ACSM Special Populations 2 — Questions and Answers
Question 1: When prescribing aerobic exercise for a client with type 2 diabetes, which timing consideration is most important to reduce hypoglycemia risk?
- Exercise only in the morning before breakfast
- Avoid exercise within 1 hour of insulin injection sites used in the legs
- Monitor blood glucose before, during, and after exercise sessions (Correct answer)
- Limit sessions to 10 minutes to prevent glucose depletion
Correct answer: Monitor blood glucose before, during, and after exercise sessions
Monitoring blood glucose before, during, and after exercise is the most critical safety practice to detect and manage hypoglycemia in clients with diabetes.
Question 2: A pregnant client in her second trimester asks about safe heart rate targets during exercise. What is the ACSM-recommended approach?
- Maintain HR below 140 bpm at all times
- Use RPE of 12–14 on the Borg 6–20 scale as the primary intensity guide (Correct answer)
- Limit exercise to HR below 120 bpm
- Use VO2max percentage targets the same as non-pregnant women
Correct answer: Use RPE of 12–14 on the Borg 6–20 scale as the primary intensity guide
ACSM recommends using RPE of 12–14 (somewhat hard) as the primary intensity guide during pregnancy because heart rate targets are less reliable due to cardiovascular adaptations.
Question 3: Which exercise modification is most appropriate for an older adult (75 years) with osteoporosis and high fall risk?
- Eliminate all resistance training to prevent fractures
- Prioritize seated or supine exercises and balance training over impact activities (Correct answer)
- Focus exclusively on high-impact aerobics to stimulate bone density
- Avoid exercise until bone density improves with medication
Correct answer: Prioritize seated or supine exercises and balance training over impact activities
Seated/supine exercises reduce fall risk while balance training directly addresses fall prevention, making this the safest approach for high fall-risk older adults with osteoporosis.
Question 4: A client with chronic obstructive pulmonary disease (COPD) reports dyspnea during exercise. Which initial intensity guideline should guide their aerobic program?
- Start at 80% of peak VO2 to maximize pulmonary adaptation
- Use a dyspnea rating of 3–4 on the modified Borg Dyspnea Scale as the intensity target (Correct answer)
- Keep intensity below the ventilatory threshold at all times
- Avoid aerobic exercise and focus solely on breathing exercises
Correct answer: Use a dyspnea rating of 3–4 on the modified Borg Dyspnea Scale as the intensity target
A modified Borg Dyspnea Scale rating of 3–4 (moderate) is the recommended intensity target for COPD patients, balancing training stimulus with respiratory tolerance.
Question 5: Which resistance training recommendation is most appropriate for a client who is 8 weeks postpartum and has been cleared by her physician?
- Begin with maximal loads to restore strength quickly
- Avoid all resistance training for 6 months postpartum
- Start with low loads, high repetitions, and focus on core and pelvic floor rehabilitation (Correct answer)
- Use the same pre-pregnancy program without modification
Correct answer: Start with low loads, high repetitions, and focus on core and pelvic floor rehabilitation
Postpartum exercise should begin with low loads, higher reps, and emphasis on core and pelvic floor to address the musculoskeletal changes of pregnancy and delivery.
Question 6: A client with end-stage renal disease undergoes hemodialysis three times per week. When is the best time to schedule exercise sessions?
- Immediately before dialysis to maximize energy levels
- During dialysis sessions (intradialytic exercise) (Correct answer)
- 24–48 hours after dialysis when fluid and electrolytes are balanced
- Exercise is contraindicated in end-stage renal disease
Correct answer: During dialysis sessions (intradialytic exercise)
Intradialytic exercise (during dialysis) is well-supported by research, improves adherence, and avoids the fatigue and hemodynamic instability common in the hours immediately after dialysis.
Question 7: Which blood glucose threshold should prompt postponement of exercise in a client with type 1 diabetes?
- Below 100 mg/dL or above 300 mg/dL
- Below 80 mg/dL or above 250 mg/dL with ketones present (Correct answer)
- Below 120 mg/dL or above 180 mg/dL
- Any reading outside 90–130 mg/dL
Correct answer: Below 80 mg/dL or above 250 mg/dL with ketones present
ACSM guidelines recommend postponing exercise if blood glucose is below 80 mg/dL (hypoglycemia risk) or above 250 mg/dL with ketones present (ketoacidosis risk).
ACSM Special Populations 2
When prescribing aerobic exercise for a client with type 2 diabetes, which timing consideration is most important to reduce hypoglycemia risk?