SECTION 6 – Physical activity science and prescription

Question 1 (1 point)
A 45-year-old individual with a family history of cardiovascular disease is
seeking advice on incorporating regular physical activity into their routine.
The healthcare provider emphasizes the numerous health benefits of
exercise. Which of the following accurately describes a key physiological
effect of regular physical activity on cardiovascular health?
Question 1 options:
a. Decreased heart rate variability leading to improved cardiac
performance.
b. Increased levels of LDL cholesterol promoting arterial plaque formation.
c. Enhanced endothelial function contributing to reduced blood pressure.
d. Heightened sympathetic nervous system activity resulting in reduced
vasodilation.

Question 2 (1 point)
A 46-year-old healthy woman asks when is the point of significant
diminishing returns from exercise in terms of mortality? She would like to
know after how many minutes of exercise does the mortality risk begin to
level off?
Question 2 options:
a. 200 minutes per week
b. 300 minutes per week
c. 400 minutes per week
d. There is no leveling off

Question 3 (1 point)
Which of the following statements best describes a significant
cardiovascular benefit attributed to high-intensity interval training (HIIT)?
Question 3 options:
a. HIIT primarily enhances cardiovascular health by promoting steady-
state, low-intensity exercise for extended periods.
b. HIIT results in a decrease in cardiac output due to reduced stroke
volume during intense exercise intervals.
c. HIIT leads to a reduction in heart rate variability, contributing to
improved cardiovascular endurance.
d. HIIT has been shown to improve left ventricular diastolic function and
increase cardiac efficiency.

Question 4 (1 point)
A 38-year-old man who is obese and has a history of hypertension
presents for a wellness visit. He has started jogging 10 minutes three times
per week for one month. He was initially sore, but now inquires about
aggressively increasing his exercise to lose weight and keep his blood
pressure down. He would like to continue jogging. His blood pressure
today is 138/78 mmHg. Which of the following is the best
recommendation in accordance with the American College of Sports
Medicine (ACSM) guidelines?
Question 4 options:
a. Increase the duration of the three weekly jogs by 20% per week until
you are at 30 minutes
b. Increase the duration of the three weekly jogs by 30% per week until
you are at 30 minutes
c. Increase the duration of the three weekly jogs by 40% per week until
you are at 30 minutes
d. Increase the duration of the three weekly jogs by 50% per week until
you are at 30 minutes
Question 5 (1 point)
In the acronym FITT, which is utilized to dose physical activity, the "I"
stands for which of the following?
Question 5 options:
a. Individual
b. Intensity
c. Interval
d. Isometric

Question 6 (1 point)
A 45-year-old sedentary individual with a body mass index (BMI) of 31
kg/m² presents to the clinic for a routine check-up. Family history reveals
that both parents have type 2 diabetes. The patient is concerned about
their diabetes risk and asks about the role of exercise in prevention. Which
of the following statements best reflects the current medical evidence
regarding exercise efficacy in preventing type 2 diabetes?
Question 6 options:
a. Increasing physical activity is most effective in preventing diabetes by
directly reducing body weight.
b. Regular physical activity primarily impacts diabetes prevention through
its effect on increasing insulin production.
c. Engaging in high-intensity interval training (HIIT) is the optimal exercise
approach for diabetes prevention.
d. Exercise can enhance insulin sensitivity and reduce visceral adiposity to
lower the risk of developing type 2 diabetes.

Question 7 (1 point)
An assessment of a 78-year-old woman finds that she would benefit from
balance exercises to prevent falls. Which of the following is the most
important step when first prescribing balance exercises for this woman?
Question 7 options:
a. Having the patient practice standing on an unstable surface
b. Having the patient practice standing with eyes closed to improve
proprioception
c. Screening for osteoporosis
d. Starting with exercises using a hand-hold support to aid stability

Question 8 (1 point)
As part of a wellness assessment, it is determined that a 55-year-old man
does not meet the recommended levels of physical activity. He states that
he does not like to exercise because it is boring and uncomfortable. In
encouraging him to be more physically active, his health care provider can
explain that while "exercise" is planned, structured and repetitive,
"physical activity" is defined as:
Question 8 options:
a. Movement that occurs as a result of performing daily tasks.
b. Exercise that is not planned.
c. Exercise that is done for fun and not to improve fitness.
d. Any movement produced by the contraction of skeletal muscles that
increases energy expenditure above a resting level.

Question 9 (1 point)
A 68-year-old healthy man who wants to prevent cardiovascular disease
asks how much he should exercise. Which of the following is the minimum
amount of moderate intensity aerobic activity recommended for adults?
Question 9 options:
a. 90 minutes a week
b. 120 minutes a week
c. 150 minutes a week
d. 180 minutes a week

Question 10 (1 point)
A 32-year-old healthy woman who is pregnant wants to maintain her
optimal health during the pregnancy. She regularly cycles at the
community center, at a vigorous intensity. She asks at a minimum how
much she should cycle to maintain her fitness. Which of the following is
the correct recommendation for the woman?
Question 10 options:
a. 45 minutes a week at a moderate intensity
b. 60 minutes a week at a vigorous intensity
c. 75 minutes a week at a vigorous intensity
d. 90 minutes a week at a moderate intensity

