ACE CPT Domain I: Screening, Medical Clearance and the Five Movement Assessments

The four Domain I tasks on the ACE CPT

The ACE Personal Trainer Exam Content Outline gives Domain I four tasks. Each sits on top of a list of "knowledge of" and "skills in" statements; the right-hand column picks the ones most likely to become decisions in a question.

Task 2 is the behavior-change side of onboarding, and the ACE Mover Method guide covers it in depth. The rest of this guide covers Tasks 1, 3 and 4.

ACE's study advice for this domain, from ACE Answers: know each assessment's purpose, who it is appropriate for, its contraindications and what the results reveal. Since "there is no practical component to the exam," you aren't expected to memorize every protocol step or every value in the tables, though a few values matter (ACE's example: a BMI of 30 or more places a client in the obesity category).

Screening with the PAR-Q+

ACE Answers tells candidates to use the most recent PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) from the PAR-Q+ Collaboration's official site, which offered a 2025 version on October 27, 2026. The site describes the pathway:

1. Page 1, everyone. The client answers seven general health questions. If every answer is no, the client is cleared for unrestricted physical activity and signs the participation declaration.
2. Pages 2 and 3, after any yes. Follow-up questions ask about living with a chronic medical condition. If every follow-up answer is no, the client is cleared with minimal supervision (low risk) and signs the declaration on page 4.
3. ePARmed-X+, after any follow-up yes. The client completes the condition-specific ePARmed-X+ and/or sees a qualified exercise professional. The result is one of three recommendations: low risk (unrestricted), intermediate risk (low-to-moderate intensity under consultation or supervision) or high risk (low-intensity activity until meeting a qualified professional, with healthcare clearance possibly required).

The exam question to expect is a reading of that pathway: which page a "yes" sends the client to, and what a "no" on every follow-up means.

The ACSM screening algorithm on ACE's preparticipation form

ACE's free Exercise Preparticipation Health-screening Questionnaire reprints the American College of Sports Medicine's screening algorithm. It works in three steps:

1. Symptoms. If the client reports symptoms such as chest discomfort with exertion, unreasonable breathlessness, dizziness or fainting, ankle swelling, or leg cramping when walking short distances, stop: the client should seek medical clearance before exercising.
2. Current activity. Has the client done planned, structured exercise for at least 30 minutes at moderate intensity on at least 3 days a week for at least 3 months?
3. Medical conditions. Does the client have known cardiovascular, metabolic (type 1 or type 2 diabetes) or renal disease?

The outcome depends on the combination:

The form also defines the intensities: light is 30–39% of heart-rate reserve (RPE 9–11), moderate is 40–59% (RPE 12–13) and vigorous is 60% or more (RPE 14 or higher).

One edition note: ACE's form reprints the algorithm from the 10th edition (2018) of ACSM's Guidelines for Exercise Testing and Prescription, and ACE's handbook now lists the 12th edition (2026). ACSM's published change lists for the 11th and 12th editions show no change to the algorithm itself, and ACSM's 12th-edition notice cites the 2015 revision as its example of a substantial change to the screening algorithm. Nothing in those change lists alters the readings above. PAR-Q+ screening scenarios are among the planned ACE CPT questions if you want to drill these readings.

Medical clearance, referral and medications

The ACE Personal Trainer certification is for training people "who are apparently healthy or have medical clearance to exercise," in the words of ACE's Certification and Recertification Handbook. When clearance is needed, ACE's Sample Medical Release Form shows what a trainer asks for: a description of the planned activity, any medications that raise or lower exercise capacity or the heart-rate response, the physician's recommendations or restrictions, and a signed approval. That is the link to the outline's item on the effects of common medications on heart rate and blood pressure.

ACE Answers works through a selection example worth knowing. A 45-year-old with a repaired rotator cuff, cleared by his physician and wanting to lose 40 pounds, gets BMI and girth measurements rather than skinfolds, plus a postural assessment and shoulder mobility tests. ACE also warns that assessments can discourage some clients, particularly those who are severely deconditioned or have overweight or obesity, so choose them with empathy and at the right time.

ACE's five movement assessments, and what each one watches

ACE's free assessment protocols cover all five foundational patterns. Every protocol shares one instruction that is easy to get wrong in a question: don't cue good technique; observe the client's natural movement. Each ends the same way: identify where the limitation or compensation starts and how it affects the whole kinetic chain.

