6.2 Patient Interview, Medical History & Medication Reconciliation

ACSM Certified Clinical Exercise Physiologist ACSM-CEP

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1 Introduction & Exam Overview

1.1 The ACSM-CEP Role, Job Definition & Scope of Practice 1.2 Exam Format, Domain Weights & Scoring 1.3 Eligibility, Study Planning & Test-Day Strategy

2 Applied Exercise Physiology & Metabolic Calculations

Bioenergetics & Energy Systems (ATP-PC, glycolytic, oxidative) Acute Cardiorespiratory & Metabolic Responses to Aerobic Exercise Responses to Resistance Exercise & Chronic Training Adaptations ACSM Metabolic Equations, METs & Interpreting VO₂ / RER / Ventilatory Threshold

3 Pathophysiology of Clinical Populations

3.1 Coronary Artery Disease, Myocardial Infarction & Revascularization (PCI/CABG) 3.2 Heart Failure, Valvular Disease & Cardiac Rhythm Disorders 3.3 Hypertension, Dyslipidemia & Peripheral Artery Disease 3.4 Pulmonary Disease: COPD, Asthma & Restrictive/Interstitial Disorders 3.5 Diabetes, Metabolic Syndrome & Obesity 3.6 Renal Disease & Musculoskeletal/Orthopedic Conditions 3.7 Neuromuscular, Neurological & Cognitive Conditions (stroke, MS, Parkinson's, SCI) 3.8 Neoplastic, Immunologic & Hematologic Disorders (cancer, HIV/AIDS, anemia)

4 Clinical ECG Interpretation

4.1 ECG Leads, Waveforms, Rate & Rhythm Determination 4.2 Arrhythmias & Conduction Blocks 4.3 Ischemia, Injury & Infarction (ST changes, exercise-induced) 4.4 Drug & Electrolyte ECG Effects; Resting/Exercise Monitoring Setup & Lead Placement

5 Pharmacology for the Clinical Exercise Physiologist

5.1 Beta-Blockers, Calcium-Channel Blockers & Nitrates 5.2 RAAS Agents, Diuretics, Antiarrhythmics, Lipid-Lowering & Antithrombotic Drugs 5.3 Bronchodilators, Corticosteroids, Insulin & Oral Antidiabetic Agents 5.4 Medication Effects on HR/BP & Exercise Response; Dose/Meal/Dialysis Timing

6 Patient Assessment (Domain I, 18%)

6.1 Medical Records, HIPAA/HITRUST, Charting & Physician Referral 6.2 Patient Interview, Medical History & Medication Reconciliation 6.3 Resting Vital Signs, Body Composition & Resting ECG 6.4 Preparticipation Health Screening & Level of Monitoring (PAR-Q+, ACSM algorithm, ACC/AHA · GOLD · ADA · AACVPR) 6.5 Assessing Patient Goals, Readiness & Psychosocial Status

7 Clinical Exercise Testing (Domain II, 18%)

Submaximal Aerobic Tests (treadmill, cycle, step, 6-minute walk) Musculoskeletal Fitness, Mobility & Balance Testing Maximal Symptom-Limited GXT: Protocols, Contraindications & ECG Prep Test Termination: Relative & Absolute Indications Interpreting & Reporting Results (ECG response, RPP, claudication, Duke Treadmill Score, VO₂/RER/AT)

8 Exercise Prescription for Clinical Populations (Domain III, 22%)

FITT-VP Principles, Progression & Prescription Foundations Ex Rx for Cardiovascular Disease (CAD, HF, HTN, PAD, post-revascularization) Ex Rx for Pulmonary Disease (COPD, asthma; breathing techniques, supplemental O2) Ex Rx for Diabetes, Metabolic Syndrome & Obesity Ex Rx for Musculoskeletal, Neuromuscular, Neoplastic & Other Conditions Communicating Intensity (THR, RPE, talk test), Monitoring & Modifying the Prescription

9 Exercise Training & Leadership (Domain IV, 24%)

9.1 Discussing the Training Plan, Clinician & Patient Expectations/Goals 9.2 Instructing & Modifying Exercise Modes (cardiorespiratory, strength/endurance, flexibility, coordination, agility) 9.3 Patient Monitoring & Supervision During Exercise (telemetry, oximetry, glucometry, ECG) 9.4 Contraindications to Training & Modifying Recommendations 9.5 Documenting Clinical Status, Reporting Adverse Events & Interdisciplinary Coordination

10 Education & Behavior Change (Domain V, 13%)

10.1 Behavioral-Health Screening & Recognizing Distress (PHQ-9, Beck, SF-36; referral) 10.2 Patient Education, Health Literacy & Disease Self-Management 10.3 Motivational Interviewing & Behavior-Change Theories (Transtheoretical, HBM, Social Cognitive, Five-A's) 10.4 Promoting Adherence, Self-Efficacy, Relapse Prevention & Social Support

11 Legal, Professional & Emergency Management (Domain VI, 5%)

11.1 Emergency Equipment, Crash Cart Inspection & Emergency Procedures 11.2 CPR/AED/BLS/ACLS, Universal Precautions & EMS Activation 11.3 Scope of Practice, Legal/Ethical Standards, Liability/Negligence, Informed Consent & Professional Organizations (ACSM/AACVPR/AHA)

6.2 Patient Interview, Medical History & Medication Reconciliation

Key Takeaways Explain This Topic AI

ACSM defines a positive family-history risk factor as MI, revascularization, or sudden death before 55 in a father/first-degree male relative, or before 65 in a mother/first-degree female relative.

