ACSM EP-C Exam 2026 \LATEST UPDATE WITH
COMPLETE QUESTIONS AND ACCURATE
DETAILED ANSWERS \LATEST UPDATE 2025-
2026 For Both MIDTERM & FINAL EXAMS
1. pain in chest, neck, jaw or arms
2. shortness of breath at rest or mild exertion
3. dizziness or syncope
4. orthopnea
9 major signs/symptoms
5. ankle edema
that suggest cardiovascular,
6. palpitations/tachycardia
pulmonary and metabolic
7. intermittent claudication
disease
8. known heart murmer
9. unusual fatigue/shortness of breath with usual activities
-Asymptomatic with less than 2 risk factors
-No medical exam required
Low Risk for before exercise
-No exercise stress test required before mod or vig activity
test/program
-No MD supervision
-Asymptomatic with greater than or = 2 risk factors
Moderate Risk for before -Med exam required for vig exercise but not mod
exercise test/program -No exercise stress test required
-No MD supervision
-Symptomatic
High Risk for before exercise -Any known cardiovascular, pulmonary, renal or metabolic
test/program disease
-Yes to everything else
1. smoking
2. obesity
3. sedentary lifestyle
6 modifiable risk factors
4. pre-diabetes
5. hyperlipidemia
6. dyslipidemia
SBP: less
Normal BP level
than 120
DBP: less
than 80
, SBP: 120-139
Pre-hyperensive BP level
DBP: 80-89
SBP: greater than
Hypertensive BP level
or = 140 DBP:
greater than or =
90
optimal LDL Cholesterol less then 100
Near optimal/above optimal 100-129
LDL Cholesterol
borderline high LDL 130-159
Cholesterol
high LDL Cholesterol 160-189
very high LDL Cholesterol greater than or = 190
how many ABSOLUTE 9
conditions for Exercise
testing
1. recent significant change in the resting EKG suggesting ischemia
or heart attack
2. unstable angina
3. uncontrolled rhythms
4. symptomatic severe aortic stenosis
what are they
5. uncontrolled symptomatic heart failure
6. acute pulmonary infarction
7. acute myocarditis
8. suspected dissecting aneurysmm
9. acute systemic infection w/ fever, body aches, or swollen lymph
glands
patients with absolute should NOT
contraindications...should
not or should... perform
exercise tests until such
conditions are
stabilized/treated
, • Leftmain coronary stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities
• Severe arterial hypertension at rest (SBP of > 200
mmHg and/or a DBP of > 110 mmHg)
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy
what are they? • Neuromotor, musculoskeletal, or rheumatoid
disorders that are exacerbated by exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (e.g., diabetes, thyrotoxicosis, or
myxedema)'
• Chronic infectious disease (e.g., HIV)
• Mental or physical impairment leading to inability to exercise
adequatel
1. pre-screening/risk classification
2. take resting HR, BP, height, weight BMI and ECG (if appropriate)
3. body comp (waist and skin)
proper order or
4. cardiorespiratory fitness (max or sub max test on bike or
assessments for heath treadmill)
related physical fitness 5. muscular strength 1 or more RM upper and lower body (bench
testing (7 things) press & leg press)
6. muscular endurance (curl up, push up, or bench press)
7. flexibility (sit and reach)
take another circumference measurements are not within 5 mm
measurement if...
Risk Criteria for waist less than 70cm (28.5in)
circumference WOMEN:
very low
Risk Criteria for waist 70-89 cm (28.5-35in)
circumference WOMEN: low
Risk Criteria for waist 90-110 (35.5-43)
circumference WOMEN:
high
Risk Criteria for waist greater than 110 (43.5in)
circumference WOMEN:
very high
COMPLETE QUESTIONS AND ACCURATE
DETAILED ANSWERS \LATEST UPDATE 2025-
2026 For Both MIDTERM & FINAL EXAMS
1. pain in chest, neck, jaw or arms
2. shortness of breath at rest or mild exertion
3. dizziness or syncope
4. orthopnea
9 major signs/symptoms
5. ankle edema
that suggest cardiovascular,
6. palpitations/tachycardia
pulmonary and metabolic
7. intermittent claudication
disease
8. known heart murmer
9. unusual fatigue/shortness of breath with usual activities
-Asymptomatic with less than 2 risk factors
-No medical exam required
Low Risk for before exercise
-No exercise stress test required before mod or vig activity
test/program
-No MD supervision
-Asymptomatic with greater than or = 2 risk factors
Moderate Risk for before -Med exam required for vig exercise but not mod
exercise test/program -No exercise stress test required
-No MD supervision
-Symptomatic
High Risk for before exercise -Any known cardiovascular, pulmonary, renal or metabolic
test/program disease
-Yes to everything else
1. smoking
2. obesity
3. sedentary lifestyle
6 modifiable risk factors
4. pre-diabetes
5. hyperlipidemia
6. dyslipidemia
SBP: less
Normal BP level
than 120
DBP: less
than 80
, SBP: 120-139
Pre-hyperensive BP level
DBP: 80-89
SBP: greater than
Hypertensive BP level
or = 140 DBP:
greater than or =
90
optimal LDL Cholesterol less then 100
Near optimal/above optimal 100-129
LDL Cholesterol
borderline high LDL 130-159
Cholesterol
high LDL Cholesterol 160-189
very high LDL Cholesterol greater than or = 190
how many ABSOLUTE 9
conditions for Exercise
testing
1. recent significant change in the resting EKG suggesting ischemia
or heart attack
2. unstable angina
3. uncontrolled rhythms
4. symptomatic severe aortic stenosis
what are they
5. uncontrolled symptomatic heart failure
6. acute pulmonary infarction
7. acute myocarditis
8. suspected dissecting aneurysmm
9. acute systemic infection w/ fever, body aches, or swollen lymph
glands
patients with absolute should NOT
contraindications...should
not or should... perform
exercise tests until such
conditions are
stabilized/treated
, • Leftmain coronary stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities
• Severe arterial hypertension at rest (SBP of > 200
mmHg and/or a DBP of > 110 mmHg)
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy
what are they? • Neuromotor, musculoskeletal, or rheumatoid
disorders that are exacerbated by exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (e.g., diabetes, thyrotoxicosis, or
myxedema)'
• Chronic infectious disease (e.g., HIV)
• Mental or physical impairment leading to inability to exercise
adequatel
1. pre-screening/risk classification
2. take resting HR, BP, height, weight BMI and ECG (if appropriate)
3. body comp (waist and skin)
proper order or
4. cardiorespiratory fitness (max or sub max test on bike or
assessments for heath treadmill)
related physical fitness 5. muscular strength 1 or more RM upper and lower body (bench
testing (7 things) press & leg press)
6. muscular endurance (curl up, push up, or bench press)
7. flexibility (sit and reach)
take another circumference measurements are not within 5 mm
measurement if...
Risk Criteria for waist less than 70cm (28.5in)
circumference WOMEN:
very low
Risk Criteria for waist 70-89 cm (28.5-35in)
circumference WOMEN: low
Risk Criteria for waist 90-110 (35.5-43)
circumference WOMEN:
high
Risk Criteria for waist greater than 110 (43.5in)
circumference WOMEN:
very high
