Study guide
9.5 Asthma, Cancer & Mental Health: Precautions and Signs of Decline
CSEP Certified Personal Trainer CSEP-CPT
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1 Introduction: CSEP-CPT Certification & Theory Exam Overview
Introduction: CSEP-CPT Theory Exam Facts & Certification Pathway
2 Chapter 1: Anatomy & Biomechanics in Exercise
1.1 Musculoskeletal Anatomy & Major Muscle Actions 1.2 Planes of Motion & Joint Kinematics 1.3 Biomechanical Levers, Torques & Postural Forces 1.4 Neuromuscular Mechanics & Motor Unit Recruitment
3 Chapter 2: Exercise Physiology & Energy Metabolism
2.1 Bioenergetics & Metabolic Pathways 2.2 Cardiorespiratory Responses to Acute Exercise 2.3 Chronic Physiological Adaptations to Training 2.4 Fatigue Mechanisms & Excess Post-Exercise Oxygen Consumption 2.5 Dose-Response, Sedentary Behaviour & Age and Sex Differences
4 Chapter 3: CSEP-PATH & Pre-Participation Screening
3.1 The CSEP-PATH Framework & 6-A Process 3.2 Get Active Questionnaire (GAQ) & Reference Document Protocols 3.3 Pre-Assessment Screening: Resting Heart Rate & Blood Pressure Cut-Offs 3.4 Pre-Assessment Instructions, Medical Clearance & Contraindications 3.5 PASB-Q, Stages of Change, AAL-Q & Screening in Pregnancy
5 Chapter 4: Anthropometry & Body Composition Assessment
4.1 Body Mass Index (BMI) & Height/Weight Measurement Protocols 4.2 Waist Circumference Protocols & Health Risk Stratification 4.3 Body Composition Methods: Percent Fat Techniques vs. CSEP-PATH Anthropometry 4.4 Body Composition Interpretation & Sensitive Client Communication
6 Chapter 5: Aerobic Fitness Assessment
5.1 Principles of Submaximal Aerobic Testing & Heart Rate Monitoring 5.2 Modified Canadian Aerobic Fitness Test (mCAFT) Protocols 5.3 Ebbeling Treadmill & Rockport 1-Mile Walk Protocols 5.4 Submaximal Cycle Ergometer (YMCA) Test & Aerobic Calculations
7 Chapter 6: Musculoskeletal Fitness Assessment
6.1 Grip Strength & Vertical Jump Peak Power Protocols 6.2 Push-Up Test & Muscular Endurance Protocols 6.3 Sit-and-Reach & Flexibility Assessment Protocols 6.4 Back Extension (Biering-Sorensen) & Static Balance Protocols 6.5 Forearm Plank, Y Balance Test & Predicted 1-RM Protocols 6.6 Validity, Reliability, Objectivity & Measurement Error in CSEP-PATH Assessments
8 Chapter 7: Exercise Prescription & Aerobic Training Design
7.1 Canadian 24-Hour Movement Guidelines for Adults & Youth 7.2 FITT-VP Principles for Cardiorespiratory Fitness 7.3 Training Heart Rate Calculations & RPE Scales 7.4 Aerobic Progression Strategies & Periodization Models 7.5 Canada's Food Guide, Weight Management & Health vs. Performance Goals
9 Chapter 8: Muscular Fitness & Resistance Training Programming
8.1 Resistance Training Principles, Intensity & Repetition Ranges 8.2 Program Design: Exercise Selection, Order & Structural Splits 8.3 Flexibility & Neuromotor Training Programming 8.4 Warm-Up, Cool-Down & Recovery Strategies 8.5 Exercise Instruction, Spotting, Technique Correction & Self-Monitoring
10 Chapter 9: Exercise Prescription for Special & Chronic Populations
9.1 CSEP-CPT Scope for Clients with One Stable Chronic Condition 9.2 Exercise Modifications for Hypertension & Cardiovascular Risk 9.3 Exercise Considerations for Type 2 Diabetes & Metabolic Health 9.4 Exercise Modifications for Osteoporosis, Osteoarthritis & Older Adults 9.5 Asthma, Cancer & Mental Health: Precautions and Signs of Decline 9.6 Recognizing & Responding to Adverse Events During Exercise
11 Chapter 10: Behavior Change & Lifestyle Coaching
10.1 Transtheoretical Model (TTM) Stages of Change & Processes 10.2 Motivational Interviewing Principles & OARS Techniques 10.3 Collaborative Goal Setting (SMART) & Action Planning 10.4 Overcoming Barriers, Relapse Prevention & Self-Efficacy 10.5 Theory of Planned Behaviour, HAPA & Brief Action Planning 10.6 Communication, Empathy & Instructional Techniques for Individual Clients
