ACSM-EP Exercise Testing & Prescription — Questions and Answers
Question 1: A 58-year-old man scheduled for a graded exercise test reports that he had an acute myocardial infarction 36 hours ago. Which statement is correct?
- The test may proceed if resting blood pressure is below 140/90 mm Hg
- The test may proceed with continuous ECG monitoring only
- Exercise testing is absolutely contraindicated and the test must be postponed (Correct answer)
- The test may proceed at a submaximal workload only
Correct answer: Exercise testing is absolutely contraindicated and the test must be postponed
An acute myocardial infarction within the past 2 days is an absolute contraindication to exercise testing.
ACSM lists acute MI (within 2 days), ongoing unstable angina, uncontrolled arrhythmia with hemodynamic compromise, active endocarditis, symptomatic severe aortic stenosis, uncontrolled symptomatic heart failure, acute pulmonary embolism, acute myocarditis or pericarditis, and acute aortic dissection as absolute contraindications. These conditions mean the risk of testing outweighs any benefit, so the test is postponed until the person is medically stable. Limiting the workload or adding ECG monitoring does not remove the risk. Relative contraindications, such as resting hypertension above 200/110 mm Hg, may be overridden when benefits outweigh risks.
Question 2: A 45-year-old client has a resting heart rate of 70 bpm. Using the heart rate reserve method with an age-predicted HRmax of 220 minus age, what is the target heart rate at 60% intensity?
- 63 bpm
- 105 bpm
- 133 bpm (Correct answer)
- 143 bpm
Correct answer: 133 bpm
HRmax = 220 - 45 = 175; HRR = 175 - 70 = 105; target HR = 0.60 x 105 + 70 = 133 bpm.
The HRR (Karvonen) method is: target HR = %intensity x (HRmax - HRrest) + HRrest. Here HRmax = 220 - 45 = 175 bpm and HRR = 175 - 70 = 105 bpm. 60% of 105 is 63 bpm, and adding resting HR gives 63 + 70 = 133 bpm. Answering 63 forgets to add HRrest, 105 is simply the reserve, and 143 would be the target at 70% intensity (0.70 x 105 + 70 = 143.5).
Question 3: A client exercising on a treadmill rates her exertion as 13 ('somewhat hard') on the Borg 6-20 RPE scale. According to ACSM, which intensity category does this represent?
- Light intensity
- Vigorous intensity
- Near-maximal intensity
- Moderate intensity (Correct answer)
Correct answer: Moderate intensity
On the 6-20 Borg scale, RPE 12-13 corresponds to moderate intensity.
ACSM classifies RPE on the 6-20 scale as light (about 9-11), moderate (12-13), vigorous (14-17), and near-maximal to maximal (18 or higher). A rating of 13 therefore falls in the moderate range, which corresponds to roughly 40 to less than 60% HRR or VO2R. RPE is a subjective tool used with, not instead of, heart rate and is especially helpful for clients on beta-blockers whose heart rate response is blunted. The 6-20 scale was designed so that RPE x 10 approximates exercise heart rate in healthy young adults.
Question 4: Which weekly plan meets the minimum ACSM aerobic exercise recommendation for a healthy adult?
- Three sessions of 20 minutes of vigorous-intensity exercise
- Seven sessions of 10 minutes of light-intensity walking
- Five sessions of 30 minutes of moderate-intensity exercise (Correct answer)
- Four sessions of 15 minutes of moderate-intensity exercise
Correct answer: Five sessions of 30 minutes of moderate-intensity exercise
Five 30-minute moderate sessions total 150 minutes per week, which meets the ACSM minimum of at least 150 minutes of moderate-intensity activity.
ACSM recommends at least 150 min/week of moderate-intensity, or at least 75 min/week of vigorous-intensity, aerobic exercise (or an equivalent combination), spread over 3 or more days. Five 30-minute moderate sessions equal 150 minutes. Three 20-minute vigorous sessions equal only 60 vigorous minutes, below the 75-minute minimum. Four 15-minute moderate sessions equal 60 minutes and seven 10-minute light walks equal 70 minutes of light activity, which do not meet the target.
Question 5: Which assumption underlies the estimation of VO2max from a submaximal exercise test?
- Heart rate and workload are linearly related, and age-predicted HRmax is accurate for the individual (Correct answer)
- Blood lactate rises linearly with workload in all individuals
- Mechanical efficiency varies widely between individuals at a given workload
- Resting heart rate equals the heart rate at the ventilatory threshold
Correct answer: Heart rate and workload are linearly related, and age-predicted HRmax is accurate for the individual
Submaximal tests extrapolate the linear heart rate-workload relationship to an assumed (age-predicted) HRmax.
