10.6 Exercise Selection, Contraindications, and Referral

NASM Certified Personal Trainer Study Guide Exam

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1 1. Orientation, Official Sources, and Exam Strategy

1.1 What the NASM-CPT Credential Tests 1.2 Eligibility, Scheduling, PSI, and Exam-Day Rules 1.3 Blueprint Weights and How to Allocate Study Time 1.4 The OPT Model as the Organizing Map 1.5 How to Use ExamFinch Practice Questions 1.6 12-Week Study Plan and Readiness Metrics

2 2. Basic Sciences: Anatomy, Physiology, and Biomechanics

2.1 Nervous, Muscular, Skeletal, Cardiorespiratory, and Endocrine Systems 2.2 Bones, Joints, Muscle Actions, and Functional Anatomy 2.3 Biomechanics, Levers, Force, Torque, and Planes of Motion 2.4 Muscle Action Spectrum and Kinetic Chain Relationships 2.5 Length-Tension, Force-Couple, Reciprocal Inhibition, and Autogenic Inhibition 2.6 Motor Learning, Motor Control, and Movement Quality

3 Chapter 3: Nutrition, Energy Systems, and Weight Management

3.1 Macronutrients, Micronutrients, and Hydration Within CPT Scope 3.2 ATP-PC, Glycolytic, and Oxidative Energy Systems 3.3 EPOC, Caloric Balance, and Units of Energy 3.4 Dietary Reference Intakes, Portion Size, Meal Timing, and Nutrient Density 3.5 Supplements, Labels, Fad Diets, and Scope Boundaries 3.6 Weight-Management Factors and Referral Decisions

4 Chapter 4: Client Relations, Behavior Change, and Coaching

4.1 Rapport, Active Listening, and Client-Trainer Relationship 4.2 SMART Goals, Outcome Goals, Process Goals, and Expectation Management 4.3 Stages of Change and Readiness Conversations 4.4 Motivational Coaching, Reinforcement, and Habit Strategy 4.5 Barriers, Social Support, Environment, Stress, and Time 4.6 Psychological Responses to Exercise and Adherence

5 Assessment, Intake, Risk, and Physiological Testing

5.1 PAR-Q, Health History, Lifestyle Questionnaire, and Documentation 5.2 Medical Risk Factors, Red Flags, and Referral 5.3 Resting Heart Rate, Blood Pressure, BMI, and Waist-to-Hip Ratio 5.4 Cardiorespiratory Assessments: Step Test, Rockport, VO2max, and RPE 5.5 Body Composition, Circumference, Skinfold, and BIA 5.6 Reassessment Timing and Outcome Tracking

6 Movement Assessment, Posture, and Kinetic Chain

6.1 Kinetic Chain Checkpoints 6.2 Static Postural Assessment 6.3 Overhead Squat Assessment 6.4 Single-Leg Squat, Push, Pull, and Gait Assessments 6.5 Strength, Endurance, Power, and SAQ Assessments 6.6 Turning Assessment Findings Into First Program Decisions

7 Chapter 7: OPT Model and Program Design Framework

7.1 OPT Levels and Phases 7.2 Stabilization Endurance 7.3 Strength Endurance, Hypertrophy, and Maximal Strength 7.4 Power Training 7.5 Periodization, Specificity, Variation, Overload, and GAS 7.6 Acute Variables and Program-Design Math

8 Chapter 8: Training Modalities: Cardio, Flexibility, Core, Balance, Reactive, and SAQ

8.1 Flexibility Continuum: SMR, Static, Active-Isolated, and Dynamic 8.2 Cardiorespiratory FITTE, Stage Training, Intervals, and Steady State 8.3 Core Stabilization, Strength, and Power 8.4 Balance Stabilization, Strength, and Power 8.5 Reactive/Plyometric Training Progressions 8.6 SAQ, Resistance Systems, Modalities, and Technology

9 Chapter 9: Exercise Technique, Cueing, and Safe Instruction

9.1 Session Setup, Warm-Up, and Cool-Down 9.2 Flexibility, Core, Balance, Reactive, and Resistance Technique 9.3 Cueing: Kinesthetic, Auditory, and Visual 9.4 Progressions, Regressions, and Exercise Modification 9.5 Spotting, Breathing, and Safe Training Environment 9.6 Stop, Modify, or Refer: Signs and Symptoms During Training

10 Chapter 10: Special Populations and Program Modification

10.1 Youth Training 10.2 Seniors and Active Aging 10.3 Prenatal and Postnatal Considerations 10.4 Obesity and Weight-Management Clients 10.5 Clinical Clients, Hypertension, Diabetes, and Cardiometabolic Risk 10.6 Exercise Selection, Contraindications, and Referral

11 Professional Responsibility, Scope, Business, and Emergencies

11.1 NASM Scope of Practice 11.2 Ethics, Documentation, Records, Appearance, and Punctuality 11.3 Safety, Equipment Maintenance, and Facility Risk 11.4 Emergency Action Plans, EMS Activation, and Incident Response 11.5 Business Development, Marketing, Sales, Retention, and Ascension 11.6 Continuing Education, Recertification, and Credible Resources

12 Integrated Scenarios, Final Review, and Career Launch

12.1 Assessment-to-Program Scenario Lab 12.2 Behavior-Coaching Scenario Lab 12.3 Exercise Technique and Safety Scenario Lab 12.4 Full-Domain Final Review Plan 12.5 Test-Day Pacing and Retake Strategy 12.6 First 30 Days After Passing NASM-CPT

10.6 Exercise Selection, Contraindications, and Referral

Key Takeaways Explain This Topic AI

Exercise selection follows assessment results, goals, fitness level, medical restrictions, contraindications, and current movement quality.