Question 11 (1 point)
A 35-year-old man with hereditary hyperlipidemia who wants to prevent
cardiovascular disease asks how much at a minimum he should exercise a
day. In addition to the time prescribed for moderate to vigorous daily
activity, he should include muscle strengthening activities for at least how
many days a week?
Question 11 options:
a. 1 day a week
b. 2 days a week
c. 3 days a week
d. 4 days a week
Question 12 (1 point)
Compared to the guidelines for adults (18 to 64 years), the Physical
Activity Guidelines for Americans recommends that older adults (65 years
and older) should aim to complete which of the following?
Question 12 options:
a. One third of the recommended levels for adults
b. Half of the recommended levels for adults
c. The same as the recommended levels for adults
d. One third more than the recommended levels for adults to compensate
for age-related sarcopenia

Question 13 (1 point)
Physicians who exercise are more likely to counsel their patients to
exercise. Which of the following is the most common barrier to other
physicians providing this advice?
Question 13 options:
a. Embarrassment
b. Irrelevance to clinical specialty
c. Lack of personal knowledge
d. Reimbursement difficulties

Question 14 (1 point)
Which of the following is the MET (Metabolic Equivalent of a Task) value of
sleeping?
Question 14 options:
a. 0.9
b. 1.0
c. 1.2
d. 2.0

Question 15 (1 point)
The Metabolic Equivalent of Task (MET) is a conventional unit used to
express the level of physiological work being performed. The resting
metabolic rate while sitting quietly is considered the reference of 1 MET.
High intensity running (at 10.9 mph = 5.5 minutes/mile; or 17.5 km/hour =
3.4 minutes/km) is approximately how many METs?
Question 15 options:
a. 3 METs
b. 6 METs
c. 9 METs
d. 18 METs

Question 16 (1 point)
A 42-year-old man is interested in increasing his moderate intensity
exercise from 300 minutes/week to 360 minutes/week. Which of the
following most accurately describes the effect of the extra 60
minutes/week of exercise on reduction in mortality?
Question 16 options:
a. It is directly proportional to the increased duration.
b. It is of lower magnitude than the same increase from a baseline of less
than 300 minutes per week.
c. It has no additional effect.
d. It requires progressively increasing intensity as well as duration.
Question 17 (1 point)
A 32-year-old sedentary individual with a body mass index (BMI) of 28
kg/m² is seeking guidance on creating an exercise regimen to improve
cardiovascular fitness and aid in weight management. The healthcare
provider recommends an exercise prescription that incorporates the
principles of high-intensity interval training (HIIT). Which of the following
components is most crucial when prescribing an effective HIIT regimen for
this individual?
Question 17 options:
a. Sustaining a consistently high intensity throughout the entire exercise
session.
b. Incorporating at least 60 minutes of aerobic exercise in each HIIT
session.
c. Allowing an increasingly longer recovery period between high intensity
intervals to prevent fatigue.
d. Alternating brief periods of vigorous exercise with low-intensity active
recovery intervals.

Question 18 (1 point)
A 65-year-old female with a history of osteopenia presents to discuss
strategies to increase her bone health. She is interested in physical activity
and exercise strategies to hopefully prevent a fracture. Which of the
following exercises would have the largest impact on improving bone
strength:
Question 18 options:
a. Stationary Bike
b. Yoga
c. Tennis
d. Swimming
Question 19 (1 point)
Which of the following is correct about the Talk Test for assessment of
aerobic exercise intensity?
Question 19 options:
a. It is only applicable in trained athletes.
b. It is only performed by qualified professionals.
c. It may involve singing.
d. It requires validated measuring equipment.

Question 20 (1 point)
A 65-year-old male with a history of chronic obstructive pulmonary disease
(COPD) presents to the clinic for a follow-up evaluation. He reports
increasing shortness of breath and reduced exercise tolerance over the
past few months. On physical examination, his vital signs are stable, and he
demonstrates no signs of acute distress. Pulmonary function tests reveal a
forced expiratory volume in one second (FEV1) of 50% predicted. The
patient's healthcare provider decides to assess his functional capacity
using the 6-minute walk test (6MWT). Which of the following parameter is
the primary outcome measured during the 6MWT?
Question 20 options:
a. Maximum heart rate
b. Minimum oxygen saturation
c. Maximum rate of perceived exertion
d. Six-minute walk distance

Question 21 (1 point)
A 28-year-old female presents to the clinic for a fitness assessment as part
of her goal to improve her overall health. She is interested in
understanding her body composition to tailor her exercise and nutrition
plan. The patient's height is 165 cm (65 inches) and her weight is 65 kg
(143 lbs). Which of the following best describes the primary objective of
using skin fold thickness measurements to assess body composition?
Question 21 options:
a. Determining the absolute fat mass in kilograms
b. Estimating the lean body mass distribution in different body segments
c. Assessing the distribution of muscle and bone mass throughout the
body
d. Evaluating the subcutaneous fat layer thickness for estimation of body
fat percentagem

Question 22 (1 point)
A 70-year-old male is undergoing a comprehensive health assessment. As
part of the assessment, his grip strength is measured using a handheld
dynamometer. The participant's grip strength is found to be significantly
lower than the average grip strength observed in individuals of his age and
gender. Which of the following conclusions is most likely to be drawn from
the relationship between grip strength and mortality?
Question 22 options:
a. Grip strength is not a reliable predictor of mortality in older adults.
b. Lower grip strength is associated with a decreased risk of mortality over
the 10-year period.
c. Individuals with higher grip strength have a higher likelihood of
mortality compared to those with lower grip strength.
d. Lower grip strength at baseline is correlated with an increased risk of
mortality over the 10-year follow-up.
Question 23 (1 point)
A 23-year-old fitness enthusiast aspires to become an American College of
Sports Medicine (ACSM) certified personal trainer. She has completed a
bachelor's degree in Exercise Science and is eager to pursue this career
path. Which of the following requirements is a prerequisite for her to fulfill
in order to become an ACSM certified personal trainer?
Question 23 options:
a. Attaining a master's degree in Exercise Physiology from an accredited
institution.
b. Completing a 500-hour internship at any fitness facility of her choice.
c. Holding a valid cardiopulmonary resuscitation (CPR) and automated
external defibrillator (AED) certification.
d. Accumulating a minimum of five years of experience as a fitness
instructor in a recognized health club.

