NASM-CES Exam Questions

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141.

Which of the following answers best describes why static stretching involves taking muscle and myofascial tissues to the end range of motion?

  • End range of motion decreases motor neuron excitability.

  • End range of motion helps to fatigue the muscle, allowing it to relax more deeply, promoting greater flexibility.

  • End range stretching is essential to stimulate blood flow and increase muscle temperature.

  • End range stretching enhances the stretch reflex, which, when overcome, allows for lasting gains in flexibility.

Correct answer: End range of motion decreases motor neuron excitability. 

End range of motion decreases motor neuron excitability as well as minimizes the activation of the stretch reflex. 

The primary goal of static stretching is not to fatigue the muscle but, rather, to gradually elongate and relax it to increase flexibility. While warm-up exercises may stimulate blood flow and increase muscle temperature, static stretching aims to increase flexibility by elongating muscle and myofascial tissues, not specifically to reduce the risk of injury.

142.

A Corrective Exercise Specialist must be aware of the potential impact of habitual repetitive movements. Which of the following is least likely to be negatively affected by repetitive movements? 

  • A yoga instructor

  • A fry cook

  • A parent carrying a newborn

  • A right-handed tennis player

Correct answer: A yoga instructor

Yoga practices often involve a wide range of movements and poses that, when performed correctly, are not typically associated with the same repetitive stress that other professions or activities might involve.

A fry cook may experience repetitive injuries from holding a pan and doing the same movements during an entire shift at work. Similarly, a parent carrying a newborn and a tennis player may be performing the same activity for prolonged periods of time on the same side of their body. 

143.

A client performing myofascial rolling reports that their muscles feel relaxed and less tight after the session. Which of the following is not a global neurophysiological effect that leads to tissue relaxation?

  • Circulatory improvements

  • Golgi tendon reflex

  • Gamma loop modulation

  • Mechanoreceptor signaling 

Correct answer: Circulatory improvements

Circulatory improvements are a local mechanical effect limited to the area being targeted by the roller. The global neurophysiological effects of myofascial rolling primarily focus on the nervous system and muscular responses. Tissue relaxation in the context of myofascial rolling is more closely associated with neural responses and mechanical effects.

The global neurophysiological effects include the Golgi tendon reflex, gamma loop modulation, and mechanoreceptor signaling. All of these promote tissue relaxation due to their afferent input.

144.

Which of the following is the best example of an activity that targets the Anterior Oblique Subsystem (AOS)?

  • Kicking a soccer ball

  • Running on a treadmill

  • Performing barbell squats

  • Planking on the forearms 

Correct answer: Kicking a soccer ball

Kicking a soccer ball involves a dynamic rotational motion that activates the AOS, particularly the anterior core muscles required for the kicking motion. It engages muscles such as the rectus abdominis and obliques, which are key components of the AOS.

Running on a treadmill is primarily a cardiovascular exercise and does not specifically target the Anterior Oblique Subsystem (AOS). It focuses on improving cardiovascular fitness by engaging the cardiovascular and lower extremity muscles.

Squats are excellent for strengthening the quadriceps and lower body, but they do not primarily target the AOS. Squats are more associated with the quadriceps, hamstrings, and glutes. They are primarily performed in the sagittal plane of motion, whereas the AOS primarily functions in the transverse plane of motion. 

Planking exercises are beneficial for core stability but are not specific to the AOS. They involve the engagement of various core muscles, including the anterior and lateral core, but are not focused solely on the AOS or are involved in rotational movement. 

145.

An injury to the spinous process in the cervical region would least likely affect which of the following muscles? 

  • Latissimus dorsi 

  • Transversospinalis 

  • Spinalis 

  • Rhomboids 

Correct answer: Latissimus dorsi 

The latissimus dorsi originates along the spinous processes of T7-T12, the iliac crest of the pelvis, and the thoracolumbar fascia. It inserts into the inferior angle of the scapula and intertubercular groove of the humerus. Since it does not insert or originate at any spinous process in the cervical region, this answer is correct. 

The transversospinalis, spinalis, and rhomboid all either insert or originate at a spinous process within the cervical region of the body. 

146.

A client describes exercises that they are performing in their physical therapy sessions that are improving the dynamic stability of the shoulder. Which of the following options best describes dynamic stability as it relates to the shoulder?

