ACSM CEP Exam 2022 Questions and Answers

ACSM CEP Exam 2022 Questions and Answers Absolute Contraindications to Exercise Testing - ANSWER • 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 - ANSWER • 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 - ANSWER • 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 - ANSWER • 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 - ANSWER • 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 - ANSWER ≥1 mm of horizontal or down sloping ST↓ 60-80 ms beyond the J point suggesting myocardial ischemia Chronotropic incompetence - ANSWER 1. Peak exercise HR about 20 BPM below the age predicted HRmax or an inability to achieve > 85% of the age predicted HRmax for subjects limited by volitional fatigue. 2. Chronotropic index <.8 Heart Rate Recovery - ANSWER less than or equal to 12 BPM at 1 minute for walking, or less than or equal to 22 BPM at 2 mins for supine position Sensitivity - ANSWER % of pts. tested with known CVD who demonstrate significant ST segment changes. Exercise EKG sensitivity usually requires greater than or equal to 70% stenosis True Positive - ANSWER Horizontal or down sloping ST segment depression of ≥1.0 mm and correctly identifies a patient with CVD False Negative - ANSWER test shows no or non-diagnostic ECG changes and fails to identify patients with underlying CVD Specificity - ANSWER % of pts. without CVD who demonstrate non significant ST segment changes True Negative - ANSWER Correctly identifies an individual without CVD Causes of False Negative Test Results - ANSWER • Failure to reach an ischemic threshold • Monitoring an insufficient number of leads to detect ECG changes • Failure to recognize non-ECG signs and symptoms that may be associated with underlying CVD • Angiographically significant CVD compensated by collateral circulation • Musculoskeletal limitations to exercise preceding cardiac abnormalities • Technical or observer error Predictive Value - ANSWER A measure of how accurately a test result (positive or negative) correctly identifies the presence or absence of CVD in tested patients. Absolute Contraindications to Resistance training - ANSWER • Unstable CHD • Decompensated HF • Uncontrolled arrhythmias • Severe pulmonary HTN • Severe and symptomatic aortic stenosis • Acute myocarditis, endocarditis, or pericarditis • Uncontrolled HTN (>180/110 mmHg) • Aortic dissection • Marfan syndrome • High intensity RT (80-100% of 1-RM) in patients with active proliferative retinopathy or moderate or worse non-proliferative diabetic retinopathy Relative Contraindications to Resistance Training - ANSWER • Major risk factors for CHD • Diabetes at any age • Uncontrolled HTN (>160/100 mmHg) • Low functional capacity (<4 METs) • Musculoskeletal limitations • Individuals who have implanted pacemakers or defibrillators When to monitor EKG for an Exercise Test - ANSWER Before: Continuously, supine position and posture of exercise During: Continuously; last 15 s of each stage or the last 15 s of each 2 min period (ramp protocols) After: continuously, immediate postexercise, last 15 s of the 1st minute of recovery and every 2 minutes after When to monitor HR for an exercise test - ANSWER Before: Continuously; supine position, and posture of exercise During: Continuously, Last 15 s of each minute After: Continuously, Last 5 s of each minute When to monitor BP during an exercise test - ANSWER Before: supine position and posture of exercise During: Last 45 s of each stage or the last 45 s of each 2 min period (ramp protocols) After: recorded immediately postexercise and then 2 mins after Signs/ Symps during an exercise test - ANSWER Monitored continuously and recorded as observed RPE During an exercise test - ANSWER Before: Explain the scale During: last 15 s of each stage or every 2 mins with ramp protocols After: Obtain peak exercise value then don't measure during recovery Pregnancy Special Considerations - ANSWER 1. Sedentary women should gradually increase PA to recommended levels 2. Severely obese, GDM, HTN see Dr. before exercise 3. No contact sports 4. Terminate Exss for vaginal bleeding, dyspnea before exertion, dizziness, headache, chest pain, muscle weakness, calf pain/swelling, preterm labor, decreased fetal movement, and amniotic fluid leakage 5. Don't exss in a supine position after 16 weeks of pregnancy to avoid venous obstruction. 