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					  Personal Trainer
Exam Review Course




     ACE Exam Review   1
American Council on Exercise



     Introduction


           ACE Exam Review     2
                 About ACE
1)   ACE is dedicated to promoting physical activity
     and protecting consumers against unsafe and
     ineffective fitness products and instruction
2)   ACE sponsors university-based exercise science
     research that targets fitness products and trends
3)   One of three certifying organizations to be
     accredited by the National Organization of
     Certifying Agencies (NOCA)


                     ACE Exam Review                     3
     What makes ACE different?
1)   ACE exams are legally defensible
2)   ACE develops the study materials without
     using the actual exam
3)   Rather than teaching answers to the exam, ACE
     prepares you to be a safe and effective personal
     trainer




                     ACE Exam Review                    4
          About the ACE Exam
1)    Written simulation portion
     a.     Designed to simulate situations that a personal
            trainer might encounter in actual practice
     b.     1 hour to complete

2)    Multiple-choice portion
     a.     150 questions
     b.     3 hours to complete
     c.     72 seconds per question


                       ACE Exam Review                        5
     About the ACE exam (cont.)
3)   Number of correctly-answered questions to pass
     exam
     a.    The number will vary because each exam version
           has a different level of difficulty
     b.    For example: A candidate may have to answer
           60% of the questions correctly on one exam
           version and 70% on another



                      ACE Exam Review                       6
     About the ACE exam (cont.)
4)    How is the exam developed?
      a.   Questions are written using the Personal Trainer
           Exam Content Outline
      b.   Exam content
           1.     Client assessment (20%)
           2.     Program design (21%)
           3.     Program implementation and adjustment (29%)
           4.     Applied sciences (15%)
           5.     Professional role (15%)

                       ACE Exam Review                          7
     About the ACE exam (cont.)
5)    Who administers the exam?
      a.    CASTLE Worldwide, Inc., an independent,
            professional testing company
      b.    Ensures exam security and integrity, and
            eliminates bias
6)    Eligibility requirements for exam
      a.    18 years of age
      b.    Current CPR
      c.    100 hours of designing and implementing
            exercise programs is strongly recommended
                       ACE Exam Review                  8
ACE Personal Trainer Manual


         Chapter 1

 Exercise Physiology

          ACE Exam Review     9
                         Fitness
A.   Being active improves health: 30 minutes of
     accumulated physical activity on most days of the
     week
B.   Being ―fit‖ goes beyond health and requires a
     comprehensive exercise program that includes the
     following components
     1)    Cardiorespiratory endurance
     2)    Muscular strength and endurance
     3)    Flexibility
     4)    Body composition
                         ACE Exam Review            10
             Components of the
          cardiorespiratory system
1)   Blood: carries nutrients, gases, waste, and
     hormones
     a.     Nutrients – glucose/glycogen, fats, and amino
            acids
     b.     Gases – oxygen and carbon dioxide (carried in
            red blood cells on the protein hemoglobin)
     c.     Waste – lactic acid and other metabolic by-
            products
     d.     Hormones – sympathetic and parasympathetic
            nervous system activation

                       ACE Exam Review                      11
           Components of the
     cardiorespiratory system (cont.)
2)    Vessels: transport system for blood throughout
      the body
      a.    Arteries – carry oxygenated blood away from the
            heart
            (with the exception of the pulmonary artery)
      b.    Veins – carry de-oxygenated blood to the heart
            (with the exception of the pulmonary vein)
      c.    Capillaries – tiny vessels across which the
            exchange of gases, nutrients, and waste occurs
            between the blood and the cells of the body

                       ACE Exam Review                        12
           Components of the
     cardiorespiratory system (cont.)
3)    Heart: four-chambered pump responsible for
      distributing blood to the lungs and to the rest of
      the body

      a.    Right side – receives venous blood returning
            from the body
      b.    Left side – receives arterial blood returning from
            the lungs



                        ACE Exam Review                          13
      Components of the
cardiorespiratory system (cont.)
     c.   Atria – two upper chambers
     d.   Ventricles – two lower chambers




              ACE Exam Review               14
         Components of the
   cardiorespiratory system (cont.)
3) Heart: (cont.)
     e.    Blood distribution

           1.       The left and right sides of the heart contract
                    simultaneously
           2.       At the same time the blood from the right ventricle
                    is pumped to the lungs through the pulmonary
                    arteries, blood from the left ventricle is ejected to
                    the rest of the body through the aorta



                         ACE Exam Review                                15
           Components of the
     cardiorespiratory system (cont.)
3)    Heart: (cont.)
      f.    Systole – contraction phase of the cardiac cycle
      g.    Diastole – relaxation phase of the cardiac cycle

            1.     During diastole, the heart muscle itself is supplied
                   with oxygen through the coronary arteries
            2.     Having a high level of cardiorespiratory fitness
                   means the heart spends more time in diastole at rest
                   and at submaximal exercise due to a decreased
                   resting heart rate (RHR)


                        ACE Exam Review                                   16
           Components of the
     cardiorespiratory system (cont.)
4)    Lungs: encase the smaller branches of the
      trachea that allow gas exchange between the
      blood and the atmosphere
5)    Airways: transport system for carrying gases into
      and out of the body (commonly referred to as the
      bronchial tree)
      a.    Alveoli – microscopic ducts responsible for gas
            exchange in the lungs
      b.    The lungs contain an estimated 300 million
            alveoli providing a surface area of approximately
            230 feet

                       ACE Exam Review                          17
     Cardiorespiratory adaptations to
          acute aerobic exercise
1)     Increased heart rate (HR)
2)     Increased stroke volume (SV)
       a.    The amount of blood pumped from each ventricle
             each time the heart beats
       b.    Measured in mL per beat




                       ACE Exam Review                    18
     Cardiorespiratory adaptations to
          acute aerobic exercise
3)     Increased cardiac output
       a.    Cardiac output = HR x SV
       b.    A typical cardiac output at rest:
             60 bpm x 70 mL/beat = 4200 mL/min
             (approximately 1 gallon of blood per min)

4)     Increased breathing rate



                         ACE Exam Review                 19
     Cardiorespiratory adaptations to
          acute aerobic exercise
5)     Increased systolic blood pressure
       a.    Due to the cardiovascular system attempting to
             increase O2 delivery to the muscles
       b.    However, blood pressure greater than
             250/115 mmHg is an indication to terminate
             exercise (hypertensive response)




                        ACE Exam Review                       20
     Cardiorespiratory adaptations to
          acute aerobic exercise
6)     No change (or a slight decrease) in diastolic
       blood pressure
       a.    Due to the dilation of vessels in the muscles and
             the skin
       b.    This decreases peripheral resistance (which is an
             important benefit for individuals suffering from
             heart disease, hypertension, diabetes, and
             peripheral vascular disease)



                         ACE Exam Review                         21
     Cardiorespiratory adaptations to
          acute aerobic exercise
7)     Blood is shunted from the viscera to the working
       muscles
       a.    Dilation of vessels that supply blood to the
             exercising muscles
       b.    Constriction of vessels that supply blood to the
             abdominal area




                         ACE Exam Review                        22
     Cardiorespiratory adaptations to
          acute aerobic exercise
8)     Increased extraction of oxygen from the blood
       into the working tissues
       a.    A normal, healthy person is able to load the blood
             with more O2 in the lungs than he or she is able to
             use at the cellular level
       b.    Therefore, the more efficiently an individual can
             extract O2 from the hemoglobin in the capillaries,
             the more fit he or she becomes



                         ACE Exam Review                       23
 Cardiorespiratory adaptations due
    to regular aerobic exercise
1)   Decreased RHR
     a.   With consistent exercise (as few as three months
          of regular aerobic training), the interior
          dimensions of the ventricles increase, allowing
          them to hold more blood
     b.   The same cardiac output can be maintained at a
          lower HR due to the greater SV



                     ACE Exam Review                         24
 Cardiorespiratory adaptations due
    to regular aerobic exercise
2)   Decreased relative working heart rate
     a.    Since a given intensity requires a given amount of
           O2, HR at any given intensity will be lower due to
           increased SV
     b.    A trained individual will have to work at higher
           intensities to achieve the same HR he or she
           achieved prior to being fit




                      ACE Exam Review                         25
 Cardiorespiratory adaptations due
    to regular aerobic exercise
3)   Increased VO2max as SV increases
     a.   VO2max is the total capacity to consume
          oxygen at the cellular level
     b.   VO2max depends on two factors

          1.     The delivery of O2 to the working muscle by the
                 blood (cardiac output)
          2.     The ability to extract the O2 at the capillaries and
                 use it in the mitochondria


                      ACE Exam Review                                   26
 Cardiorespiratory adaptations due
    to regular aerobic exercise
4)   Increased O2 extraction
     a.    Improved ability to remain ―aerobic‖ at higher
           intensities
     b.    Increased capillary density
     c.    Increased mitochondrial density
     d.    Increased ability to create ATP