  • Dynamic stability is the ability to minimize unwanted joint motions during movement.

  • Dynamic stability in the shoulder refers to the ability to maintain a static position during exercises.

  • Dynamic stability describes the total range of motion in the shoulder.

  • Dynamic stability refers to the gross strength of the surrounding muscles and neighboring regions. 

Correct answer: Dynamic stability is the ability to minimize unwanted joint motions during movement.

During movement, the shoulder needs to perform tasks such as lifting, reaching, or pushing, and dynamic stability ensures that these actions occur with control. Unwanted joint motions might include excessive wobbling, shifting, or rotation of the shoulder during dynamic activities.

Isometric contractions and static positions do not capture the dynamic nature of stability during movement. The total range of motion does not describe the control that the shoulder requires for dynamic movement. Gross strength is incorrect as it does not describe control with movement.

147.

A client performing an overhead squat assessment demonstrates arms falling forward. Which of the following would not be a potential cause for this upper extremity movement impairment? 

  • Lumbar mobility restriction

  • Glenohumeral mobility restriction 

  • Thoracic mobility restriction

  • Impaired shoulder girdle stability

Correct answer: Lumbar mobility restriction

Lumbar mobility is important for squat mobility in the overhead squat assessment but is not typically a cause of the arms falling forward movement impairment. 

Glenohumeral mobility, thoracic mobility, and shoulder girdle stability directly influence the client's ability to reach overhead and extend their upper spine enough for the arms to reach upward.

148.

A Corrective Exercise Specialist closely monitors a client's repetitions while performing isolated strengthening exercises. Which of the following training variables is incorrect as it relates to isolated strengthening?

  • 1-second isometric

  • 4 -second eccentric

  • 1-second concentric

  • 10 repetitions

Correct answer: 1-second isometric

Each repetition should consist of a 4/2/1 pattern: 

  • 4-second eccentric
  • 2-second isometric
  • 1-second concentric component. 

Each repetition should be performed between 10-15 reps, 1-2 sets, at a frequency of 3-5 days per week. 

149.

A client performs a right knee mobility screening technique, and the results suggest knee extension restrictions. Which of the following would have been most likely observed during this testing?

  • The client's right thigh moves into extension

  • The client's right knee is able to extend fully with the hip flexed to 80 degrees

  • The client's left thigh moves into extension

  • The client's right knee is able to extend further into the desired range of motion without compensations

Correct answer: The client's right thigh moves into extension

In the active knee extension test, if the client has restricted knee extension, they would not be able to extend their knee fully and/or also demonstrate the test thigh moving into extension toward the table. This is due to the hamstring complex being a multi-joint muscle that crosses both the hip and the knee. 

150.

A client is instructed to target the piriformis using a myofascial roller. Which of the following options would be the best way to instruct in this technique? 

  • Instruct the client to sit upright with the roller placed under the gluteal region and with one leg crossed in a figure 4 position.

  • Advise the client to roll the entire length of the leg from hip to knee, focusing on the entire posterior chain.

  • Instruct the client to sit upright, place the roller under the glutes, and roll in controlled movements in the gluteal region.

  • Advise the client to position the roller under the lower back and roll up and down the spine.

Correct answer: Instruct the client to sit upright with the roller placed under the gluteal region and with one leg crossed in a figure 4 position.

Sitting upright with the roller placed underneath the gluteal region is an effective way to target the piriformis. Crossing one leg over the other in a figure 4 position is a highly effective way to target this muscle. This position creates tension on the piriformis, making it more accessible.

Rolling the entire posterior chain is an ineffective way to target a single muscle. While it may be a more comfortable option for the piriformis/gluteal region, it is not the best option. Rolling the gluteal region only is mainly targeting the gluteus medius and maximumus. This option is missing the figure 4 component to effectively target the piriformis. Rolling the lower back is not a way to target the piriformis, as it is located in the gluteal region.

151.

A client presents with a rare knee dominance during the overhead squat analysis. Which of the following best explains a potential cause for this observation?

  • Overactivity of the piriformis causing upright hip posture

  • Overactivity of the adductors causing knee valgus

  • Lengthening of the glutes causing knee varus

  • Lengthening of the abdominals causing heel rise

Correct answer: Overactivity of the piriformis causing upright hip posture

The knee dominance impairment is observed when the client squats with a more upright posture above the hip, causing an increased anterior translation of the knee. Overactivity of the adductor magnus and piriformis creates a more upright posture at the hip. Additional causes included overactivity of the soleus and quadriceps that contribute to excessive knee flexion and possible heel rise. 

