ACSM's Certification Review, 4e - 2013.pdf

ACSM’S Certification Review FOURTH EDITION Dwyer_FM.indd i 11/07/12 11:55 PM EDITORS* SENIOR EDITOR ASSOCIATE EDITORS Gregory B. Dwyer, PhD, FACSM, ACSM-ETT, Nancy J. Belli, MA, ACSM-HFS ACSM-CES, ACSM-RCEP, ACSM-PD Asphalt Green East Stroudsburg University New York, New York East Stroudsburg, Pennsylvania Meir Magal, PhD, FACSM, ACSM-CES North Carolina Wesleyan College Rocky Mount, North Carolina Paul Sorace, MS, ACSM-RCEP Hackensack University Medical Center Hackensack, New Jersey *See Appendix B for a list of editors for the previous two editions. Dwyer_FM.indd ii 11/07/12 11:55 PM ACSM’S Certification Review FOURTH EDITION AMERICAN COLLEGE OF SPORTS MEDICINE Dwyer_FM.indd iii 11/07/12 11:55 PM Acquisitions Editor: Emily Lupash Managing Editor: Meredith L. Brittain Marketing Manager: Sarah Schuessler Manufacturing Coordinator: Margie Orzech Creative Director: Doug Smock Compositor: Absolute Service, Inc. ACSM Publication Committee Chair: Walter R. Thompson, PhD, FACSM, FAACVPR ACSM Group Publisher: Kerry O’Rourke Umbrella Editor: Jonathan K. Ehrman, PhD, FACSM 4th Edition Copyright © 2014, 2010, 2006, 2001 American College of Sports Medicine 351 West Camden Street Two Commerce Square / 2001 Market Street Baltimore, MD 21201 Philadelphia, PA 19103 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data ACSM’s certification review. — 4th ed. / senior editor, Gregory B. Dwyer ; associate editors, Nancy J. Belli, Meir Magal, Paul Sorace. p. ; cm. Includes index. ISBN 978-1-60913-954-4 I. Dwyer, Gregory Byron, 1959- II. American College of Sports Medicine. [DNLM: 1. Sports Medicine—Case Reports. 2. Sports Medicine—Examination Questions. 3. Exercise—Case Reports. 4. Exercise—Examination Questions. 5. Physical Fitness—Case Reports. 6. Physical Fitness—Examination Questions. QT 18.2] 617.1'027076—dc23 2012037317 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223- 2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. Dwyer_FM.indd iv 11/07/12 11:55 PM PTA. ACSM-CES New Orleans. Virginia Cases: Domain of Exercise Programming and Cases: Domain of Patient/Client Assessment for CES Implementation for CPT Dennis Kerrigan. Arkansas Cases: Domain of Patient/Client Assessment for CES Cases: Domain of Exercise Prescription and (Electrocardiograms) Implementation for HFS Nikki Carosone Russo. MA. MS. North Carolina (Electrocardiograms) Cases: Domain of Exercise Counseling and Behavioral Strategies for HFS Frederick Klinge. Professional. Hargens. Ross. Mobile. Business. Missouri Health and Exercise Connections. Asphalt Green ACSM-HFD New York. ACSM-PD Cases: Domain of Legal and Professional Considerations East Stroudsburg University for CES East Stroudsburg. ACSM-RCEP. Alabama ACSM-CES. ACSM-RCEP. ACSM-HFS Julie J. Henry Ford Hospital ACSM/NCPAD-CIFT Detroit. LLC Cases: Domain of Legal/Professional for HFS Middleboro. ACSM-HFS Ochsner Health System / Varsity Sports Donald M. PhD. v Dwyer_FM. Louisiana East Stroudsburg University Cases: Domain of Management for HFS East Stroudsburg. ACSM-PD Henry Ford Hospital Arkansas State University Detroit. ACSM-CES Long Island University James Madison University Brooklyn. Belli. Professional. PhD. Maynard. Business. and James H. PhD. MS. ACSM-CPT.indd v 11/07/12 11:55 PM . ACSM-CPT Kansas City. MS. FACSM. ACSM-PD Providence Hospital Shala E. PhD. ACSM-CES Brian Coyne. Michigan Jonesboro. New York Central Oregon Community College Cases: Domain of Legal. Contributing Authors to the Fourth Edition* Nancy J. PT. ACSM-HFD H-P Fitness. Downing. ACSM-RCEP. New York Harrisonburg. BS. FACSM. Michigan Duke University Health System Cases: Domain of Patient/Client Assessment for CES Durham. PhD. ACSM-CES Shawn Drake. Pennsylvania Cases: Domain of Exercise Prescription for CES Timothy S. ACSM-ETT. ACSM-CES Marketing for CPT Wake Forest University Winston-Salem. Cummings. Oregon Marketing for CPT Cases: Domain of Health and Fitness Assessment for HFS Clinton Brawner. PhD. Massachusetts Cases: Domain of Legal. PhD. Parrott. ACSM-CPT Trent A. MEd. FACSM. ACSM-RCEP. Davis. MBA. Pennsylvania Cases: Domain of Leadership and Counseling for CES Matthew W. MS. and Bend. North Carolina Cases: Domain of Exercise Prescription for CES *See Appendix C for a list of contributors to the previous two editions. LLC Kimberly DeLeo. vi CONTRIBUTING AUTHORS TO THE FOURTH EDITION Tom Spring, MS, FAACVPR, ACSM-CPT, Janet P. Wallace, PhD, FACSM, ACSM-CES, ACSM-HFS, ACSM-CES ACSM-PD WebMD Health Services Indiana University Detroit, Michigan Bloomington, Indiana Cases: Domain of Initial Client Consultation and Cases: Domain of Exercise Prescription for CES Assessment for CPT Michael J. Webster, PhD, FACSM, ACSM-CES David E. Verrill, MS, FAACVPR, ACSM-RCEP, University of Southern Mississippi ACSM-CES Hattiesburg, Mississippi University of North Carolina at Charlotte Cases: Domain of Exercise Leadership and Client Charlotte, North Carolina Education for CPT Cases: Domain of Program Implementation and Ongoing Support for CES Dwyer_FM.indd vi 11/07/12 11:55 PM Reviewers for the Fourth Edition Christopher G. Berger, PhD Tom LaFontaine, PhD, FACSM, FAACVPR The George Washington University Optimus: The Center for Health Washington, District of Columbia Columbia, Missouri HFS Case Studies CES Case Studies Andy Bosak, PhD Tony Musto, PhD Georgia Southwestern State University University of Miami Americus, Georgia Miami, Florida HFS Job Task Analysis CES Job Task Analysis Mindy Caplan, ACSM-HFS Neal I. Pire, MA, FACSM Lake Austin Spa Resort InsPIRE Training Systems Austin, Texas Ridgewood, New Jersey HFS Practice Examination CPT Job Task Analysis Teresa Fitts, DPE, FACSM Nikki Carosone Russo, MS Westfield State College Long Island University Westfield, Massachussetts Brooklyn, New York HFS Case Studies CPT Job Task Analysis Julie Hansen, MPH, ACSM-CPT Mitchel Whaley, PhD, FACSM Montage Hotels and Resorts Ball State University Park City, Utah Muncie, Indiana CPT Case Studies CES Case Studies (Electrocardiograms) Tarra L. Hodge, MS Mary Yoke, MS Purdue University Indiana University West Lafayette, Indiana Bloomington, Indiana HFS Job Task Analysis and CPT Practice Examination CPT Case Studies Dennis J. Kerrigan, PhD Mark Zaleskiewicz, MS, FAACVPR Henry Ford Hospital Shore Medical Center Detroit, Michigan Mays Landing, New Jersey CES Case Studies and CES Practice Examination CES Job Task Analysis vii Dwyer_FM.indd vii 11/07/12 11:55 PM Dwyer_FM.indd viii 11/07/12 11:55 PM Foreword As an undergraduate student at Wake Forest University, Registered Clinical Exercise Physiologist, and those I took my first American College of Sports Medicines preparing for the Exercise is Medicine Credential will (ACSM) certification examination in 1978 (which I also find this book to be very useful. had to retake in 1979!). The experience of being certi- The fourth edition was developed strategically into fied by ACSM was one of the great accomplishments three parts for each certification — cases for each certifi- of my young career and helped me get my first job cation, a detailed breakdown of the knowledge and skills with Dr. Noel Nequin at Swedish Covenant Hospital in for each certification, and sample questions that are simi- Chicago. Under Noel’s guidance and urging, I became lar to those found on each certification examination. One certified as an ACSM program director for Preventive of the more unique features of this edition is the cases, and Rehabilitative Exercise Programs (which is no which are organized within the text according to the longer an ACSM certification) in 1983. At about that domains, a result of the recent job task analysis. The four same time (1981), I was invited to sit on the ACSM domains include health and fitness assessment (initial Certification and Education Committee (now known client consultation and assessment for CPT, health and as the Committee on Certification and Registry Boards fitness assessment for HFS, and patient/client assessment [CCRB]), and I have held various positions on that com- for CES); exercise programming (exercise programming mittee for more than 30 years. For six of those years, and implementation for CPT, exercise prescription and I served as the chair. During those 30 years, there has implementation for HFS, and exercise prescription for been an exponential growth in the number of certifica- CES); exercise counseling and behavioral strategies (ex- tion candidates and in the resources being provided to ercise leadership and client education for CPT, exercise certification candidates. counseling and behavioral strategies for HFS, and pro- In 2009, CCRB decided to simultaneously publish gram implementation for CES); program administration ACSM’s Guidelines for Exercise Testing and Prescription (legal/professional/business/marketing for CPT, manage- (8th edition), ACSM’s Resource Manual for Guidelines for ment for HFS, and leadership and counseling for CES); Exercise Testing and Prescription (6th edition), ACSM’s and legal and professional considerations for all three Resources for Clinical Exercise Physiology (2nd edition), certifications. and ACSM’s Certification Review (3rd edition). This was Greg, Nancy, Meir, and Paul will receive much praise an amazing accomplishment as the books were written for the contents of this book and their professional ap- by four sets of writers and editors. It proved to be such proach to providing for certification candidates the very a great success that the plan was implemented for the best resource to prepare for their examinations. For me, next editions of the books, including this one (except for it is a simple “thank you” to them for their dedication ACSM’s Resources for Clinical Exercise Physiology, which and their friendship. To present and future certification did not need revision). candidates — this book will be your guide to success. This fourth edition of ACSM’s Certification Review is by far the most comprehensive edition of this title. Senior Walter R. Thompson, PhD, FACSM Editor Gregory Dwyer and his talented team of associ- Regents Professor ate editors (Nancy Belli, Meir Magal, and Paul Sorace) Department of Kinesiology and Health and writers have developed the quintessential review for (College of Education) and ACSM Certified Personal Trainer (CPT), ACSM Certified Division of Nutrition Health Fitness Specialist (HFS), and ACSM Certified (Byrdine F. Lewis School of Nursing and Clinical Exercise Specialist (CES). Although the scope Health Professions) of this fourth edition targets these three certifications, Georgia State University the ACSM Certified Group Exercise Instructor, ACSM Atlanta, Georgia ix Dwyer_FM.indd ix 11/07/12 11:55 PM Dwyer_FM.indd x 11/07/12 11:55 PM Preface This fourth edition of the ACSM’s Certification Review Exercise Testing and Prescription, Seventh Edition (RM7). has been extensively revised from previous editions of As a commitment to the certification field, ACSM is coor- this text. This edition covers all the current knowledge, dinating the updating of these texts, which are publishing skills, and abilities (KSAs) for the certifications of the at the same time this book publishes. Certified Personal Trainer (CPT), the Certified Health ACSM certification levels build upon one another. Fitness Specialist (HFS), and the Certified Clinical For instance, the CES certification encompasses all HFS Exercise Specialist (CES). and CPT KSAs. Thus, individuals who intend to use this book to review for the CES certification are responsible for all KSAs covered in the HFS and CPT sections as well TEXT ORGANIZATION as all KSAs covered in the CES section. Similarly, individ- This text is organized into parts by certification level and uals preparing for the HFS certification are responsible is further subdivided into three main sections in each for all KSAs covered in the CPT section. part as follows: We are aware that facts, standards, and guidelines change on a regular basis in this ever growing field of • Case studies that involve both multiple-choice ques- knowledge. Hence, in the event that conflict may be tions as well as open-ended discussion questions noted between this book and the GETP9, the latter text are divided by certification level and domain. There should be used as the definitive and final resource. In are 30 case studies (and 10 accompanying ECGs) in such cases, where an update is needed or where a conflict the book. or error is identified, I will make every effort to provide • Job task analysis (JTA) tables that contain a detailed further explanations or corrections online. The web ad- breakdown of all the KSAs by certification level and dress for any corrections is http://certification.acsm.org/ domain. In this section, there is a further breakdown cr4updates. of what each KSA statement refers to as well as helpful If I can play a small role in your ACSM certification study resources for each KSA. The KSA section was success, I would feel truly happy that all the hard work extensively impacted by the recent ACSM JTA that put into this project has paid off. was performed on all certification levels. • Practice examinations, one for each certification, Gregory B. Dwyer, PhD, FACSM, ACSM-ETT, contain 100 multiple-choice practice questions with ACSM-CES, ACSM-RCEP, ACSM-PD answers and explanations. At the end of each exam, Senior Editor a table indicates which questions in that practice test correspond to which domain(s). ADDITIONAL RESOURCES STUDYING FOR A CERTIFICATION EXAM ACSM’s Certification Review, Fourth Edition includes ad- ditional resources for instructors that are available on The many individuals involved in the preparation of this the book’s companion Web site at http://thepoint.lww text intend that it be used as a review aid for the certification .com/ACSMCR4e. exams and assume that the reader is actively preparing to sit for one of the three ACSM certifications covered. This text INSTRUCTORS represents one of many study tools available and should not be viewed as the sole source of information to use in prepar- Approved adopting instructors will be given access to the ing to take one of these three certification exams. following additional resource: As a study or review tool, this text may help you clarify • Image bank areas of strengths and weaknesses. Your individual weak- nesses should be eliminated by further study. This text In addition, purchasers of the text can access the search- should be viewed as part of a study kit that each of you able