6. Avoid valsalva 7. Avoid hot and humid weather 8. Metabolic demand increases by about 300 kcal/day 9. Submax weight training allowed 10. Postpartum exss- about 4-6 wks after normal vaginal delivery and about 8-10 weeks after C section Children Special Considerations - ANSWER 1. Proper instruction provided for strength training. 2. B/c of immature thermoregulatory systems, avoid hot weather and stay hydrated 3. OW and physically inactive kids should gradually increase frequency and time of PA 4. Children with disabilities or disease should have their Ex Rx tailored to them 5. Decrease sedentary activity Older Adults Special Considerations - ANSWER 1. Intensity and duration should be light at first 2. Progression tailored to tolerance and preference 3. Muscular strength is more important with age 4. Supervise strength training 5. Muscle strengthening activities may need to precede aerobic training 6. Gradually exceed the recommended minimum amounts of PA 7. If chronic conditions preclude activity at the recommended min. amount, activities should be performed as tolerated to avoid being sedentary 8. Exceed min amount of PA to improve chronic conditions 9. Mod. intensity PA should be encouraged for individuals with cognitive decline 10. Structured PA sessions should end with an appropriate cool down 11. Incorporate behavior strategies to enhance participation 12. Regular feedback and positive reinforcement to increase adherence Low Back Pain Special Considerations - ANSWER 1. Promote spinal stabilization 2. Certain exercises and positions may aggravate symps (walking downhill) 3. Encourage exercises that result in a centralization of symps 4. Encourage flexibility Arthritis Special Considerations - ANSWER 1. Avoid strenuous exercises during acute flare ups and periods of inflammation 2. Long warm up and cool down 3. Individuals with significant pain and functional limitations should perform as much PA as they can 4. Exss during times of the day where pain is less severe and/ or in conjunction with peak activity of pain meds 5. Appropriate shoes 6. Functional exercises help improve neuromotor control 7. Water exercise temp- 83-88 Cancer Special Considerations - ANSWER 1. Up to 90% of all cancer survivors will experience cancer related fatigue 2. Bone is a common site of metastases in many cancers 3. Cachexia prevalent in pts. with advanced GI cancers 4. Identify when a pt. is in an immune surpressed state --> exercise at home or a medical setting 5. Avoid swimming with catheters 6. Pts. receiving chemo may experience sickness and fatigue Cerebral Palsy Special Considerations - ANSWER 1. FITT principle is unclear 2. B/c of lack of movement control, energy expenditure is high at low power output 3. If balance is a problem use the bike 4. Fatigue easily because of poor economy of movement 5. Resistance training increases strength without an adverse effect on muscle tone 6. Resistance exercises designed to target weak muscle groups that oppose hypertonic muscle groups improve the strength and normalize the tone 7. Hypertonic muscles should be stretched slowly throughout the workout program 8. Children- inhibit abnormal reflex activity, normalize muscle tone, and develop reactions to increase equilibrium 9.Athletes- sport specific fitness testing to determine fitness areas for improvement 10. Good positioning of the head, trunk, and proximal joints of extremities to control persistent primitive reflexes is preferred to strapping 11. More prone to overuse injuries b/c of their higher incidence of inactivity Diabetes Special Considerations - ANSWER 1. Hypoglycemia- most serious problem 2. Blood glucose monitoring before and after exercise is important 3. Timing of insulin should be considered 4. PA with oral hypoglycemic agents has not been studied well 5. Adjust carb intake and meds before and after exss 6. People with insulin pumps can disconnect depending on intensity and duration of exss 7. Continuous glucose monitoring can be useful to determine immediate and delayed effects of exercise 8. Exercise with a friend 9. Hyperglycemia with or without ketosis is a concern for individuals with Type 1 who are not in glycemic control 10. Dehydration resulting from polyuria may compromise thermoregulatory response 11. Retinopathy at risk for retinal detachment and hemorrhage associated with vigorous exercise 12. During