ACSM Special Populations 3 — Questions and Answers
Question 1: An older adult client demonstrates a score of 22 seconds on the Timed Up and Go (TUG) test. How should this result influence the exercise program?
- No modification needed; this is a normal score for adults over 65
- Prioritize balance, gait, and fall-prevention exercises due to elevated fall risk (Correct answer)
- Focus exclusively on cardiovascular training to improve functional capacity
- Defer all exercise until the TUG score is below 10 seconds
Correct answer: Prioritize balance, gait, and fall-prevention exercises due to elevated fall risk
A TUG score above 12–13.5 seconds in older adults indicates elevated fall risk, warranting emphasis on balance, gait training, and fall-prevention strategies.
Question 2: Which absolute contraindication to exercise during pregnancy is identified by ACSM?
- Mild gestational hypertension without organ involvement
- Placenta previa after 26 weeks of gestation (Correct answer)
- Mild anemia (hemoglobin 10–11 g/dL)
- History of preterm birth in a prior pregnancy
Correct answer: Placenta previa after 26 weeks of gestation
Placenta previa after 26 weeks is an absolute contraindication to exercise during pregnancy because it poses a risk of severe hemorrhage with physical activity.
Question 3: What is the primary mechanism by which regular aerobic exercise benefits individuals with depression?
- Increases cortisol production to enhance alertness
- Promotes neurogenesis and increases monoamine neurotransmitter availability (Correct answer)
- Reduces sleep duration to increase daytime productivity
- Decreases heart rate variability to promote parasympathetic dominance
Correct answer: Promotes neurogenesis and increases monoamine neurotransmitter availability
Exercise promotes neurogenesis (particularly in the hippocampus) and increases availability of serotonin, dopamine, and norepinephrine, which are key mechanisms underlying antidepressant effects.
Question 4: A client with multiple sclerosis (MS) reports significant fatigue after exercise in warm environments. What strategy best addresses this?
- Eliminate all exercise to prevent fatigue-induced relapse
- Schedule exercise in cool environments and use cooling vests or cold-water immersion pre-exercise (Correct answer)
- Increase exercise intensity to build heat tolerance
- Restrict exercise to 5-minute intervals regardless of fatigue level
Correct answer: Schedule exercise in cool environments and use cooling vests or cold-water immersion pre-exercise
Uhthoff's phenomenon in MS causes temporary worsening of symptoms with heat; cooling strategies and cool exercise environments significantly reduce exercise-associated fatigue and symptom exacerbation.
Question 5: For a client with hypertension who is beginning a resistance training program, which set-and-rep scheme is most appropriate initially?
- 1 RM testing followed by training at 90% 1RM
- High-intensity interval resistance training with Valsalva maneuver
- Moderate loads (60–70% 1RM), 10–15 repetitions, avoiding breath-holding (Correct answer)
- Very low load (20% 1RM) with 30+ repetitions to avoid any BP elevation
Correct answer: Moderate loads (60–70% 1RM), 10–15 repetitions, avoiding breath-holding
Moderate loads with higher repetitions and continuous breathing minimize excessive blood pressure spikes while providing sufficient training stimulus for hypertensive clients.
Question 6: When designing an exercise program for a child (age 10) who is overweight, which approach aligns with ACSM pediatric guidelines?
- Focus on caloric restriction and eliminate all non-structured activity
- Emphasize enjoyable, play-based physical activity accumulating 60 minutes daily (Correct answer)
- Use adult weight-loss protocols adapted with lighter equipment
- Restrict vigorous activity until a healthy BMI is achieved
Correct answer: Emphasize enjoyable, play-based physical activity accumulating 60 minutes daily
ACSM and pediatric guidelines emphasize enjoyable, play-based activities accumulating at least 60 minutes of moderate-to-vigorous activity daily for children, prioritizing long-term physical activity habits.
Question 7: Which physiological change associated with aging most directly reduces maximal aerobic capacity (VO2max) in older adults?
- Decreased peripheral vascular resistance
- Reduction in maximal heart rate and stroke volume (Correct answer)
- Increased mitochondrial density in skeletal muscle
- Decreased body fat percentage
Correct answer: Reduction in maximal heart rate and stroke volume
Aging causes a decline in maximal heart rate (approximately 1 bpm/year) and reduced stroke volume due to decreased cardiac compliance, both of which directly lower VO2max.
ACSM Special Populations 3
An older adult client demonstrates a score of 22 seconds on the Timed Up and Go (TUG) test.
How should this result influence the exercise program?