ACSM CEP cheat sheet

ACSM risk categories: LOW = asymptomatic with ≤1 positive CVD risk factor; MODERATE = asymptomatic with ≥2 positive risk factors; HIGH = known cardiovascular, pulmonary, or metabolic disease, or any sign/symptom of these diseases.

Positive risk factors: age (men ≥45 y, women ≥55 y); family history (first-degree male relative <55 y or female <65 y); current smoker or quit within 6 months; sedentary lifestyle; BMI ≥30 kg/m² or waist >102 cm (men)/>88 cm (women); hypertension (SBP ≥130 or DBP ≥80 mmHg, or on antihypertensive medication); dyslipidemia (LDL ≥130 mg/dL, HDL <40 mg/dL, or on lipid-lowering medication); prediabetes (FPG 100–125 mg/dL, 2-h OGTT 140–199 mg/dL, or HbA1c 5.7–6.4%).

HDL cholesterol ≥60 mg/dL is a NEGATIVE risk factor: subtract one from the total risk-factor count.

Metabolic syndrome requires ≥3 of 5: elevated waist circumference (population-specific), triglycerides ≥150 mg/dL, HDL <40 mg/dL (men) or <50 mg/dL (women), BP ≥130/85 mmHg, fasting glucose ≥100 mg/dL.

Absolute contraindications to exercise testing: acute MI within 2 days, unstable angina, uncontrolled symptomatic arrhythmia, decompensated heart failure, acute myocarditis/pericarditis, suspected dissecting aneurysm, acute pulmonary embolism or deep vein thrombosis.

Relative contraindications to exercise testing: severe hypertension (SBP >200 or DBP >110 mmHg), known left main coronary stenosis, moderate stenotic valvular disease, electrolyte abnormalities, hypertrophic cardiomyopathy, high-degree AV block, pulmonary hypertension.

Signs/symptoms mandating high-risk classification: chest pain or anginal equivalent, dyspnea at rest or with mild exertion, dizziness or syncope, orthopnea or paroxysmal nocturnal dyspnea, ankle edema, palpitations or tachycardia, intermittent claudication, heart murmur, unusual fatigue.

Beta-adrenergic blockers blunt the heart rate response to exercise; use RPE, symptom-limited endpoints, and heart rate reserve rather than absolute heart rate targets.

Age-predicted maximal heart rate: 220 − age; the Tanaka equation (208 − 0.7 × age) is more accurate in older adults and in those taking beta blockers.

1 MET = 3.5 mL O2/kg/min ≈ 1 kcal/kg/hr; functional capacity expressed in METs allows comparison across body weights and protocols.

Bruce protocol uses 3-minute stages beginning at 1.7 mph and 10% grade (≈5 METs), progressing to 2.5 mph/12%, 3.4 mph/14%, and higher stages; modified Bruce adds two lower-level warm-up stages.

Absolute indications to stop a test: angina or anginal equivalent, horizontal or downsloping ST depression >2 mm, ST elevation ≥1 mm, sustained ventricular tachycardia, SBP drop >10 mmHg from baseline despite increasing workload, signs of poor perfusion (pallor, cyanosis, cold/clammy skin), client request to stop.

Hypertensive endpoint for terminating a test: systolic pressure >250 mmHg or diastolic pressure >115 mmHg.

Relative indications to stop: marked dyspnea, leg claudication, dizziness or confusion, systolic pressure >250 mmHg, development of bundle branch block or supraventricular tachycardia, increasing chest discomfort.

Chronotropic incompetence: failure to reach ≥80% of age-predicted maximal heart rate, or use of <62% of heart rate reserve, at maximal effort.

Heart rate reserve (HRR) = HRmax − HRrest; Karvonen target HR = (HRR × intensity fraction) + HRrest.

Submaximal cycle and treadmill protocols assume a linear relationship between heart rate, workload, and oxygen uptake, a steady state at each stage (2–3 minutes), and a reasonably accurate estimate of HRmax.

After testing, use 3–6 minutes of active recovery and monitor for at least 6 minutes; abrupt cessation promotes venous pooling, hypotension, and arrhythmia.

Aerobic prescription: 3–5 days/week, 40–80% HRR (or 55–90% HRmax), 20–60 minutes per session, accumulating 150 min/week moderate or 75 min/week vigorous activity.

Weekly volume target: 500–1000 MET-min/week of moderate-to-vigorous aerobic activity is associated with clinically meaningful health benefit.

Resistance prescription: 2–3 days/week, 8–10 exercises covering major muscle groups, 1–3 sets of 8–12 repetitions at 60–70% 1RM, with 2–3 minutes rest between sets.

