ACSM CLINICAL EXERCISE
PHYSIOLOGIST ACTUAL EXAM PAPER
2026 QUESTIONS WITH ANSWERS
GRADED A+
◍ 1 MET =.
Answer: 3.5 ml/kg/mig
◍ The key components included in informed consent and health/medical
history.
Answer: Informed Consent:1. Purpose and explanation of the test2.
Attendant risks and discomforts3. Responsibilities of the participant4.
Benefits to be expected5. Inquiries6. Use of medical records7. Freedom of
consentHealth/Medical History:1. Medical diagnosis2. Previous physical
examination findings3. History of symptoms4. Recent illness,
hospitalization, new medical diagnosis, or surgical procedures.5. Orthopedic
problems6. Medication use and drug allergies7. Other habits including
caffeine, alcohol, tobacco use, or recreational drug use8. Exercise history9.
Work history10. Family history of cardiac, pulmonary, or metabolic disease,
stroke, or sudden death
◍ 1 large box.
Answer: 5mm or 0.2 seconds
◍ 1 small box.
Answer: 1mm or 0.04 sec
◍ Risk factor thresholds for ACSM risk stratification including genetic and
lifestyle factors related to the development of CV
D. .
, Answer: Age: Men >_ 45 years old. Women >_ 55 years oldFamily History:
Myocardial infarction, coronary revascularization, or sudden death before
55 years old in father or other first degree male relative or before 65 years
old in mother or other first degree female relative.Cigarette smoking:
Current cigarette smoker or those who quit within the previous 6 months or
exposure to environmental tobacco smokeSedentary lifestyle: Not
participating in at least 30 min of moderate intensity physical activity
(40%-60% VO2R) on at least 3 days of the week for at least 3
months.Obesity: Body mass index >_ 30 kg/m2 or waist girth >102 cm (40
in) for men and >88 cm (35 in) for womenHypertension: Systolic blood
pressure >_ 140 mmHg and/or diastolic blood pressure >_ 90 mmHg,
confirmed by measurements of at least 2 separate occasions, or on
anti-hypertensive medication.Dyslipidemia: low-density lipoprotein (LDL)
cholesterol >_ 130 mg/dL or high density lipoprotein (HDL) cholesterol <
40 mg/dL or on lipid-lowering medication. If total serum cholesterol is all
that is available, use >_ 200 mgd/LPrediabetes: Impaired fasting glucose =
fasting plasma glucose >_ 100 mg/dL and <_ 125 mg/dL or impaired
glucose tolerance (IGT) = 2 hours values in oral glucose tolerance test >_
140 mg/dL and <_ 199 mg/dL confirmed by measurements on at least 2
separate occasions.Negative risk factors: High density lipoprotein (HDL):
>_ 60 mg/dL
◍ 1 Rep Max (1RM) Procedure.
Answer: 1.) warm up with sub max reps (40-60% RM)2.) 3-5 reps moderate
wt (70-80% RM)3.) 2 min rest then estimated max attempt4.) 3-5 min rest
attempt with added weight until achieved in 3-5 tries5.) once attempt failed-
attempt weight between last 2
◍ Intraventricular conduction delay.
Answer: - wide QRS = >0.1 - refers to disturbances in the intraventricular
propagation of supraventricular impulses resulting in changes in the QRS
complex either in morphology or duration, or both- abnormal activation the
ventricle cause by conduction delay
,◍ The effects of common medications and substances on exercise testing.
Answer: Beta blockers: Cardiovascular medicationsDecrease or the same
cardiac outputDecrease or the same HRDecrease BPDecrease ECG
changesDecrease or the same exercise capacityAlpha blockers/Vasodilating
Agents:Same cardiac outputIncrease or the same HRDecrease BPIncrease
resting HR, Exercise HRDecrease Exercise IschemiaIncrease exercise
capacity for patients with angina and CHF, the same for patient's without
anginaAntiarrhythmic Agents:All antiarrhythmic agents may cause new or
worsened arrhythmiasBronchodilators:HR: the same at rest and exerciseBP:
the same at rest and exericseECG: the same at rest and exerciseEx Capacity:
The same VO2 max for patients limited by bronchospasmPsychotropics:No
effectAlcohol:HR: The same rest and exerciseBP: chronic use may have role
in Increased BP, increased BP after acute ingestionECG: Rest and exercise
may provoke arrhythmiasEx Capacity: Decreased performance and VO2
maxDiet pills:HR: increasedBP: increasedEx Capacity: Increased or the
same endurance and performanceCold Tablets:HR: the same rest and
exercise, may increase during exerciseBP: the exercise, may increase SBP
during exercsieECG: May produce premature ventricular contractionsEx
capacity: the same performanceCaffeine:HR: increased resting and possibly
exerciseBP: increasedEx capacity: increased enduranceNicotine:HR:
increasedBP: increasedEx capacity: Decreased or the same
◍ Oxygen consumption dynamics during exercise.