Question 24 (1 point)
A 61-year-old sedentary man presents to the clinic after an emergency
department (ED) visit for an episode of palpitations and new onset atrial
fibrillation. He converted spontaneously in the ED prior to any treatment.
His EKG today is normal sinus rhythm. Which of the following lifestyle
practices reduces the recurrence of atrial fibrillation?
Question 24 options:
a. Weight loss and increased omega 3 fatty acid intake
b. Weight loss and improved aerobic fitness
c. Improved aerobic fitness and increased omega 3 fatty acid intake
d. Reduced aerobic fitness regardless of omega 3 fatty acid intake
Question 25 (1 point)
A 27-year-old woman is 10 weeks pregnant. She is concerned about the
risks of exercise during pregnancy. Exercise is associated with increased
incidence of which of the following pregnancy-related outcomes?
Question 25 options:
a. Excessive gestational weight
b. Preterm birth
c. Vaginal delivery
d. Cesarean delivery

Question 26 (1 point)
A 25-year-old man has a family history of colon cancer, diabetes and
cardiovascular disease. He is sedentary and wants to become more active,
by increasing his physical activity at work. He currently works at an office
job for a contractor (expending 15 MET-hours per week). His boss recently
offered him four new job options ranked by physical activity level. The
weekly MET-hours for each job are shown below. Which job option would
best help him progress toward a more physical activity lifestyle, without an
increased risk of untoward medical event.
Question 26 options:
a. Level 1: Materials delivery at 30 MET-hours per week
b. Level 2: Custodial at 45 MET-hours per week
c. Level 3: Landscaping at 60 MET-hours per week
d. Level 4: Cement mason at 75 MET-hours per week
Question 27 (1 point)
Exercise is an important addition to a lifestyle prescription because it
operates through which the following mechanisms?
Question 27 options:
a. Reduced insulin-like growth factor-1 (IGF-1)
b. Stimulation of glucose transporter type 4 (GLUT-4)
c. Elevated tumor necrosis factor-α (TNF-α)
d. Elevated catecholamines

Question 28 (1 point)
A 68-year-old female patient who is osteoporotic with a BMI 19.5kg/m2 is
concerned about her bone mineral density and lack of strength to perform
ADLs. She is interested in engaging in strength training to address these
issues and improve her overall independence. What would be the most
appropriate starting point for her resistance training program?
Question 28 options:
a. 1 day per week, 1 set for all major muscle groups, 10-15 reps/set, 40-
50% of 1-RM
b. 2 days per week, 1 set for all major muscle groups, 8-12 reps/set, 40-
50% of 1-RM
c. 2 days per week, 1 set for all major muscle groups, 10-15 reps/set, 40-
50% of 1-RM
d. 2 days per week, 1 set for all major muscle groups, 10-15 reps/set, 60-
80% of 1-RM
RESPOSTAS SECTION 6
Question 1 0 / 1 point
A 45-year-old individual with a family history of cardiovascular disease is
seeking advice on incorporating regular physical activity into their routine.
The healthcare provider emphasizes the numerous health benefits of
exercise. Which of the following accurately describes a key physiological
effect of regular physical activity on cardiovascular health?
a. Decreased heart rate variability leading to improved cardiac
performance.
b. Increased levels of LDL cholesterol promoting arterial plaque formation.
c. Enhanced endothelial function contributing to reduced blood pressure.
d. Heightened sympathetic nervous system activity resulting in reduced
vasodilation.
Hide question 1 feedback
Feedback: Enhanced endothelial function contributing to reduced blood
pressure. Regular physical activity has been shown to improve endothelial
function, leading to better vasodilation and blood pressure regulation,
thus benefiting cardiovascular health and reducing risk for cardiovascular
events and mortality.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 2 0 / 1 point
A 46-year-old healthy woman asks when is the point of significant
diminishing returns from exercise in terms of mortality? She would like to
know after how many minutes of exercise does the mortality risk begin to
level off?
a. 200 minutes per week
b. 300 minutes per week
c. 400 minutes per week
d. There is no leveling off
Hide question 2 feedback
Feedback: A dose-response curve constructed based on data from the US
Department of Health & Human Services suggests that relative risk of
premature mortality begins to asymptote at approximately 400 minutes of
MVPA per week.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 3 0 / 1 point
Which of the following statements best describes a significant
cardiovascular benefit attributed to high-intensity interval training (HIIT)?
a. HIIT primarily enhances cardiovascular health by promoting steady-
state, low-intensity exercise for extended periods.
b. HIIT results in a decrease in cardiac output due to reduced stroke
volume during intense exercise intervals.
c. HIIT leads to a reduction in heart rate variability, contributing to
improved cardiovascular endurance.
d. HIIT has been shown to improve left ventricular diastolic function and
increase cardiac efficiency.
Hide question 3 feedback
Feedback: High intensity interval training (HIIT), sometimes called sprint
interval training, has been a recent topic of discussion in both lay and
scientific publications. HIIT consists of short periods of high intensity
anaerobic exercise, commonly less than 1 minute, alternating with short
periods of less intense recovery. The length of time spent at high intensity
and recovery intensity varies among regimens, as does the total duration
of a training session. Current evidence indicates that HIIT is an efficient
method for increasing cardiorespiratory fitness, providing equal fitness
benefits with about half the energy expenditure when compared with
continuous moderate-to-vigorous intensity exercise. HIIT can lead to
positive cardiac adaptations, including improved diastolic function and
increased cardiac efficiency, contributing to better cardiovascular health.
There may also be some benefits on insulin-mediated glucose control. The
unpleasant affective response associated with increased intensity is
greatest above the lactate and ventilatory thresholds. Current information
is insufficient about other potential health benefits, the risks of adverse
events, and the long-term sustainability of HIIT training regimens.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 4 0 / 1 point
A 38-year-old man who is obese and has a history of hypertension
presents for a wellness visit. He has started jogging 10 minutes three times
per week for one month. He was initially sore, but now inquires about
aggressively increasing his exercise to lose weight and keep his blood
pressure down. He would like to continue jogging. His blood pressure
today is 138/78 mmHg. Which of the following is the best
recommendation in accordance with the American College of Sports
Medicine (ACSM) guidelines?
a. Increase the duration of the three weekly jogs by 20% per week until
you are at 30 minutes
b. Increase the duration of the three weekly jogs by 30% per week until
you are at 30 minutes
c. Increase the duration of the three weekly jogs by 40% per week until
you are at 30 minutes
d. Increase the duration of the three weekly jogs by 50% per week until
you are at 30 minutes
Hide question 4 feedback
Feedback: The ACSM recommends increasing the duration of sessions of
no more than 20% per week until 30 minutes are reached. Increasing
duration too quickly can result in injury.
Citation(s):
American College of Sports Medicine, 11th Edition. ACSM's guidelines for
exercise testing and prescription. Philadelphia: Lippincott Williams &
Wilkins, 2021.