Full Text Online by going to the ACSM’s Certification needs to identify for yourself. Certainly, ACSM’s Guidelines Review, Fourth Edition Web site at http://thepoint.lww for Exercise Testing and Prescription, Ninth Edition (GETP9) .com/ACSMCR4e. See the inside front cover of this text must be considered as part of that package. The ACSM has for more details, including the passcode you will need to also written ACSM’s Resource Manual for Guidelines for gain access to the Web site. xi Dwyer_FM.indd xi 11/07/12 11:55 PM Dwyer_FM.indd xii 11/07/12 11:55 PM Acknowledgments I fear to mention specific names as I might exclude I am grateful to the many individuals with whom I have those who deserve so much of my acknowledgment. worked and collaborated, but there are a few that need Many have mentored me in my more than 30-year special acknowledgement. First of all, to Greg Dwyer for ACSM certification career (I was first certified in 1982). having the confidence in me to be such an integral part of To all those who added so much to my career, I give this project. Second, to Neal Pire for his belief in me and my heartfelt thanks (I have thought of these many indi- recommending that I contribute my talents to ACSM on a viduals often during this textbook writing/editing pro- national level. On a personal level, to my sister, Mary Lou, cess, in a good way!). To those who have been involved who is an inspiration at what can be accomplished over in this project who have added much, especially my the course of a day. Most importantly, to my family, who associate editors, I give you thanks for allowing me to love and support me to do the work that fulfills my soul. stand on your shoulders. The ACSM certification staff, the ACSM Committee on Certification and Registry — Nancy J. Belli Boards, as well as Lippincott Williams & Wilkins have fully supported this project, and a great debt of grati- tude is owed to them all. I would like to thank Dr. Jon I would like to thank all the contributors and review- Ehrman, the umbrella editor of this project, who made ers; without their dedicated work, this project would it his mission to ensure congruency between the ninth not have been possible. I would also like to thank my edition of the Guidelines and seventh edition of ACSM’s parents, Esther and Dani Magal, for the values and eth- Resource Manual for Guidelines for Exercise Testing and ics they have instilled in me, and my wife Dana and my Prescription as well as this text. Dr. Ehrman is also the children, Yuval and Amit, for giving me the inspiration, umbrella editor for ACSM’s Resources for the Personal support, and patience needed to complete this work. Trainer, Fourth Edition and the new ACSM’s Resources for the Health Fitness Specialist. — Meir Magal Finally, my wonderful family — Beth, Kevin, and Eric — have provided me much grounding, nourish- ment, and encouragement throughout the years. A special thanks to the ACSM Committee on Certification and Registry Boards for their diligent reviews of this — Gregory B. Dwyer textbook. Their commitment to ACSM and the exercise profession is invaluable. — Paul Sorace xiii Dwyer_FM.indd xiii 11/07/12 11:55 PM indd xiv 11/07/12 11:55 PM .Dwyer_FM. ............................................................................. 40 Section 3 CPT Examination .................................................................................................................................................................................................................. 101 Domain III: Exercise Counseling and Behavioral Strategies ..... Belli............................................................................................................................ ACSM-HFS Section 1 CPT Case Studies ........................................................................................................................................................................................................................................................................................................................................................................................................ 8 Case Study CPT...........I ..................................indd xv 11/07/12 11:55 PM ... 77 Case Study HFS............................... 139 HFS Examination Questions by Domain ................................IV(1) ...........................I ...III .............................................................................................................................................. vii Foreword ............ 10 Section 2 CPT Job Task Analysis.................................................................... 93 Domain I: Health and Fitness Assessment ..................................................................... Business......................... 86 Section 5 HFS Job Task Analysis .............................................. 9 CPT Case Studies Answers and Explanations .................................................................................................................................. 83 HFS Case Studies Answers and Explanations ............................ 93 Domain II: Exercise Prescription and Implementation ..........................................................................II........................ MA................................IV(2) .............................................................................................. 82 Case Study HFS.......................... ix Preface .......................................................................................II ................................................................................................................................................................. v Reviewers for the Fourth Edition ................................................................................................................................................................................................................................................... xi Acknowledgments ........................................................................................................................... 15 Domain I: Initial Client Consultation and Assessment.......................................................................................................................... 4 Case Study CPT........................................... 24 Domain III: Leadership and Education Implementation ............ 63 CPT Examination Questions by Domain ............................................................... ACSM-CES Section 4 HFS Case Studies ...........IV ......................................................................................................... 6 Case Study CPT.............................................................................................. FACSM..................................................................... 74 PART 2 ACSM CERTIFIED HEALTH FITNESS SPECIALIST (HFS) ............................................................................................................................. 1 Associate Editor: Nancy J............................................................................................................ 150 xv Dwyer_FM............... 55 CPT Examination Answers and Explanations ...................................................................................................................... 77 Case Study HFS................................................................. 3 Case Study CPT............................................................................................................. 117 Domain IV: Legal/Professional . 15 Domain II: Exercise Programming and Implementation .............................. PhD..................................................................................................................................................... 122 Domain V: Management ............................................................................................................................................................... and Marketing ...............V .................................... xiii PART 1 ACSM CERTIFIED PERSONAL TRAINER (CPT)......... 79 Case Study HFS.......... 80 Case Study HFS............ 131 HFS Examination Answers and Explanations ................................................................. Contents Contributing Authors to the Fourth Edition ............................... Professional............................................................................................................III ............................ 3 Case Study CPT....................................... 75 Associate Editor: Meir Magal.................................................. 126 Section 6 HFS Examination ........... 35 Domain IV: Legal..................................... ................................................................................................................................................. 219 CES Examination Answers and Explanations ................................................................................ECG(3) ............... 175 CES............. 166 Case Study CES.................................................................................... 239 Appendix B Editors for the Previous Two Editions ...............................................................................................................................................ECG(2) . 157 Case Study CES......I ......................................................................................................................................................................................... 176 CES.............................................................................................................................................................II(3) ........................................... 173 CES.................................................................................................... xvi CONTENTS PART 3 ACSM CERTIFIED CLINICAL EXERCISE SPECIALIST (CES) ....................................................indd xvi 11/07/12 11:55 PM ................................... 171 CES.............. ACSM-RCEP Section 7 CES Case Studies .............................................................................................................. Tables.................. 174 CES........................................................................................................... 161 Case Study CES..................................................................................... 237 Appendix A Supplementary Figures.............................................. 168 ECG Case Studies ...................... 179 ECG Case Studies Answers and Explanations .......................................................................................... 205 Domain IV: Leadership and Counseling ................................................................... 174 CES............................II(1) .... 291 Dwyer_FM.......................V(1) .V(3) ................................................................................................................................................................................................................................................................................................................................................................................................................................IV .... 165 Case Study CES........ECG(5) ................................................................................. 287 Index .................................................... 163 Case Study CES..........................ECG(1) .... 195 Domain I: Patient/Client Assessment .........ECG(10) .............................................. and Boxes from Other ACSM Certification Texts ....................................................................................... 153 Case Study CES.............ECG(9) ........................ 168 Case Study CES......................... 228 CES Examination Questions by Domain ........III .................................... 154 Case Study CES........ 216 Section 9 CES Examination ...................................... 285 Appendix C Contributors to the Previous Two Editions ...... 190 Section 8 CES Job Task Analysis .. 200 Domain III: Program Implementation and Ongoing Support ....................................................ECG(6) ..............................................................ECG(8) ...................................................................................................ECG(4) .................. 153 Case Study CES..........................................................................V(2) ................................................................... 160 Case Study CES...................................................................................................... 176 CES...................ECG(7) ...........................................II(4) ..... 178 CES Case Studies Answers and Explanations .......................................................................................................................................................................................................................... 195 Domain II: Exercise Prescription................................................................................................................................................................ 171 CES........................................................... 172 CES.....................................................................................................................II(5) ........................... 