exss, autonomic neuropathy may cause chronotropic incompetence, attenuated VO2 kinetics and anhydrosis 13. Peripheral neuropathy- foot care Dyslipidemia Special Considerations - ANSWER Individuals taking lipid lowering meds that have the potential to cause muscle damage (statins and fibric acid) may experience soreness Fibromyalgia Special Considerations - ANSWER 1. Teach the correct form for exercises to reduce injury 2. Avoid improper form and exercising when excessively fatigued 3. Consider less exercise if symps increase during or after exss 4. Avoid free weights when fatigued or have excessive pain 5. Exercise in a room with temp and humidity control 6. Consider group exercises 7. Consider yoga and tai chi HIV Special Considerations - ANSWER 1. No contraindications for exercise 2. Supervised exercises for symptomatic people 3. Should report increased general feelings of fatigue or perceived effort during activity, lower GI distress, and shortness of breath 4. Minor feelings of fatigue should not end exercise HTN Special Considerations - ANSWER 1. Pts. with uncontrolled severe HTN (SBP ≥180 mmHg and/or DBP ≥110 mmHg) should add exercise training to their treatment plan only after first being evaluated by their physician 2. B blockers and diuretics may adversely affect thermoregulatory function 3. B blockers may reduce submax and max exercise capacity 4. Alpha blockers, CA channels blockers, and vasodilators may lead to sudden excessive reductions in postexss BP 5. OW and OB pts should focus on increasing caloric expenditure 6. BP lowering effects of aerobic exercise is immediate 7. Exss intensity should be set ≥10 BPM below the ischemic threshold Intellectual Disability and Down Syndrome Special Considerations - ANSWER 1. ID- Require more encouragement 2. ID-Motor control problems and poor coordination 3. ID-Short attention span 4. Familiarize and practice before testing 5. Maximize enjoyment and adherence 6. DS- very low levels of aerobic capacity and muscle strength 7. DS- often obese 8. DS- likely to have a low HR max caused by reduced catecholamine response 9. DS- Might have atlantoaxial instability 10. DS- may experience skeletal muscle hypotonia coupled with excessive joint laxity Kidney Disease Special Considerations - ANSWER 1. Progress to greater exercise volume over time 2. Might not be able to do continuous exercise 3. Resistance- 1 set of 10 reps 70% 1 RM 2x/week 4. Hemodialysis- exss on non dialysis days and not immediately post -if done during do it during the first half -Use RPE -Measure BP in arm without fistula 5. Peritoneal Dialysis: -May attempt exss with fluid in the abdomen, if it is uncomfy then drain fluid before exss 6. Kidney Transplant: -During periods of rejection, FITT principle should be reduced but still exss Metabolic Syndrome Special Considerations - ANSWER 1. Will likely have multiple CVD risk factors 2. Initial exss at moderate intensity 3. To reduce body weight, increase PA levels to 300 min/week MS Special Considerations - ANSWER 1. In spastic muscles, increase the frequency and time of flexibility exercises 2. Incorporate functional activities 3. USE RPE 4. During acute exacerbation of symps, decrease exss 5. Commonly used disease modifying meds can have transient side effects 6. Systemic fatigue is common but can be improved 7. Heat sensitivity is common 8. HR and BP my be blunted 9. Some pts. may restrict their daily fluid intake 10. Might have trouble understanding testing and training instructions 11. Watch for signs and symps of Uhthoff Phenomenon Osteoporosis Special Considerations - ANSWER 1. Difficult to quantify exercise intensity in terms of bone loading forces 2. No guidelines for contraindications to exss 3. BMD of the spine may appear normal or increased after compression fractures or in pts with osteo of the spine. Hip BMD is a more reliable indicator for osteo 4. Increased risk for falls OW and OB special considerations - ANSWER 1. For long term weight loss maintenance exercise greater than 250 min/week 2. PA 5-7 days/week 3. Moderate to vigorous PA start at 30 min/day then progress Parkinson Disease Special Considerations - ANSWER 1. Incorporate functional exercises 2. Suffer from ANS dysfunction 3. Some meds further impair ANS functions 4. Cognitive decline and dementia are common neuro symps and can burden training 5. Emphasize fall prevention 