Question 5 0 / 1 point
In the acronym FITT, which is utilized to dose physical activity, the "I"
stands for which of the following?
a. Individual
b. Intensity
c. Interval
d. Isometric
Hide question 5 feedback
Feedback: The acronym FITT, standing for frequency, intensity, time
(duration) and type of activity (e.g., aerobic muscle-strengthening) has
been used to describe physical activity dose.
Citation(s):
American College of Sports Medicine, 11th Edition. ACSM's guidelines for
exercise testing and prescription. Philadelphia: Lippincott Williams &
Wilkins, 2021.
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.
Question 6 0 / 1 point
A 45-year-old sedentary individual with a body mass index (BMI) of 31
kg/m² presents to the clinic for a routine check-up. Family history reveals
that both parents have type 2 diabetes. The patient is concerned about
their diabetes risk and asks about the role of exercise in prevention. Which
of the following statements best reflects the current medical evidence
regarding exercise efficacy in preventing type 2 diabetes?
a. Increasing physical activity is most effective in preventing diabetes by
directly reducing body weight.
b. Regular physical activity primarily impacts diabetes prevention through
its effect on increasing insulin production.
c. Engaging in high-intensity interval training (HIIT) is the optimal exercise
approach for diabetes prevention.
d. Exercise can enhance insulin sensitivity and reduce visceral adiposity
to lower the risk of developing type 2 diabetes.
Hide question 6 feedback
Feedback: Exercise can enhance insulin sensitivity, reduce visceral
adiposity, and lower the risk of developing type 2 diabetes. This option
reflects the multifaceted benefits of exercise on diabetes prevention as
supported by current research.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 7 0 / 1 point
An assessment of a 78-year-old woman finds that she would benefit from
balance exercises to prevent falls. Which of the following is the most
important step when first prescribing balance exercises for this woman?
a. Having the patient practice standing on an unstable surface
b. Having the patient practice standing with eyes closed to improve
proprioception
c. Screening for osteoporosis
d. Starting with exercises using a hand-hold support to aid stability
Hide question 7 feedback
Feedback: Balance exercises have been shown to reduce risk of falls
among the elderly, particularly if included in a comprehensive fall
prevention program. It is recommended that these exercises be performed
for a total of two hours per week and that beginners hold on to a chair or
other support when first attempting them.
Citation(s):
Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al. American
College of Sports Medicine position stand. Exercise and physical activity for
older adults. Med Sci Sports Exerc. 2009;41(7):1510–1530.
Lee PG, Jackson EA, Richardson CR. Exercise prescriptions in older adults.
Am Fam Physician. 2017; 95(7):425-432.

