Physical activity practice questions for the lifestyle medicine boards
Physical activity is the second-largest domain. The exam tests guideline numbers, exercise prescription with FITT, pre-participation screening and how to adapt activity for special populations.
ABLM exam domain: Physical Activity Science and Prescription
14%of the ABLM exam
~21of 150 physician questions
~17of 120 health professional questions
223questions on this domain in the bank
What the exam expects you to know
ABLM builds the exam on the lifestyle medicine core competencies. For this domain they include:
Aerobic, strength, flexibility and balance components of physical activity
Evidence linking each component to health outcomes
Benefits of activity for older adults, pregnancy, children and adolescents, obesity, disability, cardiovascular disease, diabetes, cancer and stroke
Physical activity guidelines and assessment tools for clinical practice
Fitness terminology used in exercise prescriptions
Prescriptions modified for special populations, and when to refer to fitness professionals
High-yield areas
Physical Activity Guidelines for Americans: 150 to 300 minutes of moderate or 75 to 150 minutes of vigorous aerobic activity a week, plus muscle strengthening on at least 2 days
FITT prescription, intensity by heart rate, METs, perceived exertion and the talk test
Pre-participation screening and when medical clearance is needed
Exercise in pregnancy and postpartum, older adults and fall prevention, and osteoporosis
Exercise with diabetes, hypertension, cardiac rehabilitation, claudication and cancer
How to study it
Memorize the guideline numbers, then practice applying them to a specific patient. The questions usually give a comorbidity or constraint and ask for the safest effective prescription.
Free practice questions: Physical activity
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · moderatePhysical Activity Science and Prescription
A 61-year-old woman with hypertension treated with metoprolol begins an aerobic walking program. Her clinician gave her a target heart rate calculated from 220 minus age. After 3 weeks she reports that she is breathing hard and can speak only a few words at a time, yet her heart rate remains well below the target. Which approach to monitoring her exercise intensity is most appropriate?
Increase her pace until she reaches the calculated target heart rate
Guide intensity with the rating of perceived exertion or the talk test
Omit the metoprolol dose on days when she plans to exercise
Recalculate her target as 85% of age-predicted maximal heart rate
Replace aerobic walking with resistance training, which avoids heart-rate targets
Show answer and rationale
Answer: B. Guide intensity with the rating of perceived exertion or the talk test
B is correct. Beta-blockers blunt the exercise heart-rate response, so an age-predicted target may not reflect appropriate effort. Use perceived exertion or the talk test to guide an individualized walking intensity; speaking only a few words indicates vigorous rather than moderate effort. A could push her beyond the intended dose. C should not be advised: she should not omit metoprolol to reach an exercise target. D still relies on an uncalibrated predicted heart rate. E unnecessarily replaces useful aerobic exercise instead of correcting its monitoring.
Question 2 of 4 · moderatePhysical Activity Science and Prescription
A 67-year-old woman with osteoporosis has no vertebral fracture, back pain, or recent fall. During instruction for daily activities, she asks how to turn toward a light cup placed beside her. Which movement advice best reflects the osteoporosis exercise consensus?
Turn the feet for each reach and keep the trunk fixed during the movement
Allow smooth trunk rotation within a comfortable range while handling the cup
Use repeated end-range rotations to develop spinal mobility before daily reaching
Perform the turn in a flexed posture to reduce loading of the lumbar extensors
Add external resistance to the turn to make the task a bone-loading exercise
Show answer and rationale
Answer: B. Allow smooth trunk rotation within a comfortable range while handling the cup
A (incorrect): Turning with the feet can be a useful strategy, but a rule against comfortable trunk rotation unnecessarily restricts this low-load task.
B (correct): The consensus permits smooth, comfortable rotation. This is not permission for forceful twisting, especially under load.
C (incorrect): Repeated end-range movement is not required for functional reaching and does not provide the same safety qualification.
D (incorrect): High-degree spinal flexion, particularly when weighted, is the movement pattern the consensus cautions against.
E (incorrect): Bone-loading exercise belongs in an appropriate training plan; adding load to this reach is not needed to teach safe movement.
Source: Brooke-Wavell et al. Strong, Steady and Straight: UK Consensus Statement on Physical Activity and Exercise for Osteoporosis (2022). Primary source, Table 5, Recommendations for safe movement: rotation movements; Conclusions: high-degree spinal flexion. https://pmc.ncbi.nlm.nih.gov/articles/PMC9304091/
Question 3 of 4 · easyPhysical Activity Science and Prescription
A 70-year-old woman with stable COPD lives 2 hours from the nearest rehabilitation center. She has been assessed as suitable for a properly supported telerehabilitation program and has reliable technology. Which recommendation best matches ATS guidance?
Require center-based rehabilitation, since telerehabilitation is reserved for patients who cannot travel at all
Offer a choice of center-based rehabilitation or telerehabilitation
Offer telerehabilitation only after she first completes an initial center-based program
Recommend an unsupervised home walking plan, which ATS rates as equivalent to rehabilitation
Offer telerehabilitation only if a center-based program has a waiting list longer than 3 months
Show answer and rationale
Answer: B. Offer a choice of center-based rehabilitation or telerehabilitation
B is correct. The 2023 ATS pulmonary rehabilitation guideline makes a strong recommendation, based on moderate-quality evidence, to offer adults with stable chronic respiratory disease the choice of center-based pulmonary rehabilitation or telerehabilitation, as a shared decision. A, C and E impose eligibility gates the guideline does not require; a properly supported telerehabilitation program is an alternative in its own right, not a fallback or a step after center-based care. D is wrong because an unsupervised walking plan without assessment, exercise prescription and follow-up is not equivalent to a structured telerehabilitation program.
Source: Rochester et al. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: ATS Clinical Practice Guideline (2023). Summary of Recommendations, recommendation 5 (offer the choice of center-based pulmonary rehabilitation or telerehabilitation); Question 5. doi:10.1164/rccm.202306-1066ST. https://pmc.ncbi.nlm.nih.gov/articles/PMC10449064/
Question 4 of 4 · easyPhysical Activity Science and Prescription
A preventive medicine resident notes that about half of US adults report meeting physical activity recommendations on national surveys, and she plans to rely on self-report to evaluate a community walking program. In the NHANES 2003-2004 accelerometer study by Troiano and colleagues, which finding about adults is most relevant to her plan?
About half met it by accelerometer, closely matching self-report
Measured activity rose with age as adults reached retirement
Under 5% met the 30-min/day target by accelerometer
Accelerometer adherence exceeded self-report, which misses housework
Women were more active than men across the adult age groups
Show answer and rationale
Answer: C. Under 5% met the 30-min/day target by accelerometer
A (incorrect): Incorrect. Accelerometer-measured adherence was substantially lower than self-reported adherence.
B (incorrect): Incorrect. Physical activity declined from childhood through adolescence and continued to decline with age.
C (correct): Correct. Among adults, adherence to the recommendation of 30 minutes of physical activity a day was less than 5% by accelerometer, and the authors cautioned that self-reported activity must be interpreted with great care.
D (incorrect): Incorrect. Adherence measured by accelerometer was substantially lower, not higher, than adherence by self-report.
E (incorrect): Incorrect. Males were more physically active than females.
Source: Troiano RP, Berrigan D, Dodd KW, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181-188. Abstract Results (males more active than females; activity declines with age; 42% of children 6-11 and 8% of adolescents met 60 min/day; adult adherence to 30 min/day less than 5%) and Conclusions (accelerometer adherence substantially lower than self-report). https://pubmed.ncbi.nlm.nih.gov/18091006/
For exam preparation only, not clinical advice.
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