211 Domain V: Legal and Professional Considerations ........................................................................................................................ MS...................................................................................................................................................................................................................................................................... 158 Case Study CES.................................................................................... 177 CES............................................................................................. 151 Associate Editor: Paul Sorace................................II(2) ......................................................................................................................................................................... MA. Associate Editor 1 Dwyer_Part1_Sec1. CPT PART 1 ACSM Certified Personal Trainer (CPT) NANCY J.indd 1 11/07/12 11:55 PM . BELLI. ACSM-HFS. Dwyer_Part1_Sec1.indd 2 11/07/12 11:55 PM . was a high school basketball player Surgeries None since appendix was removed 10 yr ago. ACSM-HFS.indd 3 11/07/12 11:55 PM . you do your club’s routine health assessment revealing the following information: Height 5 ft 6 in Weight 195 lb Body mass index (BMI) 31 kg m2 Resting blood pressure at 138/88 mm Hg assessment Resting heart rate (HRrest) 88 bpm Lipids High-density lipoprotein (HDL): 56. Beth would like to begin an intense exercise regimen after hearing about high-intensity training from a friend and fitness enthusiast. You also suggest starting a stretching program to help with some lower back pain she reports when sitting at work for prolonged periods of time. MS. She will manage her diet as you see fit and would like advice from a dietician to begin her quest to lose at least 20 lb. low-density lipopro- tein (LDL): 122. father died from cancer at age 66 yr. vitamins designed for women Exercise history None to speak of in the past 20 yr or so. no orthopedic surgeries or injuries As mentioned. who would like to start an exercise program with you as soon as possible. your manager tells you that Beth called to begin a weight loss program and may also want to work with your club’s staff dietician. Beth (54 yr old). 3 Dwyer_Part1_Sec1.I Author’s Certifications: ACSM-CPT. and siblings (two younger sisters) are in good health as far as she knows Medications Aleve. triglycerides (TG): 111 (all mg dL1) Fasting blood glucose 102 mg dL1 Family history Mother had a heart attack at about the age of 58 yr. Upon meeting Beth. Prior to your initial visit. SECTION 1 CPT Case Studies CPT DOMAIN I: INITIAL CLIENT CONSULTATION AND ASSESSMENT CASE STUDY Author: Tom Spring. ACSM-CES Your fitness manager has assigned a new client to you. occasional Advil for knee pain. After discussing her preferences for exercise. FAACVPR CPT. you think she would be well suited for resis- tance training using free weights and body weight exercises as well as aerobic exercise on the treadmill and elliptical trainers. Upon completing a body composition and fitness evaluation using the Jackson-Pollock 3-site skinfold method. Beth should be characterized as meeting all the American College of Sports Medicine (ACSM) Risk 5. She solicits that she may use in her initial training phase for your advice to avoid the cost associated with cardiovascular exercise. a new client. You decide to provide some choosing the training range used in the calculations. What would you expect Beth’s maximum heart rate Factor Thresholds for cardiovascular disease. and why they might be selected.I 1.indd 4 11/07/12 11:55 PM . only for resistance training B) Hyperlipidemic C) After meeting with the dietician C) Dyslipidemic D) After physician clearance has been obtained D) At risk for atherosclerosis DISCUSSION QUESTIONS FOR CASE STUDY CPT.I 1. Discuss the rationale for the club’s dietician. DOMAIN II: EXERCISE PROGRAMMING AND IMPLEMENTATION CASE STUDY Author: Nikki Carosone Russo. has joined your facility and is seeking his initial fitness evaluation and first workout session. 2. 3.II Author’s Certifications: ACSM-CPT You are a CPT at a corporate fitness center. Beth should be risk classified as 4. you decide to perform an Discuss the limitations and scope of practice for initial fitness assessment. she would be sion would occur when? considered A) Immediately. she would be A) High risk classified as B) Low risk A) Normal CPT C) Moderate risk B) Prediabetic D) Indeterminate C) Hypoglycemic D) Diabetic 2. including high-intensity exercise A) Normal B) Immediately.acsm. you record his measurements as follows: Weight: 165 lb Triceps skinfold: 12 mm Subscapular skinfold: 14 mm Chest skinfold: 16 mm Waist circumference: 33 in Hip circumference: 39 in Dwyer_Part1_Sec1. have been obtained. Based on Beth’s lipid profile. 4 CERTIFICATION REVIEW • www. your next ses. Stan. Based on Beth’s fasting glucose level. Beth’s desire to lose weight lead to significant calculate an appropriate training heart rate for Beth discussion regarding her dietary habits. He currently weighs 165 lb.org MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CPT. who is 5 ft 9 in tall. MS CPT. Discuss which fitness the certified personal trainer (CPT) as it relates to field tests would be appropriate for you to perform providing dietary information. After Beth’s initial history and required clearance advice and tips for her to help out where you can. except to be (approximately) (using formula 220-age)? A) Hypertension A) 145 bpm B) Obesity B) 166 bpm C) Sedentary lifestyle C) 186 bpm D) Family history D) Cannot be determined 3. Using the Karvonen heart rate reserve formula. According to her history and goals. Stan is a 39-yr-old male. 6. his doctor found a “slight bulging disc” in his “lower back” area. specifically his chest and biceps. Stan does not currently have any low back pain and hopes that a structured. In order to address Stan’s goals for building muscle C) High risk mass and improving strength. all of the following agility training are resistance training guidelines for healthy adults B) Moderate intensity (40%–60% oxygen uptake except reserve [V̇O2R]) aerobic activities.3%. He lacks the proper motivation and feels that working with a CPT will help him overcome this hurdle. the individual A) An increase of 5–10 min every 1–2 wk over the should maintain a regular breathing pattern first 4–6 wk that typically involves exhaling during the B) An increase of 2–5 min every 1–2 wk over the “lift” and inhaling during the “lowering” phase first 4–6 wk of each exercise. Based on the rates of progression when initially exercises that are single joint and involve only working with Stan. or compound flexibility exercises exercises that involve more than one muscle D) Vigorous intensity (60% V̇O2R) aerobic group at a time. lose 5 lb. resting heart rate and blood pressure were measured at 66 bpm and 118/70 mm Hg. During the goals review portion of the evaluation. Stan also states that he usually sticks to select equipment and weight machines and would like to start doing more free weight and sport-specific exercises to increase strength. His strength assessment reveals he is within normal ranges for strength and his sit and reach test shows he falls slightly below the flexibility parameters and has slight low back and hamstring tightness. According to the ACSM’s GETP. this client would be classified as D) An increase of 10–15 min every 2 wk over the A) Low risk first 4–6 wk B) Moderate risk 4. and gain muscle in his upper body. activities. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CPT. He does not have any orthopedic contra- indications to exercise but reports that 5 yr ago. He tells you that historically. Stan does take an allergy suppressant during the spring and summer months and is prone to allergy-related symptoms such as headaches. SECTION 1 CPT Case Studies 5 Based on the results of the skinfold test. balance and 5. progression look like? D) While performing repetitions. CPT When discussing his medical history. C) A combination of moderate-to-vigorous B) The resistance training program should feature aerobic activities. Design an exercise program for Stan based on the (reps) per set would you recommend? ACSM’s GETP standards as well as Stan’s goals of A) 6–8 exercising at least 3 d wk1. his lower body has always appeared stronger and he would like to primarily work on increasing tone his upper body. According to the most recent edition of the ACSM’s C) An increase of 10–15 min every week over the Guidelines for Exercise Testing and Prescription first 4 wk (GETP). Stan is an avid golfer. Stan states that his lower body is very strong because he used to play competitive basketball and was on the track team in college. respectively. Currently. and his golf swing. he prefers to work his full body at least 3 d wk1. During the initial evaluation. weight-bearing and exercises that are multijoint.II 1. calisthenics. Stan reports that he is not a smoker and is not currently taking any medications.indd 5 11/07/12 11:55 PM . how many repetitions 2. B) 12–15 A) Full-body strength training program once C) 8–12 per week: muscular strength and endurance. what would your rate of one specific muscle group at a time. Dwyer_Part1_Sec1. and general lethargy during that time. sinus infections. you predict his body fat to be 23. definition. full-body routine will keep him strong and pain free. Optimally. His primary goals are to stay active enough to keep up with his two young children. Stan reported that he is a sporadic exerciser who would like to become a regular exerciser. D) 10–15 resistance exercises. weight- A) Each major muscle group should be trained bearing and flexibility exercises 2–3 d wk1. weight-bearing and flexibility exercises C) The resistance training program should feature 3. 6 mL O2 kg1 min1 Predicted final treadmill velocity corresponding with 100% of age predicted maximal heart rate: 6. Given Stan’s occasional back pain. On the urging of his wife. He has been married for 9 yr and has two daughters ages 7 and 5 yr. Webster.8 m min1) Dwyer_Part1_Sec1. training 30–40 miles wk1. He has a Master’s degree in Chemistry and worked in laboratory research for 5 yr before beginning his current position as a sales representa- tive for a major pharmaceutical company. respectively. Bob’s clients are hospital physicians in a major metropolitan city with a population of approxi- mately 5 million. Caucasian male.III Author’s Certifications: ACSM-CES Bob is a relatively sedentary.5 g — 70% saturated fats Caffeine intake: 500 mg (five cups of coffee) Alcohol intake: 16 oz of regular beer (28. He finds the job to be enjoyable yet stressful.500 cal Daily carbohydrate (CHO) intake: 350 g — 60% simple or refined carbohydrates — 40% complex carbohydrates Daily protein intake: 100 g Daily fat intake: 55. FACSM CPT. PhD. Bob had a physical exam and it revealed the following: Anthropometric measures Height: 5 ft 10 in (178 cm) Weight: 198 lb (90 kg) Body fat: 28% Resting blood pressure (measured on two separate occasions): 142/78 mm Hg Fasting blood glucose and lipids Blood glucose (measured on two separate occasions): 112 mg dL1 Total cholesterol: 198 mg dL1 LDL cholesterol: 136 mg dL1 HDL cholesterol: 29 mg dL1 3-d dietary recall and nutritional analyses Daily caloric intake: 2. and 3–4 hr of work on the computer. which he has been with for the past 7 yr. Based on what you know about Stan from his initial 2. meeting with physicians 3–4 hr. His body fat was 10%. 6 CERTIFICATION REVIEW • www.indd 6 11/07/12 11:55 PM . He was a recreationally competitive runner.acsm.org DISCUSSION QUESTIONS FOR CASE STUDY CPT. Weekends typically require another 5–6 hr of computer work at home. he has not been involved in any regular physical activity and has gradually put on weight. He typically gets no more than 6 hr of sleep each night. what are the various modalities of recommendations would you make regarding resistance training that you think he might be most flexibility training to help keep him limber and CPT inclined to adhere to? pain free? DOMAIN III: EXERCISE LEADERSHIP AND CLIENT EDUCATION CASE STUDY Author: Michael J. what assessment.II 1. his height and weight were 5 ft 10 in (178 cm) and 154 lb (70 kg).5 g) Submaximal treadmill exercise test Predicted maximal oxygen uptake (V̇O2max): 35. with a best 5-km race time of 18:30.0 mph (160. When Bob was in college. Since his graduation from college. 37-yr-old. A typical work day involves approximately 2 hr of driving. He entertains clients at restaurant lunch and dinner meetings approximately four times per week. fat: 390 energy balance and that all weight loss is from fat. Bob has done some reading on the Internet about however.4 kg m2 C) 26. protein: 400. You B) Overweight find that he is in the stage of change. that it doesn’t take into account the muscle mass What aspects of Bob’s diet are good and what areas and overall body composition. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CPT. SECTION 1 CPT Case Studies 7 Flexibility (category based on gender and age) Sit and reach test: Poor Muscular strength. and fat calories? ture (EE). and start eating better. Determine Bob’s current classification based on his BMI. protein: 510. A) Carbohydrate: 1.2 D) 28. endurance (percentile rating based on gender and age) one repetition maximum (1-RM) bench press: 30th percentile Sit-ups: 20th percentile CPT Push-ups: 20th percentile Bob’s physician strongly recommended that he begin an exercise program. protein: 400.9 D) 39.400. Calculate Bob’s current BMI. 4. Bob wants to decrease his daily energy intake by 200 cal. How many pounds would Bob need to lose to A) 25. coming from an increase in exercise energy expendi. Bob understands how his BMI is calculated. Bob comes to you for guidance.8 C) 28. with the balance 6. Bob knows that the physician’s recom- mendation is what he needs and he is committed to making some changes to improve his overall health. lose weight.9 kg m2 B) Carbohydrate: 1. 5.0 kg m2 B) 23. 2. What is Bob’s daily energy intake of carbohydrate.400.indd 7 11/07/12 11:55 PM . Although hating to admit it. fat: 200 A) 48 cal B) 200 cal C) 483 cal D) 683 cal DISCUSSION QUESTIONS FOR CASE STUDY CPT.6 2. protein.2 kg m2 achieve a target body weight of 20% body fat? B) 26.400.3 kg m2 A) 19.III 1. Is Bob’s argument need to be addressed? valid? How would you address Bob’s concern? Dwyer_Part1_Sec1. protein: 700. fat: 250 in 12 wk? You can assume that he is presently in C) Carbohydrate: 1. In order to best help Bob with necessary behavioral A) Normal weight changes. you evaluate his readiness to change. he is D) Action advised to diet and exercise. C) Class 1 obesity A) Precontemplation D) Class 2 obesity B) Contemplation C) Preparation 3. His argument is diets and considers his diet to be “fairly” good. D) Carbohydrate: 1. To address Bob’s weight and body composition.750. fat: 500 penditure be to achieve a target BMI of 24. What should his daily exercise energy ex.III 1. he questions its validity. BS.IV(1) Author’s Certifications: ACSM-CPT You have recently started working in a very busy health club as a full-time fitness specialist. assisting members with the proper use and safety of the exercise equipment.m. PTA CPT CPT. and maintenance of the fitness equipment. C) Have the member sit down and tell him to rest. PROFESSIONAL. grip on the bar. new member orientations. and you are able to personal train clients “off hours. The facility also offers personal training packages to their members. center. training in a fitness center. it is emergency drills be conducted? appropriate to A) Once per year A) Give him advice on what he should do with his B) Twice per year marriage. DISCUSSION QUESTION FOR CASE STUDY CPT. Your personal training client. 