ACSM's risk stratification uses eight positive risk factors (age, family history, smoking, sedentary lifestyle, obesity, hypertension, dyslipidemia, prediabetes) and one negative risk factor (HDL ≥60 mg/dL, which subtracts one positive).

Medication reconciliation compares the referral list, patient-reported medications (including OTC and supplements), and pharmacy/EMR records to resolve discrepancies before testing or training.

Sedentary lifestyle is defined as not performing at least 30 minutes of moderate-intensity activity on at least 3 days a week for at least 3 months.

This risk-factor count is a separate tool from ACSM's current preparticipation screening algorithm, which does not use risk-factor counting to decide general exercise clearance.

Last updated: July 2026

Patient Interview, Medical History & Medication Reconciliation

Quick Answer: The patient interview fills gaps a chart review alone cannot — current symptoms, true medication-taking behavior, and lifestyle factors. Two products of the interview matter most for CEP practice: an accurate count of ACSM's cardiovascular disease (CVD) risk factors (used for risk stratification, revisited in Chapter 7) and a reconciled, accurate medication list, since drug therapy directly changes how heart rate, blood pressure, and symptoms should be interpreted during testing and training.

Structuring the Interview

A structured interview is more reliable than an open-ended conversation because it systematically covers domains a chart alone may miss: current symptoms, exercise history, occupational and functional demands, and the patient's own understanding of their condition. A useful sequence is chief complaint/reason for referral, past medical and surgical history, family history, medications and allergies, social history (tobacco, alcohol, activity), and a review of cardiopulmonary and metabolic symptoms (the signs-and-symptoms list is covered alongside resting assessment in Section 6.3).

Family History: What Actually Counts

Not every family illness is a positive risk factor. ACSM defines a positive family-history risk factor specifically as myocardial infarction, coronary revascularization, or sudden cardiac death before age 55 in the patient's father or another first-degree male relative, or before age 65 in the patient's mother or another first-degree female relative. A grandparent's heart attack at 78, or a sibling's diabetes diagnosis, does not meet this specific, age- and relationship-bound definition — precision here matters for accurate risk stratification.

The ACSM CVD Risk Factor Table

ACSM's Guidelines for Exercise Testing and Prescription define eight positive risk factors and one negative risk factor used to stratify cardiovascular risk (this count feeds directly into the exercise-testing supervision decisions covered in Chapter 7):

Risk Factor Positive Threshold
Age Men ≥45 years; women ≥55 years

Family history MI, revascularization, or sudden death before 55 (father/first-degree male) or before 65 (mother/first-degree female)

Cigarette smoking Current smoker, quit within the past 6 months, or exposure to secondhand smoke
Sedentary lifestyle Not performing ≥30 min of moderate-intensity activity on ≥3 days/week for ≥3 months
Obesity BMI ≥30 kg/m², or waist girth >102 cm (40 in) in men / >88 cm (35 in) in women
Hypertension SBP ≥140 mmHg and/or DBP ≥90 mmHg (confirmed on ≥2 occasions), or on antihypertensive medication

Dyslipidemia LDL ≥130 mg/dL, or HDL <40 mg/dL, or total cholesterol ≥200 mg/dL, or on lipid-lowering medication

Prediabetes Fasting glucose 100–125 mg/dL, or 2-hr OGTT 140–199 mg/dL
HDL cholesterol (negative) ≥60 mg/dL — subtracts one positive risk factor from the total

A patient's total positive count, after subtracting a qualifying HDL, is what determines the initial low/moderate/high risk classification. This is a different tool from ACSM's current preparticipation screening algorithm taught in Section 6.4, which deliberately does not use risk-factor counting to decide whether general exercise clearance is needed.

Medication Reconciliation: Comparing Three Sources

Medication reconciliation means comparing (1) the medication list on the physician referral, (2) what the patient reports actually taking, including over-the-counter drugs and supplements, and (3) pharmacy or EMR records, then documenting and resolving any discrepancies. This matters clinically because many cardiac and metabolic medications alter the exercise response the CEP is trying to measure — for example, a beta-blocker blunts the heart-rate response, making heart rate an unreliable intensity marker (Chapter 5 covers these drug effects in depth). Reconciliation should also capture timing relative to exercise — for example, insulin dosing or diuretic timing — since a mistimed dose can create hypoglycemic or orthostatic risk during a session.

Social History & Habits

Beyond smoking status, which feeds the CVD risk factor above, the interview should capture alcohol use, occupational physical demands, current and historical exercise habits, and any known barriers to activity such as pain, fear of symptoms, transportation, or caregiving duties — these directly inform the goals and readiness assessment covered in Section 6.5.

Two Different Tools, Not Interchangeable

It is worth stating plainly because the exam tests the distinction: the risk-factor count built in this section is used for exercise-testing risk stratification (how much supervision a maximal test needs — Chapter 7) and, in some settings, program-level risk categorization. It is not the tool that decides whether a patient needs medical clearance to begin exercising in the first place — that decision belongs to ACSM's current preparticipation screening algorithm, covered next in Section 6.4, which intentionally does not use risk-factor counting. Confusing the two is a common error: a patient can have several positive risk factors yet still not require medical clearance under the current algorithm if they are already regularly active with no symptoms.

Common Interview Pitfalls
Accepting a patient's self-reported medication list without comparing it to the chart
Recording "no family history" without asking about the relative's age and relationship
Skipping questions about secondhand-smoke exposure when the patient states "I don't smoke"
Failing to document the sources compared and how discrepancies were resolved