A positive CVD risk factor (Correct answer)
- Within the normal, non-risk range
- Only a risk factor if HDL is also low
Correct answer: A positive CVD risk factor
LDL-C ≥ 130 mg/dL is an ACSM positive CVD risk factor threshold; a value of 145 mg/dL exceeds this threshold.
Question 3: When conducting a health appraisal for an older adult (age 75), which assessment would be MOST critical to include beyond standard CVD risk screening?
- VO2max estimation via field test
- Functional independence, fall risk, and polypharmacy review (Correct answer)
- Maximal anaerobic power assessment
- Body fat percentage via hydrostatic weighing
Correct answer: Functional independence, fall risk, and polypharmacy review
In older adults, assessing functional independence, fall risk, and medication interactions (polypharmacy) is essential because these factors directly impact safe exercise participation.
Question 4: A client taking a calcium channel blocker for hypertension presents for exercise testing. Which hemodynamic response should the exercise physiologist anticipate during testing?
- Exaggerated heart rate increase with exercise
- Blunted blood pressure response and potential reflex tachycardia (Correct answer)
- Significantly reduced oxygen consumption at all workloads
- No difference in heart rate or blood pressure response versus non-medicated individuals
Correct answer: Blunted blood pressure response and potential reflex tachycardia
Calcium channel blockers reduce peripheral vascular resistance, blunting the normal blood pressure rise during exercise and sometimes causing reflex tachycardia.
Question 5: According to ACSM, which of the following symptoms would constitute an indication to STOP an exercise test immediately?
- Heart rate increase of 10 bpm per MET
- ST-segment depression of 0.5 mm in the absence of other symptoms
- Systolic blood pressure drop of > 10 mmHg from baseline with increasing workload (Correct answer)
- Mild dyspnea appropriate to exercise intensity
Correct answer: Systolic blood pressure drop of > 10 mmHg from baseline with increasing workload
A systolic BP drop > 10 mmHg from baseline (exertional hypotension) during increasing workload is an ACSM indication to stop the exercise test, as it suggests cardiovascular compromise.
Question 6: A health appraisal reveals a client smokes 1 pack of cigarettes per day. Under ACSM risk factor criteria, cigarette smoking is considered a positive CVD risk factor if the client:
- Has smoked for more than 10 years regardless of current status
- Currently smokes or quit within the past 6 months (Correct answer)
- Smokes more than 10 cigarettes per day
- Has any history of smoking at any point in their lifetime
Correct answer: Currently smokes or quit within the past 6 months
ACSM defines cigarette smoking as a positive CVD risk factor for current smokers or those who quit within the previous 6 months.
Question 7: During a health appraisal, a client reports a sedentary lifestyle. According to ACSM, physical inactivity is defined as a positive CVD risk factor when the client:
- Does not participate in any recreational sports or activities
- Does not meet the minimum of 30 minutes of moderate-intensity exercise on most days of the week (Correct answer)
- Exercises fewer than 5 days per week at any intensity
- Has not exercised vigorously in the past year
Correct answer: Does not meet the minimum of 30 minutes of moderate-intensity exercise on most days of the week
ACSM defines sedentary lifestyle as a positive CVD risk factor when the client does not participate in at least 30 minutes of moderate-intensity physical activity on most (≥3) days per week.
ACSM-EP Health Appraisal & Risk Assessment 5
Which of the following absolute contraindications to exercise testing would require postponing a graded exercise test?