CCRP AACVPR Exam V2 – American Association of Cardiovascular and Pulmonary Rehabilitation – 2026/2027 Edition – Questions with Evidence-Based Verified Answer | 100% Correct

CCRP AACVPR Exam V2 – American Association of Cardiovascular and Pulmonary Rehabilitation – 2026/2027 Edition – Questions with Evidence-Based Verified Answer | 100% Correct What is the rate of continuation for those who start a cardiac rehab exercise program or any other type of behavioral change, irrespective of initial health status or type half or less of The drop out rate is higher in the first 3 months What is the biggest predictor for a patient to participate in cardiac rehab? the fervor of the primary physicians' recommendation or referring physician appears to be one of the most powerful predictors of the patient's participation in exercise, especially if a baseline fitness assessment and an exercise prescription are provided at the point of care. True of False The amount of exercise needed to improve health is the same as the amount of exercise needed to improve cardio system False- You actually need more exercise to improve your heart, you can see health benefits from the addition of small amounts of exercise True or False lifestyle intervention, including at least 150 minutes of physical activity per week, was even more effective than pharmacologic treatment, in reducing the incidence of Type 2 diabetes. TRUE! Diabetes Prevention Study Name three tools that can be used to encourage the addition of physical activity and exercise into a cardiac rehab participant's lifestyle Activity Pyramid, pedometers and accelerometers may assist clients in tracking their daily activities and facilitate exercise Besides watts what is another unit that can be used on the bike to determine workload? kilopond-meters per min−1 (kpm/min) How should a bike seat be set up? At the ideal seat height the knee should be slightly flexed at full extension. Physiological responses to exercise on a cycle ergometer differ from those obtained on a treadmill. How much lower is the max oxygen uptake? Physiological responses to exercise on a cycle ergometer differ from those obtained on a treadmill. Moreover, maximum oxygen uptake is 5% to 20% lower than on the treadmill. How should an arm bike be set up? seated in the upright position, with the fulcrum of the handle adjusted at shoulder height and the arm should be slightly bent at the elbow during farthest extension movements What is the range for RPM on the arm bike? 60 - 75 Comparing arm bikes to leg exercises: oxygen uptake, HR & BP response Oxygen uptake during any equivalent submaximal level (eg, 50 W) of arm work exceeds that of leg work. Accordingly, the rates of increase of heart rate and blood pressure responses during arm ergometry are more rapid. Other physiological responses to dynamic arm exercise, eg, stroke volume and diastolic blood pressure, also differ from those of leg How often should a treadmill or arm cycle used in stress testing be calibrated? Monthly or sooner What is the equation to make sure treadmill MPH displayed are accurate the actual miles per hour calculated by: Belt length (inches) x number of revolutions/min divided by 1056 (1056 = conversion of inches per minute to miles per hour) How often should treadmills be serviced? 1000 hours of use How you do check the calibration on a mechanically-braked cycle ergometer? To check the calibration on a mechanically-braked cycle ergometer, the belt should be removed from the wheel. The mark on the pendulum weight should be set at "0," and a weight that is known to be accurate should be attached to the belt. The weight should hang freely. A reading of that weight should be given accurately on the scale. If all conditions are met and the scale continues to show an incorrect reading for the known weight, the adjusting screw should be turned until the scale reads the correct weight How is treadmill elevation calibrated? Treadmill elevation is calibrated by measuring a fixed distance on the floor and determining the difference in height of the treadmill over the fixed distance. Example: What do you use to adjust the elevation calibration? carpenter's level to check elevation and adjust potentiometer on the treadmill What calculation is used to test elevation calibration? Divide the difference between the two heights by the elevation you set. If the elevation is correct the difference of the two heights should = your grade in decimal format Proper skin preparation for ECG • Skin preparation: - Clip excess hair from application sites - Gently rub the area with a gauze or dry washcloth pad to remove dead skin cells and oily residue - Cleanse site with mild soap and water - Dry skin completely before applying electrodes The quality