                      ACE Exam Review                       27
 Cardiorespiratory adaptations due
    to regular aerobic exercise
5)   Increased fatty acid oxidation at any submaximal
     intensity
6)   More glycogen is stored in trained muscles and
     less lactic acid is produced
7)   Increased tolerance to lactic acid produced during
     exercise



                     ACE Exam Review                  28
                    Altitude
1)   Since there is less partial pressure of O2 at higher
     altitudes, HR and respiratory rate increase
2)   During exercise HR may increase up to 50%
     higher than normal
3)   Decrease exercise pace so the client can complete
     the session without becoming exhausted
4)   It can take up to 2–5 weeks to acclimate to a new
     altitude


                      ACE Exam Review                   29
                       Heat
1)   Due to increased dilation of blood vessels near
     the skin, venous return and SV decrease
2)   At any given exercise pace, HR will be higher as
     the heart tries to maintain cardiac output to meet
     the needs of the working muscles
3)   Producing sweat so that it may evaporate from
     the skin is the body’s cooling mechanism
4)   High humidity does not allow sweat to evaporate
5)   The main concerns of exercising in the heat are
     sweat evaporation and consumption of 4–8
     ounces of water every 10–15 minutes during
     exercise
                      ACE Exam Review                  30
                       Cold
1)   Exercising in the cold causes the kidneys to
     increase urine production, risking dehydration
2)   Heat production during exercise is usually
     enough to prevent hypothermia
3)   When exercise stops, however, the client needs to
     be protected from the cold
4)   Keys to exercising in the cold are drinking plenty
     of fluids and dressing in layers


                     ACE Exam Review                  31
          Energy production
1)   Adenosine triphosphate (ATP)

     a.   Manufactured by the mitochondria in the muscle
          cell
     b.   ATP is the energy source used to drive muscle
          contraction
     c.   Fatty acids and glucose are used to produce ATP
     d.   Amino acids are not a preferred energy source,
          but are used in an undernourished individual


                     ACE Exam Review                        32
                 Energy production
Energy System   Substrate              Limitation to Produce ATP      Primary Use
ANAEROBIC
Phosphagen      Creatine phosphate     Muscle stores very little CP   High-intensity, short-
                (CP) Stored ATP        and ATP                        duration activities;
                                                                      less than 10 seconds
                                                                      to fatigue
Anaerobic       Glucose and            Lactic acid build-up causes    High-intensity, short-
glycolysis      glycogen               rapid fatigue                  duration activities;
                                                                      from 1–3 minutes to
                                                                      fatigue
AEROBIC
                Fatty acids,           Depletion of muscle            Long-duration, sub-
                glucose, and           glycogen; insufficient O2      anaerobic threshold
                glycogen               delivery                       activities; longer than
                                                                      3 minutes to fatigue


                                     ACE Exam Review                                       33
     Metabolic equivalent (MET)
1)    A system for classifying physical activities based
      on their intensities (in other words, based on their
      requirement for O2 consumption)
2)    1 MET = resting O2 consumption, which is
      approximately 3.5mL/kg/min
3)    Physicians commonly prescribe exercise in terms
      of METs for cardiac rehab patients



                       ACE Exam Review                   34
                 MET (cont.)
4)   To determine the VO2 equivalent of any MET
     value, simply multiply the MET value by 3.5
     a.    For example, a typical step aerobics class is about
           7 METs
     b.    Therefore, the O2 consumption for a typical step
           aerobics class is:
           3.5 mL/kg/min x 7 METs = 24.5 mL/kg/min




                       ACE Exam Review                        35
      Metabolism and exercise
1)   Two terms are commonly used when describing
     metabolic rate: basal metabolic rate (BMR) and
     resting metabolic rate (RMR)
2)   BMR is the body’s minimum daily energy
     requirement for normal function
     a.    Assessed after an overnight stay in a lab where
           subject has been fasting for 12 hours and sleeping
           for 8 hours at a constant temperature
     b.    Consists of energy used for ventilation, blood
           circulation, and temperature regulation
     c.    Measured in calories

                      ACE Exam Review                       36
 Metabolism and exercise (cont.)
3)   RMR is a more common measurement than BMR
     a.   Assessed after an overnight fast and 8 hours of
          sleep
     b.   The sleep is at home and the measurement is in
          the lab
     c.   BMR is usually 10% lower than RMR
     d.   RMR typically ranges from 1,200 cal/day for
          women to 1,500 cal/day for men


                     ACE Exam Review                        37
 Metabolism and exercise (cont.)
4)   Effect of regular exercise
     a.    Moderate aerobic exercise plus strength training
           increase BMR to a greater degree than aerobic
           exercise alone
     b.    Aerobic training increases caloric expenditure
           during the activity and uses body fat for fuel
     c.    Strength training may increase lean mass and
           cause an increase in caloric requirement by 7–10
           calories per day for each additional pound of lean
           mass
     d.    Therefore, both aerobic exercise and strength
           training are recommended for weight loss
                      ACE Exam Review                         38
 Metabolism and exercise (cont.)
5)   BMR tends to decrease with age
     a.   For each decade after age 25, 3–5% of muscle
          mass is lost
     b.   Some decline still occurs in individuals who
          exercise regularly
     c.   Training may attenuate or slow the decline




                     ACE Exam Review                     39
          Neuromuscular anatomy
1)   Motor nerve: conducts impulses from the central
     nervous system (CNS) to the periphery signaling
     muscles to contract or relax
2)   Motor unit: a motor nerve and all its associated
     muscle fibers
     a.    All fibers comprising a motor unit are
           homogeneous (they are either all fast-twitch or
           all slow-twitch)
     b.    Motor units made up of 5–10 fibers are
           responsible for fine, delicate movements such as
           blinking the eye
     c.    Motor units made up of thousands of fibers are
           responsible for forceful movements such as
           jumping
                      ACE Exam Review                         40
     Musculoskeletal anatomy
1)   Muscle fiber: a muscle cell
2)   Myofibrils: a contractile protein in a muscle
     fiber; there are many myofibrils arranged in
     patterns within a muscle fiber
3)   Sarcomere: the functional contracting unit of the
     muscle cell
     a.    Myofibrils are made up of several repeating
           sarcomeres along the length of the muscle cell
     b.    The area between the Z-lines
                      ACE Exam Review                       41
 Musculoskeletal anatomy (cont.)




4)   Actin and myosin: contractile protein filaments
     within the myofibril; they generate muscle
     contraction by sliding past one another
                     ACE Exam Review                   42
 Musculoskeletal anatomy (cont.)
5)   Muscle contraction
     a.    An electronic impulse from the brain to the muscle
           is transmitted to cause contraction
     b.    Contraction occurs due to the interaction of the
           actin and myosin filaments, which causes
           shortening of the individual muscle fibers




                       ACE Exam Review                        43
 Musculoskeletal anatomy (cont.)
6)   Sliding filament theory

     a.    For muscle contraction to occur there must be
           two factors present
           1.     Sufficient ATP
           2.     A nervous impulse from the CNS

     b.    When these two factors are present, tiny
           projections from the myosin filament attach to
           the actin filament forming a cross-bridge



                      ACE Exam Review                       44
 Musculoskeletal anatomy (cont.)
6)   Sliding filament theory (cont.)
     c.    The myosin pulls the actin toward the center of the
           sarcomere and the individual muscle fiber shortens




                       ACE Exam Review                       45
 Musculoskeletal anatomy (cont.)
7)   Discontinuation of contraction occurs when
     a.    Neural impulses stop
     b.    Muscle fiber ―runs out‖ of ATP
     c.    There is a build-up of metabolic by-products
     d.    Myosin and actin filaments bump up against the
           Z-lines




                      ACE Exam Review                       46
 Musculoskeletal anatomy (cont.)
8)        Muscle spindles
     a.   Sensory receptors that lie parallel to the muscle fibers
     b.   Respond to muscle fibers being over-stretched by
          causing a muscular contraction
     c.   Component of the stretch reflex
9)        Golgi tendon organs
     a.   Sensory receptors located in the muscle tendon
     b.   Respond to extreme muscle tension by causing the muscle
          to relax
     c.   Component of inhibition
                              ACE Exam Review                        47
Musculoskeletal anatomy (cont.)
10)   Connective tissue
      a.    Fascia
      b.    Tendons
      c.    Ligaments
      d.    Cartilage




                        ACE Exam Review   48
           All-or-none theory
1)   When a single muscle fiber shortens, it generates
     its maximum force capability; there is no
     gradation of force
2)   When a motor unit is stimulated, all the muscle
     fibers it innervates contract with maximum force