Knee valgus and varus are not typically observed with excessive knee dominance.

152.

A client performing a prone plank on the forearms is having difficulty maintaining a solid core contraction. Based on recent research, which of the following cues would be the most effective in this scenario? 

  • Cue the client to actively dorsiflex their ankles

  • Cue the client to perform an anterior pelvic tilt

  • Cue the client to actively plantarflex their ankles

  • Cue the client to widen their base of support

Correct answer: Cue the client to actively dorsiflex their ankles

Based on recent research, there was a difference in the abdominal muscle activation in clients who were cued to actively isometrically contract their ankles in dorsiflexion, not plantarflexion, than those who performed a traditional plank.

Research has shown increased core activation with a posterior, not anterior pelvic tilt. While widening the base of support may help a client improve their stability and balance while in a plank, it is not a studied method or cue to help increase core muscle activation. 

153.

A client demonstrating knee dominance is instructed to perform specific activities during the activate phase of her Corrective Exercise Program. Which of the following best summarizes the goal of the activate phase with this postural impairment?

  • Activate muscles responsible for hip and knee flexion deceleration and stabilize the lumbopelvic hip complex

  • Activate muscles responsible for maintaining neutral knee alignment

  • Activate muscles responsible for hip and knee extension and stabilize the abdominals 

  • Improve hip and knee coordination for functional activities

Correct answer: Activate muscles responsible for hip and knee flexion deceleration and stabilize the lumbopelvic hip complex 

In knee dominance, we see poor deceleration of hip and knee flexion, leading to increased anterior translation of the tibia over the ankle. By improving the activation of the glutes, quads, and core, the body can correctly control the deceleration of the lower extremity during a squat and functional movements. 

Neutral knee alignment is too broad of a term to summarize the goal of the activation phase in this client. Improving hip and knee coordination is primarily performed in the integrate phase.

154.

A client is entering the integration phase of the Corrective Exercise Program to address her knee valgus impairments. She demonstrates mild knee valgus with double-leg jumps; however, she does not have knee valgus with weighted squats, lunges, and other single-leg strengthening exercises. She requests to practice cutting and more difficult maneuvers in the next session. 

Which of the following would be the best response in this scenario? 

  • Encourage the client to continue improving her current deceleration activities before moving on to more difficult ones

  • Agree to allow the client to perform the requested activities as her strength is adequate

  • Increase the weight of her strengthening routine

  • Decrease the volume of her program to allow for the increase in integration exercises

Correct answer: Encourage the client to continue improving her current deceleration activities before moving on to more difficult ones

More advanced and difficult integration exercises must only be performed if the client can control the previous positions. Although the client demonstrates good form with static and slower-moving exercises, it is important to build eccentric lower body strength and dynamic control with repetition and practice of her current integration exercises before moving on to cutting and more difficult maneuvers to avoid increasing the risk of injury. 

Changing the volume or difficulty of her strengthening or activation exercises will not directly improve her ability to perform integration or eccentric jumping/cutting activities. These activities will continue to need practice and repetition to improve neuromuscular control. 

155.

As the number of clients who work at desk jobs with extended periods of sitting grows exponentially each year, the fitness professional must be aware of the potential adverse health outcomes. 

Which of the following is not a potential adverse health outcome associated with sedentary behavior?

  • Type 1 diabetes 

  • Cancer

  • Type 2 diabetes

  • Obesity

Correct answer: Type 1 diabetes 

Type 1 diabetes is not associated with sedentary behavior because it is primarily an autoimmune condition in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. It is not caused or influenced by factors related to physical activity or a sedentary lifestyle. Type 1 and type 2 diabetes are distinct conditions with different underlying causes and risk factors. 

Adverse health outcomes associated with sedentary behavior include cardiovascular disease, cancer, type 2 diabetes, obesity, and hypertension.

156.

In order for a client to perform at an optimal level, mobility and flexibility will need to be adequate for the required task. Which of the following statements correctly describes the relationship between mobility and flexibility? 

  • Mobility refers to the range of motion in a joint, while flexibility is the ability of muscles to lengthen.

