Study guide
CV, Pulmonary, Metabolic & Musculoskeletal Risk Factors
ACSM-EP ACSM Certified Exercise Physiologist
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1 Introduction & Exam Overview
The ACSM-EP Credential & Current Exam Facts Exam Blueprint, Cognitive Levels & Study Strategy
2 Foundations of Exercise Physiology
Bioenergetics & Energy Systems Cardiorespiratory Responses & Adaptations to Exercise Neuromuscular Physiology
3 Functional Anatomy & Biomechanics
Musculoskeletal Anatomy & Movement Terminology Biomechanical Principles
4 Preparticipation Health Screening & Risk Assessment
The ACSM Preparticipation Screening Algorithm & Medical Clearance Informed Consent & Health-History Questionnaire CV, Pulmonary, Metabolic & Musculoskeletal Risk Factors Clinical Reference Values
5 Health & Fitness Assessments
Selecting, Sequencing & Terminating Fitness Assessments Cardiorespiratory Fitness Testing Muscular Fitness, Flexibility & Neuromotor Assessment Anthropometric & Body Composition Assessment
6 Exercise Prescription Foundations: FITT-VP & Programming
The FITT-VP Framework & Training Principles Session Structure, Warm-Up/Cool-Down & Recovery Program Design, Overtraining & Injury Recognition
7 Cardiorespiratory Exercise Prescription
Prescribing CR Exercise & Intensity Methods ACSM Metabolic Equations & Caloric Expenditure
8 Resistance, Flexibility & Neuromotor Prescription
Resistance Training Prescription Flexibility, Neuromotor & Plyometric Prescription
9 Progression, Nutrition & Weight Management
Exercise Progression & Modification Energy Balance, Nutrition & Fuel Utilization Body-Composition Modification, Ergogenic Aids & Weight-Management Programming
10 Clients with Controlled Disease & Special Populations
Exercise for Controlled Cardiovascular, Pulmonary & Metabolic Disease Exercise for Arthritis, Osteoporosis, Obesity & Low-Back Pain Older Adults Children, Adolescents & Pregnant Clients Environmental Considerations: Heat, Cold, Altitude & Air Quality
11 Exercise Counseling & Behavior Modification
Communication Techniques & Group Exercise Leadership Behavior-Change Models & Theories Motivational Interviewing, Goal Setting & Adherence Health Literacy, Educational Resources & Stress Management Professional Standards, Mental Health & Referral (Scope of Practice)
12 Risk Management & Emergency Procedures
Risk Management, Legal & Professional Responsibilities Emergency Procedures, First Aid & Basic Life Support
CV, Pulmonary, Metabolic & Musculoskeletal Risk Factors
Key Takeaways Explain This Topic AI
Four categories of risk factors/conditions warrant physician consultation before exercise testing or training: cardiovascular, pulmonary, metabolic, and musculoskeletal.
Cardiovascular consultation triggers include inappropriate resting heart-rate/blood-pressure changes, new-onset chest/neck/shoulder/arm discomfort, fainting, dizzy spells, and claudication.
Physical activity favorably modifies blood pressure, dyslipidemia (raises HDL-C, lowers triglycerides), insulin sensitivity, body composition, and cardiorespiratory fitness itself.
Claudication is exercise-induced calf cramping or aching relieved by rest; syncope is a temporary loss of consciousness; ischemia is inadequate blood/oxygen supply to tissue.
Age, sex, and family history/genetics are risk factors that cannot be favorably modified by an exercise program, unlike blood pressure, lipids, and glycemic control.
Last updated: July 2026
Four Categories Requiring Physician Consultation
Even though the current screening algorithm (Section 4.1) does not tally risk factors to sort clients into risk tiers, the ACSM-EP outline separately tests recognition of specific conditions, in four categories, that should trigger a recommendation for medical-personnel consultation before exercise testing or training (Task B, Knowledge a-d). These overlap with, but are distinct from, the signs/symptoms list in Section 4.1.
Category Conditions/findings that warrant consultation
Cardiovascular Inappropriate changes in resting heart rate and/or blood pressure; new-onset discomfort in the chest, neck, shoulder, or arm; a change in the pattern of discomfort at rest or during exercise; fainting; dizzy spells; claudication
Pulmonary Asthma; exercise-induced asthma/bronchospasm; extreme breathlessness at rest or during exercise; chronic bronchitis; emphysema
Metabolic Obesity; metabolic syndrome; diabetes or glucose intolerance; hypoglycemia
Musculoskeletal Acute or chronic pain; osteoarthritis; rheumatoid arthritis; osteoporosis; inflammation/pain; low back pain
An EP-C who identifies any of these during history intake or ongoing sessions should route the client toward physician consultation using the same communication standards described in Section 4.2 -- factual, non-alarming, and documented.