                     ACE Exam Review                 49
     All-or-none theory (cont.)
3)   The amount of force generated during a muscle
     group’s contraction depends on the following
     a.    The size of the individual muscle fibers
           contracting (the larger the fiber, the greater the
           force)
     b.    The number of muscle fibers recruited (more
           fibers equal more force)
     c.    The length of the muscle fiber prior to contraction
     d.    The speed of contraction


                       ACE Exam Review                          50
  The length-tension relationship
1) The amount of force that a muscle can exert is
   related to its length
2) Peak force production is usually seen at resting
   length or slightly greater (1.2 times resting length)
3) At approximate resting length, more of the myosin
   cross-bridge heads can align with active actin
   receptor sites
4) Therefore, clients with poor posture that have
   chronically shortened or lengthened muscle groups
   are not able to produce optimal force at the
   misaligned joints

                       ACE Exam Review                     51
            Force vs. velocity
1)   A maximal force contraction is dependent on the
     number of actin and myosin cross-bridges formed
2)   The higher the speed of contraction, the fewer the
     number of connected myosin and actin cross-
     bridges
3)   An optimal speed of contraction while lifting
     weights appears to be 1 to 2 seconds concentric,
     followed by 2 to 4 seconds eccentric


                     ACE Exam Review                    52
                    Muscle fiber types
Slow-twitch (Type I, Oxidative)      Fast-twitch (Type II, Glycolytic)
Contract slowly                      Contract rapidly
Contract less forcefully             Contract forcefully
Fatigue resistant                    Fatigue quickly
Primary energy system is aerobic     Primary energy system is anaerobic
Used in endurance activities         Used in short-term activities requiring strength
                                     and power
                                     Fast-twitch fibers are further classified into type
                                     IIa and type IIb
                                     Type IIa fibers are slightly more oxidative than
                                     type IIb
                                     It is possible to increase either the oxidative
                                     qualities or the glycolitic qualities of type IIa
                                     fibers through training
                                     However, muscle fibers cannot be changed from
                                     one type to another
                                   ACE Exam Review                                       53
     Muscle fiber types (cont.)
1)   Muscles contain a mixture of fast-twitch and
     slow-twitch fibers (determined genetically)
2)   Different fiber types are recruited for different
     activities




                      ACE Exam Review                    54
           Muscular adaptations to
          regular resistance training
1)   Neural adaptations

     a.      Improved recruitment patterns
     b.      Improved motor learning
     c.      Neural adaptations are responsible for gains in
             strength with little or no change in muscle cross-
             sectional area after as much as 6 weeks of
             training

2)   Hypertrophy of fast-twitch fibers

                         ACE Exam Review                          55
         Muscular adaptations to
     regular resistance training (cont.)
3)     Increased size and number of actin and myosin
4)     Increased lean body mass
5)     Increased connective-tissue strength
6)     Decreased risk for joint injury
7)     Increased bone density




                        ACE Exam Review                56
             Chronic stress has many
            negative effects on the body
Physiological system                    Effects of stress
Musculoskeletal system                  Tension headache, neck and shoulder
                                        discomfort, and back pain
Cardiovascular system                   Premature coronary artery disease (CAD),
                                        hypertension, increased platelet adhesiveness,
                                        and heart attack
Immune system                           Suppression of T-cell function, increased
                                        vulnerability to infections, and viral illnesses
CNS                                     Impaired memory and neural degeneration
Gastrointestinal system                 Stomach ache, nausea, constipation, and
                                        diarrhea

These negative changes primarily occur due to elevated levels of stress
hormones (norepinephrine and cortisol)
Exercise may help decrease stress hormone levels and alleviate these
symptoms

                                ACE Exam Review                                            57
            Muscular actions
1)   Isometric (static)
     a.    No visible movement occurs
     b.    The resistance matches the muscular tension
     c.    Examples
           1.     Wall sit
           2.     Plank




                       ACE Exam Review                   58
          Muscular actions (cont.)
2)   Concentric (shortening)

     a.     Muscle shortens and overcomes resistive force
     b.     Examples

            1.     Up-phase of biceps brachii curl
            2.     Up-phase of push-up




                        ACE Exam Review                     59
          Muscular actions (cont.)
3)   Eccentric (lengthening)
     a.     Muscle produces force as it lengthens, returning
            toward resting position
     b.     External force exceeds the contractile force of the
            muscle
     c.     Examples

            1.     Down-phase of biceps brachii curl
            2.     Down-phase of push-up

                        ACE Exam Review                        60
ACE Personal Trainer Manual
                 Chapter 2

           Human Anatomy
Please refer to the Anatomy Supplement
and ACE Personal Trainer Manual for
tables, descriptions and illustrations of the
skeletal system and major muscle groups.

                 ACE Exam Review                61
ACE Personal Trainer Manual


         Chapter 3

   Biomechanics &
  Applied Kinesiology
          ACE Exam Review     62
                     Levers
1)   A lever is a rigid bar (bone) with a fixed point
     around which it rotates when an external force is
     applied to it
2)   The fixed point is the fulcrum (joint)




                      ACE Exam Review                    63
                     Torque
1)   Rotation at a joint
2)   Result of a force acting on a lever at some
     distance from the fulcrum
3)   Rotation occurs in the direction of the greater
     force




                      ACE Exam Review                  64
             Muscular roles
1)   Agonist (prime mover)
     a.   Causes a desired motion
     b.   Opposite of antagonist
2)   Antagonist (―opposing‖ muscle)
     a.   Acts in opposition to the action of the agonist
     b.   The antagonist stretches as the agonist contracts




                      ACE Exam Review                         65
          Muscular roles (cont.)
3)   Synergist
     a.    Can act as an assister, stabilizer, or co-contractor
     b.    Assister

           1.     A muscle that assists an agonist muscle in its
                  function
           2.     Example: the teres major is involved in all
                  the same actions as the latissimus dorsi but due to
                  its smaller size and position it can only contribute a
                  fraction of the amount of force



                       ACE Exam Review                                66
          Muscular roles (cont.)
3)   Synergist (cont.)
     c.    Stabilizer

           1.     Example: when all portions of the trapezius
                  contract to stabilize the scapulae during a
                  side lateral arm raise
           2.     This allows the scapula to become a stable base for
                  efficient arm movement




                        ACE Exam Review                             67
          Muscular roles (cont.)
3)   Synergist (cont.)
     d.    Co-contractor

           1.     Example: when the gluteus maximus contracts to
                  counteract the hip flexion that occurs while rising
                  from a low squat
           2.     This allows the rectus femoris to extend the knee as
                  a person is rising without inclining the trunk
                  forward

     e.    Both stabilizing and co-contracting play important
           roles in posture and efficient joint mechanics

                       ACE Exam Review                                  68
ACE Personal Trainer Manual


         Chapter 4

       Nutrition

          ACE Exam Review     69
     Energy balance equations
1)   Neutral calorie balance
     a.    Calories consumed = calories expended
     b.    No change in weight
2)   Positive calorie balance
     a.    Calories consumed > calories expended
     b.    Weight gain
3)   Negative calorie balance
     a.    Calories consumed < calories expended
     b.    Weight loss
                         ACE Exam Review           70
           Rate of weight loss
1)   Regular exercise and proper nutrition result in
     the best long-term weight loss
2)   One pound of fat = 3,500 calories
3)   For realistic weight loss
     a.    300–400 calories per workout session
     b.    Minimum of 3 days per week
     c.    Create a deficit of 500–1000 calories per day
4)   Average person can expect to lose 1–2 pounds
     per week
5)   Obese person can expect to lose 1–3 pounds per
     week
                      ACE Exam Review                      71
     National Institutes of Health
          recommendations
1)   Healthy eating plans that reduce calories but do
     not rule out specific foods or food groups
2)   Regular physical activity and/or exercise
     instruction
3)   Tips on healthy behavior changes that also
     consider your cultural needs



                     ACE Exam Review                    72
     National Institutes of Health
          recommendations
4)   Slow and steady weight loss of about ¾ to 2
     pounds per week and not more than 3 pounds per
     week (weight loss may be faster at the start of a
     program)
5)   Medical care if you are planning to lose weight
     by following a special formula diet, such as a
     very-low-calorie diet
6)   A plan to keep the weight off after you have lost
     it
                     ACE Exam Review                     73
         Scope of practice
As a fitness professional, it is within your
scope to make dietary suggestions using the
MyPyramid Food Guidance System
(www.mypyramid.gov) and the 2005 Dietary
Guidelines for Americans
(www.nal.usda.gov/fnic); this information
updates the Food Guide Pyramid released in
1992 and the 2000 Dietary Guidelines for
Healthy Americans
                 ACE Exam Review           74
MyPyramid Food Guidance System




            ACE Exam Review   75
 MyPyramid Food Guidance System
            (cont.)
1)      Emphasizing activity, moderation,
        personalization, proportionality, variety, and
        gradual improvement will help clients gain
        control of their nutritional habits
2)      Approximate daily energy intakes

1,600 calories:   Sedentary older adults

2,200 calories:   Active teenage girls, active women, and sedentary men

2,800 calories:   Active teenage boys, active men, and very active women


                               ACE Exam Review                             76
 Updated Physical Activity Recommendations
 2005 Dietary Guidelines for Americans
1)   To reduce the risk of chronic disease in
     adulthood: engage in at least 30 minutes of
     moderate-intensity physical activity, above
     usual activity, at work or home on most
     days of the week
2)   For most people, greater health benefits can
     be obtained by engaging in physical
     activity of more vigorous intensity or
     longer duration
                   ACE Exam Review             77
Updated Physical Activity Recommendations
 2005 Dietary Guidelines for Americans
                    (cont.)
3) To help manage body weight and prevent
   gradual, unhealthy body weight gain in
   adulthood: engage in approximately 60
   minutes of moderate- to vigorous-intensity
   activity on most days of the week while not
   exceeding caloric intake requirements


                   ACE Exam Review               78
Updated Physical Activity Recommendations
  2005 Dietary Guidelines for Americans
                  (cont.)

