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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
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