of the signal received from the electrodes is a direct result of skin preparation and lead placement. True or False Use an alcohol pad to prepare the skin for the electrode FALSE Cleaning with alcohol should be avoided or limited to situations in which electrode adhesion is an issue (excessively oily or lotion covered skin), because alcohol dries out the skin and in turn pulls the moisture out of the electrode. Without this moisture the electrode gel can act as a barrier to the ECG signal. If alcohol is used, allow to dry prior to application Describe the lead placement in a three lead system for II: • White (RA) (negative) - infraclavicular fossa close to right shoulder - below clavicle • Red (LL) (positive) - on lower edge of rib cage on left side of abdomen • Black (LA) (ground) - infraclavicular fossa close to left shoulder - below clavicle What is the ground in a three lead system? Black (LA) is the ground What is the positive in a three lead system? Red (LL) positive What is the negative in a three lead system? White (RA) negative Why is cool-down important is cardiac rehab? The attenuation of the catecholamine response, especially in patients with heart disease, may reduce the likelihood of threatening ventricular dysrhythmias, which are potential harbingers of sudden cardiac death. What are the following examples of? 5 minutes of slower walking or jogging, cycling and approximately 5 minutes of stretching exercises, and in some cases, alternate activities (yoga, tai chi, relaxation training Types of cool-downs What are the four parts of an aerobic training session? Warm-up, Exercise, Cool-down, Stretching Optional fifth: Recreation Activity Time/Games with modified rules and less of a focus on winning Benefits of warm-up: warm-up may reduce the susceptibility to musculoskeletal injury by increasing connective tissue extensibility, improving joint range of motion and function, and enhancing muscular performance. A preliminary warm-up may also have preventive value, decreasing the occurrence of ischemic ST-segment depressions, threatening ventricular dysrhythmias, and transient global left ventricular dysfunction following sudden strenuous exertion. What is the range of VO2R for the warm-up? 10-30%VO2R Describe the Exercise component of an aerobic training session: The stimulus (conditioning) phase includes CR (endurance), resistance, and flexibility programming. Depending on the individual's goals or outcomes; one, two, or all program areas can be included. A comprehensive program should include all three conditioning components. What MET level should CAD patients accomplished before attempting Resistance Training? It is advisable for CAD patients to have normal or only slightly reduced left ventricular function (EF 35%) and a functional capacity 5 METs before starting a RT regimen. Contraindications for RT • Unstable angina • Uncontrolled arrhythmias • Left ventricular outflow obstruction • Symptomatic heart failure • Severe valvular disease • Uncontrolled hypertension (ie, systolic BP ≥ 160; diastolic BP ≥ 105 mmHg) Traditional RT program defined as lifting ≥ 50% of his/her 1-repetition (RM) maximum ACSM and AACVPR guidelines recommend the following for starting a traditional RT program • Post-MI and post-surgical patients should defer traditional RT for at least 5 weeks after their event/surgery • Post-PCI (percutaneous coronary intervention = angioplasty, stent) patients should defer traditional RT for at least 2-3 weeks after the revascularization procedure. • It is recommend that CAD patients complete a minimal period (ie, 2 weeks for post-PCI and 4 weeks for post-MI/surgery) of supervised CR endurance training before starting a traditional RT. • To prevent soreness and minimize the risk of injury, the initial load should allow 12-15 repetitions comfortably. If a 1RM pretest is used, this load would be approximately 30-40% 1RM for the upper body and 50-60% for hips and legs. Low-risk-stratified, well-trained patients may progress to higher relative loads depending on program goals. • Perform 1 set of 8-10 exercises (major muscle groups) 2-3 d/week. An additional set may be added, but additional gains are not proportionate. Some specific considerations for RT: - Exercise large muscle groups before small muscle groups - Increase loads by 5% when the patient can comfortably lift 12-15 repetitions - Raise weights with slow, controlled movements; emphasize complete extension of the limbs when lifting - Avoid straining - Exhale (blow out) during the exertion phase of the lift (eg, exhale when pushing a weight stack overhead and inhale when lowering it) - Avoid sustained, tight gripping, which may evoke an excessive BP response to lifting - An RPE of 11-13 may be used as a subjective