4) To sustain weight loss in adulthood:
   participate in at least 60 to 90 minutes of
   daily moderate-intensity physical activity
   while not exceeding caloric intake
   requirements. Some people may need to
   consult with a healthcare provider before
   participating in this level of activity.
                    ACE Exam Review              79
ACE Personal Trainer Manual


         Chapter 5

   Health Screening

          ACE Exam Review     80
                Typical forms
1)   Legal issues
     a.    Informed Consent
     b.    Liability Waiver
2)   Health and medical issues
     a.    Health Risk Appraisal/Health History Form
     b.    PAR-Q
     c.    Medical/Physician’s Release Form
3)   Psychological issues
     a.    Lifestyle Information Form
     b.    Exercise History and Attitude Questionnaire
     c.    Exercise Confidence Survey
                      ACE Exam Review                    81
     Reasons for health screening
1)    Referral: identify those in need of referral to a
      healthcare provider for more extensive medical
      evaluation
2)    Safety: ensure the safety of exercise testing and
      participation
3)    Testing and/or program development: determine
      the appropriate type of exercise test or program



                       ACE Exam Review                    82
          ACSM intensity guidelines
1)   Moderate-intensity exercise
     a.      3–6 METs
     b.      40–60% VO2max
     c.      40–60% HRR
     d.      12–13 RPE
2)   Vigorous-intensity exercise
     a.      Greater than 6 METs
     b.      Greater than 60% VO2max
     c.      Greater than 60% HRR
     d.      Greater than 13 RPE

                         ACE Exam Review   83
Heart-rate and blood-pressure measurements
1)   Heart Rate
     a.   Palpation
     b.   Auscultation with a stethoscope
     c.   Sites: radial and carotid
     d.   Average resting heart rate: 60–100 bpm
2)   Blood Pressure
     a.   Systolic blood pressure / diastolic blood pressure
     b.   Measured using a sphygmomanometer, cuff, and
          stethoscope
     c.   Expressed in mmHg
     d.   Allow 30 to 60 seconds between trials to allow
          normal circulation to return
                      ACE Exam Review                          84
               7th JNC report on
              high blood pressure

Category                SBP mmHg                DBP mmHg

Normal                  <120              and   <80

Prehypertension         120–139           or    80–89

Hypertension, Stage 1   140–159           or    90–99

Hypertension, Stage 2   ≥160              or    ≥100


                        ACE Exam Review                    85
                 Medication
1)   Health history forms should include information
     regarding any medications the client may be
     taking (prescription or over-the-counter)
2)   The personal trainer must be aware of the effects
     of medications on heart rate




                     ACE Exam Review                   86
     Musculoskeletal conditions
1)   Both chronic and acute injuries must be addressed
     in the health screen
2)   Serious injuries and past surgeries also should be
     included




                     ACE Exam Review                  87
ACE Personal Trainer Manual


         Chapter 6

Testing & Evaluation

          ACE Exam Review     88
     Purpose of measurements
1)   Establishes a baseline
2)   Helps to monitor progress
3)   Increases your level of professionalism




                     ACE Exam Review           89
 Disadvantages of measurements
1)   Can be intimidating
2)   Can be discouraging
3)   Not always accurate




                    ACE Exam Review   90
      Maximal oxygen uptake
1)   Also known as maximal oxygen consumption,
     VO2max, and aerobic capacity
2)   The maximum amount of oxygen a person can
     consume during exercise
3)   Expressed in liters or milliliters




                      ACE Exam Review            91
     Absolute vs. relative VO2max
1)    Absolute

      a.   O2 uptake determined without body weight as a
           factor
      b.   Usually used for non-weightbearing exercise tests
           such as cycling
      c.   Expressed in L/min




                      ACE Exam Review                      92
Absolute vs. relative VO2max (cont.)
2)   Relative

     a.    Absolute O2 uptake divided by body weight
     b.    Used for weightbearing exercise tests such as
           walking, jogging and stepping
     c.    Expressed in mL/kg/min
     d.    This method allows for comparison to others of
           different body weights



                      ACE Exam Review                       93
Absolute vs. relative VO2max (cont.)
2)   Relative (cont.)
     e.    A heavy person may have a high VO2max
           (L/min) when compared to a lighter person, but
           when expressed in relative terms (mL/kg/min),
           the lighter person may show a higher level of
           cardiorespiratory fitness


Formula:
     Relative O2 uptake = O2 uptake (L/min) x 1,000
                                    BW (kg)

                        ACE Exam Review                     94
     Percentage of maximal heart rate
                 (MHR)
1)       Method of monitoring exercise intensity
2)       Can be determined by a maximal functional
         capacity test or by the age-predicted maximal
         heart rate formula (220 – age)

Formula:
     Target heart rate (THR) = 220 – age x desired intensity %




                           ACE Exam Review                       95
     Heart-rate Reserve (HRR)
1)   The result of subtracting resting heart rate
     (RHR) from maximal heart rate (MHR)
2)   Represents the working range between
     resting and maximal heart rate within which all
     activity occurs

Formula: HRR = (220 – age) – RHR



                      ACE Exam Review                  96
          Karvonen formula
1)   The mathematical formula that uses HRR to
     determine target heart rate (THR)
2)   A common mistake is forgetting to add back in
     the RHR

Formula: HRR x desired intensity % + RHR




                    ACE Exam Review                  97
     Metabolic equivalent (MET)

1)    A simplified system for classifying physical
      activities where 1 MET = resting O2 consumption
2)    Resting O2 consumption equals approximately 3.5
      mL/kg/min



        Formula: 1 MET = 3.5 mL/kg/min


                        ACE Exam Review                 98
 Rating of perceived exertion (RPE)
1) Developed by Gunnar
   Borg, this scale
   provides a standard
   means for subjective
   self-evaluation of
   exercise intensity level
2) Original scale: 6–20
3) Revised (modified)
   scale: 0–10
                       ACE Exam Review   99
     Submaximal aerobic exercise test
1)     A cardiorespiratory fitness test designed so that
       the intensity does not exceed 85% HRR
2)     Provides an estimation of the VO2max without
       the risks associated with maximal exercise testing
3)     Examples
       a.    YMCA Submaximal Step Test
       b.    McArdle Step Test
       c.    Rockport Fitness Walking Test (1-mile walk)
       d.    BYU Jog Test

                        ACE Exam Review                    100
     Graded exercise test (GXT)
1)   A treadmill or cycle-ergometer test that measures
     (clinical setting) or estimates (field setting)
     maximum aerobic capacity by gradually
     increasing the intensity until a person has reached
     a maximal level or voluntary exhaustion
2)   Examples
     a.    YMCA Submaximal Bicycle Test
     b.    Ross Submaximal Treadmill Protocol


                      ACE Exam Review                 101
      Body Mass Index (BMI)
1)   A relative measure of body height to body
     weight for determining degree of obesity
2)   Should not be used solely in determining body
     composition for the athletic client, because BMI
     does not distinguish between fat mass and fat-free
     mass

Formula:         Weight (kg)
                 Height2 (m)
                     ACE Exam Review                 102
       Skinfold measurements
1)   Used to determine the ratio of fat mass to fat-free
     mass in the body
2)   Fat mass: adipose tissue
3)   Fat-free mass: bone, muscle, and organs
4)   Measurements are performed with a skinfold
     caliper