Risk Factors Favorably Modified by Physical Activity
Task B, Knowledge e asks EP-Cs to identify which risk factors respond to a physical-activity intervention, since this is central to counseling clients on why the exercise prescription matters medically, not just aesthetically. Regular physical activity favorably modifies:
Blood pressure -- reduces resting systolic/diastolic blood pressure in both hypertensive and normotensive individuals.
Dyslipidemia -- raises HDL-C, lowers triglycerides, and produces a modest reduction in LDL-C, especially combined with weight loss.
Insulin sensitivity and glycemic control -- lowers fasting glucose and reduces type 2 diabetes risk and progression.
Body composition -- reduces total and visceral fat when combined with appropriate energy balance.
Cardiorespiratory fitness itself -- a risk factor in its own right; low CRF is one of the strongest independent predictors of all-cause and cardiovascular mortality.
Non-modifiable risk factors -- age, sex, and family history/genetics -- cannot be changed by an exercise program, but they still inform how conservatively an EP-C should screen and program.
Key Terms (Task B, Knowledge f)
The outline requires fluency with a specific glossary that recurs throughout the exam:
Total cholesterol (TC), HDL-C, LDL-C, triglycerides -- the plasma lipid panel components classified in Section 4.4.
Impaired fasting glucose (IFG) -- a fasting plasma glucose in the prediabetes range (Section 4.4).
Hypertension -- chronically elevated blood pressure (Section 4.4 for exact cut-points).
Atherosclerosis -- progressive narrowing and hardening of arteries from plaque buildup; the underlying pathology behind most cardiovascular risk factors on this list.
Myocardial infarction (MI) -- death of heart-muscle tissue from an interrupted blood supply, commonly called a heart attack.
Dyspnea -- the subjective sensation of shortness of breath.
Tachycardia -- a resting heart rate above the normal range, conventionally above 100 beats per minute.
Claudication -- cramping or aching leg pain brought on by exercise and relieved by rest, caused by inadequate blood flow, typically from peripheral artery disease.
Syncope -- a temporary loss of consciousness from inadequate cerebral blood flow, commonly called fainting.
Ischemia -- inadequate blood, and therefore oxygen, supply to a tissue, most often referenced for the myocardium during exertion.
Why the Categories Matter Beyond Recall
These four categories and this glossary are not just definitions to memorize in isolation -- they are the vocabulary the screening algorithm (4.1), the informed-consent conversation (4.2), and the clinical reference values (4.4) all depend on. A client who reports "cramping in my calves when I walk uphill that goes away when I stop" is describing claudication, which is both a cardiovascular risk factor requiring consultation and a major sign/symptom in the screening algorithm's symptomatic branch -- the same finding routes through both frameworks to the same conservative outcome: recommend medical clearance before continuing.
Distinguishing Similar Conditions Within a Category
The outline's category examples reward precise reading, not just category-level recall. Within musculoskeletal, osteoarthritis is a degenerative, wear-related joint condition most common with aging or overuse, while rheumatoid arthritis is a systemic autoimmune disease that also causes joint pain and inflammation but through a different mechanism and often at a younger age -- both require consultation, but for different underlying reasons. Within metabolic, metabolic syndrome is not a single risk factor but a cluster diagnosis built from several of the very values covered in Section 4.4 -- elevated waist circumference, elevated triglycerides, low HDL-C, elevated blood pressure, and elevated fasting glucose, with three of five criteria required for the diagnosis -- so recognizing metabolic syndrome on an exam item often means recognizing that pattern across several reported values rather than a single number. Within pulmonary, exercise-induced bronchospasm is specifically triggered by exertion and can be present even in a client without a standing asthma diagnosis, so it should not be dismissed just because the health history does not list "asthma."
Applying the Categories in Practice
When a new finding surfaces during intake, work through it in two steps: first, identify which of the four categories it belongs to (cardiovascular, pulmonary, metabolic, or musculoskeletal), then check whether it also appears on the Section 4.1 signs/symptoms list. A finding that appears on both lists -- such as extreme breathlessness at rest, which is both a pulmonary risk factor and a major symptom -- is never ambiguous: it requires medical consultation before testing or training proceeds, regardless of the client's current activity status.