12 Chapter 11: Professional Practice, Scope & Risk Management
11.1 CSEP Scope of Practice Boundaries & Referral Pathways 11.2 Informed Consent, Liability Waivers & Client Documentation 11.3 Legal Liability, Negligence & Privacy Legislation (PIPEDA) 11.4 Emergency Action Plans, Facility Safety & Certification Maintenance 11.5 The CSEP Code of Conduct & Ethical Professional Practice
9.5 Asthma, Cancer & Mental Health: Precautions and Signs of Decline
Key Takeaways Explain This Topic AI
Under the CSEP-CPT Health Screening Tool, a client with asthma who has symptoms on more than 2 days a week or more than 1 night a week, or who used rescue medication more than twice in the last week, is referred before training.
For exercise-induced bronchoconstriction, use a long gradual warm-up, keep the client's reliever inhaler at hand, and avoid cold, dry or polluted air.
Cancer is not on the CSEP-CPT Health Screening Tool, so a CSEP-CPT works with a survivor only if they have the knowledge to do so safely; otherwise the client needs clearance or a CSEP-CEP.
Regular physical activity reduces depressive and anxiety symptoms, but a CSEP-CPT supports, and does not replace, mental health care; anyone with suicidal thoughts is directed to urgent help, such as Canada's 9-8-8 crisis line.
Signs that a stable condition is deteriorating, such as rising blood pressure, more frequent hypoglycemia, increased rescue-inhaler use or new symptoms, mean pausing progression and referring.
Last updated: October 2026
9.5 Asthma, Cancer & Mental Health: Precautions and Signs of Decline
The CSEP-CPT may work with one stable, lower-risk medical condition. Competency 5.3 asks you to describe precautions for clients with a stable chronic condition such as a musculoskeletal disorder, cancer, cardiovascular disease, diabetes, mental health conditions or asthma. Competency 3.4 asks you to recognize symptoms that may signal a negative change in health status. Sections 9.2 to 9.4 covered hypertension, diabetes, osteoporosis and osteoarthritis. This section completes the list.
Important
The CSEP-CPT Health Screening Tool lists only the more common conditions. For a condition that is not on it, such as cancer or a mental health condition, CSEP's screening flowchart asks: Do you have the knowledge, skills and abilities to conduct thorough pre-screening and provide exercise advice for that condition? If not, the client obtains clearance from an appropriate health care provider or is referred to a CSEP-CEP.
Asthma
Screening (CSEP-CPT Health Screening Tool) : refer for clearance or to a CSEP-CEP if the client:
has chest tightness, wheeze, shortness of breath or cough on more than 2 days a week or more than 1 night a week ; or
has used rescue medication more than 2 times in the last week .
The GAQ Reference Document adds that if shortness of breath at rest is asthma relieved by medication, light to moderate activity is safe. If it is not relieved by medication, the client consults a doctor.
Precautions for a stable client :
Confirm the client has their own reliever inhaler with them. They use it as their physician has directed, which may include before exercise.
Use a long, gradual warm-up (10 minutes or more) and a gradual cool-down. Warm, humid air is better tolerated than cold, dry air; consider indoor exercise or a scarf over the mouth in winter.
Avoid known triggers: smoke, pollen, heavy air pollution, strong fragrances and chlorine for some swimmers.
Interval or intermittent activity is often better tolerated than long continuous vigorous efforts.