                      ACE Exam Review                 103
 Skin-fold measurements (cont.)
5)   The Jackson and Pollock (1985) three-site
     method has a relatively small margin of error for
     the general population
     a.    Sites for men: chest, abdomen, and thigh
     b.    Sites for women: triceps, suprailium, and thigh
6)   Should be repeated by the same technician during
     reassessment to decrease error
7)   Should be performed prior to physical activity
     because fluid transfer to the skin could result in
     overestimations
                      ACE Exam Review                        104
 Bioelectrical impedance analysis
1)   Involves passing a small current through the body
     and measuring the opposition to the current’s
     flow

     a.    Fat-free tissue is a good conductor of electricity
     b.    Fat tissue is a poor conductor of electricity




                       ACE Exam Review                          105
 Bioelectrical impedance analysis (cont.)
2)   Estimations can have the same margin of error as
     skinfold measurements as long as the client
     follows the correct pre-test protocol
     a.    Abstain from eating or drinking within 4 hours of
           the assessment
     b.    Avoid moderate or vigorous physical activity
           within 12 hours of the assessment
     c.    Void completely before the assessment
     d.    Abstain from alcohol consumption for 48 hours
           before the assessment
     e.    Avoid diuretic agents, including caffeine, prior to
           the assessment unless prescribed by a physician
                       ACE Exam Review                       106
          Circumference (girth)
             measurements
1)   Can be used to assess body composition as well
     as body-fat distribution
2)   Measurements are taken with a cloth measuring
     tape and must be taken at specific anatomical
     sites for accuracy
3)   More practical for obese clients



                     ACE Exam Review                  107
 Calculating desired body weight
1)    Once body composition is known, the personal
      trainer can assist the client in goal-setting using
      the desired body-weight equation
2)    This equation assumes there is no loss in lean BW

Formula:
     Desired body weight =           lean body weight
                                   1 – desired body fat %

                       ACE Exam Review                      108
          Common flexibility tests
     Measures range of motion (ROM) at specific
     joints
1)      Trunk flexion (sit-and-reach)
2)      Trunk extension
3)      Hip flexion
4)      Shoulder flexibility

     As with any test or exercise, the client’s health
     and injury history should be considered
                          ACE Exam Review           109
     Muscular strength assessments
     Muscular strength assessments measure the
     greatest amount of force that muscles can
     produce in a single maximal effort
1)      Common muscular strength tests

        a.    1 repetition maximum (1 RM) bench press
        b.    1 RM leg press

2)      1 RM strength testing is not commonplace
        among personal trainers as the risks typically
        outweigh the benefits
                        ACE Exam Review                  110
Muscular endurance assessments
     Muscular endurance assessments measure a
     muscle’s ability to exert a submaximal force
     either repeatedly or statically over time
1)      Common muscular endurance tests
        a.    Push-up test
        b.    Half sit-up test

     As with any test or exercise, the client’s health
     and injury history should be considered
                          ACE Exam Review           111
      Test termination criteria
1)   Onset of angina or angina-like symptoms
2)   Significant drop (20 mmHg) in systolic blood
     pressure or failure of systolic blood pressure to
     rise with an increase in exercise intensity
3)   Excessive rise in blood pressure:
     systolic pressure >260 mmHg or
     diastolic pressure >115 mmHg
4)   Signs of poor perfusion: lightheadedness,
     confusion, ataxia (uncoordinated movement),
     pallor (pale skin), cyanosis (bluish coloration,
     especially around mouth), nausea, or cold and
     clammy skin
                      ACE Exam Review                    112
 Test termination criteria (cont.)
5)   Failure of heart rate to increase with increased
     exercise intensity
6)   Noticeable change in heart rhythm
7)   Subject requests to stop
8)   Physical or verbal manifestations of severe
     fatigue
9)   Failure of testing equipment

                      ACE Exam Review                   113
               Reassessment
1)   Measurable changes usually take about 4–6
     weeks
2)   The first follow-up assessments should be
     administered 4–12 weeks after the onset of
     training
3)   The information gained during the follow-up
     assessment can be useful in client motivation as
     well as in future exercise programming


                     ACE Exam Review                    114
ACE Personal Trainer Manual


         Chapter 7

  Cardiorespiratory
  Fitness & Exercise
          ACE Exam Review     115
     General training principles
1)   Specificity: a specific demand made on the body
     will result in a specific response by the body
2)   Overload: beneficial adaptations occur in
     response to demands placed on the body at levels
     beyond a certain threshold, but within the limits
     of tolerance and safety
3)   Reversibility: ―use it or lose it‖; the body’s
     fitness level will decline in response to
     discontinuing an exercise program
                      ACE Exam Review                 116
     Cardiorespiratory endurance
          exercise programs
1)   Expected improvements over 10–20 weeks of
     training
     a.    Increase in aerobic capacity of 15–20%
     b.    Decrease in RHR by approximately 10 bpm
2)   Components
     a.    Warm-up
     b.    Target heart-rate zone training
     c.    Cool-down
3)   Monitoring intensity
                       ACE Exam Review               117
     Cardiorespiratory endurance
      exercise programs (cont.)
4)   Overload and progression
     a.   Phases
          1.       Conditioning (initial 4–7 weeks)

                          Lower end of training range
                          3–4 days per week
                          15–30 minutes
                          40–60% HRR
                          Helps clients to achieve early success and
                           to want to continue

                        ACE Exam Review                            118
Cardiorespiratory endurance
 exercise programs (cont.)
a.   Phases (cont.)

     2.     Improvement (8–20 weeks)
                     Frequency, intensity and duration all
                      increase to mid-range
                     3–4 days per week initially, then
                      3–5 days per week
                     30–40 minutes
                     60–70% HRR initially, then 70–
                      85% HRR when client is ready
                     Goal is to expend 300+ calories

                ACE Exam Review                               119
Cardiorespiratory endurance
 exercise programs (cont.)
a.   Phases (cont.)

     3.     Maintenance (5–6 months after initiation)
                     Higher end of training range
                     3–5 days per week
                     30–45 minutes
                     70–85% HRR
                     Should be enjoyable, convenient, and
                      adaptable
                     Goal is to maintain fitness developed
                      during improvement phase

                 ACE Exam Review                              120
Cardiorespiratory endurance
 exercise programs (cont.)
b.   These are only guidelines—it may take some
     clients longer to progress through conditioning
     and improvement phases
c.   After the initial conditioning stage, increase
     intensity 5–10% every 2 weeks
d.   Decrease intensity if overtraining occurs
e.   Signs of overtraining
     1.     Increased RHR
     2.     Depression or mood disturbances
     3.     Increased incidence of colds and flu
     4.     Overuse injuries
                 ACE Exam Review                       121
Cardiorespiratory endurance
 exercise programs (cont.)
e.   Signs of overtraining (cont.)
     5.     Muscle and joint soreness
     6.     Fatigue
     7.     Insomnia
     8.     Decreased appetite
     9.     Plateau or worsening of performance that is not
            improved by rest or reduced training




                 ACE Exam Review                              122
     Cardiorespiratory endurance
      exercise programs (cont.)
5)   Methods
     a.   Continuous training
          1.     Intermediate Slow Distance (ISD)
                        20–60 min of continuous aerobic exercise
                        Most common for fitness improvement
          2.     Long Slow Distance (LSD)
                        60+ min of continuous aerobic exercise
                        Usually for athletic training after at least 6
                         months of successful ISD training
                        Increased risk of injury



                     ACE Exam Review                                123
Cardiorespiratory endurance
 exercise programs (cont.)
b.   Interval training

     1.     Alternating high-intensity and low-intensity
            training in the same session
     2.     Aerobic or anaerobic
     3.     Predetermined intervals of intensity, duration, and
            repetition
     4.     Can be used for beginners as well as athletes
c.   Fartlek training

     1.     Similar to interval training except the work-rest
            intervals are determined by how the client feels
     2.     Has great application for running

                 ACE Exam Review                                124
Cardiorespiratory endurance
 exercise programs (cont.)
d.   Circuit training

     1.     Client performs a series of exercises at different
            stations
     2.     Relatively brief rest intervals between stations
     3.     Has applications for both aerobic and muscular
            endurance exercise




                 ACE Exam Review                                 125
Cardiorespiratory endurance
 exercise programs (cont.)
e.   Aerobic composite (cross-training)

     1.     Combining a group of aerobic activities into one
            training session
     2.     Example: cycling to a track, running for 20
            minutes, and cycling home
     3.     Great for decreasing boredom and chronic injuries




                 ACE Exam Review                               126
     Cardiorespiratory endurance
      exercise programs (cont.)
6)   Specificity
     a.    Group 1 (beginners): activities in which intensity
           is maintained at a constant level and energy
           expenditure is low such as walking or cycling
     b.    Group 2 (intermediate): activities in which
           energy expenditure is related to skill, still
           maintaining a constant intensity such as aerobics
           or cross-country skiing
     c.    Group 3 (advanced): activities that are variable
           in both skill and intensity such as soccer or
           racquet sports
                       ACE Exam Review                        127
 ACE Personal Trainer Manual
           Chapter 8
Muscular Strength & Endurance
           Chapter 9
Strength Training Program Design

            ACE Exam Review    128
Muscular conditioning programs
1)   Importance of opposing muscle groups and
     muscular balance (neutral alignment)
2)   Assess tightness and weakness (kyphosis and
     lordosis)—refer to student outline for illustrations
     and associated muscle imbalances
3)   Ask clients about their lifestyles and repetitive
     movements they perform throughout their day
4)   Design a program to address those issues, but
     don’t neglect the importance of training the entire
     body as a system

                      ACE Exam Review                    129
     Muscular conditioning programs
                 (cont.)
5)    Overload and progression
      a.   Progressive increase in resistance over time
           that causes muscles to fatigue in 30–90 seconds
      b.   Increase the intensity by no more than 5–10%
      c.   ―2-for-2‖ rule: if the client can perform 2 or more
           repetitions over his or her assigned repetition goal
           in the last set in 2 consecutive workouts, load
           should be added to the next training session


                       ACE Exam Review                       130
     Muscular conditioning programs
                 (cont.)
6)      Specificity

Load      Outcome     % 1 RM        Rep Range Sets    Rest Periods
Light     Endurance   <70              12–20   1–3    20–30 sec.