Contraindications may be absolute or specific to a position, load, range, intensity, or modality rather than a blanket no-exercise rule.

Absolute stop signals (chest pain, fainting, severe dyspnea, neurological symptoms, radiating pain) require stopping and following emergency/referral procedures.

Referral is required for diagnosis, treatment, medical nutrition therapy, psychological counseling, and any service outside the CPT scope of practice.

Last updated: June 2026

Choosing, Avoiding, and Referring

Exercise selection is a decision tree. The trainer starts with the client's goal, assessment, fitness level, movement quality, environment, equipment, medical history, and any provider restrictions, then asks: can this exercise be performed safely today? If not, the options are modify, substitute, regress, stop, or refer . NASM CPT7's blueprint names exercise selection based on assessment results, goals, fitness level, and contraindications, alongside special populations and referral indicators — meaning the exam can test exercise choice and scope in a single scenario.

Finding Exercise-selection response Referral trigger

Knee valgus in squat Reduce load, cue alignment, strengthen glutes, change stance/variation Pain, swelling, instability, or unresolved symptoms

Limited shoulder mobility Use landmine, incline, cable, or front-loaded options Numbness, radiating pain, or a medical restriction

Pregnancy after 12 weeks Avoid prone/supine, reduce impact, monitor symptoms Bleeding, dizziness, severe pain, provider restriction

Hypertension Avoid Valsalva and heavy straining; gradual intensity Chest pain, severe headache, faintness, BP >200/110

Diabetes with foot symptoms Low-impact; inspect footwear and surfaces Wound, numbness, infection concern, glucose questions

Older adult fall risk Supported balance, stable resistance Recent unexplained falls or dizziness

Contraindications, Stop Signals, and Scope

A contraindication rarely means "no exercise at all." More often it means no specific position, load, intensity, range, or modality until cleared. A client with controlled hypertension can train, but heavy breath-holding and maximal lifts may be inappropriate; a prenatal client past 12 weeks can train, but prone and supine positions are avoided. This is the difference between a relative contraindication (modify around it) and an absolute one (do not perform).

Absolute stop signals are categorically different: chest pain, fainting, severe or unusual shortness of breath, sudden neurological symptoms, radiating pain, uncontrolled bleeding, sudden loss of balance, or a client becoming unresponsive require stopping and following emergency or referral procedures . The trainer must not respond with a stretch, a diagnosis, or a motivational speech as the primary action.

Referral also applies to services outside CPT scope. NASM scope language is explicit: personal trainers design safe exercise programs, provide general nutrition and lifestyle suggestions, respond to emergencies, and refer when appropriate. They do not diagnose or treat pain or disease, prescribe medical nutrition therapy or specific meal plans, provide psychological counseling, or adjust medication. Crossing any of those lines is scope creep.

Communicating, Documenting, and Substituting

" That avoids diagnosing while making the safety rationale clear. Written clearance should be specific enough to guide training — "exercise is okay" may not answer whether loaded flexion, intervals, overhead pressing, or impact is permitted; if restrictions are vague and risk is meaningful, ask the client to get clarification from the provider. When coordinating with a client's care team, obtain written consent before sharing personal health information, and document the referral, the client's response, and any restrictions received.

Good substitutions keep the training goal while removing the risk. If a client cannot safely reach the floor for push-ups, use an elevated push-up or cable press. If balance fails during reverse lunges, use supported split squats or step-ups. If a modality is contraindicated, replace the training effect with a safer tool.

Exam traps use confident but unsafe answers: diagnose the injury, prescribe a medication change, ignore chest pain, force a standard assessment, or write a medical diet. The final, practical rule: modify the variables you are qualified to control, and refer the variables you are not qualified to interpret. That boundary is one of the most important professional skills a NASM-CPT candidate must demonstrate.

Building the Referral Network and Recognizing Red Flags

A professional CPT cultivates a referral network before it is needed — physicians, physical therapists, registered dietitians, mental-health professionals, and pelvic-floor specialists — so that when a situation exceeds scope, the trainer can hand off smoothly rather than improvise. NASM distinguishes clearly between providing general guidance (which trainers may do) and specific clinical services (which they may not). The table below maps common requests to the appropriate professional:

• Client need / request In CPT scope? Refer to
• Diagnose pain or an injury No Physician / physical therapist
• Specific calorie/macro meal plan No Registered dietitian
• Treat or rehab a diagnosed injury No Physical therapist
• Adjust medication or dosing No Prescribing physician
• Counsel for an eating disorder or depression No Licensed mental-health professional
• General nutrition and lifestyle tips Yes (trainer, within scope)
• Design a safe, cleared exercise program Yes (trainer, within scope)

A practical screen for whether something is a red flag requiring referral versus a trainable finding: ask whether the issue is a symptom of possible pathology (pain at rest, night pain, unexplained weakness, numbness, radiating pain, dizziness, chest discomfort, unexplained weight change) or a movement-quality finding (a correctable compensation, limited range, weak stabilizers). Pathology-type findings are referred; movement-quality findings are coached.

Documentation, Consent, and the Exam Mindset

Documentation is both a professional and a legal safeguard. The trainer records the clearance status, specific restrictions, the modifications applied, any symptoms reported, the referral made, and the client's response , using objective, observation-based language — never a diagnostic label the trainer invented. Before communicating with a client's healthcare provider, the trainer obtains written informed consent to share personal health information, respecting confidentiality.

On exam day, the reliable mindset is to look past the confident-sounding-but-unsafe option: the answer that diagnoses, medicates, ignores a red flag, or forces a standard protocol is almost always wrong. The defensible choice protects the client, preserves scope, documents the decision, and refers what the trainer is not qualified to interpret — while still progressing the client through every variable the trainer is qualified to control.