Answer: Heart rate: The normal HR response to progressive exercise is a
relatively linear increase, corresponding to 10 +/- 2 beats/MET for
physically active subjects. Chronotropic incompetence may be signified by
the following: 1. peak exercise HR that is >2 SD (~20 beats/min) below the
age-predicted HR max or an inability to achieve >_ 85% of the age
predicted HR max for subjects who are limited by volitional fatigue and not
taking beta blockers2. A chronotropic index <0.8 (35); where CI is
calculated as the percentage of heart rate reserve to percent metabolic
reserve achieved at any test stageStroke Volume: Increases curvilinearly
with work rate until its reaches near maximum at a level equivalent to
, approximately 50% of aerobic capacity.Cardiac Output: In healthy adults,
increases linearly with an increased work rate. SVxHR=Cardiac Output.
Ventilation: Increases 15 to 25 fold at maximal exercise, during mild to
moderate exercise increased by increasing tidal volume. Ventilatory
threshold: Increases linearly with work rate and VO2 until lactate threshold
when point ventilation increases more rapidly.
◍ Dual-energy X-ray Absorptiometry (DEXA).
Answer: Advantages: Gold standard accuracy, easy to administer, higher
level of comfort, very informative, Disadvantages: Difficult to find, can be
expensive, lack of standardization, Limitations: Individual's size can cause
concern because they might not fit into the scanner, morbidly obese don't fit
into the scanner, large, expensive, used in clinical or research setting, emits
low level radiation, and user error.
◍ Indicators of an old MI.
Answer: - Abnormal/significant Q waves- 1 box wide of > 1/3 of R-wave
◍ Absolute Contraindications to Exercise Testing.
Answer: 1. recent change in ECG 2. unstable angina 3. uncontrolled
dysrhythmia causing sxs4. symptomatic severe AS 5. uncontrolled HF w/
sxs 6. acute PE or pulmonary infarct 7. acute myocarditis/pericarditis 8.
suspected / known dissecting aneurysm 9. acute systemic infection**Risk of
testing outweigh the benefits**
◍ Absolute indications to Terminate Exercise Testing.
Answer: 1. Drop in SBP > 10 mmHg w/ increased workload2. Moderately
severe angina3. Increase in Dizziness4. signs of poor perfusion5. technical
difficulties6. Sustained V-TAch7. ST elevation (+1mm) in leads w/o Q
waves
◍ Blood Glucose Management with exercise.
Answer: - Requires balance between hepatic glucose production, peripheral
glucose uptake, combined with effective insulin response- Continuous
monitoring- Regular PA
PHYSIOLOGIST ACTUAL EXAM PAPER
2026 QUESTIONS WITH ANSWERS
GRADED A+
◍ 1 MET =.
Answer: 3.5 ml/kg/mig
◍ The key components included in informed consent and health/medical
history.
Answer: Informed Consent:1. Purpose and explanation of the test2.
Attendant risks and discomforts3. Responsibilities of the participant4.
Benefits to be expected5. Inquiries6. Use of medical records7. Freedom of
consentHealth/Medical History:1. Medical diagnosis2. Previous physical
examination findings3. History of symptoms4. Recent illness,
hospitalization, new medical diagnosis, or surgical procedures.5. Orthopedic
problems6. Medication use and drug allergies7. Other habits including
caffeine, alcohol, tobacco use, or recreational drug use8. Exercise history9.
Work history10. Family history of cardiac, pulmonary, or metabolic disease,
stroke, or sudden death
◍ 1 large box.
Answer: 5mm or 0.2 seconds
◍ 1 small box.
Answer: 1mm or 0.04 sec
◍ Risk factor thresholds for ACSM risk stratification including genetic and
lifestyle factors related to the development of CV
D. .
, Answer: Age: Men >_ 45 years old. Women >_ 55 years oldFamily History:
Myocardial infarction, coronary revascularization, or sudden death before
55 years old in father or other first degree male relative or before 65 years
old in mother or other first degree female relative.Cigarette smoking:
Current cigarette smoker or those who quit within the previous 6 months or
exposure to environmental tobacco smokeSedentary lifestyle: Not
participating in at least 30 min of moderate intensity physical activity
(40%-60% VO2R) on at least 3 days of the week for at least 3
months.Obesity: Body mass index >_ 30 kg/m2 or waist girth >102 cm (40
in) for men and >88 cm (35 in) for womenHypertension: Systolic blood
pressure >_ 140 mmHg and/or diastolic blood pressure >_ 90 mmHg,
confirmed by measurements of at least 2 separate occasions, or on
anti-hypertensive medication.Dyslipidemia: low-density lipoprotein (LDL)
cholesterol >_ 130 mg/dL or high density lipoprotein (HDL) cholesterol <
40 mg/dL or on lipid-lowering medication. If total serum cholesterol is all
that is available, use >_ 200 mgd/LPrediabetes: Impaired fasting glucose =
fasting plasma glucose >_ 100 mg/dL and <_ 125 mg/dL or impaired
glucose tolerance (IGT) = 2 hours values in oral glucose tolerance test >_
140 mg/dL and <_ 199 mg/dL confirmed by measurements on at least 2
separate occasions.Negative risk factors: High density lipoprotein (HDL):
>_ 60 mg/dL
◍ 1 Rep Max (1RM) Procedure.