Moderate Hypertrophy, 70–80             8–12   1–6    30–120 sec.
         strength
Heavy     Maximum     80–100            1–8    1–5+   2–5 min.
          strength




                            ACE Exam Review                         131
     Muscular conditioning programs
                 (cont.)
7)    Exercise sequence
      a.   Work the largest muscle groups first
      b.   This allows clients to perform the most strength-
           oriented exercises while they are the least fatigued
8)    Range of motion
      a.   Full range of joint motion should be executed with
           each lift
      b.   This strengthens the agonists and stretches the
           antagonists
      c.   Strength training can improve range of motion if
           done properly
                       ACE Exam Review                       132
          Exercise progression
           and modification
1)   Strategies to overcome strength plateaus
     a.    Modify FITT
     b.    Change order of strength-training exercises
     c.    Substitute new exercises that target the same
           muscle groups
2)   Competitive Athletes
     a.    Exercise specificity
     b.    Injury prevention
     c.    Plyometrics

                       ACE Exam Review                     133
ACE Personal Trainer Manual


        Chapter 10

       Flexibility

          ACE Exam Review     134
     Flexibility exercise programs
1)    When to stretch?
      a.    After the body has been ―warmed-up‖
      b.    5–15 min of light warm-up activity followed by a
            static stretch
      c.    Post-workout is probably the best time to stretch




                       ACE Exam Review                          135
Flexibility exercise programs (cont.)
2)   Overload and progression
     a.   Stretch to the point of mild discomfort
     b.   Because connective tissue is visco-elastic, the
          stretch needs to be of low-force and long-duration
          to produce tissue elongation even after the stretch
          position is discontinued
     c.   This type of permanent elongation as a result of
          static stretching is called plastic deformation
     d.   Over time, a consistent stretching program may
          cause the connective tissues to ―reset‖ to an
          elongated length, and range of motion will
          increase
                      ACE Exam Review                        136
Flexibility exercise programs (cont.)
3)   Specificity regarding client needs
     a.    Posture

           1.     Base a stretching program on the initial assessment
                  results
           2.     Be aware of the types of postures associated with
                  specific muscular tightness

     b.    Injuries

           1.     Be aware of previous injuries
           2.     Recently injured soft tissues should not be stretched


                       ACE Exam Review                                137
Flexibility exercise programs (cont.)
4)   Types of stretching
     a.    Ballistic
           1.      High-force, rapid, jerking movements often referred
                   to as "bouncing"
           2.      Not recommended because it may activate the
                   muscle spindles and invoke the stretch reflex
     b.    Dynamic
           1.      An active stretch that mimics the activity to be
                   performed
           2.      Done through a full range of motion in a slow and
                   controlled manner
           3.      Examples include running in slow motion and
                   practicing slow swings of a tennis racquet


                        ACE Exam Review                               138
Flexibility exercise programs (cont.)
4)   Types of stretching (cont.)
     c.    Proprioceptive neuromuscular facilitation (PNF)
           1.     A method of promoting the response of
                  neuromuscular mechanisms through the stimulation
                  of proprioceptors in an attempt to gain more stretch
                  in a muscle
           2.     There are several methods, but the most common
                  used in training is the contract-relax method
           3.     This requires a trained and experienced partner
                  and involves an isometric contraction followed by
                  a passive, static stretch



                       ACE Exam Review                             139
Flexibility exercise programs (cont.)
4)   Types of stretching (cont.)
     d.    Static

           1.       A slow, controlled stretch that holds the desired
                    tissues at an elongated length for 10–30 seconds
           2.       Recommended form of stretching because it takes a
                    minimum of 6 – 10 seconds to elicit the stretch
                    response from the neuromuscular mechanisms




                         ACE Exam Review                                140
ACE Personal Trainer Manual


        Chapter 11

Programming for the
   Healthy Adult
          ACE Exam Review     141
          Sources of information
1)      The forms
2)      The interview with the client
3)      The assessment and test results
4)      The client’s primary care physician
     Only after gathering these pieces of
     information can the personal trainer design the
     appropriate, safe, and effective exercise
     program
                        ACE Exam Review           142
                Rates of change
1)   Weight Loss
     a.    Maximum rate of weight loss is 1–2 lb per week
     b.    Body fat decrease of approximately 1% per month
2)   Muscle Gain
     a.    Maximum rate of muscle gain is 1–2 lb per
     month
     b.    Initial rate of muscle gain is 2–4 lb in the first 8
           weeks
3)   Progression
     a.    10% rule
     b.    Increases in resistance, time, or distance should be
           no greater than 10% per week
                       ACE Exam Review                            143
       The energy cost of exercise
1)      Regular exercise should be partly responsible
        for creating a negative energy balance for weight
        loss
2)      Educating clients about the energy cost of
        exercise may help them understand the role of
        physical activity in weight management
3)      Estimated calorie costs of selected exercises
Formula:
Energy cost of an activity = calorie cost x BW (lb) x minutes of activity


                               ACE Exam Review                              144
                 Goal setting
1)   Effective goal-setting will translate a client’s
     vague statements into precise goals
2)   SMART goal

     a.    S pecific
     b.    M easurable
     c.    A ttainable
     d.    R elevant
     e.    T ime-bound

                         ACE Exam Review                145
                    Goal setting (cont.)
3)        SMART goal example: ―I will lose 10 lb in three months by
     performing 30 minutes of cardio three days per week and strength training
     two days per week and through proper nutrition so that I can really enjoy
     my upcoming holiday cruise!‖
          a.       Specific: ―lose 10 lb body fat‖
          b.       Measurable: progress will be assessed using a change
                   in body weight and the skinfold caliper body-
                   composition method
          c.       Attainable: by increasing physical activity and
                   decreasing caloric intake by 150 cal per day, losing
                   10 lb in 3 months can safely and effectively be
                   achieved (equates to approximately .8 lb lost per week)
          d.       Relevant: look better for cruise and have more
                   energy to enjoy it
          e.       Time-bound: goal is set to be achieved within 3
                   months

                                 ACE Exam Review                             146
            Goal setting (cont.)
4)   Behavior-centered goals
     a.    Focus on establishing a pattern of behavior
           (exercising 3 days per week for 20 minutes per
           session)
     b.    Good for beginners who may be intimidated by
           the evaluation process (weight scales, body-fat
           measurements, tape measures, etc.)
5)   Outcome-centered goals
     a.    Focus on results (losing 10 lb, as in the previous
           SMART goal example)
     b.    May be good for clients who are motivated by
           physiological results rather than behavior-change
           results
                       ACE Exam Review                          147
     ACSM recommendations for
        exercise program design

1)   Based on the FITT principle
     a.    Frequency: days per week
     b.    Intensity: difficulty of exercise
     c.    Time: duration
     d.    Type: mode of activity




                       ACE Exam Review         148
       ACSM recommendations for
        exercise program design (cont.)
              Freq. Intensity                           Time                    Type
Cardio           3–5        (55/65)-90% HRmax,          20–60 continuous        Large muscle
                            (40/50)-85% HRR or          minutes or 10-          groups; dynamic
                            VO2R,                       minute bouts            activity
                                                        accumulated
                            or 12-16 RPE
                                                        throughout the day

Resistance       2–3        Volitional fatigue          1 set of 3-20 reps      8-10 exercises
                            (e.g., 19-20 RPE) or        (e.g., 3-5, 8-10, 12-   that include all
                            stop 2-3 reps before        15); 1 set of 10-15     the major muscle
                            volitional fatigue (e.g.,   reps if >50 yrs         groups
                            16 RPE)