8 CERTIFICATION REVIEW • www. D) None of the above.” You are responsible for getting your own personal train- ing clients and are paid as an independent contractor. the cable on the lat pull-down machine C) Refer him to local professionals that specialize broke. Your job responsibilities include supervising the fitness floor. B) Start chest compressions. TRUE OR FALSE AND MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CPT. C) Get ice for your client. The weights dropped and your client lost his in counseling and behavior change. Review of the emergency is having difficulties with his marriage and has plan should also be done. Why is it important to keep your clients’/members’ files in a secure place? Dwyer_Part1_Sec1. activate liability insurance when he or she is personal EMS and monitor him until help arrives.IV(1) 1. use” sign on the equipment. The very first thing his exercise.indd 8 11/07/12 11:55 PM . D) Immediately attend to the member and ask him 5. you should do is B) Fill out an incident report and put a “do not A) Activate emergency medical services (EMS).m. is going through 3. Medical emergency plans must be written and a difficult time and has confided in you that he easily available to all staff. If he says yes. He is now complaining of pain in D) Just listen and do nothing. BUSINESS. As an ACSM CPT. How often should started drinking excessively. While personal training your client in the fitness his training program. Your regular work hours are Monday to Friday. True or False: A CPT does not need professional if he is having chest pain. The first thing you do is 2.acsm. 8 a. C) Quarterly B) Explain to him about the risk factors of D) Once per month excessive alcohol intake and how it can affect 4.IV(1) 1. general exercise programming. Joe. AND MARKETING CASE STUDY Author: Kimberly DeLeo. to 5 p. his shoulder. a member stops A) Try to fix the machine so your client can finish abruptly and grabs his chest.org DOMAIN IV: LEGAL. While running on the treadmill. measurable laxity B) The client should be referred to a physical C) Excessive edema. DISCUSSION QUESTION FOR CASE STUDY CPT. elevation. As a precaution. immobilize. ice. elevation. what does the D) The client does not require clearance before acronym RICES stand for? resuming training. Tom reached for a forehand volley and felt his right ankle roll over (inverted). prior to resuming training after an injury? strength loss A) The client should be referred to a physician B) Moderate edema. compression. which of the following cold D) 40-yd dash to test speed applications is recommended concerning the 6. According to ACSM’s Guidelines. What assessments would you perform to address B) Rest. Belli.IV(2) 1.IV(2) Author’s Certifications: ACSM-HFS You are a personal trainer at a health/fitness facility. What additional adjustments and progressions will you make to Tom’s program to get him back to playing with confidence? Dwyer_Part1_Sec1. 2. sterilization 5. He tells you that he has not had any pain or swelling but he lacks confidence in his ability to fully use the right ankle. Tom. SECTION 1 CPT Case Studies 9 DOMAIN IV: LEGAL. MA CPT CPT. elevation. AND MARKETING CASE STUDY Author: Nancy J. stabilization and hamstrings D) Rehab. therapist before resuming training. and proprioception exercises to the on the skin program. hemorrhage. pain. Tom comes in for his training session 2 days later and relays the series of events to you and says that his ankle feels weak. before resuming training. slightly favoring the right leg/ankle. According to the most recent ACSM’s Guidelines. BUSINESS. ice. light pain. eversion B) Ice the ankle for 15 min placing the ice directly exercises. directly on the skin B) Add unilateral dynamic leg balance. PROFESSIONAL. C) Ice the ankle for 20 min using a mixture of ice C) Add exercises that strengthen the quads and and water hamstrings. A) Rehab. According to the most recent American Heart hamstring Association and American Red Cross Guidelines C) One-legged balance assessment for First Aid (2010). symptoms of mild ankle sprain? which of the following actions is required by Tom A) Light edema. measurable laxity C) The client should immobilize the ankle and D) Excessive edema. According to ACSM’s Guidelines.indd 9 11/07/12 11:55 PM . Tom immediately got up and walked around and stretched the surrounding musculature and continued to play for the next 90 min. compression. point tenderness. Tom’s lack of confidence in fully using his leg/ankle? stabilization A) Muscular endurance assessment for the quads C) Rest. D) Ice the ankle for 25 min using a gel pack D) Add flexibility exercises for his quads and hamstrings. While playing doubles this past weekend. hemorrhage. support B) Flexibility assessment for the quads and 3. hemorrhage. what are the signs/ 4. elevate. cold. You have been working with your client. for approximately 3 months to enhance his overall tennis stamina and performance. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CPT. moderate pain. Tom iced his ankle when he got home after the match. inactivity.IV(2) 1. What adjustments will you make to Tom’s program? management of Tom’s soft-tissue injury? A) Add exercises that strengthen the medial aspect A) Ice the ankle for 10 min using a gel pack of the lower leg and ankle. be immediately referred to a physician before palpable or observable defect resuming training. compression. excessive pain. org CPT CASE STUDIES ANSWERS AND EXPLANATIONS CASE STUDY CPT. ACSM’s to trained dietary professionals should be the course Guidelines for Exercise Testing and Prescription. Baltimore (MD): Lippincott Williams acceptable resources for clients with general questions.acsm. MyPyramid. 6 min walk. senior editor.. of action. exercises that are multijoint or compound 3—A. 9th ed. including the High end: (78 0.II Multiple-Choice Answers for Case Study CPT. Submaximal tests are appropriate. Calculation 220 54 166 Discussion Question Answers for Case 166 88 78 Study CPT. Referral and deferral Resource: Pescatello LS. senior editor. 8–12 Wilkins. 2.indd 10 11/07/12 11:55 PM . mass. Low risk been exercising for 1 mo or more. Resource: ACSM’s GETP.I CPT Multiple-Choice Answers for Case Study CPT. Maximal testing would not be appropriate in 1—C. track tests range will maintain a moderate intensity and promote (e. and to some Resource: ACSM’s GETP. Table 7. After physician clearance has been obtained Baltimore (MD): Lippincott Williams and 4—B. should never be given. push-up. muscular endurance weight loss if maintained for a significant duration.g. 3—D. Prediabetic Wilkins. weight-bearing and flexibility exercises To improve muscular strength. 2014.I Low end: (78 0.5) 88 127 1. 2014. a resistance exercise that General Exercise Recommendations for Healthy allows a person to complete 8–12 repetitions per Adults. Chapter 7.g.II An increase of 5–10 min every 1–2 wk over the first 4–6 wk of exercise. particularly for a person who is pre- diabetic. 4th ed. adjusted upward over the next 4–8 mo. Chapter 7. and/or time of exercise is gradually Guidelines for Exercise Testing and Prescription. Resource: ACSM’s GETP. An increase of 5–10 min every 1–2 wk over the exercises that involve more than one muscle first 4–6 wk group at a time. fitness training program for apparently healthy 5—B. Avoid overstepping the CPT’s scope of practice 5—B. submaximal treadmill protocols. ACSM’s intensity. Resource: Pescatello LS. ACSM’s Resources for the Personal Trainer. General Principles of Exercise Prescription. This pain). Normal recommendations. specific 6—A. 3. This table indicates the Resistance Training Guidelines for Healthy Adults.gov are 9th ed. Box 7. These are general recommendations set should be selected. various step tests (depending upon knee new exerciser with moderate risk stratification. after the individual has 1—A. Vigorous intensity (60% V̇O2R) aerobic Principles of Exercise Prescription.1 extent — endurance. 10 CERTIFICATION REVIEW • www. Moderate risk a gym setting due to her moderate risk stratification. Principles of Exercise Prescription. Hypertension Resource: Bushman BA. and Wilkins. senior editor. Rockport). This translates to a resis- provided in the GETP for designing a health/ tance that is ⬃60%–80% of the individual’s 1-RM. Baltimore: Lippincott Williams and 4—C.gov and ChooseMyPlate. curl-up) (depending on back pain).3. the frequency. Dwyer_Part1_Sec1. General Resource: ACSM’s GETP.7) 88 143 Young Men’s Christian Association (YMCA) bike Fifty percent to 70% should be chosen for Beth as a test. General 2—D. Chapter 7. Chapter 7. activities. 2—A. 2014. CASE STUDY CPT. 166 bpm by avoiding direct dietary advice. The resistance training program should feature adults.I tests (e.. or transtheoretical model 198 lb 173. Contemplation b. The SOC postulates that Dwyer_Part1_Sec1. to achieve the target weight.5) and Wilkins.4 lb of fat 3. Determine the number of days to obtain his BMI is an index used to assess weight relative target.44 lb FM 142. ACSM’s divided by 84 d ⬃683 cal d1 Guidelines for Exercise Testing and Prescription. 3—C. 2014.6 lb 16.44 lb FM Resource: Pescatello LS. include the stages of change and the processes of change. you will want to be care.78 m2 78.0–34. The stages of motivational readiness for change (SOC). dietary energy deficit 483 cal daily 2—B. Baltimore (MD): Lippincott Williams diture.4 kg m2 d. 16.56 lb LBM and Wilkins.8 • Class 1 obesity (30. Weight machines are a great starting point for Stan. Determine the caloric content of the amount Case Study CPT. f. be appropriate for low back issues. SECTION 1 CPT Case Studies 11 Discussion Question Answers for Case 2. Overweight exercise energy expenditure.4 lb (TTM). 198 lb (body weight [BW]) 28% body fat 55.400 cal Resource: Pescatello LS. Bob’s calculated BMI 28.9) To correctly answer this question requires • Class 2 obesity (35.9) • Overweight (25.9) 4—A.indd 11 11/07/12 11:55 PM . If you are Although Stan is relatively young.5–24. • Normal weight (18.III of weight need to be lost. 483 cal 142.8 lb fat loss 24. 28.56 (LBM)/(1 0. Determine current fat mass (FM). Once again.400 kcal of fat 1—D. Baltimore (MD): Lippincott Williams 198 lb 55.II strating correct posture and flexibility exercises.2 lb (TBW) 19. there are many great resources that can be CPT cant low back issue. 12 wk 7 d wk1 84 d to height and is calculated by dividing the body e. CASE STUDY CPT. Determine amount of weight loss needed to achieve target weight at 20% body fat. senior editor.2 lb TBW To correctly answer this question requires multiple steps: d.9 kg x 5—B. Baltimore (MD): Lippincott Williams • Underweight (18. Determine the daily energy deficit necessary mass (kg) by the height (m) squared (kg/m2).4.500 kcal lb1 of fat 57. Determine target BW (TBW) at 20% body fat. which classifies him as overweight. he has a signifi. ACSM’s als are classified as follows: Guidelines for Exercise Testing and Prescription. Determine the daily exercise energy expen- 9th ed.III Multiple-Choice Answers for c. be careful of his low back by demon- Study CPT.9) a. Resource: Pescatello LS. c. 683 cal deficit needed 200 cal and Wilkins. unsure. Based on BMI.9 x/1. calculated as kg m2.0–39. Determine the goal body weight correspon- ding with a BMI of 24. ful with resistance exercise (all exercises) that his lower back is well supported and light resistance is applied to the area (as opposed to heavy resistance). consulted. b. 2014. 9th ed. 2014. 57. a.9.9) multiple steps: • Class 3 obesity ( 39. 9th ed. There are some “popular” stretches that may not 1. 198 lb (BW) 178. 19. Determine current lean body mass (LBM).0–29. senior editor. individu. Thus.2) 178. Determine the current amount of weight that needs to be lost. ACSM’s Guidelines for Exercise Testing and Prescription. senior editor. ACSM’s intake.indd 12 11/07/12 11:55 PM . which is 40% higher than 6—A. Mitchell DC. He needs to decrease his intake of saturated fats (typically The energy content of each gram of carbo.” protein intake accounts for 16% of his daily energy Resource: Pescatello LS.400 cal per day). Knight CA. Preparation: An individual that is currently Resource: Pescatello LS. Prescription: A Health-Related Approach.” BMI generally works well. senior editor.org individuals move through a series of stages and Discussion Question Answers for Case face common barriers when making behavior Study CPT. Contemplation: An individual that is not chronic disease. 2004. p. active at the recommended level but for 2. he has an exces- Bob is not presently active. senior editor. 2014. Carbohydrate: 1. Exercise Testing and New York (NY): McGraw-Hill Companies. Bob’s overall caloric intake is quite likely higher fewer than 6 mo. c. Precontemplation: An individual that is not small-framed sedentary individuals are quite likely active and is not thinking about becoming to be classified incorrectly. Bob’s argument is valid. 9th ed. 1.acsm. This is approximately at the recom- mended intake of 55%. and 9 cal. He should emphasize the intake of whole grain This indicates that he is at the “contemplation products followed by fruits and vegetables. Its use should be in moderation (less than two drinks 350 g 4 cal g1 1. Guidelines for Exercise Testing and Prescription. 12 CERTIFICATION REVIEW • www. His alcohol consumption accounts for 8% of his respectively. protein: 400. protein and fat is 4. Muscular individuals as well as a. however. he indi- sive consumption of simple/refined carbohydrates. hence his gradual weight gain e.5 g 9 cal g1 499. 2011. Maintenance: An individual that has been over the years. However. 7th ed. 223–33. Baltimore (MD): Lippincott Williams mended range (20%–35%). 2014. p. Bob’s intake is well in excess of 100 g 4 cal g1 400 cal the 90th percentile. sity in a large population than for an individual. ACSM’s engaging in some physical activity but not at Guidelines for Exercise Testing and Prescription. Caffeine intake for adults ranges from protein intake 106 to 170 mg d1. 