guide to effort. - Stop exercise if warning signs or symptoms occur, especially dizziness, dysrhythmias, unusual shortness of breath, or anginal discomfort Reductions in flexibility are often evident by the decade of life and progress with aging. third involves slowly stretching a muscle to the end of the range of motion (point of tightness without invoking discomfort) and then holding that position for an extended period of time (usually 15 to 30 seconds). Static stretching involves slowly stretching a muscle to the end of the range of motion (point of tightness without invoking discomfort) and then holding that position for an extended period of time (usually 15 to 30 seconds). The optimal number of stretches per muscle group is to The optimal number of stretches per muscle group is 2 - 4 Why is static stretching recommended over other forms of flexibility exercises? The risk of injury is low, requires little time and assistance, and is quite effective. For these reasons, static stretching is recommended. Guidelines for flexibility in exercise Rx: • Precede stretching with a warm up to elevate muscle temperature • Do a static stretching routine that exercises the major muscle tendon units that focuses on muscle groups (joints) that have reduced range of motion • Perform a minimum of 2 to 3 d·wk-1, ideally 5-7 d·wk-1 • Stretch to the end of the range of motion at a point of tightness, without inducing discomfort • Hold each stretch for 15 to 30 seconds • 2 to 4 repetitions for each stretch THR for patients with angina or ECG changes 10 beats per minute below the ischemic ECG or angina threshold Special considerations for patients with angina -longer warm-up (10 to 20 mintues), HR up only 10-15 beats per minute -non weight bearing exercises at low levels of exertion for very deconditioned patients with angina -avoid exercises that increase angina higher than a level two on the 1 - 4 angina scale -if patient still has angina after three nitro are taken and/or exercise has been stopped it is a MEDICAL EMERGENCY -avoid exercise in cold weather -caution should be taken when adding in RT exercises or upper body exercises Special considerations for patients with CABG • As there is often significant soft tissue and bone trauma to the thoracic cavity after CABG, range of motion (ROM) exercise should be undertaken in the early post-surgical period. ROM should be performed without feelings of pulling on the incision or mild pain. • CABG patients that experience sternal movement or wound complications should not perform upper body ergometry or RT until healing is complete. As described earlier, the CABG patient should perform 3-4 weeks of CR endurance exercise before initiating traditional RT. • Asymptomatic PCI patients can begin RT after 2 weeks of CR endurance exercise training • Walking is a highly recommended and beneficial mode of exercise that can be initiated within a few days of the CABG or PCI procedure. Special considerations for patients with pacemaker/ICD • The device discharge thresholds must be known so that heart rate levels during exercise can be kept safely below this value (~10-20 -1) to prevent inappropriate shocks. • Ratings of perceived exertion should be used in conjunction with HR to regulate exercise intensity. • Upper body/should motion should be limited initially to prevention dislodging of the leads and traditional RT should not be performed until 4 to 6 weeks post-implantation. Absolute Contraindications for Exercise • Recent change in ECG • Unstable angina • Uncontrolled cardiac arrhythmias • Symptomatic severe aortic stenosis or other valvular disease • Decompensated symptomatic heart failure • Acute pulmonary embolus or pulmonary infarction • Acute noncardiac disorder that may affect exercise performance or may be aggravated by exercise (eg, Infection, thyrotoxicosis) • Acute myocarditis or pericarditis • Acute thrombophlebitis • Physical disability that would preclude safe and adequate exercise performance Relative Contraindications to Exercise: • Electrolyte abnormalities • Tachyarrhythmia or bradyarrhythmias • High-degree atrioventricular block • Atrial fibrillation with uncontrolled ventricular rate • Hypertrophic obstructive cardiomyopathy with peak resting left ventricular outflow gradient of 25 mmHg • Known aortic dissection • Severe resting arterial hypertension (systolic [BP] 200 mmHg and diastolic BP 100 mmHg) • Mental impairment leading to inability to cooperate with testing *Contraindications can be superseded if benefits outweigh risks of exercise Adverse Responses to Exercise Leading to Exercise Discontinuation • Diastolic BP ≥ 110 mmHg • Decrease in systolic BP 10 mmHg • Significant ventricular or atrial dysrhythmias • Second-or-third-degree heart block • Signs/symptoms of exercise intolerance, including angina, marked dyspnea, and electrocardiogram changes suggestive of ischemia. The normal ECG response to exercise includes the following: • Minor and insignificant changes in P wave morphology • Superimposition of the P and T waves of successive beats • Increases in septal Q wave amplitude • Slight decreases in R wave amplitude • Increases in T wave amplitude (although wide variability exists among subjects) • Minimal shortening of the QRS duration • Depression of the J point • Rate-related shortening of the QT interval A patient exercises has depression of the J point that leads to marked ST-segment upsloping. Should the patient stop exercising? Depression of the J point that leads to marked ST-segment upsloping is due to competition between normal repolarization and delayed terminal depolarization forces rather than to ischemia. Exercise-induced myocardial ischemia may be manifested by three different types of ST-segment changes on the ECG. Name them: -ST segment elevation -ST segment depression -ST segment normalization ST-segment elevation is repolarization ST-segment elevation is early repolarization Exercise-induced ST-segment elevation in leads displaying a previous Q wave infarction may be indicative of or . Exercise-induced ST-segment elevation in leads displaying a previous Q wave infarction may be indicative of wall motion abnormalities or ventricular aneurysm. Exercise-induced ST-segment elevation on an otherwise normal ECG (except in aVR or V1-2) generally indicates significant , and localizes the ischemia to a specific area of myocardium. Exercise-induced ST-segment elevation on an otherwise normal ECG (except in aVR or V1-2) generally indicates significant myocardial ischemia, and localizes the ischemia to a specific area of myocardium. What is the most common manifestation of exercise-induced myocardial ischemia. ST-segment depression (depression of the J point and the slope at 80 msec past the J point) is the most common manifestation of exercise-induced myocardial ischemia. Name the standard criterion for a ST depression. The standard criterion for a positive test is ≥ 1.0 mm (1 mV) of horizontal or downsloping ST segment 80 msec after the J point. True or False ST-segment depression does not localize ischemia to a specific area of myocardium. True ST-segment depression does not localize ischemia to a specific area of myocardium. The more leads with (apparent) ischemic ST-segment shifts, the more the disease. The more leads with (apparent) ischemic ST-segment shifts, the more severe the disease. Why is significant ST-segment depression occurring only in recovery an important diagnostic finding? Significant ST-segment depression occurring only in recovery likely represents a true positive response, and should be considered an important diagnostic finding. Slowly ST-segment depression should be considered a borderline response, and added emphasis should be placed on other clinical and exercise variables. Slowly upsloping ST-segment depression should be considered a borderline response, and added emphasis should be placed on other clinical and exercise variables. In right bundle-branch block, exercise-induced ST-segment depression in the should not be used to diagnose ischemia In right bundle-branch block, exercise-induced ST-segment depression in the anterior precordial leads (V1, V2, and V3) should not be used to diagnose ischemia What leads can show ischemia in a RBBB? ST segment changes in the lateral leads (V4, V5, and V6) may be indicative of ischemia even in the presence of this conduction abnormality The is the ratio of the maximal ST-segment change to the maximal change in HR from rest to peak exercise. An ST/HR index of ≥ is defined as abnormal. The ST/HR index is the ratio of the maximal ST-segment change to the maximal change in HR from rest to peak exercise. An ST/HR index of ≥ 1.6 is defined as abnormal. The evaluates the maximal slope relating the amount of the ST-segment depression to HR during exercise. An ST/HR slope of mV/beat/min is defined as abnormal. The ST/HR slope evaluates the maximal slope relating the amount of the ST-segment depression to HR during exercise. An ST/HR slope of 2.4 mV/beat/min is defined as abnormal. True or False Ischemia may be manifested by normalization of resting ST segments. True Ischemia may be manifested by normalization of resting ST segments. ECG abnormalities at rest, including T-wave inversion and ST-segment depression, may return to normal during anginal symptoms and during exercise in some patients. Although patients with exercise-induced ST-segment depression can be asymptomatic, when concomitant angina occurs, the likelihood that the ECG changes are due to CAD is significantly . Although patients with exercise-induced ST-segment depression can be asymptomatic, when concomitant angina occurs, the likelihood that the ECG changes are due to CAD is significantly increased. True or False Angina pectoris without ischemic ECG changes may be as predictive of CAD as ST-segment changes alone. Angina pectoris without ischemic ECG changes may be as predictive of CAD as ST-segment changes alone. True or False Exercise-associated dysrhythmias occur in healthy subjects as well as patients with cardiac disease. True Exercise-associated dysrhythmias occur in healthy subjects as well as patients with cardiac disease. Increased sympathetic drive and changes in extracellular and intracellular electrolytes, pH, and oxygen tension contribute to disturbances in myocardial and conducting tissue automaticity and reentry, which are major mechanisms of dysrhythmias. True or False Supraventricular Dysrhythmias: Isolated premature atrial contractions are common and require no special precautions. True What is it called when a patient has 7 PVCs per minute frequent ventricular ectopy Criteria for terminating exercise based on ventricular ectopy include: Criteria for terminating exercise based on ventricular ectopy include sustained ventricular tachycardia, as well as multifocal PVCs, and triplets of PVCs. The decision to terminate exercise should also be influenced by simultaneous evidence of myocardial ischemia and/or adverse signs or symptoms. Isolated premature ventricular complexes or contractions (PVCs) occur during exercise in to of healthy subjects and in to of patients with CAD. Isolated premature ventricular complexes or contractions (PVCs) occur during exercise in 30 to 40% of healthy subjects and in 50 to 60% of patients with CAD. The five components of health-related physical fitness are: • Muscular Strength: muscular strength is ability of a muscle to exert a maximal force through a given range of motion or at a single given point. • Muscular Endurance: muscular endurance refers to the capacity of a muscle to exert a submaximal force through a given range of motion or at a single point over a given time. • Cardiovascular Endurance: cardiovascular endurance is the ability to continue training the cardiovascular system for a period longer than twenty minutes (on average). • Flexibility: flexibility is the ability of a joint to move through a full range of motion. • Body Composition: Body composition is the ratio of lean body mass to fat body mass. expression of total body oxygen uptake and one unit = 3.5 ml/kg/min of oxygen consumption 1 MET Oxygen uptake (VO2) usually expressed in ml/kg/min (can be converted to METs by dividing by 3.5 Fick Equation where VO2 = cardiac output x arterio-venous oxygen content difference What do peak oxygen uptake levels of less than 14-15 ml/kg/min reflect Peak oxygen uptake levels of less than 14-15 ml/kg/min reflect very low functional capacity and portend a poor prognosis, particularly in those with heart failure. Rate Pressure Product (Double Product) is estimated by heart rate x systolic blood pressure (RPP = [HR x SBP]/100) and generally reflects myocardial demand (MVO2). Why is RPP important in regards to ischemia? This measure is particularly important in patients with myocardial ischemia as signs and symptoms of ischemia generally occur at a consistent and reproducible RPP. Regular exercise training will generally decrease RPP at a similar submaximal exercise level which may result in decreased ischemic symptoms Ejection Fraction usually measured by echocardiography or cardiac catheterization, is calculated by dividing stroke volume (SV) by end-diastolic volume (EDV). Normal EF Normal EF at rest is generally between 50-60% A reduced EF ( 50%) is associated with left-ventricular systolic dysfunction and may produce signs and symptoms of heart failure (eg, HF with a reduced EF). While an EF ≤ 35% represents significant left ventricular dysfunction, EF can decrease to 10-15% in those with very poor left ventricular function HFrEF Patient with HF with a reduced EF (HFrEF) HFpEF heart failure with a preserved EF (HFpEF) HFpEF is more common in what populations? This condition is particularly common in older adults, and is more common in women, diabetics, and hypertensive patients. Acute response to exercise What happens to HR, SV, Cardiac Output, SBP, DBP, Double Product - Rapid increase in HR, SV, cardiac output - SBP increases with increasing work rate - DBP remains the same or slightly decreases - Double product (HR x SBP) increases linearly with exercise intensity and reflects the work of the heart (myocardial oxygen consumption = MVO2) - Heart rate and cardiac output increase linearly with increasing work rate and reaches plateau at 