ACSM-CEP Cheat Sheet

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Patient Assessment 18% of exam ACS Spectrum HF Classification BP & PAD Staging Metabolic & Diabetes Criteria Pulmonary Staging Preparticipation Clearance DKA vs HHS MONA Mnemonic

Exercise Testing 18% of exam Test Protocols ECG Basics & Blocks Ischemia & Infarction ECG Interpreting Results Contraindications Termination Triage Digoxin vs Ischemia

Exercise Prescription 22% of exam FITT-VP & Intensity MET & Metabolic Math Intensity Selection FITT-VP Mnemonic

Exercise Training and Leadership 24% of exam Rate-Limiting & Vasoactive Drugs Other Drug Effects Beta-Blocker vs DHP-CCB BAND Drugs Mnemonic

Education and Behavior Change 13% of exam Behavior Change Tools Stages of Change Motivational Interviewing Adherence Strategies Health Literacy

Legal and Professional Responsibilities 5% of exam Negligence & Consent Emergency Response CEP vs EP-C Scope Chain of Survival 15-15 Rule

Quick Facts Exam ACSM-CEP Credential Clinical Exercise Physiologist Items 115 (100 scored) Time 210 minutes Pass 550/800 scaled Domains 6 weighted domains Fee $350 member / $460 Provider Pearson VUE Blueprint Jul 10, 2025

MONA (ACS Recognition) AS Morphine, Oxygen, Nitrates, Aspirin M: pain relief O: only if hypoxic N: raises ischemic threshold A: antiplatelet therapy

DKA vs HHS AS

DKA Glucose usually >250 Ketones positive, pH low Type 1 diabetes, rapid Kussmaul breathing, fruity breath

HHS Glucose usually >600 Ketones minimal, pH normal Type 2, older, slower Severe dehydration, confusion Acidotic vs hyperosmolar crisis

Preparticipation Clearance Decision AS Inactive, no symptoms → No clearance needed ( For light-moderate exercise ) Inactive, symptoms or disease → Clearance recommended ( Before starting program ) Active, known disease only → Continue current program ( Clearance before vigorous ) Active, new symptoms appear → Discontinue, seek clearance ( Overrides activity history )

ACS Spectrum AS Stable angina Fixed stenosis, rest relief Unstable angina Rest pain, negative troponin NSTEMI Partial occlusion, positive troponin STEMI Complete occlusion, ST elevation Silent ischemia No pain despite ECG change Anginal equivalent Dyspnea, fatigue, jaw pain

Heart Failure Classification AS HFrEF EF 40% or less HFmrEF EF 41 to 49% HFpEF EF 50% or more NYHA I No symptom limitation NYHA II Symptoms with ordinary activity NYHA III Symptoms with less activity NYHA IV Symptoms present at rest

BP and PAD Staging AS Normal BP Under 120/80 mmHg Elevated BP 120-129, under 80 Stage 1 hypertension 130-139 or 80-89 Stage 2 hypertension 140+ or 90+ ABI normal 1.00 to 1.40 ABI mild-moderate PAD 0.41 to 0.90 ABI severe PAD 0.40 or below

Metabolic and Diabetes Criteria AS Diabetes A1C 6.5% or higher Diabetes fasting glucose 126 mg/dL or higher Diabetes OGTT 200 mg/dL, 2-hour MetSyn diagnosis 3 of 5 criteria MetSyn triglycerides 150 mg/dL or higher MetSyn blood pressure 130/85 mmHg or higher MetSyn fasting glucose 100 mg/dL or higher

Pulmonary Staging AS COPD diagnosis FEV1/FVC under 0.70 GOLD 1 FEV1 80% or more GOLD 2 FEV1 50 to 79% GOLD 3 FEV1 30 to 49% GOLD 4 FEV1 under 30% GOLD Group E 2+ exacerbations, any symptoms Exercise SpO2 floor 88 to 90%

Absolute vs Relative Contraindications TE

Absolute Recent MI, 2-3 days Unstable angina Uncontrolled arrhythmia Acute aortic dissection

Relative Left main stenosis Severe resting hypertension High-grade AV block Hypertrophic cardiomyopathy Defer testing vs weigh risk

