ACSM-ACS-CES Sample Questions & Answers
Managing treatment side effects and screening clients for risk tie for the heaviest weight, alongside cancer treatments, evidence supporting exercise during treatment and survivorship, cancer biology, coaching behavior change, and practical program design.
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- Question 1Advanced
Cancer Treatments and Procedures · Surgical Treatments
A 48-year-old female client is referred to your cancer exercise program. She underwent a right-sided modified radical mastectomy with an axillary lymph node dissection six weeks ago.
She is scheduled to begin a 6-week course of external beam radiation therapy (EBRT) to the right chest wall and axilla next week. Her current primary complaint is limited range of motion (ROM) in her right shoulder, accompanied by mild generalized fatigue.
She is eager to start a resistance training program to "get her strength back" before radiation begins. Based on her surgical history and upcoming treatment plan, which approach is most appropriate?
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Correct answer: C
This is the optimal and safest approach. Following a mastectomy and axillary lymph node dissection, early goals must prioritize restoring functional ROM through gentle active and active-assisted movements, not aggressive stretching or heavy lifting. Because radiation therapy (EBRT) often causes further tissue fibrosis and restricts mobility, improving ROM before and during radiation is critical. Concurrently, utilizing lower-body resistance training and moderate aerobic exercise safely addresses her goal of rebuilding systemic strength and managing fatigue without overstressing the healing surgical site. The lymph node dissection also puts her at risk for lymphedema, requiring careful monitoring.
- Question 2IntermediateSelect 2
Cancer Treatments and Procedures · Chemotherapy
Certain classes of chemotherapy agents and targeted therapies are known to induce cardiotoxicity, which can manifest as left ventricular dysfunction, arrhythmias, or heart failure. Which TWO of the following treatment agents are most strongly associated with an increased risk of cardiotoxicity, requiring careful monitoring of cardiovascular responses during exercise? (Select TWO)
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Correct answers: A, C
Anthracyclines (such as doxorubicin) are notorious for causing dose-dependent, potentially irreversible cardiotoxicity. Exercise specialists must be aware of this history to properly monitor for signs of cardiac distress.
Trastuzumab (Herceptin), a HER2-targeted monoclonal antibody, is highly associated with cardiotoxicity, particularly when given after or alongside anthracyclines. This often presents as a reversible decrease in Left Ventricular Ejection Fraction (LVEF).
- Question 3Beginner
Treatment Side Effects and Toxicities · Acute Side Effects
A client undergoing active chemotherapy contacts you to say they are currently in their "nadir" period and their physician mentioned they have severe neutropenia. Which of the following is the MOST appropriate exercise modification?
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Correct answer: A
The "nadir" is the point during a chemotherapy cycle when blood cell counts are at their lowest. Severe neutropenia means the client has a dangerously low level of neutrophils (white blood cells), leaving them highly immunocompromised. The primary exercise modification is to avoid public places, such as commercial gyms or pools, where the risk of contracting an infection is high. Safe, light-to-moderate exercise can usually continue in a clean, private environment.
- Question 4Intermediate
Treatment Side Effects and Toxicities · Chronic and Late-Appearing Effects
A 60-year-old colon cancer survivor presents with chronic chemotherapy-induced peripheral neuropathy (CIPN) affecting both feet, resulting in significant numbness and altered proprioception. When designing their exercise program, which modification is MOST critical for client safety?
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Correct answer: B
Chemotherapy-Induced Peripheral Neuropathy (CIPN) causes sensory loss, numbness, and poor proprioception in the extremities, drastically increasing the risk of falls. A critical safety modification is to minimize fall risks during aerobic conditioning by choosing stable modalities (like a recumbent or upright stationary bike) over a treadmill. Balance exercises should be included but must be strictly supervised and performed in a safe environment (e.g., near a wall or rail).
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