Question 8 0 / 1 point
As part of a wellness assessment, it is determined that a 55-year-old man
does not meet the recommended levels of physical activity. He states that
he does not like to exercise because it is boring and uncomfortable. In
encouraging him to be more physically active, his health care provider can
explain that while "exercise" is planned, structured and repetitive,
"physical activity" is defined as:
a. Movement that occurs as a result of performing daily tasks.
b. Exercise that is not planned.
c. Exercise that is done for fun and not to improve fitness.
d. Any movement produced by the contraction of skeletal muscles that
increases energy expenditure above a resting level.
Hide question 8 feedback
Feedback: Physical activity is defined by Casperson, et al. as "any bodily
movement produced by skeletal muscles that results in energy
expenditure." Exercise is one subset of physical activity, as are activities of
daily living such as occupational and household activities. Other
organizations, such as the ACSM and Department of Health & Human
services, maintained this definition over the years.
Citation(s):
Casperson CJ, Powell KE, Christenson GM. Physical activity, exercise, and
physical fitness: definitions and distinctions for health-related research.
Public Health Rep. 1985;100(2):126-131.
American College of Sports Medicine, 11th Edition. ACSM's guidelines for
exercise testing and prescription. Philadelphia: Lippincott Williams &
Wilkins, 2021.
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 9 0 / 1 point
A 68-year-old healthy man who wants to prevent cardiovascular disease
asks how much he should exercise. Which of the following is the minimum
amount of moderate intensity aerobic activity recommended for adults?
a. 90 minutes a week
b. 120 minutes a week
c. 150 minutes a week
d. 180 minutes a week
Hide question 9 feedback
Feedback: The guidelines for older adults include 150 minutes a week of
moderate-intensity aerobic activity (anything that gets your heart beating
faster counts).
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 10 0 / 1 point
A 32-year-old healthy woman who is pregnant wants to maintain her
optimal health during the pregnancy. She regularly cycles at the
community center, at a vigorous intensity. She asks at a minimum how
much she should cycle to maintain her fitness. Which of the following is
the correct recommendation for the woman?
a. 45 minutes a week at a moderate intensity
b. 60 minutes a week at a vigorous intensity
c. 75 minutes a week at a vigorous intensity
d. 90 minutes a week at a moderate intensity
Hide question 10 feedback
Feedback: Women should do at least 150 minutes of moderate-intensity,
or 75 minutes of vigorous intensity, aerobic activity (or any combination of
the two) each week during pregnancy and the postpartum period.
Preferably, aerobic activity should be spread throughout the week.
Women who habitually engaged in vigorous-intensity aerobic activity or
who were physically active before pregnancy can continue these activities
during pregnancy and the postpartum period.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 11 0 / 1 point
A 35-year-old man with hereditary hyperlipidemia who wants to prevent
cardiovascular disease asks how much at a minimum he should exercise a
day. In addition to the time prescribed for moderate to vigorous daily
activity, he should include muscle strengthening activities for at least how
many days a week?
a. 1 day a week
b. 2 days a week
c. 3 days a week
d. 4 days a week
Hide question 11 feedback
Feedback: For substantial health benefits, adults should do at least 150
minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of
moderate-intensity or 75 minutes (1 hour and 15 minutes) to 150 minutes
(2 hours and 30 minutes) a week of vigorous-intensity aerobic physical
activity or an equivalent combination of moderate- and vigorous-intensity
aerobic activity. Preferably, aerobic activity should be spread throughout
the week. Adults should also do muscle-strengthening activities of
moderate or greater intensity and that involve all major muscle groups on
2 or more days a week as these activities provide additional health
benefits.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 12 0 / 1 point
Compared to the guidelines for adults (18 to 64 years), the Physical
Activity Guidelines for Americans recommends that older adults (65 years
and older) should aim to complete which of the following?
a. One third of the recommended levels for adults
b. Half of the recommended levels for adults
c. The same as the recommended levels for adults
d. One third more than the recommended levels for adults to compensate
for age-related sarcopenia
Hide question 12 feedback
Feedback: The Physical Activity Guidelines state that adults ages 65 years
and older gain substantial health benefits from regular physical activity
and that recommended amount of physical activity (150 minutes/week of
moderate-intensity activity or 75 minutes/week of vigorous-intensity
activity) is the same as for adults less than 65 years of age. The need for
longer recovery time between sessions and choosing activities that are
orthopedically and medically appropriate are important considerations,
but the guideline remains the same for 18–64-year-olds, as it is for 65+.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 13 0 / 1 point
Physicians who exercise are more likely to counsel their patients to
exercise. Which of the following is the most common barrier to other
physicians providing this advice?
a. Embarrassment
b. Irrelevance to clinical specialty
c. Lack of personal knowledge
d. Reimbursement difficulties
Hide question 13 feedback
Feedback: Physicians who exercise are more likely to counsel their patients
to exercise. Inadequate time and lack of knowledge/experience regarding
exercise are the most common barriers to physicians undertaking such
counseling.
Citation(s):
Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal exercise
habits and counseling practices of primary care physicians: a national
survey. Clin J Sport Med. 2000;10(1):40-48.
Din NU, Moore GF, Murphy S, Wilkinson C, Williams NH. Health
professionals' perspectives on exercise referral and physical activity
promotion in primary care: Findings from a process evaluation of the
National Exercise Referral Scheme in Wales. Health Educ J. 2015
Nov;74(6):743-757. doi: 10.1177/0017896914559785. PMID: 26527835;
PMCID: PMC4604423.

Question 14 0 / 1 point
Which of the following is the MET (Metabolic Equivalent of a Task) value of
sleeping?
a. 0.9
b. 1.0
c. 1.2
d. 2.0
Hide question 14 feedback
Feedback: The MET value of sitting quietly is 1.0. Sleeping is estimated to
be 0.9 METs.
Citation(s):
Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011Compendium of
Physical Activities: a second update of codes and MET values. Med Sci
Sports Exerc. 2011;43(8):1575-1581.

Question 15 0 / 1 point
The Metabolic Equivalent of Task (MET) is a conventional unit used to
express the level of physiological work being performed. The resting
metabolic rate while sitting quietly is considered the reference of 1 MET.
High intensity running (at 10.9 mph = 5.5 minutes/mile; or 17.5 km/hour =
3.4 minutes/km) is approximately how many METs?
a. 3 METs
b. 6 METs
c. 9 METs
d. 18 METs
Hide question 15 feedback
Feedback: High intensity running at approximately 11 mph (17.5 km/hr) is
18 METs. Walking the dog (brisk walking) is an example of a 3 MET activity,
while biking at a moderate pace (12 mph or 19.2 km/hr) is approximately 6
METs and more vigorous activity like jumping rope is approximately 9
METs.
Citation(s):
Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of
Physical Activities: a second update of codes and MET values. Med Sci
Sports Exerc. 2011;43(8):1575-1581.
American College of Sports Medicine, 11th Edition. ACSM's guidelines for
exercise testing and prescription. Philadelphia: Lippincott Williams &
Wilkins, 2021.