Answer: 1.) warm up with sub max reps (40-60% RM)2.) 3-5 reps moderate
wt (70-80% RM)3.) 2 min rest then estimated max attempt4.) 3-5 min rest
attempt with added weight until achieved in 3-5 tries5.) once attempt failed-
attempt weight between last 2
◍ Intraventricular conduction delay.
Answer: - wide QRS = >0.1 - refers to disturbances in the intraventricular
propagation of supraventricular impulses resulting in changes in the QRS
complex either in morphology or duration, or both- abnormal activation the
ventricle cause by conduction delay
,◍ The effects of common medications and substances on exercise testing.
Answer: Beta blockers: Cardiovascular medicationsDecrease or the same
cardiac outputDecrease or the same HRDecrease BPDecrease ECG
changesDecrease or the same exercise capacityAlpha blockers/Vasodilating
Agents:Same cardiac outputIncrease or the same HRDecrease BPIncrease
resting HR, Exercise HRDecrease Exercise IschemiaIncrease exercise
capacity for patients with angina and CHF, the same for patient's without
anginaAntiarrhythmic Agents:All antiarrhythmic agents may cause new or
worsened arrhythmiasBronchodilators:HR: the same at rest and exerciseBP:
the same at rest and exericseECG: the same at rest and exerciseEx Capacity:
The same VO2 max for patients limited by bronchospasmPsychotropics:No
effectAlcohol:HR: The same rest and exerciseBP: chronic use may have role
in Increased BP, increased BP after acute ingestionECG: Rest and exercise
may provoke arrhythmiasEx Capacity: Decreased performance and VO2
maxDiet pills:HR: increasedBP: increasedEx Capacity: Increased or the
same endurance and performanceCold Tablets:HR: the same rest and
exercise, may increase during exerciseBP: the exercise, may increase SBP
during exercsieECG: May produce premature ventricular contractionsEx
capacity: the same performanceCaffeine:HR: increased resting and possibly
exerciseBP: increasedEx capacity: increased enduranceNicotine:HR:
increasedBP: increasedEx capacity: Decreased or the same
◍ Oxygen consumption dynamics during exercise.
Answer: Heart rate: The normal HR response to progressive exercise is a
relatively linear increase, corresponding to 10 +/- 2 beats/MET for
physically active subjects. Chronotropic incompetence may be signified by
the following: 1. peak exercise HR that is >2 SD (~20 beats/min) below the
age-predicted HR max or an inability to achieve >_ 85% of the age
predicted HR max for subjects who are limited by volitional fatigue and not
taking beta blockers2. A chronotropic index <0.8 (35); where CI is
calculated as the percentage of heart rate reserve to percent metabolic
reserve achieved at any test stageStroke Volume: Increases curvilinearly
with work rate until its reaches near maximum at a level equivalent to
, approximately 50% of aerobic capacity.Cardiac Output: In healthy adults,
increases linearly with an increased work rate. SVxHR=Cardiac Output.
Ventilation: Increases 15 to 25 fold at maximal exercise, during mild to
moderate exercise increased by increasing tidal volume. Ventilatory
threshold: Increases linearly with work rate and VO2 until lactate threshold
when point ventilation increases more rapidly.
◍ Dual-energy X-ray Absorptiometry (DEXA).
Answer: Advantages: Gold standard accuracy, easy to administer, higher
level of comfort, very informative, Disadvantages: Difficult to find, can be
expensive, lack of standardization, Limitations: Individual's size can cause
concern because they might not fit into the scanner, morbidly obese don't fit
into the scanner, large, expensive, used in clinical or research setting, emits
low level radiation, and user error.
◍ Indicators of an old MI.
Answer: - Abnormal/significant Q waves- 1 box wide of > 1/3 of R-wave
◍ Absolute Contraindications to Exercise Testing.
Answer: 1. recent change in ECG 2. unstable angina 3. uncontrolled
dysrhythmia causing sxs4. symptomatic severe AS 5. uncontrolled HF w/
sxs 6. acute PE or pulmonary infarct 7. acute myocarditis/pericarditis 8.
suspected / known dissecting aneurysm 9. acute systemic infection**Risk of
testing outweigh the benefits**
◍ Absolute indications to Terminate Exercise Testing.
Answer: 1. Drop in SBP > 10 mmHg w/ increased workload2. Moderately
severe angina3. Increase in Dizziness4. signs of poor perfusion5. technical
difficulties6. Sustained V-TAch7. ST elevation (+1mm) in leads w/o Q
waves
◍ Blood Glucose Management with exercise.
Answer: - Requires balance between hepatic glucose production, peripheral
glucose uptake, combined with effective insulin response- Continuous
monitoring- Regular PA