4. hydrate. and the 90th percentile is 227–382 mg d1. “average individual’s” statistical risk of developing b. Each gram of alcohol contains carbohydrate intake 7 cal but does not provide essential nutrients. Specifically. The BMI assesses the active. cates that he is committed to becoming active. Inc. 7th ed. which is within the recommended range. Inc.400. 223. Knight I. Bob’s fat intake is at the lower end of the recom- 9th ed. Exercise Testing and 55. however. Resource: Nieman D. Action: An individual that is physically and Wilkins. however. Dwyer_Part1_Sec1.III changes and that intervention approaches many vary by the client’s identified stage of change. Resource: Nieman D. animal fats) and replace this with unsaturated fats. Food Chem Toxicol. New York (NY): McGraw-Hill Companies. there is little evidence fat intake of health risk with excessive intake. Zepp JE. His stage of readiness for change. Baltimore (MD): Lippincott Williams d.42:1923–30. For the “average individual. energy intake. saturated fats is 14%. the BMI does The different SOC include the following: not take into consideration an individual’s body CPT composition. His daily carbohydrate intake is physically active at the recommended level adequate and amounts to 56% of his total daily for six or more months. Beverage caffeine intake in US consumers and subpopulations of interest: Estimates from the Share of Intake Panel survey. than his daily need. Bob’s daily daily energy intake. his intake of and Wilkins. fat: 500 the recommended range of 10%.5 (500) cal Prescription: a health-related approach. the recommended level. 2011. It is a much better indicator for physically active but is thinking about determining the prevalence of overweight and obe- becoming active. Putting a sign on the needs to know when it is appropriate to refer damaged equipment is also very important for their clients/members to the appropriate health the safety of other members. If he setting and state that business resides in. 3rd ed. systems in place to safeguard client confidentiality. it is important that you activate EMS immediately. personal issue. It is not “ok” to talk about anything your client has shared with you. SECTION 1 CPT Case Studies 13 CASE STUDY CPT. If an AED is available. alcohol consumption. Champaign (IL): Human 9th ed.indd 13 11/07/12 11:55 PM .” CPTs must have resuscitation (CPR). Any information that you collect must be kept 3—C. 1—C. If possible.IV(1) Multiple-Choice Answers to should be conducted at least quarterly for all Case Study CPT. activate professional liability insurance. Resource: American College of Sports Medicine. Resource: Pescatello LS. Refer him to local professionals that specialize ACSM Health/Fitness Facility Standards and in counseling and behavior change. You can counsel/coach clients on making positive lifestyle changes but need It is important to fill out an incident report to be very careful to draw the line and to keep immediately after an incident and while it is all recommendations professional. 5—False 2—D. 2007. Personal trainers must follow the guidelines set can stay with the member and monitor him by the Family Educational Rights and Privacy Act until help arrives. Quarterly confidential. emergency plan of the facility. you will need to start cardiopulmonary with you is just that: “personal.IV(1) staff. The per- becomes unconscious and does not have a sonal information that your client/member shares pulse. 2014. care professional. 20. including part-time staff. Most fitness EMS and monitor him until help arrives. CPT Resource: American College of Sports Medicine. especially when You will need to attend to the member to see they are training “off” their regular paid hours. If he says yes. If he is having chest pain. unless you obtain Accidents and emergencies can happen at any written permission for specific information and time. A CPT fresh in the victim’s mind. 2007. p.IV(1) another person to make the call so that you 1. p. or any other use” sign on the equipment. and Wilkins. 3rd ed. Regular drills Dwyer_Part1_Sec1. Guidelines. centers do not cover trainers. what is wrong. ask Case Study CPT. Champaign (IL): Human It is beyond the scope of practice for a CPT Kinetics. 23. then that should be used first. senior editor. ACSM’s ACSM Health/Fitness Facility Standards and Guidelines for Exercise Testing and Prescription. You should also make (FERPA) and Health Insurance Portability and sure that you have the automated external Accountability Act (HIPPA) laws depending on the defibrillator(AED) available just in case. Guidelines. It is important that all staff know the keep that paper on file for 6 yr. Fill out an incident report and put a “do not marriage. to give advice and/or counsel clients on their 4—B. Baltimore (MD): Lippincott Williams Kinetics. Immediately attend to the member and ask him Personal trainers should always carry their own if he is having chest pain. Discussion Question Answer to It is always better to be safe. compression. Rest. Additional adjustments and progressions include 1—A. ice. 2010 American Heart Association and American II. flexibility. Lateral movement exercises on the floor. be to prevent reinjuring the ankle. such as the following: ported to the hospital and/or a second or third a. point tenderness. Medical clearance or refer. Is there compensa- 2010. Towel scrunches for plantar foot muscles degree sprain occurs as stability would then be b. Inversion ankle sprains account for about 3—C. Hopping and jumping g.” Observe the operation of ice and water be applied for 20 min using a the kinetic chain during his movements. and motion resuming training. also be appropriate. Assess ankle joint strength. muscles 5—C. barrier between the bag and skin. and then a balance pad to wobble board f. sessions) to increase strength and mobility as ral is required if the person needs to be trans. Review Tom’s injury history concerning his leg.IV(2) CPT 1. First Aid: 2010 American both sides and push off both feet. Lateral movement and change of direction drills such as figure eight drills and box runs h. 2—C. tion for muscular imbalances? 4—D. Observe his ability to move efficiently to Resource: Part 17. and proprioception exercises to the dynamic program. Ice the ankle for 20 min using a mixture of ice 90% of all ankle sprains. Based on assessments. stabilization a. One-legged balance assessment c.IV(2) Multiple-Choice Answers to Discussion Question Answer to Case Study CPT. Marble pickup and release for plantar foot compromised. eversion d. Eversion exercises with an elastic band for peroneals 6—B. Slide board activities Dwyer_Part1_Sec1. Circulation. 14 CERTIFICATION REVIEW • www. needed. See if he Heart Association and American Red favors either side and/or if there is a domi- Cross Guidelines for First Aid. pain. Look at his mechanics — especially above and Red Cross Guidelines recommend a mixture of below the “injury. Light edema. No signs/symptoms are present with a progressions (both as homework and during first degree sprain. The client does not require clearance before III. elevation. nant muscular pattern. then a towel.acsm.122:S934–46.indd 14 11/07/12 11:55 PM . The goal should and water. Add unilateral dynamic leg balance.IV(2) Case Study CPT. the following: strength loss I.org CASE STUDY CPT. Tom does not appear to have sustained an IV. Eversion strengthening exercises may e. while performing exercises and movement. add exercises with injury. a. One-legged balance exercises — static then exercises. waiver edition (15) • Medical clearance form (be sure to • Chapter 2 include Health Insurance Portability U. scope.indd 15 11/07/12 8:18 PM . 4th edition (10) by client prior to initial client Medicine (AHA/ACSM) Health/Fitness • Chapters 10 and 11 interview Facility Preparticipation Screening • Figures 10. hydration.. assess risk and need for medical doctor (MD) release form.1 and 10.43) • Trainer–client contract • Organizational policies and procedures Skill in effective communication • Provide information on the club’s Web ACSM’s Resources for the Personal and in using multimedia site dedicated to service introduction. • Schedule initial client consultation.1. • Figures 10. • Remind client of day and time of next meeting and length of appointment. goals. • Chapter 10 style. 11. 4th edition (10) consultation • Assess compatibility. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of components and • Use new Client Intake form to qualify ACSM’s Resources for the Personal preparation for the initial client client. such as attire. SECTION 2 CPT Job Task Analysis CPT DOMAIN I: INITIAL CLIENT CONSULTATION AND ASSESSMENT A. • Remind client to complete and return forms. phone. • Discuss medical considerations and limitations. 4th edition (10) resources (i. and 11. Health Insurance Release of Information Authorization Portability and Accountability Act Form) (42.3 • Exchange contact information (including emergency contact) and identify schedule preferences. Testing and Prescription (GETP).4. 15 Dwyer_Part1_Sec2. Provide instructions and initial documents to the client in order to proceed to the interview. and schedule.S. Physical Activity ACSM’s Guidelines for Exercise Readiness Questionnaire (PAR-Q). etc. • Verbal and nonverbal communication • Chapter 10 text messaging) and/or in-person skills resources • Trainer contact information • Verbally explain process and preparation to client. Department of Health and and Accountability Act [HIPAA] Human Services. Knowledge of the necessary • American Heart Association/ ACSM’s Resources for the Personal paperwork to be completed American College of Sports and Trainer. • Provide service intro package.2 Questionnaire. 9th informed consent. e-mail. Trainer. equipment.e. • Give the opportunity to ask questions and/or to contact if concerns arise. Trainer. all policies and procedures Guidelines for Exercise Testing and procedures • Review medical history form. cancellation. Interview client in order to gather and provide pertinent information to proceed to the fitness testing and program design.1. • Chapter 3 and program participation • Review health/medical history for Knowledge of health behavior known disease. or procedures. 9th edition (15) • Chapter 2 • Tables 2. billing. Knowledge of the use of medi.acsm. location of “public access” automated external defibrillator (AED) (in the cases of unstaffed facilities). stratify Prescription.2 and 2.4.e. and 11. identification of emergency exits and phones with emergency numbers on them. and safety of equipment. 4th edition (10) Knowledge of signs and symp. preparticipa. and 11 tion screening tools. modification theories and American College of Sports Medicine strategies in order to determine (ACSM) Risk Stratification or coro- client goals and expectations nary artery disease (CAD) risk factors Knowledge of orientation and stratify into low. and/or negative risk factors. ask questions to clarify. 3rd edition (10) cal clearance for exercise testing • Refer client to physician if warranted. proper setup. moderate. 11. informed • Operational information concerning • Figures 11. use motiva- tional interviewing. manner. connect goal to core values plan for lapses in behavior. Knowledge or Skill Statement Explanation/Examples Resources Knowledge in ACSM risk factors • Determine number of risk factors ACSM’s Resources for the Personal and associated risk thresholds based on medical and family history Trainer.3. 16 CERTIFICATION REVIEW • www.indd 16 11/07/12 8:18 PM . administration. • Chapter 11 toms suggestive of chronic • Distinguish between positive and • Tables 11. current health status. including equipment high risk. consent. which provides general guidelines on physical activity.6 consent. 4th edition (10) medical history. metabolic. • Chapters 11.5. usage. toms based on Table 13. 10. and progress. use and facility layout • Identify stage of change.1 and 11. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the components • Purpose. 7th edition (18) Skill in obtaining a health/medical and establish trust and confidential. ACSM’s Guidelines for Exercise pulmonary disease • Determine number of signs and symp. • Group or personal orientation session.3 Dwyer_Part1_Sec2. signs/symptoms. track changes. legal ACSM’s Resources for the Personal and limitations of a health/ concerns.2. hours of opera. hands-on walk through of facility. and 45 history. client commitment • Chapters 7. Review and analyze client data (i. medical clearance. 44.org B. document ACSM’s Health/Fitness Facility informed consent responses in a clear and concise Standards and Guidelines. or literature or Web site with available resources and services C. and ity. personalized exercise regime. 11.2 cardiovascular. Testing and Prescription (GETP). classify risk) to formulate a plan of action and/or conduct physical assessments. Trainer. trainer–client contract.. using Table 13. ACSM’s Resource Manual for and organizational policies and tion. ) and effective strat. and theory of planned • Create a structure of accountability. Trainer. Trainer. 9th edition (15) • Chapter 11 Dwyer_Part1_Sec2. classify risk) to formulate a plan of action and/or conduct physical assessments. measurable.1–2. • Chapter 11 Skill in setting effective client. • Establish support and reinforcement. 7th edition (18) egies that support and facilitate lem behavior from environment. readiness • Establish positive self-image. Review and analyze client data (i. and time-bound [SMART] goal • Create weekly manageable goals 9th edition (15) setting.) Knowledge or Skill Statement Explanation/Examples Resources CPT Skill in determining appropriate • Classify risk based on health/medical ACSM’s Guidelines for Exercise physical assessments based on history for known disease.4 recommendations • Choice of assessments based on risk. • Chapters 44 and 45 behavioral change • Substitute healthy behaviors for un. • Determine between client-centered ACSM’s Guidelines for Exercise attainable.. ACSM’s Guidelines for Exercise healthy ones. • Chapters 7 and 8 to change model. phy. goals. 4th edition (10) health behavior change (e. 7th edition (18) • Chapter 46 ACSM’s Guidelines for Exercise Testing and Prescription (GETP). • Coach clients to set achievable goals ACSM’s Resources for the Personal oriented behavioral goals and overcome potential obstacles. • Figures 2. signs/symp. or coronary artery disease (CAD) 9th edition (15) sultation. toms.indd 17 11/07/12 8:18 PM . 