Question 16 0 / 1 point
A 42-year-old man is interested in increasing his moderate intensity
exercise from 300 minutes/week to 360 minutes/week. Which of the
following most accurately describes the effect of the extra 60
minutes/week of exercise on reduction in mortality?
a. It is directly proportional to the increased duration.
b. It is of lower magnitude than the same increase from a baseline of less
than 300 minutes per week.
c. It has no additional effect.
d. It requires progressively increasing intensity as well as duration.
Hide question 16 feedback
Feedback: All-cause mortality continues to decrease with progressive
duration of moderate intensity exercise but the relative risk reduction rate
progressively decreases – i.e., it is not directly proportional to the duration
of exercise.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.

Question 17 0 / 1 point
A 32-year-old sedentary individual with a body mass index (BMI) of 28
kg/m² is seeking guidance on creating an exercise regimen to improve
cardiovascular fitness and aid in weight management. The healthcare
provider recommends an exercise prescription that incorporates the
principles of high-intensity interval training (HIIT). Which of the following
components is most crucial when prescribing an effective HIIT regimen for
this individual?
a. Sustaining a consistently high intensity throughout the entire exercise
session.
b. Incorporating at least 60 minutes of aerobic exercise in each HIIT
session.
c. Allowing an increasingly longer recovery period between high intensity
intervals to prevent fatigue.
d. Alternating brief periods of vigorous exercise with low-intensity active
recovery intervals.
Hide question 17 feedback
Feedback: High-Intensity Interval Training (HIIT) is a form of interval
training a cardiovascular exercise strategy alternating short periods of
intense anaerobic exercise with less intense recovery periods.
Citation(s):
MacInnis MJ, Gibala MJ. Physiological adaptations to interval training and
the role of exercise intensity. J Physiol. 2017;595(9):2915-2930.

Question 18 0 / 1 point
A 65-year-old female with a history of osteopenia presents to discuss
strategies to increase her bone health. She is interested in physical activity
and exercise strategies to hopefully prevent a fracture. Which of the
following exercises would have the largest impact on improving bone
strength:
a. Stationary Bike
b. Yoga
c. Tennis
d. Swimming
Hide question 18 feedback
Feedback: Activities such as hopping, lower body strength training,
skipping and running, racquet sports provide significant impact and
loading forces on bones. Swimming and cycling are non-load bearing, and
while a very good form of exercise (particularly for those with
osteoarthritis), in order to increase BDM bones must be actively loaded. It
is important to note that bone loading should be progressive, and some
activities that require a high degree of coordination may be
contraindicated for individuals with balance issues.
Citation(s):
U.S. Department of Health and Human Services. Physical Activity
Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department
of Health and Human Services; 2018.
Question 19 0 / 1 point
Which of the following is correct about the Talk Test for assessment of
aerobic exercise intensity?
a. It is only applicable in trained athletes.
b. It is only performed by qualified professionals.
c. It may involve singing.
d. It requires validated measuring equipment.
Hide question 19 feedback
Feedback: The Talk Test is performed by the individual during physical
activity to assess the intensity of the activity being undertaken. No formal
training or equipment is required. Being able to sing is an indicator of very
light- to light-intensity exercise. Being able to speak a sentence or two is an
indicator of moderate-intensity exercise. Barely being able to speak is an
indicator of high-intensity exercise.
Citation(s):
Reed JL, Pipe AL. The talk test: a useful tool for prescribing and monitoring
exercise intensity. Curr Opin Cardiol. 2014 Sep;29(5):475-80. doi:
10.1097/HCO.0000000000000097. PMID: 25010379.

Question 20 0 / 1 point
A 65-year-old male with a history of chronic obstructive pulmonary disease
(COPD) presents to the clinic for a follow-up evaluation. He reports
increasing shortness of breath and reduced exercise tolerance over the
past few months. On physical examination, his vital signs are stable, and he
demonstrates no signs of acute distress. Pulmonary function tests reveal a
forced expiratory volume in one second (FEV1) of 50% predicted. The
patient's healthcare provider decides to assess his functional capacity
using the 6-minute walk test (6MWT). Which of the following parameter is
the primary outcome measured during the 6MWT?
a. Maximum heart rate
b. Minimum oxygen saturation
c. Maximum rate of perceived exertion
d. Six-minute walk distance
Hide question 20 feedback
Feedback: The primary test outcome is the final distance walked (6MWD).
Among healthy individuals, the average 6MWD is between 400 and 700
meters. The 6MWD has been established as a significant marker of disease
severity for COPD patients since it directly correlates with lower quality of
life indices, respiratory and functional impairment, and survival. The other
variables can be measured as a part of the 6MWT but are not a part of the
primary outcomes measured.
Citation(s):
Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D,
McCormack MC, Carlin BW, Sciurba FC, Pitta F, Wanger J, MacIntyre N,
Kaminsky DA, Culver BH, Revill SM, Hernandes NA, Andrianopoulos V,
Camillo CA, Mitchell KE, Lee AL, Hill CJ, Singh SJ. An official European
Respiratory Society/American Thoracic Society technical standard: field
walking tests in chronic respiratory disease. Eur Respir J. 2014
Dec;44(6):1428-46. doi: 10.1183/09031936.00150314. Epub 2014 Oct 30.
PMID: 25359355.