Submaximal tests assume a steady-state heart rate at each workload, a linear relationship between heart rate and workload, an accurate age-predicted maximal heart rate, and a consistent mechanical efficiency (VO2 at a given workload) across people. Because HRmax can vary by about plus or minus 10 bpm from the 220 minus age estimate, VO2max predictions carry a standard error of about 10-20%. Medications such as beta-blockers, anxiety, caffeine, and dehydration violate these assumptions and bias the estimate.
Question 6: During a graded exercise test, which finding is an ACSM indication to terminate the test?
- Systolic blood pressure of 190 mm Hg at a high workload
- A drop in systolic blood pressure of more than 10 mm Hg despite an increase in workload (Correct answer)
- RPE of 13 on the 6-20 scale
- Heart rate increasing linearly with workload
Correct answer: A drop in systolic blood pressure of more than 10 mm Hg despite an increase in workload
A fall in systolic pressure of more than 10 mm Hg with increasing workload is an indication to stop the test.
ACSM termination criteria include a drop in SBP of more than 10 mm Hg with increasing workload (especially with other evidence of ischemia), angina, signs of poor perfusion, SBP above 250 or DBP above 115 mm Hg, serious arrhythmias, ST elevation, and the participant's request. An SBP of 190 mm Hg at high workload is an expected rise and a linear heart rate rise is normal. An RPE of 13 is only moderate effort, while termination is considered at an RPE near 19-20. A falling SBP suggests the heart cannot increase output, a sign of severe ventricular dysfunction or ischemia.
Question 7: A sedentary, asymptomatic 55-year-old man with known type 2 diabetes wants to begin a moderate-intensity walking program. According to the ACSM preparticipation screening algorithm, what should the exercise professional recommend?
- Begin immediately because he has no signs or symptoms
- Obtain medical clearance before starting, because he has a known metabolic disease and does not exercise regularly (Correct answer)
- Complete a maximal graded exercise test with ECG before any activity
- Begin only light-intensity exercise without any medical input
Correct answer: Obtain medical clearance before starting, because he has a known metabolic disease and does not exercise regularly
Inactive individuals with known metabolic disease should obtain medical clearance before starting exercise, even without symptoms.
The current ACSM algorithm screens first for regular exercise participation, then for known cardiovascular, metabolic, or renal disease, and then for signs or symptoms. A person who does not exercise regularly and has known metabolic disease such as diabetes should receive medical clearance before starting, even if asymptomatic. Individuals without known disease or symptoms who are inactive may begin light-to-moderate exercise without clearance. A maximal GXT is not required for clearance in this situation.
Question 8: A client trains each major muscle group three days per week using a full-body routine. According to ACSM, what is the minimum recovery between sessions that train the same muscle group?
- 12 hours
- 24 hours
- 48 hours (Correct answer)
- 96 hours
Correct answer: 48 hours
ACSM recommends at least 48 hours between resistance sessions for the same muscle group.
ACSM advises resistance training each major muscle group 2-3 days per week with at least 48 hours between sessions for the same muscle group. A Monday-Wednesday-Friday schedule fits this rule. Training the same muscles on consecutive days (24 hours) or twice in a day (12 hours) limits recovery and protein synthesis, increasing overuse injury risk. Four days of rest (96 hours) is not necessary and reduces training frequency below the effective range.
Question 9: A client sustains an activity of 7 METs. According to ACSM absolute intensity classification, how is this activity categorized?
- Light intensity
- Moderate intensity
- Vigorous intensity (Correct answer)
- Maximal intensity only
Correct answer: Vigorous intensity
Activities of 6.0 METs or more are classified as vigorous intensity.
ACSM absolute intensity categories: light is less than 3.0 METs, moderate is 3.0-5.9 METs, and vigorous is 6.0 METs or more. At 7 METs this activity is vigorous. Absolute intensity does not account for fitness, so 7 METs may be near-maximal for a deconditioned person but moderate for a fit athlete. Relative intensity (%VO2R, %HRR, or RPE) should therefore be used when prescribing for a specific client.
ACSM-EP Exercise Testing & Prescription
A 58-year-old man scheduled for a graded exercise test reports that he had an acute myocardial infarction 36 hours ago.
Which statement is correct?
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