6. Avoid dual tasking 7. Pay attention to the development and management of fatigue when performing resistive exercise Pulmonary Disease Special Considerations - ANSWER 1. Resistance training (upper body) important in COPD 2. Train inspiratory muscles 3. Dyspnea rating 4-6 on a 1-10 scale is the recommended exss intensity 4. Measure O2 during exercise to avoid desaturation 5. Supplemental O2 for pts PaO2 ≤55 mmHg or a %SaO2≤88% while breathing room air 6. In severe COPD, using noninvasive positive pressure ventilation to help with exercise Spinal Cord Injury Special Considerations - ANSWER 1. Empty bowels and bladder before exss 2. Skin pressure sores should be avoided at all times 3. Decrease cardio. performance in complete spinal cord injuries 4. During exss, autonomic dysreflexia results in an increased release of catecholamines that increases HR, VO2, BP, and exercise capacity 5. Short bouts of 5-10 mins with 5 min recovery 6. Tetraplegia will experience muscle fatigue before exhausting central cardio. capacity 7. High SCI may benefit from lower body positive pressure 8. Stabilize all trunk muscles by completing strength training in and out of a wheelchair 9. Endure higher core temp during endurance exercise. Despite the enhanced thermoregulatory drive, they generally have lower sweat rates Hot Environment Considerations - ANSWER 1. Hyperthermia- metabolic heat > heat loss 2. Heat acclimatization= higher and more sustained sweating rates 3. Active individuals should drink at least 1 pt of fluid for each pound of body weight lost during exss 4. Decreased sweating rate and decreased cutaneous BF responsible for greater heat storage Exertional Heatstroke - ANSWER Signs and symps: disorientation, dizziness, irrational behavior, apathy, headache, nausea, vomiting, hyperventialtion, wet skin Mental Status: disoriented, unresponsive Core temp elevation: >40° C Exertional Heat Exhaustion - ANSWER Signs and Symps: Low BP, elevated HR and respiratory rates, skin is wet and pale, headache, weakness, dizziness, decreased muscle coordination, chills, nausea, vomiting, diarrhea Mental Status: Agitated Core Temp Elevation:None to moderate (37°-40° C) Heat Syncope - ANSWER Signs/symps: HR and breathing rates are slow; skin is pale; patient may experience sensations of weakness, tunnel vision, vertigo, or nausea before syncope Mental Status: Brief fainting episode Core temp elevation: little to none Exertional Heat Cramps - ANSWER Signs/ symps: Begins as feeble, localized, wandering spasms that may progress to debilitating cramps Core temp elevation: Moderate (37°-40° C) THR in the heat - ANSWER Will be achieved at a lower workload Heat Acclimatization - ANSWER Improved heat transfer from the body's core to the external environment, improved CV function, more effective sweating, improved heat tolerance WBGT Children <75.0 - ANSWER All activities are allowed WBGT Children 75- 78.6 - ANSWER Longer rest periods in the shade; enforce drinking every 15 mins WBGT Children 79-84 - ANSWER Stop activity of unacclimitized individuals and those in high risk categories; limit activities of all other WBGT Children >85.0 - ANSWER Cancel all athletic activities Frostbite - ANSWER 1. Most common in exposed skin (nose, ears, cheeks) 2. Contact frostbite may occur by touching cold objects with bare skin 3. Frostbite risk is <5% when the ambient temperature is greater than -15° C (5° F) 4. Principal cold stress determinants are air temp, wind speed, and wetness 5. Wind exacerbates heat loss 6. Wind does NOT cause an exposed object to become colder than the ambient temp 7. Wet skin exposed to wind cools faster 8. Can occur in 30 min or less when the WDT falls below -27 Celsius (-8 F) High Altitude - ANSWER o Ascent to higher altitudes reduces the partial pressure of oxygen in the inspired air, resulting in decreased arterial oxygen levels. Immediate compensatory responses include increased ventilation and cardiac output (usually through elevated HR) o Acclimatization occurs at ≥1 week Acute Mountain Sickness - ANSWER Most common Symps: headache, nausea, fatigue, decreased appetite, poor sleep, poor balance Can progress to HACE High Altitude Cerebral Edema - ANSWER Exacerbation of unresolved AMS Occurs in <2% of individuals ascending >12,000 ft High Altitude Pulmonary Edema - ANSWER -Occurs in <10% of individuals ascending >12,000 ft -Individuals