Flexibility prescription: 2–3 days/week, static stretches held 10–30 seconds for 2–4 repetitions per muscle group, taken to the point of tightness but not pain.

Neuromotor exercise (balance, agility, coordination, tai chi) 2–3 days/week, 20–30 minutes, is recommended for older adults and those at fall risk.

Progression stages: initial (4–6 weeks, low intensity, focus on adherence), improvement (4–5 months, faster gains), maintenance (6+ months); adjust one FITT variable at a time, typically adding 5–10 minutes every 1–2 weeks.

Karvonen formula: target HR = [(HRmax − HRrest) × %intensity] + HRrest; preferred over simple %HRmax because it accounts for resting heart rate.

Energy expenditure: kcal/min = (METs × 3.5 × body weight in kg) ÷ 200.

Intensity anchors: RPE 12–13 on the Borg 6–20 scale corresponds to moderate intensity; 14–16 corresponds to vigorous; the talk test provides a practical surrogate.

Session structure: 5–10 minute warm-up, 20–60 minute conditioning phase, and 5–10 minute cool-down; cool-down supports venous return and reduces post-exercise hypotension and arrhythmia risk.

Cardiac rehabilitation phases: Phase I inpatient (typically 2–5 days), Phase II outpatient with ECG monitoring (commonly up to 36 sessions), Phase III and Phase IV maintenance programs.

Diabetes precautions: check glucose before and after exercise, avoid late-evening sessions, inspect feet daily, wear appropriate footwear, and keep a fast-acting carbohydrate source available.

Hypertension precautions: avoid the Valsalva maneuver, exhale during the exertion phase, and modify heavy resistance work that produces extreme pressor responses.

Obesity and joint disease: favor low-impact, non-weight-bearing modalities (cycle, water, elliptical), extend duration rather than intensity, and monitor for heat intolerance.

Supervision requirements: trained staff with current CPR/AED certification, an accessible emergency plan, and functioning emergency equipment at every session.

Submaximal test validity rests on stable assumptions: a known or predictable HRmax, achievement of steady state, consistent mechanical efficiency, and absence of medications or conditions that alter heart rate.

Transtheoretical model stages: precontemplation (no intention within 6 months), contemplation (intention within 6 months), preparation (intention within 30 days plus some action), action (<6 months of behavior), maintenance (>6 months); interventions must match the stage.

Processes of change divide into experiential/cognitive processes (consciousness raising, dramatic relief, self-reevaluation) used early, and behavioral processes (self-liberation, helping relationships, counterconditioning, stimulus control) used in action and maintenance.

Self-efficacy has four sources: mastery experiences, vicarious experience, verbal persuasion, and interpretation of physiological/affective states; mastery experience is the strongest.

Motivational interviewing core skills (OARS): open-ended questions, affirmations, reflections, and summaries; the righting reflex (arguing for change) is counterproductive.

SMART goals: Specific, Measurable, Attainable, Relevant, Time-bound; short-term goals build self-efficacy toward long-term outcomes.

Decisional balance (weighing pros and cons) is most useful for clients in contemplation; behavioral strategies such as self-monitoring and stimulus control are used in preparation and action.

Health belief model constructs predicting uptake: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action.

Emergency action plan essentials: written plan, defined roles, posted emergency numbers, accessible AED with a target retrieval time of 3–5 minutes, and annual rehearsal/drills.

Scope of practice: the ACSM Certified Exercise Physiologist may conduct assessments and prescribe and supervise exercise for apparently healthy and medically cleared populations, but may not diagnose disease or prescribe medical treatment.

Negligence requires four elements: duty of care, breach of that duty, causation, and resulting damages; documented standard-of-care adherence is the primary defense.

Informed consent must disclose the purpose, procedures, risks, benefits, alternatives, and the right to withdraw; it must be obtained before testing or participation.

Documentation uses the SOAP format: Subjective, Objective, Assessment, Plan; records are contemporaneous, legible, confidential, and never altered after the fact.

Universal precautions: treat all blood and body fluids as potentially infectious, use gloves and barrier devices, and disinfect contaminated equipment and surfaces.

Exertional heat stroke: core temperature typically >40°C (104°F) with central nervous system dysfunction (confusion, collapse); it is a life-threatening emergency requiring immediate cooling and EMS activation, unlike heat exhaustion.

Facility environment: exercise areas are generally maintained at 68–72°F (20–22°C) with relative humidity ≤60% to limit heat stress and maintain safe footing on floors.