ACSM CEP 2026 ACTUAL SAMPLE
QUESTIONS AND ANSWER (COMPLIED
FROM REAL EXAM)
Absolute Contraindications to Exercise Testing
• A recent significant change in the resting ECG suggesting significant ischemia, recent
MI (within 2 d), or other acute cardiac event
• Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Suspected or known dissecting aneurysm
• Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
Relative Contraindications to Exercise Testing
• Left main coronary stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities (hypokalemia or hypomagnesemia)
• Severe arterial hypertension (SBP>200 mmHg and/or DBP >110 mmHg) at rest
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
• Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by
,exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (diabetes, thyrotoxicosis, or myxedema)
• Chronic infectious disease (e.g. HIV)
• Mental or physical impairment leading to inability to exercise adequately
General Indications for Stopping an Exercise Test
• Onset of angina or angina-like symptoms
• Drop in SBP of ≥10 mmHg with an increase in work rate or if SBP decreases below
the value obtained in the same position prior to testing
• Excessive rise in BP: SBP>250 mmHg and/or DBP>115 mmHg
• Shortness of breath, wheezing, leg cramps, or claudication
• Signs of poor perfusion: light-headedness, confusion, ataxia (loss of full control of
bodily movements), (pallor) unhealthy pale appearance, cyanosis (bluish skin color),
nausea, or cold and clammy skin
• Failure of HR to increase with increased exercise intensity
• Noticeable change in heart rhythm by palpation or auscultation
• Subject requests to stop
• Physical or verbal manifestations of severe fatigue
• Failure of the testing equipment
Absolute Indications for stopping an exercise test
• Drop in SBP ≥10 mmHg with an increase in work rate, or if SBP decreases below the
value obtained in the same position prior to testing when accompanied by other
, evidence of ischemia
• Moderately severe angina (defined as 3 on standard scale)
• Increasing nervous system symptoms (e.g. ataxia, dizziness, or near syncope)
• Signs of poor perfusion (cyanosis or pallor)
• Technical difficulties monitoring the ECG or SBP
• Subject's desire to stop
• Sustained ventricular tachycardia
• ST elevation (+1.0 mm) in leads without diagnostic Q waves (other than V1 or aVR)
Relative Indications for stopping an exercise test
• Drop in SBP ≥10 mmHg with an increase in work rate, or if SBP below the value
obtained in the same position prior to testing
• ST or QRS changes such as excessive ST depression (>2 mm horizontal or down
sloping ST-segment depression) or marked axis shift
• Arrhythmias other than sustained V Tach, including multifocal PVCs, triplets of PVCs,
SVT, heart block, or bradyarrhythmias
• Fatigue, shortness of breath, wheezing, leg cramps, or claudication
• Development of bundle-branch block or intraventricular conduction delay that cannot
be distinguished from V Tach
• Increasing chest pain
• Hypertensive response (SBP>250 mmHg and/or DBP>115 mmHg)
ST segment depression
≥1 mm of horizontal or down sloping ST↓ 60-80 ms beyond the J point suggesting
myocardial ischemia
QUESTIONS AND ANSWER (COMPLIED
FROM REAL EXAM)
Absolute Contraindications to Exercise Testing
• A recent significant change in the resting ECG suggesting significant ischemia, recent
MI (within 2 d), or other acute cardiac event
• Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Suspected or known dissecting aneurysm
• Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
Relative Contraindications to Exercise Testing
• Left main coronary stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities (hypokalemia or hypomagnesemia)
• Severe arterial hypertension (SBP>200 mmHg and/or DBP >110 mmHg) at rest
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
• Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by
,exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (diabetes, thyrotoxicosis, or myxedema)
• Chronic infectious disease (e.g. HIV)
• Mental or physical impairment leading to inability to exercise adequately
General Indications for Stopping an Exercise Test
• Onset of angina or angina-like symptoms
• Drop in SBP of ≥10 mmHg with an increase in work rate or if SBP decreases below
the value obtained in the same position prior to testing
• Excessive rise in BP: SBP>250 mmHg and/or DBP>115 mmHg
• Shortness of breath, wheezing, leg cramps, or claudication
• Signs of poor perfusion: light-headedness, confusion, ataxia (loss of full control of
bodily movements), (pallor) unhealthy pale appearance, cyanosis (bluish skin color),
nausea, or cold and clammy skin
• Failure of HR to increase with increased exercise intensity
• Noticeable change in heart rhythm by palpation or auscultation
• Subject requests to stop
• Physical or verbal manifestations of severe fatigue
• Failure of the testing equipment
Absolute Indications for stopping an exercise test
• Drop in SBP ≥10 mmHg with an increase in work rate, or if SBP decreases below the
value obtained in the same position prior to testing when accompanied by other
, evidence of ischemia
• Moderately severe angina (defined as 3 on standard scale)
• Increasing nervous system symptoms (e.g. ataxia, dizziness, or near syncope)
• Signs of poor perfusion (cyanosis or pallor)
• Technical difficulties monitoring the ECG or SBP
• Subject's desire to stop
• Sustained ventricular tachycardia
• ST elevation (+1.0 mm) in leads without diagnostic Q waves (other than V1 or aVR)
Relative Indications for stopping an exercise test
• Drop in SBP ≥10 mmHg with an increase in work rate, or if SBP below the value
obtained in the same position prior to testing
• ST or QRS changes such as excessive ST depression (>2 mm horizontal or down
sloping ST-segment depression) or marked axis shift
• Arrhythmias other than sustained V Tach, including multifocal PVCs, triplets of PVCs,
SVT, heart block, or bradyarrhythmias
• Fatigue, shortness of breath, wheezing, leg cramps, or claudication
• Development of bundle-branch block or intraventricular conduction delay that cannot
be distinguished from V Tach
• Increasing chest pain
• Hypertensive response (SBP>250 mmHg and/or DBP>115 mmHg)
ST segment depression
≥1 mm of horizontal or down sloping ST↓ 60-80 ms beyond the J point suggesting
myocardial ischemia