Test Termination Triage TE Patient requests stop → Terminate now ( Absolute, no exceptions ) Sustained VT appears → Terminate now ( Absolute indication ) ST elevation 1mm+ → Terminate now ( No prior Q waves ) SBP drop + ischemia signs → Terminate now ( Absolute indication ) SBP >250 or DBP >115 → Terminate now ( Hypertensive response ) ST depression >2mm → Usually stop ( Relative, use judgment ) Multifocal PVCs, couplets → Usually stop ( Relative indication ) Increasing chest pain → Usually stop ( Relative indication )

Exercise Test Protocols TE Bruce protocol 3-min stages, general use Modified Bruce Adds low-intensity start stages Naughton protocol 1-MET steps, cardiac patients Cycle ramp Continuous rise, best for CPET Ideal test length 8 to 12 minutes Treadmill VO2peak 5-10% higher than cycling Cycle ergometry ECG More stable, less artifact

Absolute vs Relative Termination TE

Absolute Patient requests stop Sustained VT ST elevation 1mm+ Poor-perfusion signs

Relative Marked ST depression Multifocal PVCs Increasing chest pain Hypertensive response Stop always vs use judgment

ECG Basics and AV Blocks TE Normal PR interval 0.12 to 0.20 sec Normal QRS duration Under 0.12 seconds ECG paper speed 25 mm per second Small ECG box 0.04 seconds Mobitz I PR lengthens, then drops Mobitz II Constant PR, sudden drop Third-degree block P and QRS independent

Digoxin Effect vs True Ischemia TE

Digoxin effect Downsloping, scooped shape Present at rest too Therapeutic-dose finding Shortens QT interval

True ischemia Horizontal/downsloping, 1mm+ New with exercise Resolves during recovery Signals reduced blood flow Medication effect vs new ischemia

Ischemia and Infarction ECG TE Ischemia sign ST-segment depression Injury sign ST-segment elevation Infarction sign Pathologic Q wave Ischemic ST depression 1mm+ horizontal or downsloping Pathologic Q wave 0.04 sec, 25% of R Anterior MI leads V3 and V4 Inferior MI leads II, III, aVF Lateral MI leads I, aVL, V5-V6

Interpreting Test Results TE Rate-pressure product HR times systolic BP Duke Treadmill Score Time, ST deviation, angina index DTS low risk +5 or higher DTS high risk -11 or lower Maximal-effort RER 1.10 or higher at peak Ventilatory threshold Submaximal, effort-independent marker Mason-Likar placement Limb leads moved to torso

FITT-VP PR Frequency, Intensity, Time, Type, Volume, Progression F: days/week I: %HRR or RPE T: session minutes T: activity type V: weekly MET total P: advance slowly

Exercise Intensity Selection PR GXT HRmax measured → Karvonen %HRR ( Most precise HR method ) Beta-blocker or pacemaker → RPE Borg 6-20 ( HR response unreliable ) Atrial fibrillation present → RPE or talk test ( HR unpredictable ) Gas-exchange data available → Ventilatory threshold ( Highest precision option ) No GXT performed → Skip age-predicted HRmax ( Wide individual error ) Deconditioned, tolerating program → Increase time first ( Then frequency, then intensity )

FITT-VP and Intensity PR Aerobic frequency 3 to 5 days/week Moderate intensity 40-59% heart rate reserve Vigorous intensity 60-89% heart rate reserve Karvonen formula HRR-based target heart rate Weekly volume goal 500 to 1,000 MET-min Resistance starting load 40 to 60% of 1RM Progression order Time, then frequency, then intensity

MET and Metabolic Math PR 1 MET 3.5 mL/kg/min oxygen RER near 0.70 Mostly fat oxidation RER near 1.00 Mostly carb oxidation Kcal per liter O2 About 5 kcal mph to m/min Multiply by 26.8 Watts to kgm/min Multiply by 6 (ACSM)

Rate-Limiting Drugs (BAND) TR Beta-blockers, Amiodarone, Non-DHP CCBs, Digoxin blunt HR B: beta-blockers A: amiodarone N: non-DHP CCBs D: digoxin, rate control

Beta-Blocker vs DHP-CCB TR

Beta-blockers Blunt HR throughout exercise Use RPE, not %HRmax Bronchospasm risk (nonselective) Mask hypoglycemia warning signs

