The ACSM exam is 135 multiple-choice questions. Overall, the questions are very flexible. There are very few rote memorization questions. Many questions don’t have a single correct answer, only a best answer. You have to rely on a thorough understanding of each topic to judge which is the best option. This post is mainly to let you understand the direction of the questions, and I’ll also provide a few questions I remember so you can see how flexible they are.
The exam is divided into four major categories, each with a different proportion of questions. I’ve listed the questions I encountered according to these four categories:
Domain I: Initial Client Consultation and Assessment (25%)
- Medical clearance: Judging which clients need to be evaluated by a doctor before starting. This is pretty important content. It’s mainly decided by assessing the client’s symptoms, diseases, and whether they exercise regularly. You need to pay attention to the definitions for each of these. For example, hypertension and chronic obstructive pulmonary disease don’t count as diseases you need to factor in; also, the definition of regular exercise here is different from how you evaluate cardiovascular risk and the usual exercise recommendations you give.
- Cardiovascular risk calculation: You need to memorize the definitions for each item, including age, blood sugar levels, family history, etc. They did test on “negative” risk factors, which means things that can actually “reduce” risk!
- Client forms: There are quite a few kinds. You need to be clear on what forms exist and what each one is for, like informed consent, waiver, client intake form, scope of practice, etc.
- Assessing client risk: Divided into forms filled out by the client themselves and those filled out by the physician. Know which forms belong to which.
- Other assessments: There are four types of gait in the book, and the exam tested arthrogenic gait. Also methods for assessing physical fitness, etc.
Domain II: Exercise Programming and Implementation (45%)
- Exercise programming: The questions are very flexible. Some give a long narrative and ask us to recommend an exercise prescription. The key is to look at the population (older adults, pregnant women, children, general adults), diseases (heart disease, hypertension, diabetes, etc.), exercise habits (sedentary / active lifestyle), and goals (weight loss, physique, endurance, etc.). Before the exam, you can review the fine details of exercise prescriptions again. They test on this very closely and flexibly, and you have to find the best answer from the options. Like testing whether you need 60-80% 1-RM or 70-85% 1-RM, 60-69% HRR or 70-79% HRR, 1 set or ≥1 set, 5 days/week or daily, and 6-8 muscle groups or 8-10 muscle groups. If you only memorize the gist, there’s no way you’ll get it.
- Older adults: Know the content of neuromuscular training, the starting prescription for training, and the difference in training outcomes compared to adults.
- Pregnant women: Know the conditions for stopping exercise, contraindicated exercises, and the allowed exercise intensity.
- Nutrition: The ratios of each macronutrient. For example, I got a question this time about “minimum 20% fat.” For detailed nutrition, you have to consult a dietitian; you can’t plan meals yourself.
- Weightlifting movements: I encountered two video questions catching movement errors. One tested the knees caving in too much during a squat; the other tested the lumbar spine not being stabilized during a triceps pull. They also tested what the Olympic lifts include (clean, jerk, snatch). Additionally, a question from the practice book appeared where they gave four long strings of movement names and you had to decide the appropriate weightlifting routine for the client. If you’re not familiar, you can look up the English names of various exercises online before the test. On the spot, you can try to figure it out by thinking about the body parts being trained.
- Training discomfort and complications: You need to know DOMS, overtraining syndrome, rhabdomyolysis, etc. I got tested on all three.
- Follow-up timing: I got one question asking about someone who comes to a trainer because they want to run a 10km in three months. How often should you reassess their fitness? The options were daily, weekly, bi-weekly, and monthly. I didn’t read this part while studying, so I picked bi-weekly. If anyone knows the answer, please let me know!
Domain III: Exercise Leadership and Client Education (20%)
- Methods to increase motivation: A few questions were simple definitions, like which stage of the TTM wanting to start exercising belongs to. Most were very flexible questions, like giving a scenario along with a trainer’s sentence and asking which model this is using; or a scenario where a certain model should be used, and asking which sentence fits. You have to be very clear on the various theories and models and know their similarities and differences to be able to answer. It felt a lot like taking a high school civics exam.
- TTM is tested very often. I was also asked about motivational interviewing and social cognitive theory. The test bank also includes the health belief model, socioeconomic model, change talk, the 5 A’s, SMART goals, and even SMARTS goals.
Domain IV: Legal and Professional Responsibilities (10%)
- This “legal” part is obviously “US law,” and since the exam is in English, you need to know their terminology before the test to have a chance.
- Negligence is the favorite legal topic to test. It covers the following:
- The four conditions needed for a lawsuit (duty of care, breach of duty, causation, remoteness of damage)
- Omission (failure to act, like failing to notice what should be noticed), commission (acting)
- Nonfeasance (failure to act, regardless of intent/no intent), misfeasance (acting, with intent)
- Malpractice (failing to execute according to professional methods)
- Informed consent does not waive negligence liability, but a release / waiver does.
- Which insurance can cover negligence, besides professional liability insurance. There were a lot of insurance types in the options that I couldn’t read… I searched online later and it should be general liability insurance. ACSM sells professional and general liability insurance themselves, so maybe they tested this just to sell insurance? XD
- HIPPA (Health insurance portability and accountability act) is the second favorite. Translated into Chinese, it’s the “Health Insurance Portability and Accountability Act,” which regulates the flow of patient data in the US—basically, a law protecting client privacy. I picked this for anything about personal data.
- There was one question asking whether the format for informed consent should reference HIPPA or an IRB (Institutional review board). I picked IRB myself, because I’m sure submitting to an IRB before required subjects to write this, but I’m not sure of the answer either.
Also, the exam system on the day allows you to pull up a calculator. The numbers given will include metric units in addition to imperial ones. I did memorize unit conversions before the test. It looks like maybe I didn’t need to?
The exam questions and direction are roughly like this. Now that everyone has an idea, we’ll talk about how to prepare in the next post. You can also come back and read this over before the exam to make sure you know everything. If I wrote anything wrong, you’re welcome to let me know!