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ACSM CERTIFIED CLINICAL EXERCISE SPECIALISTSM JOB TASK ANALYSIS
The job task analysis is intended to serve as a blueprint of the job of an ACSM Certified Clinical Exercise
SpecialistSM. As you prepare for the exam, it is important to remember that all examination questions are
based on this outline.
Job Definition

The ACSM Certified Clinical Exercise SpecialistSM (CES) is an allied health professional with a minimum
of a Bachelor’s degree in exercise science. The CES works with patients and clients challenged with
cardiovascular, pulmonary, and metabolic diseases and disorders, as well as with apparently healthy
populations in cooperation with other healthcare professionals to enhance quality of life, manage health
risk, and promote lasting health behavior change. The CES conducts pre-participation health screenings,
maximal and submaximal graded exercise tests, and performs strength, flexibility and body composition
tests. The CES develops and administers programs designed to enhance cardiorespiratory fitness,
muscular strength and endurance, balance, and range of motion. The CES educates their clients about
testing, exercise program components, and clinical and lifestyle self-care for control of chronic disease
and health conditions.

Performance Domains and Associated Job Tasks

The Job Task Analysis (JTA) for the CES describes what the professional does on a day-to-day basis. The JTA is divided into domains and associated tasks performed on the job. The percentages listed below indicate the number of questions representing each domain on the 100-question CES examination.  Domain I: Patient/Client Assessment - 30%  Domain II: Exercise Prescription - 30%  Domain III: Program Implementation and Ongoing Support - 20%  Domain IV: Leadership and Counseling - 15%  Domain V: Legal and Professional Considerations - 5% Domain I: Patient/Client Assessment
Associated Job Tasks
A. Determine and obtain the necessary physician referral and medical records to assess the 1) Knowledge of:
a. the procedure to obtain informed consent from participant to meet legal b. information and documentation required for program participation. Copyright 2010 – American College of Sports Medicine – Page 1 of 15 c. the procedure to obtain physician referral and medical records required for d. the procedure to obtain participant’s medical history through available 2) Skill in
a. assessing participant physician referral and medical records to determine B. Perform a preparticipation health screening including review of the participant’s medical history and knowledge, their needs and goals, the program’s potential benefits and additional required testing and data. 1) Knowledge of:
a. normal cardiovascular, pulmonary and metabolic anatomy and physiology. b. cardiovascular, pulmonary and metabolic pathologies, clinical progression, diagnostic testing and medical regimens/procedures. c. instructional techniques to assess participant’s expectations and goals. d. commonly used medication for cardiovascular, pulmonary and metabolic e. the effects of physical inactivity, including bed rest, and methods to counteract normal physiologic responses to exercise. g. abnormal responses/signs/symptoms to exercise associated with different pathologies (e.g., cardiovascular, pulmonary, metabolic). h. anthropometric measurements and their interpretation. normal 12-lead and telemetry ECG interpretation. interpretation of ECGs for abnormalities (e.g., arrhythmias, blocks, ischemia, infarction). k. normal and abnormal heart and lung sounds. pertinent areas of a participant’s medical history (e.g., any symptoms since their procedure, description of discomfort/pain, orthopedic issues). m. validated tools for measurement of psychosocial health status. n. a variety of behavioral assessment tools (e.g., SF-36, health-related quality of life, Chronic Respiratory Disease Questionnaire) and strategies for their use. o. psychological issues associated with acute and chronic illness (e.g., anxiety, depression, social isolation, suicidal ideation). Copyright 2010 – American College of Sports Medicine – Page 2 of 15 q. functional and diagnostic exercise testing methods, including symptom-limited r. indications and contraindications to exercise testing. s. normal and abnormal (i.e., signs/symptoms) endpoints for termination of exercise testing and interpretation of muscle strength/endurance and flexibility. u. current published guidelines for treatment of cardiovascular, pulmonary and metabolic pathologies (e.g., ACC/AHA (American College of Cardiology/American Heart Association) Joint Guidelines, GOLD - Global Initiative for Chronic Obstructive Pulmonary Disease, ADA (American Diabetes Association) guidelines). 2) Skill in:
a. auscultation methods for common cardiopulmonary abnormalities. b. data collection during baseline intake assessment. c. assessment and interpretation of information collected during the baseline intake d. formulating an exercise program based upon the information collected during the e. selection, application and monitoring of exercise testing for healthy and patient muscle strength, endurance and flexibility assessments for healthy and patient populations. g. patient preparation and ECG electrode application for resting and exercise C. Evaluate the participant’s risk to ensure safe participation and determine level of monitoring/supervision in a preventive or rehabilitative exercise program. 1) Knowledge of:
a. applied exercise physiology principles. b. cardiovascular, pulmonary and metabolic pathologies, their clinical progression, diagnostic testing and medical regimens/procedures to treat. c. ACSM’s pre-participation screening algorithm. d. the participant’s risk factor profile (i.e., cardiovascular, pulmonary and metabolic) to determine level of exercise supervision using ACSM, AHA, and AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation) risk Copyright 2010 – American College of Sports Medicine – Page 3 of 15 e. indications and contraindications to exercise testing. functional and diagnostic exercise testing methods, including symptom-limited maximal and submaximal aerobic testing. g. interpretation of ECGs for abnormalities (e.g., arrhythmias, blocks, ischemia, h. normal and abnormal (i.e., signs/symptoms) endpoints for termination of exercise testing and interpretation of muscle strength/endurance and flexibility. commonly used medication for cardiovascular, pulmonary and metabolic diseases. k. current published guidelines for treatment of cardiovascular, pulmonary and metabolic pathologies (e.g., ACC/AHA Joint Guidelines, GOLD - Global Initiative for Chronic Obstructive Pulmonary Disease, ADA guidelines). 2) Skill in:
a. risk stratification using established guidelines (ACSM, AHA vs. informal). b. selection, application and monitoring of exercise tests for apparently healthy participants and those with chronic disease. c. ECG interpretation and interpreting exercise test results. Domain II: Exercise Prescription
Associated Job Tasks
A. Develop a clinically appropriate exercise prescription using all available information (e.g., clinical and physiological status, goals and behavioral assessment). 1) Knowledge of
a. applied exercise physiology principles. b. the FITT (Frequency, Intensity, Time, Type) principle for aerobic, muscular fitness /resistance training and flexibility exercise prescription. c. cardiovascular, pulmonary and metabolic pathologies, their clinical progression, diagnostic testing and medical regimens/procedures to treat. d. the effects of physical inactivity, including bed rest, and methods to counteract e. normal physiologic responses to exercise. Copyright 2010 – American College of Sports Medicine – Page 4 of 15 abnormal responses/signs/symptoms to exercise associated with different pathologies (e.g., cardiovascular, pulmonary, metabolic). g. validated tools of measurement of psychosocial health status. h. functional and diagnostic exercise testing methods, including symptom-limited normal and abnormal (i.e., signs/symptoms) endpoints for termination of exercise testing. tests to assess and interpret muscle strength/endurance and flexibility. k. commonly used medication for cardiovascular, pulmonary and metabolic diseases, and their effect on exercise prescription. exercise principles (prescription, progression/maintenance and supervision) for apparently healthy participants and participants with cardiovascular, pulmonary, and/or metabolic diseases. m. appropriate mode, volume and intensity of exercise to produce desired outcomes for apparently healthy participants and those with cardiovascular, pulmonary and metabolic diseases. n. the application of metabolic calculations. p. behavioral assessment tools (e.g., SF-36, health-related quality of life, Chronic Respiratory Disease Questionnaire) and strategies for use. q. psychological issues associated with acute and chronic illness (e.g., anxiety, depression, social isolation, suicidal ideation). 2) Skill in:
a. interpretation of functional and diagnostic exercise testing with applications to b. interpretation of muscular strength/endurance testing with applications to c. developing an exercise prescription based on a participant’s clinical status. B. Review the exercise prescription and exercise program with the participant, including home exercise, compliance and participant’s expectations and goals. 1) Knowledge of:
a. applied exercise physiology principles. b. normal physiologic responses to exercise. Copyright 2010 – American College of Sports Medicine – Page 5 of 15 c. abnormal responses/signs/symptoms to exercise associated with different pathologies (e.g., cardiovascular, pulmonary, metabolic). d. anthropometric measurements and their interpretation. exercise principles (prescription, progression/maintenance and supervision) for apparently healthy participants and participants with cardiovascular, pulmonary, and/or metabolic diseases. g. the FITT (Frequency, Intensity, Time, Type) principle for aerobic, muscular fitness /resistance training and flexibility exercise prescription. h. appropriate mode, volume and intensity of exercise to produce desired outcomes for apparently healthy participants and those with cardiovascular, pulmonary and metabolic diseases. the application of metabolic calculations. k. terminology appropriate to provide the client with education regarding their instructional techniques for safe and effective prescription implementation and understanding by participant. m. the timing of daily activities with exercise (e.g., medications, meals, n. disease-specific strategies and tools to improve tolerance of exercise (e.g., breathing techniques, insulin pump use and adjustments, prophylactic nitroglycerin). o. instructional strategies for improving exercise adoption and maintenance. p. common barriers to exercise compliance and strategies to address these (e.g., physical, psychological, environmental, demographic). q. instructional techniques to assess participant’s expectations and goals. r. risk factor reduction programs and alternative community resources (e.g., dietary counseling, weight management/Weight Watchers®, smoking cessation, stress management, physical therapy/back care). 2) Skill in:
a. communicating with participants from a wide variety of educational backgrounds. b. effectively communicating exercise prescription and exercise techniques. c. applying various models to optimize patient compliance and adherence in order Copyright 2010 – American College of Sports Medicine – Page 6 of 15 C. Instruct the participant in the safe and effective use of exercise modalities, exercise plan, reporting symptoms and class organization. 1) Knowledge of:
a. applied exercise physiology principles. b. normal physiologic responses to exercise. c. abnormal responses/signs/symptoms to exercise associated with different pathologies (e.g., cardiovascular, pulmonary, metabolic). d. the timing of daily activities with exercise (e.g., medications, meals, e. commonly used medication for cardiovascular, pulmonary and metabolic lay terminology for explanation of exercise prescription. g. the operation of various exercise equipment/modalities. h. proper biomechanical technique for exercise (e.g., gait assessment, proper muscle strength/endurance and flexibility modalities and their safe application and instruction. tools to measure exercise tolerance (heart rate/pulse, blood pressure, glucometry, oximetry, rating of perceived exertion, dyspnea scale, pain scale). k. principals and application of exercise session organization. 2) Skill in:
a. the observational assessment of participants. b. communicating with participants from a wide variety of educational backgrounds. c. communicating with participants regarding the proper organization of exercise Domain III: Program Implementation and Ongoing Support
Associated Job Tasks
A. Implement the program (e.g., exercise prescription, education, counseling, goals). 1) Knowledge of:
a. abnormal responses/signs/symptoms to exercise associated with different pathologies (i.e., cardiovascular, pulmonary, metabolic). b. normal and abnormal 12-lead and telemetry ECG interpretation. Copyright 2010 – American College of Sports Medicine – Page 7 of 15 c. the FITT principle (Frequency, Intensity, Time, Type) for aerobic, muscular fitness /resistance training and flexibility exercise prescription. d. exercise progression/maintenance and supervision for apparently healthy participants and participants with cardiovascular, pulmonary, and/or metabolic diseases. e. disease-specific strategies and tools to improve tolerance of exercise (e.g., breathing techniques, insulin pump use and adjustments, prophylactic nitroglycerin). instructional strategies for improving exercise adoption and maintenance. g. strategies to maximize exercise compliance (e.g., overcoming barriers, values h. the operation of various exercise equipment/modalities. proper biomechanical technique for exercise (e.g., gait, weight lifting form). tools to measure clinical exercise tolerance (e.g., heart rate, glucometry, oximetry, subjective assessments). k. the principles and application of exercise session organization. commonly used medications for cardiovascular, pulmonary and metabolic diseases. m. exercise program monitoring (e.g., telemetry, oximetry, glucometry). n. principles and application of muscular strength/endurance and flexibility training. o. methods to assess participant’s educational goals. p. counseling techniques to optimize participant’s disease management, risk 2) Skill in:
a. educating participants on the use and effects of medications. b. the application of metabolic calculations. c. communicating the exercise prescription and related exercise programming d. observation of clients for problems associated with comprehension and e. muscular strength/endurance and flexibility training. B. Continually assess participant feedback, clinical signs and symptoms and exercise tolerance and provide feedback to the participant about their exercise, general program participation and clinical progress. Copyright 2010 – American College of Sports Medicine – Page 8 of 15 1) Knowledge of:
a. cardiovascular, pulmonary and metabolic pathologies, their clinical progression, diagnostic testing and medical regimens/procedures to treat. b. normal and abnormal exercise responses, signs and symptoms associated with different pathologies (i.e., cardiovascular, pulmonary, metabolic). c. normal and abnormal 12-lead and telemetry ECG interpretation. d. normal and abnormal heart and lung sounds. e. the components of a participant’s medical history necessary to screen during appropriate mode, volume and intensity of exercise to produce desired outcomes for apparently healthy participants and those with cardiovascular, pulmonary and metabolic diseases. g. psychological issues associated with acute and chronic illness (e.g., depression, h. the timing of daily activities with exercise (e.g., medications, meals, how medications or missed dose(s) of medications impact exercise and its progression. methods to provide participant feedback relative to their exercise, general program participation and clinical progress. 2) Skill in:
a. auscultation methods for common cardiovascular and pulmonary abnormalities. b. the assessment of normal and abnormal response to exercise. c. adjusting the exercise program based on participant’s signs and symptoms, d. communicating exercise techniques, program goals and clinical monitoring and e. applying and interpreting tools for clinical assessment (e.g., telemetry, oximetry and glucometry, perceived rating scales). C. Reassess and update the program (e.g., exercise, education and client goals) based upon the participant’s progress and feedback. 1) Knowledge of:
a. techniques to determine participant’s medical history through available b. normal physiologic responses to exercise. Copyright 2010 – American College of Sports Medicine – Page 9 of 15 c. abnormal responses/signs/symptoms to exercise associated with different pathologies (e.g., cardiovascular, pulmonary, metabolic). d. participant’s educational and behavioral goals and methods to obtain them. e. counseling techniques focusing on participant goal attainment. exercise progression/maintenance and supervision for apparently healthy participants and participants with cardiovascular, pulmonary, and/or metabolic diseases. g. appropriate mode, volume and intensity of exercise to produce desired outcomes for apparently healthy participants and those with cardiovascular, pulmonary and metabolic diseases. h. strategies to maximize exercise compliance (e.g., overcoming barriers, values risk factor reduction programs and alternative community resources (e.g., dietary counseling/Weight Watchers®, smoking cessation, physical therapy/back care). proper biomechanical technique for exercise (e.g., gait, weight lifting form). k. clinical monitoring of the exercise program (e.g., telemetry, oximetry and glucometry, adjusting exercise intensity). commonly used medication for cardiovascular, pulmonary and metabolic diseases. m. the application and instruction of muscle strength/endurance and flexibility n. modification of the exercise prescription for clinical changes and attainment of o. community resources available to the participant following discharge from the 2) Skill in:
a. modifying the exercise program based on participant’s signs and symptoms, b. utilizing metabolic calculations and clinical data to adjust the exercise c. observation of participant for problems associated with comprehension and d. communicating exercise techniques, program goals and clinical monitoring and e. applying and interpreting tools for clinical assessment (e.g., telemetry, oximetry and glucometry, perceived rating scales). Copyright 2010 – American College of Sports Medicine – Page 10 of 15 D. Maintain participant records to document progress and clinical status. 1) Knowledge of:
a. participant’s medical history through available documentation. b. cardiovascular, pulmonary and metabolic pathologies, diagnostic testing and medical management regimens and procedures. c. commonly used medication for cardiovascular, pulmonary and metabolic d. HIPAA (Health Insurance Portability and Accountability Act) regulations relative e. medical documentation (e.g., progress notes, SOAP notes). 2) Skill in:
a. applying knowledge of medical documentation and regulations. b. summarizing participants’ exercise sessions, outcomes and clinical issues into an Domain IV: Leadership & Counseling
Associated Job Tasks
A. Educate the participant about performance and progression of aerobic, strength and flexibility 1) Knowledge of:
a. physiological responses, signs, and symptoms to exercise associated with different pathologies (i.e., cardiovascular, pulmonary, metabolic). b. exercise (as written above) principles (prescription, progression/maintenance and supervision) for apparently healthy participants and participants with cardiovascular, pulmonary, and/or metabolic diseases. c. exercise progression, maintenance and supervision for apparently healthy participants and participants with cardiovascular, pulmonary, and/or metabolic diseases. d. tools for measuring clinical exercise tolerance (e.g., heart rate, glucometry, e. the application and instruction of muscle strength/endurance and flexibility exercise modalities and the operation of associated equipment. g. proper biomechanical techniques (e.g., gait assessment, resistance training Copyright 2010 – American College of Sports Medicine – Page 11 of 15 h. methods to educate participant in proper exercise programming and progression. the timing of daily activities with exercise (e.g., medications, meals, insulin/ glucose monitoring). disease-specific strategies and tools to improve exercise tolerance (e.g., breathing techniques, insulin pump use, prophylactic nitroglycerin). k. behavioral strategies for improving exercise adoption and maintenance. barriers to exercise compliance and associated strategies (e.g., physical, psychological, environmental). 2) Skill in:
a. communication of exercise techniques, prescription and progression. b. the assessment of participant symptoms, biomechanics and exercise effort. B. Provide disease management and risk factor reduction education based on the participant’s 1) Knowledge of:
a. education program development based on participant’s medical history, needs b. methods to educate participant in risk factor reduction. c. published national standards on risk factors for cardiovascular, pulmonary and d. risk factor reduction programs and alternative community resources (e.g., dietary counseling/Weight Watchers®, smoking cessation, physical therapy/back care). e. strategies to improve participant compliance to risk factor reduction. h. validated tools for measurement of psychosocial health status (e.g., SF-36, strait- psychological issues associated with acute and chronic illness (e.g., anxiety, depression, social isolation, suicidal ideation). outcome evaluation methods (e.g., AACVPR outcomes model). 2) Skill in:
a. communicating with participants from a wide variety of backgrounds. b. selection of participant outcome parameters. Copyright 2010 – American College of Sports Medicine – Page 12 of 15 C. Create a positive environment for participant adherence and outcomes by incorporating effective motivational skills, communication techniques and behavioral strategies. 1) Knowledge of:
a. current behavior facilitation theories (e.g., health-belief model, transtheoretical b. behavioral strategies and coaching methods for improving exercise adoption and c. communication strategies that foster a positive environment. d. methods to educate participant in motivational skills and behavioral strategies. e. barriers to exercise compliance (e.g., physical, psychological, environmental). community resources available for participant use following discharge from the program. D. Collaborate and consult with health care professionals to address clinical issues and provide referrals to optimize participant outcomes. 1) Knowledge of:
a. cardiovascular, pulmonary and metabolic pathologies, clinical progression, diagnostic testing, medical regimens and treatment procedures. b. techniques to determine participant’s medical history through available c. commonly used medication for cardiovascular, pulmonary and metabolic d. tools for measuring clinical exercise tolerance (e.g., heart rate, glucometry, e. risk factor reduction programs and alternative community resources (e.g., dietary counseling/Weight Watchers®, smoking cessation, physical therapy/back care). psychological issues associated with acute and chronic illness (e.g., anxiety, depression, suicidal ideation). g. assessment tools to measure psychosocial health status. community resources available for participant use following program discharge. 2) Skill in:
b. interpretation of psychosocial assessment tools. Copyright 2010 – American College of Sports Medicine – Page 13 of 15 Domain V: Legal and Professional Considerations
Associated Job Tasks
A. Evaluate the exercise environment to minimize risk and optimize safety by following routine inspection procedures based on established facility and industry standards and guidelines.
1) Knowledge of:
a. government and industry standards and guidelines (e.g., AACVPR, HIPAA, OHSA (Occupational Health and Safety Administration). b. the operation, calibration and maintenance of exercise equipment. B. Perform regular inspections of emergency equipment and practice emergency procedures (e.g., crash cart, advanced cardiac life support procedures, activation of emergency medical system). 1) Knowledge of:
a. standards of practice during emergency situations (e.g., American Heart b. local and institutional procedures for activation of the emergency medical system. c. standards for inspection of emergency medical equipment. 2) Skill in:
a. the application of basic life support procedures and external defibrillator use. C. Promote awareness and accountability and minimize risk by informing participants of safety procedures, self-monitoring of exercise and related symptoms. 1) Knowledge of:
a. signs and symptoms of exercise intolerance. b. the timing of daily activities with exercise (e.g., medications, meals, c. commonly used medications for cardiovascular, pulmonary and metabolic d. communication techniques to ensure safety in participant’s self-monitoring and e. contraindicated and higher risk exercises, and proper exercise form to minimize 2) Skill in:
a. the instruction and modification of exercises to minimize risk of injury. Copyright 2010 – American College of Sports Medicine – Page 14 of 15 D. Comply with Health Insurance Portability and Accountability Act (HIPAA) laws and industry- accepted professional, ethical and business standards in order to maintain confidentiality, optimize safety, and reduce liability. 1) Knowledge of:
a. HIPAA regulations relative to documentation and protecting patient privacy (e.g., written and electronic medical records). b. the use and limitations of informed consent. c. advanced directives and implications for rehabilitation programs. d. professional responsibilities and their implications related to liability and E. Promote a positive image of the program by engaging in healthy lifestyle practices. 1) Knowledge of:
a. common sources of health information, education and promotion techniques. 2) Skill in:
a. the practice and demonstration of a healthy lifestyle. F. Select and participate in continuing education programs that enhance knowledge and skills on a continuing basis, maximize effectiveness and increase professionalism in the field. 1) Knowledge of:
a. continuing education opportunities as required for maintenance of professional b. total quality management (TQM) and continuous quality improvement (CQI) concepts and application to personal professional growth. Copyright 2010 – American College of Sports Medicine – Page 15 of 15

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