DHP CCBs Minimal direct HR effect Reflex tachycardia possible Peripheral edema common No hypoglycemia masking HR-blunting vs vasodilating

Rate-Limiting and Vasoactive Drugs TR Beta-blockers Blunt HR, use RPE Non-DHP CCBs Blunt HR and AV node DHP CCBs Vasodilate, reflex tachycardia Nitrates Raise ischemic threshold Nitrate plus PDE-5 inhibitor Absolute contraindication, severe hypotension ICD training ceiling 10-20 bpm below shock zone

Other Drug Effects TR Digoxin ECG effect Scooped ST depression Diuretics Post-exercise hypokalemia arrhythmia risk Amiodarone toxicity Pulmonary and thyroid effects Statins Myalgia, rare rhabdomyolysis Anticoagulants/antiplatelets Bleeding risk, avoid contact SGLT2 inhibitors Euglycemic DKA risk Beta-2 agonists Expected mild tachycardia

Behavior Change Tools ED Transtheoretical Model Stages of change Health Belief Model Perceived risk and benefit Self-Determination Theory Autonomy, competence, relatedness Motivational interviewing Elicits patient's own motivation PAR-Q+ Self-guided readiness screen

Chain of Survival LE Recognize, Call, CPR, Shock, Advanced care, Recovery 1: recognize, call EMS 2: early high-quality CPR 3: early defibrillation 4: advanced EMS care 5: post-arrest care 6: recovery

CEP vs EP-C Scope LE

ACSM-CEP Clinical hours required Unstable, high-risk patients ECG-monitored testing Medication-adjusted prescription

EP-C No clinical hours Healthy or stable patients Non-medical settings General fitness prescription Clinical scope vs non-clinical

Negligence and Informed Consent LE Negligence elements Duty, breach, causation, damages Consent timing Before testing or training Consent must cover Risks, benefits, alternatives, stop right HIPAA standard Minimum necessary PHI use Standard of care Reasonably prudent CEP action

15-15 Rule LE 15 grams carbs, wait 15 minutes, recheck Glucose below 70 = treat Give 15g fast carb Wait 15 minutes Recheck, repeat if low

Emergency Response Basics LE CPR compression rate 100 to 120 per minute CPR compression depth 2 to 2.4 inches CPR ratio 30:2, single rescuer Hypoglycemia rule 15g carb, recheck 15 min Heat stroke threshold Over 104F plus CNS signs BLS requirement Required for all CEP staff ACLS requirement 1+ staff in clinical programs

Common Traps

Syncope timing Vasovagal after exercise ≠ Cardiac during exercise

Digoxin Effect vs True Ischemia Scooped, present at rest ≠ New change during exercise

Risk Factors vs Clearance Algorithm Risk count sets test supervision ≠ 3-factor algorithm sets clearance

VO2max vs VO2peak Max implies a true plateau ≠ Peak is highest value seen

Mobitz I vs Mobitz II PR lengthens before it drops ≠ PR stays constant, drops suddenly

DHP vs Non-DHP CCB DHP vasodilates, reflex tachycardia ≠ Non-DHP blunts HR like BB

CABG vs PCI Precautions CABG: 6-8 wks, no lifting ≠ PCI: 24-48 hrs, site only

Last Minute 1 . Weights 18-18-22-24-13-5 2 . 115 items, 550 pass, 210min 3 . Absolute stop: VT, ST-elevation, request 4 . Relative stop: ST-depression, multifocal PVCs 5 . Beta-blockers blunt HR, use RPE 6 . Digoxin scoops ST, not ischemia 7 . SGLT2i: euglycemic DKA risk 8 . Know Duke Treadmill Score formula 9 . Mason-Likar: limb leads to torso 10 . CPR 30:2, depth 2-2.4in 11 . Hypoglycemia: 15g carb, recheck 15min 12 . Negligence: duty, breach, causation, damages 13 . CEP clinical hours; EP-C none 14 . RER 1.10 = max effort

ACSM-CEP Practice Questions 212 questions Study Guide 51 topics Cheat Sheet 106 facts Flashcards 50 cards Shorts 1 short Blogs 1 blog Free CE

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