making repeated ascents and descents >12,000 ft and who exercise strenuously early in exposure have an increased susceptibility to HAPE -Blue lips and nail beds may be present Social Cognitive Theory - ANSWER Triadic reciprocation: The individual (emotion, personality, cognition, biology), behavior, and environment all interact to influence future behavior Self Efficacy - ANSWER One's belief in their capacity to successfully complete a course of action such as exercise Task Self Efficacy - ANSWER Belief in capability to physically complete the task; the measure must be specific to the task Barriers Self Efficacy - ANSWER Belief in the capability to exercise regularly in the face of common barriers Outcome Expectations - ANSWER Anticipatory results of a behavior; if specific outcomes are valued, then behavior change is more likely to occur Transtheoretical Model - ANSWER Developed as a framework for understanding behavior change. 5 stages: Precontemplation, contemplation, preparation, action, maintenance Precontemplation to contemplation - ANSWER Processes Focus: Consciousness raising, environmental reevaluation, dramatic relief Decisional Balance: Pros < Cons Self Efficacy: Low Contemplation to Preparation - ANSWER Processes Focus: Consciousness raising, environmental reevaluation, self reevaluation, dramatic relief Decision Balance: Pros>Cons Self Efficacy: increasing Preparation to Action - ANSWER Processes Focus: Self Liberation Decision balance: Pros>>Cons Self Efficacy: high Action to Maintenance - ANSWER Processes Focus: stimulus control, reinforcement management, counterconditioning, helping relationships Decision balance: Pros >>Cons Self Efficacy: high Health Belief Model - ANSWER An individual's beliefs about whether or not he/she is susceptible to disease, and his/her perceptions of the benefits of trying to avoid it, influence his/her readiness to act Self Determination Theory - ANSWER 3 primary psycho social needs that need to be satisfied: relatedness, competence (mastery) , and autonomy (self determination) Theory of Planned Behavior - ANSWER -Intention to perform a behavior is the primary determinant of behavior. -Intentions are determined by an individual's attitude, subjective norms, and predictive behavioral control Perceived behavioral control - ANSWER individual's belief about how easy or difficult performance of the behavior is likely to be Social Ecological - ANSWER Considers the impact of and connections between individuals and their environment How to build Self Efficacy - ANSWER Mastery experiences, social modeling., social persuasion, reduction of stress and physical/emotional arousal Client Centered PA Counseling (Five A's Model) - ANSWER 1. Address agenda 2. Assess 3. Advise 4. Assist 5. Arrange Follow up Cognitive Behavioral Approaches - ANSWER 1. Reinforcement 2. Goal Setting 3. Social Support 4. Association vs disassociation 5. Affect Regulation 6. Relapse Prevention Reinforcement - ANSWER Extrinsic: helps increase short term adherence Intrinsic: More likely to adhere long term Goal Setting - ANSWER - Must be a part of an ongoing process - SMART goals (Specific, measurable, action oriented, realistic, timely) Social Supoport - ANSWER 1. Guidance- advice and info 2. Reliable alliance- assurance that others can be counted on in times of stress 3. Reassurance of worth- recognition of one's competence that individuals in the exercise group or personal trainer believe in their abilities 4. Attachment- emotional closeness 5. Social integration- sense of belonging 6. Opportunity for nurturance- providing assistance to others in the exercise group Disassociation Strategies - ANSWER Encourage the individual to block out feelings associated with exertion such as fatigue, sweating, or discomfort, usually by focusing on positive thoughts Association Strategies - ANSWER Focus on bodily sensations such as respiration, temperature, and enjoyment Affect Regulation - ANSWER -Key component to intrinsic motivation - Positive affective responses to moderate intensity exercise can be predictive of PA participation 6 and 12 months later Relapse Prevention - ANSWER -Having individuals brainstorm ways and create plans to stay active when they are outside of their traditional routine -Varying their exercise routine to avoid boredom -Creating new exercise goals to enhance and maintain motivation