Flexibility   Minimum       Stretch to tightness at     15-30 sec.;             Static stretch for
                2–3;        the end of the ROM                                  all the major
                                                        2-4 reps
                            but not to pain; mild                               muscle groups
              ideal 5 – 7
                            discomfort


                                   ACE Exam Review                                             149
ACE Personal Trainer Manual


        Chapter 12

Special Populations &
   Health Concerns
          ACE Exam Review     150
Guidelines for most special populations
(refer to hand-out for specific concerns)
1)   Physician’s clearance
     a.    Request exercise guidelines and limitations
           from client’s physician
     b.    Maintain close contact with client’s
           physician
2)   Extended warm-up and cool-down
     a.    Longer than 10 minutes
     b.    Many special populations have
           compromised metabolic and/or
           cardiorespiratory systems and it takes longer for
           their bodies to adjust during acute bouts of
           exercise
                       ACE Exam Review                         151
Guidelines for most special populations (cont.)
3)   Cardiorespiratory exercise
     a.    Low- or non-impact
     b.    Longer duration and lower intensity
     c.    May be accumulated in shorter bouts
           throughout the day
4)   Strength
     a.    Lower resistance and higher repetitions
     b.    Exceptions are osteoporosis and obesity
5)   Modify as needed
                      ACE Exam Review                152
ACE Personal Trainer Manual


        Chapter 13

Principles of Adherence
     & Motivation
          ACE Exam Review     153
     Factors that affect adherence
1)    Personal factors
      a.    Education
      b.    Income
      c.    Smoking
      d.    Weight
      e.    Past exercise experience
      f.    Exercise perceptions
      g.    Self-efficacy

                         ACE Exam Review   154
Factors that affect adherence (cont.)
2)   Program factors
     a.    Convenience
     b.    Location
     c.    Cleanliness
     d.    Friendliness of staff
     e.    Cost
     f.    Variety in programming and equipment
     g.    Intensity

                         ACE Exam Review          155
Factors that affect adherence (cont.)
3)   Environmental factors

     a.    Support from family and friends
     b.    Contracts
     c.    External rewards




                       ACE Exam Review       156
ACE Personal Trainer Manual


        Chapter 14

 Communication &
 Teaching Techniques
          ACE Exam Review     157
               Four stages of a
          client-trainer relationship
1)   Rapport
     a.     Empathy: ability to experience another person’s
            world as if it were your own
     b.     Warmth: unconditional positive regard for
            another person
     c.     Genuineness: being honest and open
2)   Investigation
     a.     Health screen
     b.     Physical tests
                        ACE Exam Review                       158
              Four stages of a
     client-trainer relationship (cont.)
3)     Planning
       a.   Set SMART goals
       b.   Client should be involved in this process

4)     Action
       a.   Where the teaching and training takes place
       b.   The personal trainer coaches the client toward
            his or her goals

                       ACE Exam Review                       159
             Stages of learning
1)   Cognitive stage of learning
     a.    Learners make many mistakes and have highly
           variable performances
     b.    Participants rely on the instructor to detect
           errors in performance
2)   Associative stage of learning
     a.    Learners have acquired the basic fundamentals or
           mechanics of the skill
     b.    Participants begin to detect their own errors
3)   Autonomous stage of learning
     a.    The skill now becomes autonomic or habitual
     b.    Participants can now perform without thinking and
           can detect their own errors
                       ACE Exam Review                     160
             Types of learners
1)   Auditory learners
     a.    Listen intently to the content of your words
     b.    Instruction example: teach auditory learners
           breathing by making a light sound while exhaling
           and inhaling
2)   Visual learners
     a.    Watch you and your actions carefully
     b.    Instruction example: teach visual learners
           breathing by exaggerating facial expressions and
           moving hands in the direction of the airflow

                       ACE Exam Review                    161
            Types of learners
3)   Kinesthetic learners

     a.    Gather information through physical changes or
           feelings
     b.    Instruction example: teach kinesthetic learners
           breathing by having the participant focus on the
           feeling of the air moving through the airway and
           the feeling of the lungs expanding and contracting

4)   Most people prefer one style of learning but can
     adapt to others

                      ACE Exam Review                       162
          Exercise instruction
1)   ―Tell-show-do‖ approach to teaching
     a.    Tell: a concise verbal description of the skill to
           be attempted
     b.    Show: demonstration of the accurate desired
           action
     c.    Do: an opportunity for the client to perform and
           practice the desired skill
     d.    This approach allows the personal trainer to
           provide the client with an auditory, visual, and
           kinesthetic learning experience
                       ACE Exam Review                          163
     Exercise instruction (cont.)
2)   Feedback

     a.   Should be informational rather than
          controlling
     b.   Based on performance standards
     c.   Specific
     d.   Immediate




                      ACE Exam Review           164
     Exercise instruction (cont.)
3)   Spotting techniques
     a.    Trainer safety: the personal trainer should
           position his or her body in correct biomechanical
           position when spotting
     b.    Client safety

           1.     The personal trainer should be able to recognize
                  muscle substitution patterns that occur as muscles
                  fatigue and approach failure
           2.     It is the personal trainer’s responsibility to provide
                  protection in high-risk barbell exercises such as
                  the squat, bench press, and incline press

                       ACE Exam Review                                165
ACE Personal Trainer Manual

         Chapter 15

Basics of Behavior Change
   & Health Psychology

          ACE Exam Review     166
             Transtheoretical
          Stages-of-Change model
1)   Pre-contemplation
     a.    Individual is not exercising and not intending to
           start
     b.    Pre-contemplators deny having a problem and are
           typically unaware of the problem
     c.    Most difficult people to reach for behavioral
           change
     d.    Education is critical at this stage
     e.    Typically, they initiate change only when others
           pressure them

                       ACE Exam Review                         167
            Transtheoretical
     Stages-of-Change model (cont.)
2)    Contemplation
      a.   Individual is not exercising but seriously intends
           to start
      b.   Contemplators acknowledge they have a problem
           and begin to seriously think about overcoming it
      c.   They are not quite ready for change and are
           planning to take some action within the next 6
           months
      d.   The average contemplator stays in this stage for
           approximately 2 years, telling themselves they will
           change but continuously putting it off
      e.   Education and peer support are critical
                       ACE Exam Review                          168
            Transtheoretical
     Stages-of-Change model (cont.)
3)    Preparation
      a.    Exercise is occurring occasionally but not
            regularly
      b.    People in this stage are planning on starting
            to exercise within the next month
      c.    Goal setting and creating a specific plan of
            action are important during this stage
      d.    Continued environmental and peer support are
            helpful

                        ACE Exam Review                     169
            Transtheoretical
     Stages-of-Change model (cont.)
4)    Action
      a.   Exercise has occurred regularly for less than
           6 months
      b.   During this stage the exerciser is following
           specific program guidelines
      c.   Relapses are common, as this is the least stable
           stage
      d.   Personal trainers are critical during this stage


                       ACE Exam Review                        170
            Transtheoretical
     Stages-of-Change model (cont.)
5)    Maintenance

      a.   A regular exercise program has taken place for
           longer than 6 months and the exerciser strives to
           prevent relapses
      c.   This stage also requires adherence to specific
           exercise program guidelines
      d.   5 years of continuous maintenance is likely to
           result in termination of the unwanted behavior
           (being sedentary)

                       ACE Exam Review                         171
ACE Personal Trainer Manual


        Chapter 16

Musculoskeletal Injuries

          ACE Exam Review     172
                Acute injury
1)   Seek medical approval and recommendations
     prior to continuing existing program
2)   Rest, decrease FITT, and cross-train




                     ACE Exam Review             173
              Chronic injury
1)   If chronic injury with pain exists for two weeks
     or more, seek medical approval and
     recommendations prior to continuing existing
     program
2)   Rest, decrease FITT, and cross-train




                     ACE Exam Review                    174
     New medical conditions and/or
        changes in health status
1)    Seek medical approval and recommendations
      prior to continuing existing program
2)    Use ACE and other resources to create
      program modifications




                     ACE Exam Review              175
          Environmental conditions
1)   Exercising in heat

     a.     Begin exercising in the heat gradually
     b.     Always wear lightweight, well-ventilated clothing
     c.     Never wear impermeable or non-breathable
            garments




                       ACE Exam Review                     176
          Environmental conditions
1)   Exercising in heat (cont.)
     d.     Replace body fluids as they are lost
            1.     4–8 ounces of water every 10–15 minutes during
                   exercise
            2.     8–16 ounces of water 1 hour prior to exercise
            3.     16–24 ounces of water during the 30 minutes after
                   exercise, whether thirsty or not
     e.     Record daily body weight
     f.     Reduce FITT when appropriate
     g.     Avoid times of day when heat and/or humidity are
            the greatest


                        ACE Exam Review                             177
Environmental conditions (cont.)
2)   Exercising in cold

     a.    Wear several layers of clothing
     b.    Allow for adequate ventilation of sweat
     c.    Select garment materials that allow the body to
           give off body heat during exercise and retain body
           heat during inactive periods
     d.    Replace body fluids in the cold, just as in
           the heat


                       ACE Exam Review                     178
Environmental conditions (cont.)
3)   Exercising in higher altitudes
     a.    Acclimatize to altitude
     b.    Reduce FITT when appropriate
     c.    Increase warm-up and cool-down periods
     d.    Be aware of the signs and symptoms of altitude
           sickness
           1.     Shortness of breath
           2.     Headache
           3.     Nausea
           4.     Lightheadedness
     e.    Allow a minimum of three weeks to adjust at
           moderate altitudes (4,000 feet and higher)

                       ACE Exam Review                      179
ACE Personal Trainer Manual


        Chapter 17

Emergency Procedures

          ACE Exam Review     180
            Facility readiness
1)   First aid box
     a.    Where is it?
     b.    What’s in it?
     c.    How often is it restocked?
     d.    Who’s in charge of it?