100% VO2max True or False True Do not place AED electrode over transdermal medication patch (nicotine, nitroglycerine) Name two calcium channel blockers will likely decrease heart rate at rest and during exercise. calcium channel blockers Diltiazem and Verapamil Adaptations to Exercise (Resting HR, Exercise HR, Max HR, AVO2, SV, Q, BP at rest, VO2Max, VE) • Resting HR decreases • Exercise HR at submax levels decrease • Maximal HR stays the same or may decrease slightly • Arterial Venous Oxygen content (AVO2) differences increases • Stroke volume increases • Cardiac output (Q) increases • Blood volume at rest increases • Resting SBP stays the same or slightly increases • VO2 max increases • Maximum ventilation (VE) increases Name the three main purposes of an individualized exercise prescription: (1) enhance some facet of physical fitness (eg, CR endurance, muscular strength/endurance) (2) promote health by modification of chronic disease risk factors (eg, decrease excess body fat, normalize blood lipids or blood pressure) (3) ensure safety during exercise participation (ie, decrease incidence of cardiovascular complications and/or musculoskeletal MHRR or VO2R exercise prescription range 40%/50% - 80% List abnormal signs and symptoms for which an upper limit for exercise intensity should be set, regardless of the calculated MHRR or VO2R: • Onset of angina or other symptoms of cardiovascular insufficiency • Plateau or decrease in systolic blood pressure, systolic blood pressure of 250 mmHg (or diastolic blood pressure of 115 mmHg) • ≥ 1 mm ST-segment depression, horizontal or downsloping • Radionuclide evidence of left ventricular dysfunction or onset of moderate-to-severe wall motion abnormalities during exertion • Increased frequency of ventricular dysrhythmias • Other significant ECG disturbances (eg, 2º or 3º AV block, atrial fibrillation, supraventricular tachycardia, complex ventricular ectopy, etc.) • Other signs/symptoms of intolerance to exercise The peak exercise heart rate should generally be at least below for problems The peak exercise heart rate should generally be at least 10 beats·min-1 below the heart rate associated with any of the above-referenced criteria. RPE The 15-point (6-20) RPE scale is typically used for this purpose with RPE values of 11 to 13 being recommended for the early outpatient exercise sessions, whereas a range of 12 to 15 is recommended for the higher training intensities during subsequent exercise training sessions. RPE ragne for early outpatient exercise sessions RPE values of 11 to 13 being recommended for the early outpatient HIT High intensity interval training, AACVPR states more research needed True or False Calculating exercise heart rate ranges based on age-predicting maximal heart rate formulae (ie, 220-age) is appropriate for CAD FALSE DON'T DO IT Ways to establish intensity of exercise prescription without GTT: RPE, resting HR plus an arbitrary value (generally 20 bpm for post-MI or post-CABG patients on beta blockers or 30 bpm for non-beta blocked patients), Talk Test, 6 Minute Walk, Submax Exercise Test (use HR or METS from test to establish ranges) Can you use Pharmacologic stress tests for exercise prescription? does NOT provide an assessment of functional capacity, hemodynamic responses to progressive exercise, or an indication of the ischemic "threshold". Consequently, data from these tests are of little value in the determination of appropriate CR exercise training intensity. dobutamine increases myocardial demand dipyridamole or adenosine reduce myocardial supply standard recommendation for duration. standard recommendation is to have the patient start with a light to moderate exercise intensity and increase duration until the desired level (30-40+ minutes) is attained before increasing intensity. Frequency Recommendations: Most CAD patients can achieve improvements in functional capacity with two to three sessions per week, provided that the intensity and duration of these sessions are adequate. However, patients in need of aggressive risk factor intervention (ie, to decrease obesity or hypertension, normalize blood lipids, improve glucose tolerance, etc.) will likely benefit from a greater frequency of cardiorespiratory exercise. Increasing the number of sessions per week (to four to five) will help to modify these risk factors over time; however, the exercise professional should be able to recognize that there is a direct relationship between the frequency of exercise and the risk of orthopedic injury. patients should be able to achieve duration of to minutes of continuous CR exercise before increasing the intensity. patients should be able to achieve duration of ≥ 20 to 30 minutes of continuous CR exercise before increasing the intensity.