9th edition (15) • Provide feedback. social support) schedule. • Chapter 11 • Concentrate on what client is willing and able to do and works for them. social cognitive • Make formal commitment.e. stratify into low. specific. ACSM’s Resource Manual for theory. summary of initial client con. (cont. • Chapter 12 sician recommendations D.g. Prescription. risk stratification. • Connect goals to deep motivation. Trainer.e. Evaluate behavioral readiness to optimize exercise adherence. • Help client create specific SMART ACSM’s Resources for the Personal gies to enhance exercise and goals. and risk factors. SMART goals) • Chapters 8 and 9 ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. • Chapter 2 medical clearance or physician or high risk. • Chapters 8 and 9 forcement. SECTION 2 CPT Job Task Analysis 17 C. rein.. moderate. 4th edition (10) (socioecologic model. physician referral. Testing and Prescription (GETP). realistic and relevant.. Guidelines for Exercise Testing and behavior. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of behavioral strate. Knowledge of applications of • Raise consciousness through ACSM’s Resources for the Personal health behavior change models education. ACSM’s Resources for the Personal limiting orthopedic or metabolic condi. 4th edition (10) (i. Testing and Prescription (GETP). • Identify and eliminate cause of prob. Trainer. 4th edition (10) tions. and behavior-oriented goals. equipment availability. etc. Testing and Prescription (GETP). balance. circumduction. bone. skeletal muscle.6 insertions of muscles. 4th edition (10) perior. • Figure 3. origins. 4th edition (10) respiratory systems • Identify the structures of the heart.indd 18 11/07/12 8:18 PM . abduction. 4th edition (10) and connective tissue ponents of skeletal system. Knowledge of the basic anatomy • Location of and relationship between ACSM’s Resources for the Personal of the cardiovascular (CV) and heart and lungs Trainer.2 • Table 3. CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the basic struc. Guidelines for Exercise Testing and porting surface of an object such as Prescription. contained within Table 3. • Chapter 5 • Identify the structures of the upper ACSM’s Resource Manual for and lower respiratory tract. antagonist. • Energy production with and without ACSM’s Resources for the Personal tween aerobic and anaerobic oxygen Trainer. hyperex- tension. 7th edition (18) • Chapter 1 Knowledge of the definition of • Anatomical locations and positions ACSM’s Resources for the Personal the following terms: inferior. • Line of gravity: defines proper body ACSM’s Resources for the Personal ships among center of gravity. 4th edition (10) base of support.3 Knowledge of the interrelation. com.49 Knowledge of differences be. and proper spinal alignment retical point that can be used to repre. 18 CERTIFICATION REVIEW • www. flexion. • Identify types and classification of ACSM’s Resources for the Personal tures of bone.1 and 5. structure and function.3 • Chapter 3 • Figure 3. 4th edition (10) Table 3.2 each • Figure 5. rotation. Trainer.48 and 3. agonist. Assess physical fitness. • Joint movements and lever systems • Chapter 3 pronation. lateral. • Chapter 3 ity. extension. medial. and • Figures 3. and kyphosis • Chapter 3 • Figures 3.4 sent the total weight of an object ACSM Resource Manual for • Base of support: the area of the sup. muscular endurance.1 adduction.1 Trainer. and anthropometric measures in order to set goals and establish a baseline for program development. including cardiorespiratory fitness.4 Dwyer_Part1_Sec2. alignment and posture Trainer. flexibility. deviations from normal Trainer. 4th edition (10) energy systems and the effects • Adaptations to exercise capacity and • Chapter 5 of acute and chronic exercise on physiological systems • Tables 5.2 ACSM’s Resources for the Personal each muscle action occurs • Joint motions and planes of motion — Trainer.org E. 7th edition (18) the feet standing • Chapter 2 • Balance: ability to maintain a position for a given period of time without moving — control center of mass with respect to base of support • Stability: ability to lean without chang- ing the base of support • Spinal alignment and movements Knowledge of the following • Identify normal spinal curvatures and ACSM’s Resources for the Personal curvatures of the spine: lordosis. • Table 3. su.5 and 3. Guidelines for Exercise Testing and Prescription. • Center of gravity: location of a theo. muscular strength. supination. and stabilizer Knowledge of the plane in which • Anatomical planes — Figure 3. 4th edition (10) scoliosis. axial and • Chapter 3 appendicular skeletons.acsm. stabil. cardiac output (Q̇). adaptations to • Chapter 5 resistance training muscle fibers. ACSM’s Resources for the Personal adaptations that occur at rest and ment in CV and respiratory function. lower BP at fixed submaxi- mal work rate. 4th edition (10) cular strength and endurance systems. • Figure 5. capillary supply. nervous system Knowledge of the physiologic re. and anthropometric measures in order to set goals and establish a baseline for program development. 4th edition (10) during submaximal and maximal decreased risk from premature death. 9th edition (15) • Chapter 1 • Box 1. diastolic BP (DBP) may decrease • Chapters 5 and 12 tural changes slightly or remain unchanged.1 and anaerobic exercise training benefits ACSM’s Guidelines for Exercise Testing and Prescription (GETP). respectively • Chapters 15 and 17 Knowledge of the physiological • Use of Likert-type chart to determine ACSM’s Resources for the Personal basis of acute muscle fatigue and appropriate muscle soreness ranges Trainer. soreness. • Chapter 14 (DOMS) vs. Dwyer_Part1_Sec2. and nervous • Chapter 5 system Knowledge of blood pressure • Acute: linear increase in systolic BP ACSM’s Resources for the Personal (BP) responses associated with (SBP) with increased levels of exer.2 Knowledge of the physiological • Adaptations to muscle fibers and ACSM’s Resources for the Personal basis for improvements in mus. • Chapter 15 exercise following chronic aerobic reduction in death. pain. aerobic enzyme Trainer. • Postural changes can produce hypo- tensive response.2 tems.3 nous oxygen (a-v O2) difference • Static and dynamic resistance training effects on muscle fibers and physi- ological systems Knowledge of the normal • Benefits of CV training ACSM’s Resources for the Personal chronic physiologic adaptations • Benefits of resistance training Trainer. musculoskeletal in. 4th edition (10) resistance training stroke volume (SV). arteriove. increased health • Box 15. aerobic enzyme sys. (cont.1 jury or overtraining Knowledge of the physiological • CV benefits of exercise: improve. • Chronic: resting SBP and DBP may decrease.indd 19 11/07/12 8:18 PM . Trainer. Trainer. • Table 5. • Chapter 5 blood flow and pressure. including cardiorespiratory fitness. and pos. • Periods of metabolic and CV adjust. 4th edition (10) associated with CV exercise and • Muscular hypertrophy. ACSM’s Resources for the Personal sponses related to warm-up and ments from rest to exercise and exer. 4th edition (10) cool-down cise to rest. Trainer. cise.) CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the normal acute • Supply oxygenated blood to active ACSM’s Resources for the Personal responses to CV exercise and tissues: effects on heart rate (HR). contractile proteins. SECTION 2 CPT Job Task Analysis 19 E. 4th edition (10) acute. Trainer. flexibility. discoloration • Box 14. muscular endurance. muscular strength. chronic exercise. 4th edition (10) delayed onset muscle soreness • Signs of muscle damage: swelling. Assess physical fitness. • Figure 3. ulna. ball and socket) different types of joints. • Chapter 3 • Table 3. 4th edition (10) muscle group. 4th edition (10) trophy.5 ACSM’s Resources for the Personal major bones including but are not Trainer.g. latissimus dorsi.22–3. • Muscular strength: the ability of mus. 20 CERTIFICATION REVIEW • www. ster. isometric exerts a constant tension Trainer.23. flexibility. body composition. isokinetic.26– triceps. muscular strength. and 3. muscular en. muscles.43–3. • Upper and lower extremity joints. concentric.3 Knowledge of the following • Hypertrophy: increase in muscular size ACSM’s Resources for the Personal terms related to muscles: hyper. adductors. fatigue 9th edition (15) • Body composition: the relative • Chapter 1 amounts of muscle.36. biceps.5 • Chapter 3 major. Trainer. cle to exert force • Table 5. atrophy. 3. carpals. 4th edition (10) following: trapezius.4–3. • Atrophy: wasting away or loss of a Trainer. and • Isometric (static): no change in muscle • Chapter 14 eccentric length • Isokinetic: muscle resistance through- out the range of motion (ROM) by controlling speed of movement • Concentric: muscle shortening (contraction) • Eccentric: muscle lengthening Knowledge of major muscles in. (cont. quad- riceps. 4th edition (10) (static).4 and 3.1–3.indd 20 11/07/12 8:18 PM . and hyperplasia part — usually muscle • Chapter 3 • Hyperplasia: increased cell production in a normal tissue Knowledge of the ability to dis. • Box 15. abductors. 3. internal 3. muscular endurance. scapula.1 muscular strength. rectus abdominis. pectoralis exercises — Tables 3. fat.19.org E. • CV fitness: the ability of the circulatory ACSM’s Resources for the Personal cuss the physiologic basis of the and respiratory systems to supply oxy. hamstrings. ACSM’s Resources for the Personal cluding but are not limited to the movements. 4th edition (10) • Chapter 3 • Table 3.5 dius.3 ACSM’s Resources for the Personal and joint ROM for each major Trainer. femur. erector • Tables 3. 3. bone. • Describe characteristics that comprise ACSM’s Resources for the Personal tions (e. and resistance Trainer. and anthropometric measures in order to set goals and establish a baseline for program development.33–3. hinge. and • Muscular endurance: the ability of ACSM’s Guidelines for Exercise flexibility muscle to continue to perform without Testing and Prescription (GETP). including cardiorespiratory fitness.2 durance.45 and external obliques.1 other vital parts of the body • Flexibility: the range of motion around a joint Dwyer_Part1_Sec2. • Chapter 3 num.) CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of muscle actions. Trainer. tibia. 4th edition (10) components of health-related gen during sustained physical activity • Chapters 5 and 15 physical fitness — CV fitness. gluteus maximus.acsm. • Isotonic: muscle contraction.2 Knowledge of the primary action • Table 3. 4th edition (10) limited to the clavicle. humerus.. which ACSM’s Resources for the Personal such as isotonic. ra. and tarsals Knowledge of joint classifica. fibula. and gastrocnemius Knowledge of the identification of • Figure 3. Assess physical fitness.27. • Figures 3.5 spinae. and • Box 1. ease and reliability in adminis. pre. 4th edition (10) of the various body composi. measuring. adaptations to Trainer. infrared. and anthropometric measures in order to set goals and establish a baseline for program development. signs. physiological observa- tions continued for at least 5 min or longer of recovery. CV test prior to strength • Body composition • Chapter 12 assessment) • CV assessment • Muscular fitness • Flexibility Knowledge of appropriate docu.) CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the normal • Benefits of CV training ACSM’s Resources for the Personal chronic physiologic adaptations • Muscular hypertrophy. orthopedic or metabolic restric- and body composition tions. • Chapter 12 tion techniques including but not test preparation. resistance. flexibility.5. (cont. ACSM’s Resources for the Personal mentation of abnormal signs or ing health status Trainer. ACSM’s Resources for the Personal fitness test results (i. Dwyer_Part1_Sec2. ation of the risk/benefit ratio 9th edition (15) and proper procedures to be • Absolute contraindications — Box 3.indd 21 11/07/12 8:18 PM . abnormal response to increase in intensity. 4th edition (10) vs..) • Stop training session and refer to physician. muscular endurance. muscle fibers. 4th edition (10) associated with CV. and injuries (shortness of to a physician breath. mass testing vs. dual-energy X-ray absorptiometry (DEXA).2 • Flex: improve ROM and joint mobility Knowledge of relative and abso.2 limited to skinfolds. reliability. SECTION 2 CPT Job Task Analysis 21 E. muscular endurance. • Chapter 5 and flexibility training tems. muscular testing.4. • Relative contraindications — Box 3. • Formal and informal means of evaluat.g. Testing and Prescription (GETP). 4th edition (10) (e. 4th edition (10) symptoms during an exercise • Recognizing situations. unfavorable results) sponses to exercise. • Chapter 12 strength. ease in administer. testing.5.5. plethysmog- raphy (BOD POD). • Chapters 3 and 4 followed after discontinuing an should not perform exercise tests until • Boxes 3. ing.e.. Trainer. 4. ACSM’s Guidelines for Exercise lute contraindications to exercise may be tested only after careful evalu. tering.5. including cardiorespiratory fitness. • Discuss basis of technique.5 exercise test conditions are stabilized or adequately treated • Test termination criteria — Box 4. symp. favorable application of knowledge of acute re. muscular strength. • Chapter 11 session and subsequent referral toms. low level exercise until HR and BP stabilize. equipment availability Knowledge of interpretation of • Use norm charts to classify results. bioelectrical impedance. Trainer. ACSM’s Resources for the Personal disadvantages. test termination criteria. or general indications • Postexercise procedures includes pas- sive cool-down. CV fitness. nervous system • Table 5. predetermined end- point. individual Trainer. Knowledge of the advantages. Assess physical fitness. and limitations sources of error. aerobic enzyme sys. • Box 12. and 4. volitional fatigue. • Chapters 5 and 12 Knowledge of the recommended • HR ACSM’s Resources for the Personal order of fitness assessments • BP Trainer. etc. and calculating. and client comfort. and circumference measurements Knowledge of preactivity fitness • Selection of test dependent on ACSM’s Resources for the Personal testing including assessments of population. 4th edition (10) flexibility. 