Watch for exercise-induced bronchoconstriction : cough, wheeze, chest tightness or unusual breathlessness, often 5 to 15 minutes into exercise or soon after it.
Signs of decline : needing the reliever more often, night-time symptoms, reduced exercise tolerance, or an asthma attack during a session (see Section 9.6 for the response).
Cancer
Exercise during and after cancer treatment is safe for most people and improves fatigue, anxiety, depressive symptoms, physical function and quality of life. Typical evidence-based targets come from the 2019 ACSM roundtable (Campbell et al.): moderate aerobic exercise about 30 minutes, 3 times a week , plus resistance training twice a week , for at least 8 to 12 weeks. The general message is to avoid inactivity .
Scope : cancer appears as an example on GAQ Question 4 but not on the CSEP-CPT Health Screening Tool. Clients in active treatment , with treatment complications, or with more than one condition usually belong with a CSEP-CEP or a supervised oncology exercise program. A survivor whose condition is stable may train with a CSEP-CPT who has the needed knowledge, ideally with clearance from the oncology team.
Precautions to know :
- Issue Why it matters Precaution
- Cancer-related fatigue Energy fluctuates day to day Flexible plan; start low; use RPE; short bouts
Low blood counts during treatment (anemia, low white cells, low platelets) Breathlessness; infection risk; bleeding or bruising risk Follow the oncology team's guidance; clean equipment; avoid contact or fall-risk activities
Bone metastases Fracture risk Avoid high-impact and heavy loading on affected bones; requires specialist guidance
Lymphedema or risk of lymphedema Swelling after lymph node treatment Supervised, gradually progressed resistance training is appropriate; watch for increased swelling
Peripheral neuropathy from chemotherapy Reduced sensation and balance Stable surfaces, balance support, low-impact modes
Surgical sites, ports, ostomies Tissue healing; device protection Follow surgeon's restrictions; avoid pressure on devices
Mental Health Conditions
Regular physical activity reduces symptoms of depression and anxiety and improves sleep and wellbeing. CSEP offers an Exercise and Depression Specialization for professionals who want advanced competence.
Role boundaries : the CSEP-CPT supports activity and healthy behaviours. They do not diagnose, counsel or treat mental illness, and they refer to mental health professionals when needed. If a client discloses thoughts of suicide or is in crisis, the trainer stays with them and helps them reach urgent help: 9-8-8 (the Suicide Crisis Helpline, call or text in Canada), 9-1-1 for immediate danger, or their care team.
Practical precautions :
Keep goals small, flexible and enjoyable. Missed sessions are expected and are not failures. Use autonomy-supportive language (Section 10.6).
Consider social or outdoor activity if the client enjoys it, and keep sessions predictable for clients with anxiety.
Medications can change the exercise response. Some antidepressants and antipsychotics affect heart rate, blood pressure on standing (dizziness), thermoregulation, weight and alertness. Monitor RPE and symptoms, and avoid rapid position changes and exercising in heat.
Watch for over-exercise used to cope, or links with disordered eating, and refer if present (Section 4.4).
Recognizing a Negative Change in Health Status (Competency 3.4)
Clients with a stable condition can become unstable. Re-screen at each check-in and act on warning signs:
Condition Possible signs of decline CSEP-CPT action
Hypertension Resting BP above 160/90 mmHg, new headaches or dizziness, medication changes Do not exercise; refer to health care provider
Type 2 diabetes More frequent hypoglycemia; new foot sores or numbness; vision changes Refer (Health Screening Tool flags)
Asthma Increased reliever use; night symptoms Refer before continuing
Heart disease New or worsening chest discomfort, breathlessness, palpitations, swelling Stop; urgent medical assessment
Osteoarthritis Pain, stiffness or swelling lasting more than 14 days; new loss of mobility Pause the aggravating exercise; refer
Osteoporosis A new fracture, a fall, or new long-term corticosteroid use Refer
Any condition New diagnosis, a second condition, or a change in medication or treatment plan Re-screen; a second condition means a CSEP-CEP
Remember that "stable" means no change in medication or treatment plan in the past 6 months . A recent change resets the clock.