2)   Emergency medical system (EMS) plan
     a.    Procedures and the role of the personal trainer
     b.    Emergency contact information
                       ACE Exam Review                       181
                 Emergency
1)   A situation that requires the activation of EMS
     (life threatening condition, heart attack, neck or
     back injury)
2)   A health professional will need to clear the client
     prior to exercise, and the program may need
     modification




                      ACE Exam Review                     182
                Acute injury
1)   A condition caused by a singular event that
     requires either an EMT or an immediate referral
2)   Medical attention is advised prior to the next
     exercise session




                      ACE Exam Review                  183
              Overuse injury
1)   A condition that has increased in pain or
     discomfort over a short period of time
2)   If there is general discomfort for two weeks or
     more advise the client to seek medical attention
     prior to exercise




                     ACE Exam Review                    184
                      RICE
1)   Rest, Ice, Compression, and Elevation
2)   Do not apply ice directly to the skin
3)   Ice should be applied no more than 20–30
     minutes per hour




                      ACE Exam Review           185
            Responses to exercise
Normal responses           Warning signs
Elevated heart rate        Squeezing pressure in chest
Increased respiration      Extreme shortness of breath
Sweating                   Profuse sweating or no sweating

Cramping                   Pain inappropriate for intensity
Fatigue                    Nausea
Redness in face            Red, hot appearance


                        ACE Exam Review                       186
ACE Personal Trainer Manual

         Chapter 18

   Legal Guidelines &
      Professional
     Responsibilities
          ACE Exam Review     187
               Scope of practice
1)    The range and limit of responsibilities normally
      associated with a specific job or function
2)    Limits the authority of a personal trainer
3)    Examples
      a.     Referring to more qualified professionals when
             necessary
      b.     Educating a client about the USDA Dietary
             Guidelines
      c.     Designing an exercise program for an apparently
             healthy adult
Important point: personal trainers never diagnose or prescribe

                         ACE Exam Review                       188
             Standard of care
1)   Appropriateness of an exercise professional's
     actions in light of current professional standards
2)   Based on the age, condition, and knowledge of
     the participant
3)   Examples:
     a.    Proper risk factor and medical screening
     b.    Exercise testing and physical assessments
     c.    Proper development of exercise program
     d.    Proper supervision of a client during exercise
                       ACE Exam Review                      189
      Standard of care (cont.)
4)   With the ACE Personal Trainer certification, your
     conduct could be compared to the standards
     presented in the manual and your ethics could be
     equated to the ACE Code of Ethics



(Appendix A: ACE Personal Trainer Manual)



                     ACE Exam Review                190
                  Negligence
1)   Both the failure to act and appropriateness of
     action
2)   Acting inappropriately as compared with what a
     reasonable and prudent professional would do
3)   Examples
     a.    Failing to stop a client from exercising above a
           recommended heart rate (failure to act or act of
           omission)
     b.    Encouraging a client to work above his or her
           recommended heart rate (appropriateness of
           action or act of commission)

                       ACE Exam Review                        191
      Comparative negligence
1)   Measures the relative fault of both the plaintiff
     and defendant
2)   The court may apportion guilt and any
     subsequent award and damages




                      ACE Exam Review                    192
      Contributory negligence
1)   The client plays a role in getting injured
2)   The plaintiff (client) cannot recover damages
     from the defendant (trainer)




                      ACE Exam Review                193
                         Forms
1)   Health risk appraisal (health history screen)
     a.    Purpose
           1.     Aids the personal trainer in determining heart
                  disease risk factors and/or medical conditions that
                  may make it unsafe for the client to participate in
                  physical activity
           2.     Provides a framework for designing a safe and
                  effective exercise program

     b.    Limitations
           1.     Cannot be used by a personal trainer to
                  diagnose any medical condition
           2.     Must be updated when any new medical condition
                  arises (having clients update their health history
                  forms every 6–12 months is a good practice)
                         ACE Exam Review                            194
                Forms (cont.)
2)   Physical Activity Readiness Questionnaire
     (PAR-Q)
     a.    Purpose
           1.     Serves as a minimal prerequisite for beginning a
                  low- to moderate-intensity exercise program
           2.     Quick and easy to administer
     b.    Limitations
           1.     Lack of detail
           2.     May overlook important health conditions,
                  medications, and past injuries


                         ACE Exam Review                             195
                Forms (cont.)
3)   Physician’s clearance (medical release)
     a.    Purpose

           1.    Provides the personal trainer with clarification of a
                 client’s status
           2.    Explains any limitations and/or modifications to
                 physical activity




                      ACE Exam Review                               196
                Forms (cont.)
4)   Informed consent (―express assumption of risk‖)
     a.    Purpose
           1.     When a client signs an informed consent, he or she
                  is acknowledging to have been specifically
                  informed about the risks associated with the activity
           2.     The two most important issues are voluntary
                  participation and known danger
           3.     Uses ―assumption of risk‖ defense if challenged in
                  court
     b.    Limitations
           1.     Not a liability waiver
           2.     Intended to communicate the dangers of the
                  exercise program or test procedures


                         ACE Exam Review                            197
                Forms (cont.)
5)   Liability waiver
     a.    Purpose
           1.     Used to release a personal trainer from liability for
                  injuries resulting from an exercise program
           2.     Represents a client’s voluntary abandonment of
                  the right to file suit
     b.    Limitations
           1.     Does not protect the personal trainer from being
                  sued
           2.     Documents that are poorly worded hold little value
                  in court, as each state has its own policies



                         ACE Exam Review                             198
            Insurance coverage
1)   General liability
     a.    Covers basic trip and fall injuries that occur in a
           non-business environment
     b.    These policies will not provide coverage for
           accidents that occur at work or while working
2)   Professional liability
     a.    Includes coverage based on allegations claiming
           injury to clients
     b.    Covers acts of omission (things the personal
           trainer did not do)
     c.    Covers acts of commission (actual conduct)
     d.    Necessary for independent contractors (self-
           employed personal trainers)
                         ACE Exam Review                         199
            Securing information
             and confidentiality
1)   Do's
     a.       Do keep all client records in a secure, locked place
     b.       Do keep client records on file for at least 5 years
     c.       Do inform your client that you will keep all
              information confidential
2)   Don'ts
     a.       Do not disseminate client names, addresses, or any
              other information to anyone without written
              permission from the client

                          ACE Exam Review                           200
     Health Insurance Portability and
      Accountability Act (HIPAA)
1)     In 1996, this federal statute was designed to
       protect the health information of individuals from
       unnecessary use or abuse
2)     Protected health information (PHI) applies to
       information created or received by healthcare
       providers
3)     HIPAA does not currently affect personal trainers
       or fitness facilities
4)     However, as part of the personal trainer’s initial
       interview and assessment with a potential client,
       PHI is gathered
                        ACE Exam Review                 201
     Health Insurance Portability and
      Accountability Act (HIPAA)
5)     The following precautions are recommended for
       the handling of PHI

       a.   Shred any duplicative or unnecessary medical
            documents that you may have for the client
       b.   Keep all files and offices locked when not in use
       c.   Ensure that PHI is not openly displayed on a
            workspace



                       ACE Exam Review                      202
     Health Insurance Portability and
      Accountability Act (HIPAA)
5)     The following precautions are recommended for
       the handling of PHI (cont.)
       d.   If an electronic system is used to store client
            information, ensure that the system is password
            protected
       e.   Sending a fax with PHI requires the personal
            trainer to first notify the recipient that a fax is
            going to be transmitted and mark the cover sheet
            "private and confidential"
       f.   If hard copies of PHI are mailed, label the
            envelope as confidential
       g.   It is not advisable to e-mail PHI
                        ACE Exam Review                       203