  • Flexibility is the ability of joints to move freely, whereas mobility is the capacity of muscles to stretch.

  • Both terms are interchangeable and describe the overall ease of movement in the body.

  • Mobility and flexibility both directly impact a client's total body strength. 

Correct answer: Mobility refers to the range of motion in a joint, while flexibility is the ability of muscles to lengthen.

While mobility and flexibility are important components of overall movement and physical function, they don't directly contribute to total body strength in the same way that strength training exercises do.

Flexibility is associated with muscles, not joints, and mobility is about joint movement.

157.

Which of the following statements correctly describes the key differences between open and closed chain movement as it relates to exercise?

  • Closed chain movements are typically where impairments are most apparent.

  • Open chain movements are typically where impairments are most apparent.

  • Open and closed chain movements both involve free distal segments and can provide insight into movement impairment. 

  • Both open and chain movements are important to integrate into the assessment process, but neither provide insight into movement impairments. 

Correct answer: Closed chain movements are typically where impairments are most apparent.

During closed chain movements, movement impairments will be more apparent. This may be due to a multitude of reasons, such as the increased load on the joints with less room for compensations with a fixed point. 

158.

A soccer player sustains a muscle strain as a result of landing incorrectly during a game. He reports severe pain and notices slight discoloration of the area. He can move the limb with significant difficulty. 

Which of the following muscle strain grades would best describe this injury?

  • Grade II

  • Grade I

  • Grade III

  • Grade IV

Correct answer: Grade II

A Grade II strain results in noticeable weakness of the affected muscle. The client will report moderate to severe pain, mild swelling, and discoloration of the area. 

Grade I is characterized by mild or moderate pain and mild weakness. Grade III will present as a complete loss of muscle function as well as severe pain accompanied by a pop or ripping sensation. 

Grade IV is not a muscle strain classification.

159.

Research is an ever-changing landscape and it is up to the Corrective Exercise Specialist to stay up to date with the most recent findings. Which of the following statements concerning the recent research with myofascial rolling is false?

  • Roller pressure may modulate pain through ascending antinociceptive pathways.

  • Roller pressure may modulate pain through the stimulation of muscle and cutaneous receptors. 

  • Roller pressure reduces spinal-level excitability.

  • Roller pressure may modulate pain through the stimulation of afferent central nociceptive pathways.

Correct answer: Roller pressure may modulate pain through ascending antinociceptive pathways.

Roller pressure may modulate pain through descending, not ascending, antinociceptive pathways. Ascending pathways are neural pathways that transmit pain signals from the periphery to the brain. These pathways are responsible for the perception of pain. Descending pathways, on the other hand, are neural pathways that can inhibit or reduce the perception of pain.

Roller pressure has been postulated through research to modulate pain through the stimulation of muscles and cutaneous receptors as well as afferent central nociceptive pathways. Roller pressure reduces spinal-level activity in order to decrease evoked pain. Consider the relaxing and inhibitory effect that myofascial rolling has on the muscular system. 

160.

Which of the following scenarios best describes how the sensory system, afferent, and efferent neurons produce a complex movement pattern?

  • As a person touches a hot stove, sensory receptors in their hand send signals to the brain through afferent neurons, resulting in the withdrawal of the hand (efferent response) to avoid injury.

  • The central nervous system generates a motor pattern independently of sensory input, resulting in a coordinated movement.

  • Sensory receptors in the eyes transmit information to the muscles, causing them to contract and produce a movement pattern.

  • An athlete executes a complex movement pattern after several weeks of focused practice.

Correct answer: As a person touches a hot stove, sensory receptors in their hand send signals to the brain through afferent neurons, resulting in the withdrawal of the hand (efferent response) to avoid injury.

This scenario accurately describes the process of sensory input (touching a hot stove), signal transmission through afferent neurons to the brain, and the efferent response (withdrawal of the hand) as a protective mechanism.

Sensory information is essential for a coordinated movement pattern. Therefore, the central nervous system does not generate patterns independently. 

The sensory system in the eyes primarily relates to vision, and while it can influence muscle contractions (e.g., tracking objects with the eyes), it does not represent a comprehensive movement pattern. This scenario implies an automatic, reflexive response but does not specify the sensory input or the generation of a complex movement pattern.

The athlete practicing for several weeks and executing a movement pattern is an example of motor learning.