Question 21 0 / 1 point
A 28-year-old female presents to the clinic for a fitness assessment as part
of her goal to improve her overall health. She is interested in
understanding her body composition to tailor her exercise and nutrition
plan. The patient's height is 165 cm (65 inches) and her weight is 65 kg
(143 lbs). Which of the following best describes the primary objective of
using skin fold thickness measurements to assess body composition?
a. Determining the absolute fat mass in kilograms
b. Estimating the lean body mass distribution in different body segments
c. Assessing the distribution of muscle and bone mass throughout the
body
d. Evaluating the subcutaneous fat layer thickness for estimation of body
fat percentage
Hide question 21 feedback
Feedback: In order to improve reliability of skin-fold measurements testers
must be highly trained and experienced, to ensure a high test-retest
reliability coefficient. As skin-fold measures only subcutaneous fat, the test
may not accurately indicate visceral fat. Furthermore, body compositions
standards vary significantly based on age, gender, and ethnicity, Skin,
making normative comparison difficult. Skin-fold calipers are relatively
inexpensive, with high quality calipers costing around $250-$500
compared to more sophisticated laboratory equipment (i.e., BodPod,
DEXA) that can be $50,000-$250,000.
Citation(s):
Esparza-Ros F, Moreira AC, Vaquero-Cristóbal R, Barrigas C, Albaladejo-
Saura M, Vieira F. Differences between Four Skinfold Calipers in the
Assessment of Adipose Tissue in Young Adult Healthy Population.
Nutrients. 2022 May 16;14(10):2085. doi: 10.3390/nu14102085. PMID:
35631225; PMCID: PMC9144069.

Question 22 0 / 1 point
A 70-year-old male is undergoing a comprehensive health assessment. As
part of the assessment, his grip strength is measured using a handheld
dynamometer. The participant's grip strength is found to be significantly
lower than the average grip strength observed in individuals of his age and
gender. Which of the following conclusions is most likely to be drawn from
the relationship between grip strength and mortality?
a. Grip strength is not a reliable predictor of mortality in older adults.
b. Lower grip strength is associated with a decreased risk of mortality over
the 10-year period.
c. Individuals with higher grip strength have a higher likelihood of
mortality compared to those with lower grip strength.
d. Lower grip strength at baseline is correlated with an increased risk of
mortality over the 10-year follow-up.
Hide question 22 feedback
Feedback: Lower grip strength at baseline is correlated with an increased
risk of mortality over the 10-year follow-up. Numerous studies have shown
that lower grip strength is associated with higher mortality rates in older
adults and can serve as a predictor of overall health and mortality risk.
Citation:
Bohannon RW. Grip Strength: An Indispensable Biomarker For Older
Adults. Clin Interv Aging. 2019 Oct 1;14:1681-1691. doi:
10.2147/CIA.S194543. PMID: 31631989; PMCID: PMC6778477.

Question 23 0 / 1 point
A 23-year-old fitness enthusiast aspires to become an American College of
Sports Medicine (ACSM) certified personal trainer. She has completed a
bachelor's degree in Exercise Science and is eager to pursue this career
path. Which of the following requirements is a prerequisite for her to fulfill
in order to become an ACSM certified personal trainer?
a. Attaining a master's degree in Exercise Physiology from an accredited
institution.
b. Completing a 500-hour internship at any fitness facility of her choice.
c. Holding a valid cardiopulmonary resuscitation (CPR) and automated
external defibrillator (AED) certification.
d. Accumulating a minimum of five years of experience as a fitness
instructor in a recognized health club.
Hide question 23 feedback
Feedback: The correct answer is C) Holding a valid cardiopulmonary
resuscitation (CPR) and automated external defibrillator (AED)
certification. ACSM requires candidates to hold a current CPR and AED
certification to be eligible for the ACSM Certified Personal Trainer exam.)
Citation(s):
American College of Sports Medicine. Which Certification is Right for You.
https://www.acsm.org/certification/get-certified

Question 24 0 / 1 point
A 61-year-old sedentary man presents to the clinic after an emergency
department (ED) visit for an episode of palpitations and new onset atrial
fibrillation. He converted spontaneously in the ED prior to any treatment.
His EKG today is normal sinus rhythm. Which of the following lifestyle
practices reduces the recurrence of atrial fibrillation?
a. Weight loss and increased omega 3 fatty acid intake
b. Weight loss and improved aerobic fitness
c. Improved aerobic fitness and increased omega 3 fatty acid intake
d. Reduced aerobic fitness regardless of omega 3 fatty acid intake
Hide question 24 feedback
Feedback: Omega-3 fatty acid intake has not been shown to reduce the
risk of recurrence in atrial fibrillation. Abed, et al., found that weight loss
and improved physical fitness led to reduced risk of atrial fibrillation
recurrence.
Citation(s):
Abed HS, Wittert GA, Leong DP, et al. Effect of Weight Reduction and
Cardiometabolic Risk Factor Management on Symptom Burden and
Severity in Patients With Atrial Fibrillation: A Randomized Clinical Trial.
JAMA.2013;310(19):2050–2060.
Kowey PR, et al. Efficacy and safety of prescription omega-3 fatty acids for
the prevention of recurrent symptomatic atrial fibrillation: a randomized
controlled trial. JAMA.2010;304(21):2363-2372.
Darghosian L, et al. Effect of omega-three polyunsaturated fatty acids on
inflammation oxidative stress and recurrence of atrial fibrillation. Am J
Cardiol. 2015; 1152:196-201.
Nigam A, et al. Fish oil for the reduction of atrial fibrillation recurrence
inflammation and oxidative stress. J Am Coll Cardiol. 2014;6414: 1441-
1448.
Kotwal S, et al. Omega 3 fatty acids and cardiovascular outcomes:
systematic review and meta-analysis. Circulation: Cardiovasc Qual
Outcomes. 2012;56: 808-818.