4th edition (10) HR.org E. Obtain rating during steady state.2 associated with CV or metabolic dis- ease (Table 11. muscle compensation. ease and reliability in adminis. muscular endurance.10 • RPE: two scales used as a subjective measure to rate overall feelings of ex- ertion instead of specific areas. testing. failure for HR • Chapter 4 and SBP to increase with workload • Box 4. incomplete ROM Dwyer_Part1_Sec2.1 Skill in locating anatomical sites • Anatomical landmarks and type of fold ACSM’s Resources for the Personal for skinfold measurement to esti. 4th edition (10) mate body fat percentage the skinfold site. • Ability to recognize volitional fatigue. mass testing vs. the description of each site. 4th edition (10) cular endurance assessments testing. • Table 15. dizziness or nausea Skill in locating/palpating pulse • Three common sites are radial. ease and reliability in ad. accurately measuring chial. surements and associated risk • Waist-to-hip ratio identifies fat distribu. population.2) • Serious joint injuries that do not re- solve quickly. 4th edition (10) assessments according to estab. Testing and Prescription (GETP). including cardiorespiratory fitness. equipment availability. • Selection of test dependent on ACSM’s Resources for the Personal tering safe and appropriate CV population. • Chapters 12 and 14 and determining normal acute re.6 Skill in selecting/administering • Selection of test dependent on ACSM’s Resources for the Personal safe muscular strength and mus.5 Skill in locating anatomical sites • Anatomical sites are located within ACSM’s Guidelines for Exercise for circumference (girth) mea. • Start counting exercise HR with zero • Chapter 12 ceived exertion (RPE) as reference. 4th edition (10) physician symptoms • Chapter 11 • Onset of new signs and symptoms • Table 11. par- ticipant’s skill level/limitations.1 • Figure 12. inten. equipment availability Testing and Prescription (GETP). Skill in selecting and adminis. exercise • Ability to recognize signs of poor cir.1 • Measure for 30 s and multiply by 2 to • Chapter 15 convert to minute value. • Chapter 12 • Box 12. • Significant change in frequency. (cont. and carotid. ACSM’s Guidelines for Exercise normal acute responses to CV tions. orthopedic or metabolic sponses to resistance training restrictions. 9th edition (15) culation and perfusion. and anthropometric measures in order to set goals and establish a baseline for program development. bra. poor form. ACSM’s Resources for the Personal landmarks.) CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of various mecha.acsm.indd 22 11/07/12 8:18 PM . mass testing vs. or nature of existing signs and Trainer. flexibility. poor alignment. muscular strength. are located within the description of Trainer. higher amount of abdominal fat • Chapter 4 associated with increased risk for CAD • Box 4. • Figure 12. clients reporting mus- cular or joint problems. • Chapters 12 and 15 lished guidelines and determining tering. ministering. orthopedic or metabolic restric. 9th edition (15) tion. ACSM’s Resources for the Personal nisms for appropriate referral to a sity. individual Trainer. Assess physical fitness. individual Trainer. 22 CERTIFICATION REVIEW • www. Trainer. and obtaining rating of per. and ACSM’s Resources for the Personal of fitness plans based on client type. use as a baseline. 8. frequency and intensity of training ef. SECTION 2 CPT Job Task Analysis 23 E. and 9 goals goals.) CPT Knowledge or Skill Statement Explanation/Examples Resources Skill in selecting/administering • Selection of test dependent on ACSM’s Resources for the Personal safe flexibility assessments for population. attainable. ACSM’s Resources for the Personal appropriate time line for reas. 4th edition (10) exercise performance and body • Chapter 3 alignment • Figures 3. client availability. individual Trainer. physi. • Chapters 12 and 16 mining normal acute responses tering. 6 wk. 4th edition (10) various muscle groups and deter. be ACSM’s Resources for the Personal sessment results in a positive respectful. ism.e. cific. demonstrate professional. Develop a comprehensive (i. intensity.indd 23 11/07/12 8:18 PM . realistic Trainer. breath and holding patterns Skill in recognizing postural • Knowledge of deviations from normal ACSM’s Resources for the Personal abnormalities that may affect spinal curvatures Trainer.1 goals. ACSM’s Resources for the Personal applicable health behavior modi. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of development • Use frequency.48 and 3.49 Skill in delivering test and as. 4th edition (10) interview.e. muscular strength. 4th edition (10) sessing (i. trust. Knowledge of effective and • Use short-term goals based on spe. and anthropometric measures in order to set goals and establish a baseline for program development. cept client where they are. volume and progress (FITT-VP) Trainer. orthopedic or metabolic restric- to flexibility training tions. flexibility. ease and reliability in adminis. • Chapters 5 and 12 component of physical fitness ological changes being measured (cardiovascular.. and commit- ment level. behavior) reassessment plan/timeline. and body composition measures) Dwyer_Part1_Sec2. maintain • Chapters 9 and 12 pact client self-esteem (e. measurable. 4th edition (10) fication strategies to meet client and relevant. • Box 13. and nonjudgmental F. • Make client feel comfortable. time. test results. Assess physical fitness. risk stratification.. flexibility. Trainer. Trainer. and competence. 4th edition (10) manner and not negatively im.g. be empathetic. behavioral change status. develop a not discourage or embarrass) plan for improvement. goals. muscular strength • Standard follow-up 4 wk to 3 mo and endurance. and framework for each component based • Chapter 13 physical fitness assessments on risk stratification. • Behavior change pyramid Knowledge of the purpose and • Fitness changes dependent on time. muscular endurance. mass testing vs. equipment availability • Knowledge of normal joint ROM • Ability to detect muscle tightness. ac- information to encourage client. physical fitness.. testing. (cont. use confidentiality. including cardiorespiratory fitness. and time-bound (SMART) • Chapters 7. 12 wk) each forts. medical history. hypertension. osteoporosis. lates to the ability to perform physical • Chapter 1 ity. vascular endurance. as a set of attributes or characteristics Testing and Prescription (GETP). • Effects of chronic exercise on physi.5 changes of resting or exercise helps to identify potential contraindica- heart rate and blood pressure. 9th edition (15) personnel prior to initiating physi. ACSM’s Guidelines for Exercise factors or conditions that may re. • Understanding of physiological ACSM’s Resources for the Personal efits associated with guidelines changes of aging and growth Trainer. and goals to determine appropriate training program.. metabolic syn. muscular that people have or achieve that re. CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the risks and ben. 4th edition (10) for exercise training and program.. pregnant women 9th edition (15) • Chapters 7 and 8 Knowledge of the benefits and • American Heart Association (AHA) ACSM’s Resources for the Personal risks associated with exercise risk classification for exercise training Trainer. shortness of breath at rest or with light exer- tion. drome. quire consultations with medical ated by a physician.acsm. • Chapter 19 ming for healthy adults.g.1 • Health-related and/or skill-related components Dwyer_Part1_Sec2. Knowledge of components of • Physical fitness components defined ACSM’s Guidelines for Exercise physical fitness including cardio. diabetes exercise and health outcomes mellitus. shoulder. Testing and Prescription (GETP). inappropriate and careful review of medical history • Box 3. ological systems ACSM’s Guidelines for Exercise children and adolescents. weigh the benefits need to be evalu. 24 CERTIFICATION REVIEW • www. seniors.org DOMAIN II: EXERCISE PROGRAMMING AND IMPLEMENTATION A. qualified individuals and approved by chronic obstructive pulmonary primary health care provider. (Class B) • Chapter 19 cise programming for individuals • Recognize abnormal responses to ACSM’s Guidelines for Exercise medically cleared to exercise exercise and medication effects on Testing and Prescription (GETP). • Activity needs to be individualized. or arm. neck. 9th edition (15) strength and endurance. other • Dose-response relationship between • Chapters 8–10 cardiovascular diseases. tions and safety of testing and partici- new-onset discomfort in chest. arthritis. with exercise prescription provided by chronic back pain. pation. disease (COPD). stable exercise capacity. and claudication). • Review of preexercise test evaluation • Chapter 3 cal activity (e. flexibil. and Testing and Prescription (GETP). Review assessment results. 9th edition (15) coronary artery disease. 4th edition (10) training and guidelines for exer. and body composition activity. with chronic disease (e. of exercise ing rest or exercise. and those with • Program modifications based on con- chronic pain) dition • Exercise capacity ⬍6 metabolic equiv- alents (METs) • Target energy expenditure of 150– 400 kcal ⭈ d⫺1 Knowledge of cardiovascular risk • Risks of exercise testing that out. obesity.g.indd 24 11/07/12 8:18 PM . fainting or dizzy spells. • Box 1. changes • Absolute and relative contraindications in the pattern of discomfort dur. 4th edition (10) sessions and perform periodic holding breath..e. exercise programming for partici. and an. Include observations (i. motivation. skill and fitness levels. different am. • Selection of modalities dependent on ACSM’s Resources for the Personal ate exercises and training mo. (cont. 4th edition (10) progression sponse to resistance or stimulus. • Chapters 13 and 17 reevaluations to assess changes ported pain) and performance param- in fitness status eters (i. decrease • Figure 8. Trainer. client ability to perform Trainer. Review assessment results. functional specific exercise. • Program development based on the ACSM’s Resources for the Personal velopment for specific client following: Trainer. proper American Red Cross First Aid/CPR/ clothing. Trainer. and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise (12) Knowledge of special precau. • Client interview musculoskeletal. SECTION 2 CPT Job Task Analysis 25 A. repetitions [reps]) • Accurately chart effects of exercise. client preference.. functional.6 bient temperatures. proper hydration.5 and 8. and assessment results.5 environmental pollution) exposed to the environment. load. and Medicine position stand. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of selecting appropri. humidity. risk stratification • American College of Sports balance. specific sports. 4th Edition (10) dalities based on age. • Needs assessment — screening and • Chapters 10–13 formance. medical history. Select exercise modalities to achieve desired adaptations based on goals. and goals to determine appropriate training program. variation. agility. availability. and client commitment level Knowledge of the principles • Specificity: only muscles that are ACSM’s Resources for the Personal of specificity and program trained will adapt and change in re.3 intensity. form deviations.e. • Reassessments 4 wk to 3 mo • Compare to baseline. an in- crease in stimulus is required for fur- ther adaptations or improvements • Specific Adaptations to Imposed Demands (SAID). 4th edition (10) needs (i. ACSM’s Guidelines for Exercise tions and modifications of mental conditions affect physiological Testing and Prescription (GETP). aerobic. and exercise test results client goal. • Chapters 13 and 14 • Progressive overload: as a body adapts to a given stimulus. B. • Basic understanding of how environ.e.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of program de. systems during exercise 9th edition (15) pation in various environmental • Tools used to evaluate environmental • Chapter 8 conditions (altitude. per. and • May need to adjust length of time • Box 8. lifestyle. re. • Chapters 13–16 capacity. and adjust rest periods AED Participant Manual (21) • Chapter 6 Knowledge of the importance • Accurately track workouts and training ACSM’s Resources for the Personal and ability to record exercise sessions. • Review of goals.indd 25 11/07/12 8:18 PM . medical history. conditions • Tables 8.. Quantity aerobic) level of commitment and quality of exercise for developing • Assessment results and maintaining cardiorespiratory. and periodization Dwyer_Part1_Sec2. medical and physical limi- tations. time. • Chapters 13 and 17 ciples for general health benefits.g. 26 CERTIFICATION REVIEW • www.org B. and circuit availability. • Chapters 13 and 17 individual cal tasks • Exercises and activities that improve a person’s overall physical functionality can enhance the ability to live inde- pendently. Knowledge of differences • Adjustments in FITT .5–7. reaction time.8 Knowledge of advanced • Advanced exercises are highly techni. specific exercise. Trainer. Testing and Prescription (GETP). client goal. Testing and Prescription (GETP). 4th edition (10) overall health and fitness of the chores or essential work-related physi. 9th edition (15) • Chapter 7 • Tables 7. • Evaluate exercise based on the ACSM’s Resources for the Personal risks.. and experience.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the advantages. fitness increases. goals with greatest variation in inten. and total number of kilocalo.VP for different ACSM’s Resources for the Personal between physical activity rec. rie per week. client preference. with client if there are any preexisting pyramid training) and when such conditions that may require medical techniques are contraindicated clearance. sity. ACSM’s Guidelines for Exercise improvements. skill and fitness levels. skill. 4th edition (10) (e. • Mode of training and variety are im. medical history. supine leg raises.acsm. body alignment. continuous. Select exercise modalities to achieve desired adaptations based on goals. • Cardiovascular modes of training — ACSM’s Resources for the Personal disadvantages. tations. speed • Use of plyometric exercises for upper and power and lower body to enhance ability to generate force Knowledge of the benefits. 4th edition (10) of interval. and applications selection of modalities dependent on Trainer. unilateral • Client’s goal. Knowledge of the six motor • Performance training based on core ACSM’s Resources for the Personal skill–related physical fitness com.5 weight management. formance enhancement portant factors. or assistive.. Olympic • Exercises must not be completed • Chapters 14 and 18 lifting. strength. • Client must be evaluated on form. so does intensity. and athletic per. ACSM’s Resources for the Personal resistance training exercises cal and intensive. and sport specifics • Chapters 13 and 18 ordination. 