ACE's postural assessment checklist works the same way in a static stance: from the front (feet, knees, hips, torso, shoulders, head), from the back (spine, scapulae, shoulders) and from the side (knees, pelvic tilt, spinal curves, shoulder protraction, head position).

To connect an observation to the muscles involved, ACE's study coaches suggest a simple method in the exam prep post Posture and Movement Assessments: name the joint action you see, treat the muscle that produces it as the likely tight one to stretch, and its antagonist as the likely lengthened one to strengthen. ACE's example: a knee moving inward is hip adduction, so the adductors may benefit from stretching and the hip abductors (gluteus medius and minimus) from strengthening.

The exam's silent video items each show "a common exercise movement," so practicing these screens on real people helps with them too. The exam format guide explains those items, and the ACE IFT Model guide shows where the patterns sit in Movement Training. For the domain as a whole, planned ACE CPT prep gives Client Onboarding and Assessments 253 questions and 101 flashcards.

Baseline fitness assessments: choosing, timing and stopping

ACE's exam prep post on cardiovascular assessments groups baseline assessments into four categories: anthropometric (body size and composition), cardiovascular, muscular fitness and sport skills. Three timing and selection points from ACE's materials:

• Not every test on day one. ACE's July 2020 IFT Model article says no cardiorespiratory assessments are recommended during Base Training, because many clients starting there are unfit and may struggle to complete one. Build the aerobic base first.
• Ventilatory thresholds over predictions. The cardiovascular assessments post explains that VO2max tests are typically done in clinical or university settings, submaximal tests are generally safer, and ventilatory threshold tests measure the client's own heart rate at VT1 or VT2 instead of predicting it. The IFT guide covers the submaximal talk test for VT1.
• Know each protocol's endpoint. ACE's push-up protocol ends when the client can't complete a repetition or loses proper form for two consecutive repetitions, and the body-weight squat protocol ends when the client can no longer complete a full repetition, pauses to rest or falters standing up.

Endpoints are different from warning signs. ACE's November 2018 Certified article on resistance-exercise HIIT lists chest discomfort, musculoskeletal pain, light-headedness, severe fatigue and shortness of breath as abnormal responses that warrant ending exercise that day. The Domain III guide covers stopping exercise during sessions.

Two Passy practice questions on Domain I

These were written by Passy for practice. They are not ACE exam or practice-test items.

1. A 47-year-old prospective client has walked briskly for 40 minutes, four days a week, for the past year. He has type 2 diabetes, reports no symptoms, and wants to add vigorous jogging intervals. Using the ACSM algorithm on ACE's screening form, what is the BEST next step?

• A. Start the vigorous intervals now, since he already exercises regularly
• B. Continue moderate exercise and get medical clearance before vigorous work
• C. Stop all exercise until a physician completes a maximal exercise test
• D. Skip clearance, because diabetes is not a cardiovascular condition

Keyed answer: B. He exercises regularly by the form's definition, has a known metabolic disease and has no symptoms. For that combination the form says clearance isn't needed for moderate exercise but is recommended before vigorous exercise. A ignores the disease row. C goes beyond the form, which tells regular exercisers to stop and seek clearance only when they have signs or symptoms, and he has none. D misreads the form, which groups metabolic disease (type 1 and 2 diabetes) with cardiovascular and renal disease.

2. During ACE's bend-and-lift assessment, a new client asks, "Should I keep my chest up?" What does ACE's protocol tell the trainer to do?

• A. Cue a tall chest and neutral spine before the first repetition
• B. Avoid cueing technique and observe the client's natural movement
• C. Add a light dumbbell so compensations are easier to see
• D. Stop after one repetition and record the deviations seen

Keyed answer: B. ACE's protocol says not to cue good technique but to observe natural movement. A cues technique, C adds equipment the protocol doesn't use, and D cuts the test short: the protocol asks for five to 10 repetitions.

Your next step for ACE CPT Domain I

Print ACE's screening form and the five movement protocols, run the screens on a friend without cueing, and write down what you see from the front and the side. Then take the 20 free ACE CPT practice questions and note how many Domain I items you miss. If it's your weakest domain, Weak Spot drills a weak domain five questions at a time in planned ACE CPT prep.