Question 25 0 / 1 point
A 27-year-old woman is 10 weeks pregnant. She is concerned about the
risks of exercise during pregnancy. Exercise is associated with increased
incidence of which of the following pregnancy-related outcomes?
a. Excessive gestational weight
b. Preterm birth
c. Vaginal delivery
d. Cesarean delivery
Hide question 25 feedback
Feedback: According to Berghella and Saccone, exercise is associated with
a higher rate of vaginal delivery. Exercise leads to the incidence of less
gestational weight gain, less preterm birth and less Cesarean delivery.
Citation(s):
Vincenzo B, Saccone G. Exercise in pregnancy. Am J Obstet Gynecol. 2017;
216(4): 335-337.

Question 26 0 / 1 point
A 25-year-old man has a family history of colon cancer, diabetes and
cardiovascular disease. He is sedentary and wants to become more active,
by increasing his physical activity at work. He currently works at an office
job for a contractor (expending 15 MET-hours per week). His boss recently
offered him four new job options ranked by physical activity level. The
weekly MET-hours for each job are shown below. Which job option would
best help him progress toward a more physical activity lifestyle, without an
increased risk of untoward medical event.
a. Level 1: Materials delivery at 30 MET-hours per week
b. Level 2: Custodial at 45 MET-hours per week
c. Level 3: Landscaping at 60 MET-hours per week
d. Level 4: Cement mason at 75 MET-hours per week
Hide question 26 feedback
Feedback: As the dose of physical activity increases, the gains in risk
reduction diminish, according to Kyu, et al. Therefore, an increase from 15
to 30 MET-hours per week will provide the patient the most reduction in
the risk of colon cancer, diabetes, and cardiovascular disease. It is also the
most reasonable increase in activity from his current level. Other options
would be tripling or more his physical activity from current levels. The
other important thing to note is that higher amounts of activity (in this
case Levels 2, 3 and 4) provide additional benefit, however there are
diminishing returns in risk reduction.
Citation(s):
Kyu HH, et al. Physical activity and risk of breast, colon cancer, diabetes,
ischemic heart disease and ischemic stroke events: systematic review and
dose-response meta-analysis for the Global Burden of Disease Study 2013.
Br Med J. 2016;354: i3857.

Question 27 0 / 1 point
Exercise is an important addition to a lifestyle prescription because it
operates through which the following mechanisms?
a. Reduced insulin-like growth factor-1 (IGF-1)
b. Stimulation of glucose transporter type 4 (GLUT-4)
c. Elevated tumor necrosis factor-α (TNF-α)
d. Elevated catecholamines
Hide question 27 feedback
Feedback: Exercise stimulates GLUT-4 transporters to move glucose into
the cell independent of insulin activity. In subjects with insulin resistance,
GLUT-4 recruitment and activity was equal to the group without insulin
resistance highlighting the importance of exercise in prescriptions for
people living with diabetes. Exercise has also been shown to epigenetically
alter gene expression of GLUT-4 and improve glucose uptake.
Citation(s):
Gomez M, Bajpeyi S. The Effects of a Single Bout of Endurance Exercise on
Glucose Transporter-4 (GLUT-4) Content. Int J Exerc Sci: Conf Proc. 2019;
2(11).
Rippe JM, ed. Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019.

Question 28 0 / 1 point
A 68-year-old female patient who is osteoporotic with a BMI 19.5kg/m2 is
concerned about her bone mineral density and lack of strength to perform
ADLs. She is interested in engaging in strength training to address these
issues and improve her overall independence. What would be the most
appropriate starting point for her resistance training program?
a. 1 day per week, 1 set for all major muscle groups, 10-15 reps/set, 40-
50% of 1-RM
b. 2 days per week, 1 set for all major muscle groups, 8-12 reps/set, 40-
50% of 1-RM
c. 2 days per week, 1 set for all major muscle groups, 10-15 reps/set, 40-
50% of 1-RM
d. 2 days per week, 1 set for all major muscle groups, 10-15 reps/set, 60-
80% of 1-RM
Hide question 28 feedback
Feedback: According to the American College of Sports Medicine
Guidelines for Exercise Testing & Prescription older adults, who are new to
resistance training, should strength train a minimum of 2 (nonconsecutive)
days per week, doing at least 1 set for all major muscle groups (legs, back,
chest, shoulders, biceps, triceps, & core), using 10-15 reps/set at 40-50%
of one-rep max (1-RM). This should be viewed as starting point and the
progressive overload principle should then be applied to optimize the
training response.
Citation(s):
American College of Sports Medicine, 11th Edition. ACSM's guidelines for
exercise testing and prescription. Philadelphia: Lippincott Williams &
Wilkins, 2021.
American College of Sports Medicine; Chodzko-Zajko WJ, Proctor DN,
Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS. American
College of Sports Medicine position stand. Exercise and physical activity for
older adults. Med Sci Sports Exerc. 2009 Jul;41(7):1510-30. doi:
10.1249/MSS.0b013e3181a0c95c. PMID: 19516148.