4th edition (10) wide variety of resistance training • Biomechanical characteristics of the • Chapters 3. plyometric exercises. medical and physical limi.g. client ability to perform • Chapter 15 training programs for cardiovas. super setting. and contraindications for a following: Trainer. multijoint exercises ercises) • Bilateral vs. and assessment results. technique. conditioning level. 4th edition (10) ommendations and training prin. kinesthetic awareness. and 9th edition (15) client commitment level • Chapter 8 Knowledge of activities of daily • Ability to perform daily task such as ACSM’s Resources for the Personal living (ADL) and their role in the self-care and essential household Trainer.indd 26 11/07/12 8:18 PM . functional Trainer. balance. and 14 exercises specific to individual movement muscle groups (e. as goal along continuum • Table 13. 4. ACSM’s Guidelines for Exercise cular fitness improvements. 4th edition (10) ponents and agility. and experience Dwyer_Part1_Sec2. and plank ex. co. • Single joint vs. fitness and skill level. (cont. training. Trainer. for rectus • Exercise is designed to be primary abdominis performing crunches. medical history. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the recommended • Recommendations for healthy adults: ACSM’s Guidelines for Exercise frequency (F). proprioceptive neu. 20–30 min vig. pregnant women T ⫽ 30–60 min mod. I ⫽ mod. discomforts. and Tables 7. Select exercise modalities to achieve desired adaptations based on goals. intensity. reduction in death. current fitness • Biomechanical characteristics level. I ⫽ mod to vig. yoga. I ⫽ 5–6 times a week mod. ACSM’s Resources for the Personal risks. • Evaluate based on the following: • Box 15. • Evaluate based on the following: Pilates.8 skeletal fitness in healthy adults. the FITT principle of exercise prescription) of exercise based on goals. RPE 12–14. and assessment results. medical history.g. (cont. • Physical and psychological qualities sion example: walking. fitness and skill level. SECTION 2 CPT Job Task Analysis 27 B. 7th edition (18) times a week preferably all.5–7. 4th edition (10) wide variety of range of motion • Risks: joint hypermobility. of the client cross-country skiing. • Chapter 8 sive orthopedic stress ACSM’s Resources for the Personal • Senior resistance: F ⫽ 2 times a week Trainer. and assessment results. 9th edition (15) T ⫽ any that does not impose exces. 4th edition (10) a wide variety of cardiovascular increased health benefits • Chapter 15 training exercises and applica. and contraindications for mature death. duration (T) of physical activity • Seniors CV: F ⫽ minimum (min) 9th edition (15) necessary for development of 5 times a week moderate (mod). Trainer. 4th Edition (10) min. intensity (I). and experience Knowledge of the benefits.indd 27 11/07/12 8:18 PM .5–7. contraindica- tions and considerations • F ⫽ at least 3 times a week. prefer- ably 4 times. ACSM’s Resources for the Personal risks.8 Testing and Prescription (GETP). and contraindications for a proved performance of ADL Trainer. • Chapter 7 cardiovascular (CV) and musculo.. • Benefits: improved ROM and im. T ⫽ 30 mod ⫹ 30 vig. skill level.g. ACSM’s Resource Manual for thenics ⫹ balance Guidelines for Exercise Testing and • Children/Adolescents: F ⫽ at least 3–4 Prescription. and abilities. tai chi. ACSM’s Guidelines for Exercise seniors. jogging. or • Tables 7. Determine initial frequency. T ⫽ variety • Pregnancy: adjust for symptoms. 3 times a week vigorous (vig).e. sports) and experience C. dynamic strength. T ⫽ progressive • Chapters 13 and 19 weight-training or weight-bearing calis. and racquet • Client’s goal.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the benefits.. T ⫽ 15–30 min (150 total per week). and goals (e. partner • Biomechanical characteristics stretching) • Physical and psychological qualities of the client • Client’s goal. children/adolescents. time (duration).1 tions based on client experi. rhythmic that use large muscle groups Dwyer_Part1_Sec2. fitness and skill level.. ineffectiveness and passive stretching. and type (i. and 7–8 times a week vig (1–10 scale). I ⫽ mod • Chapter 36 to vig. • Anatomy and physical limitations ence. progres. • Benefits: decreased risk from pre. Testing and Prescription (GETP). T ⫽ dynamic. • Anatomy and physical limitations romuscular facilitation. decreased • Chapter 16 (ROM) exercises (e. combo. intensity. • Chapters 13 and 17 ance exercises • Stretching: at least 10 min after warm- up and cool-down Knowledge of applied biome. time (duration). and assessment results. use Ex Rx ⫹ special consider- ations • COPD: Chapter 10.to Trainer. Testing and Prescription (GETP). use Trainer. 9th edition (15) development of CV and muscu.acsm. Knowledge of implementation • Warm-up: 5–10 min of low. physical limita. • Chapter 7 stretching bic. and scoliosis) • Train surrounding musculature to en. • Chapters 3 and 13 tions. Prescription. Dwyer_Part1_Sec2. ACSM’s GETP.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the recommended • CV disease: Chapter 9.g. and duration • Arthritis: Chapter 10. ercises that are contraindicated. use Ex Rx. and behavioral programs • Osteoporosis: Chapter 10. ment (Figure 10. Determine initial frequency.indd 28 11/07/12 8:18 PM . chronic ACSM’s GETP. obesity. of physical activity necessary for use Borg CR 10 for pain manage. seated knee speed of movement for specific joint extension — quadriceps) associated with exercise. ACSM’s GETP ACSM’s Guidelines for Exercise frequency.2 diagnostic criteria and spe. and • Training stimulus: 20–60 min of aero. • Chapters 27 and 31 hance strength and function of joint. use Guidelines for Exercise Testing and diabetes mellitus (DM). • Evaluate muscle length. 4th edition (10) medically cleared for exercise. • Chapter 19 including stable coronary artery cial considerations ACSM’s Resource Manual for disease. and other special consider. ACSM’s GETP. use Trainer. considerations • Chapters 37–43 sion (HTN). reputable sources for information.1 for classification. injury rehabilitation. resistance. ACSM’s GETP. exercise prescription (Ex Rx) ⫹ special Prescription. back pain.org C. the FITT principle of exercise prescription) of exercise based on goals. use Box 10. Guidelines for Exercise Testing and neuromuscular and postural limi. and • Chapters 4 and 14 muscle groups (e. special considerations. cise program including warm-up. 4th edition (10) with movements of the major ercise type.. osteoporosis. movement direction.1 sport activities ACSM’s Resources for the Personal • Cool-down: 5–10 min of low. ACSM’s GETP. and/or • Box 7.. chronic • Metabolic syndrome: Chapter 10. ex.e. • Proper alignment and posture ACSM’s Resource Manual for ations (e.to ACSM’s Guidelines for Exercise of the components of an exer. other CV diseases.g. moderate-intensity CV exercise and Testing and Prescription (GETP). ms endurance exercises 9th edition (15) training stimulus. medical history. intensity. movement ACSM’s Resources for the Personal chanics and exercises associated arm and resistance arm distances. hyperten. ACSM’s GETP. use Table 10. 4th edition (10) individual abilities. (cont. cool-down. 7th edition (18) tations. • HTN: Chapter 10. ACSM’s GETP.1) and special • Chapters 7–10 loskeletal fitness in clients with considerations ACSM’s Resources for the Personal stable chronic diseases who are • DM: Chapter 10. arthritis. avoid ex.. • Injury rehabilitation: determine primary site of injury and prior injury profile. 4th edition (10) moderate-intensity CV and ms endur.3 clinical obstructive pulmonary disease criteria and special considerations (COPD). • Do not aggravate condition. Ex Rx ⫹ special considerations Knowledge of appropriate ex. and chronic pain • Obesity: Chapter 10. 7th edition (18) metabolic syndrome. neuromuscular. • Research condition through physical ACSM’s Resources for the Personal ercise modifications based on therapy and medical networks. 28 CERTIFICATION REVIEW • www. and type (i. Table 10. Trainer. Trainer.. Knowledge of repetitions (reps) • Intensity and reps are inversely ACSM’s Resources for the Personal sets. and type (i.3 • Box 7. and rest periods related.e. 4th edition (10) conditioning program design and phases of training program • Chapters 13. (Karvonen formula) with recom. ACSM’s Guidelines for Exercise • Muscle strength ⫽ 8 ⫺ 12 reps (60%– Testing and Prescription (GETP).4) ⫻ HRR] ⫹ HRrest 9th edition (15) mended intensity percentages • THR ⫽ [(0. and 15 progression of exercises when • Recognize signs of overtraining.94 (high) • Chapter 15 heart rate (HRmax) and the heart • Intensity: 64/70% ⫺ 94% ACSM’s Guidelines for Exercise rate reserve (HRR) method • HRR: HRmax ⫺ resting HR (HRrest) Testing and Prescription (GETP). necessary to avoid training pla. 7th edition (18) GETP ) to estimate work rate for vari. the FITT principle of exercise prescription) of exercise based on goals. Guidelines for Exercise Testing and metabolic equivalents (METs) • Use metabolic equations (ACSM’s Prescription. Trainer. • Make appropriate modifications for teaus or injury. and shortcomings of each ACSM’s Resource Manual for pace. 4th edition (10) and monitoring levels of exercise information available (maximal volume • Chapter 15 intensity. 80% one repitition maximum [1-RM]) 9th edition (15) • Muscle endurance ⫽ 15–25 reps (no • Chapter 7 more than 50% of 1-RM) Knowledge of using rep maxi. injuries and plateaus.2 Knowledge of the determina. 4th edition (10) determine resistance training for a specific number of reps • Chapter 14 loads • Absolute resistance: only a specific number of reps Dwyer_Part1_Sec2. rat.64 (low) Trainer. and goals Knowledge of periodization • Systematic variations in the prescribed ACSM’s Resources for the Personal for CV.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the application of • Determine appropriate method based ACSM’s Resources for the Personal various methods for establishing on conditioning level. etc. 14. (cont. medical history. of oxygen per unit of time [V̇O2max]. • Tables 13. including heart rate. 4th edition (10) necessary for desired outcome • Reps and rest time are inversely • Chapter 14 goals. • THR ⫽ [(0. Determine initial frequency. • Table 15. load. • Use a percentage of 1-RM (70%–85%) ACSM’s Resources for the Personal mum test results procedure to • RM: maximum load that can be lifted Trainer. and volume and intensity during different Trainer.1–16. • Chapter 21 ous modes of training.indd 29 11/07/12 8:18 PM . 4th edition (10) (THR) using predicted maximal • THR ⫽ 220 ⫺ age ⫻ 0. related. 9th edition (15) • Chapter 7 • Table 7. • Intensity: 40%/50% ⫺ 85% medical considerations.3. oxygen consumption and/or method.2 ing of perceived exertion (RPE). intensity.).5 and 16.85) ⫻ HRR] ⫹ HRrest • Chapter 7 based on client fitness level. ACSM’s Guidelines for Exercise Testing and Prescription (GETP). SECTION 2 CPT Job Task Analysis 29 C. and assessment results. • HRmax: 220 ⫺ age ACSM’s Resources for the Personal tion of target/training heart rates • THR ⫽ 220 ⫺ age ⫻ 0. medications. resistance training. time (duration). and “ACSM Position Stand: Progressive flexibility. • Provide feedback to client. • Chapters 13–16 resistance and plyometric training. breathing. • Model proper technique including align- ment. 7th edition (18) kettlebells. and limitations of the client Dwyer_Part1_Sec2. 14. endurance. key points. • Chapter 7 • Evaluate client performance. precisely. specifics concerning the movement. muscular strength and modes and techniques. 7th edition (15) strength.1 major joints the guidelines or how to perform and • Figure 16. and 13–16 ance. Knowledge of and the ability to • Each exercise requires understanding of ACSM’s Resources for the Personal safely demonstrate a wide range joint range of motion and surrounding Trainer. Trainer. position. and safety considerations. • Chapters 33 and 34 devices. specifics concerning the movement. and range of precautions for individuals with health motion concerns.acsm. position.org D. and safety considerations. precautions ACSM’s Resource Manual for resistance devices. biomechanics. • Choice of modality based on avail- ability. needs. concerning the technique used. ACSM’s Resources for the Personal to safely demonstrate exercises ing of joint range of motion and sur. and specifics concerning the technique used. and 18 and activities including variable techniques. all figures in chapter check for understanding. static resistance points. 4th edition (10) of resistance training modalities muscle anatomy. experience. details. different • Chapters 3. • Communicate clearly and accurately how to perform and check for understanding. biomechanics. 4th edition (10) designed to enhance CV endur. • Understanding of joint range of motion ACSM’s Resources for the Personal ing techniques and the ability and surrounding muscle origins and Trainer. dynamic con. and other resistance • Demonstration involves modeling the KettleBell Concepts (26) devices exercise accurately. Knowledge of appropriate teach. breathing. 5. Review proposed program with client. balance. different modes and • Chapters 13. physiological adaptations of resistance • Chapters 31 and 33 and motor skills. 4th edition (10) to demonstrate exercises for insertions • Chapter 16 improving range of motion of all • Communicate clearly and accurately • Table 16. demonstrate and instruct the client to perform exercises safely and effectively. and correctly — at normal speed and at slower speed/in phases. balance. are useful • Model proper technique including align. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of and ability to • FC relates to physiological adaptations ACSM’s Resource Manual for describe the unique adaptations to aerobic exercise Guidelines for Exercise Testing and to exercise training regarding • Strength adaptations related to Prescription. 4th edition (10) • Cardiovascular (CV) training (intervals). functional capacity (FC).indd 30 11/07/12 8:18 PM . for individuals with health concerns. precisely. and specifics Testing and Prescription (GETP). 30 CERTIFICATION REVIEW • www. • Have client perform exercise again while cuing for corrections. details. rounding muscle anatomy. Guidelines for Exercise Testing and stant external resistance devices. 9th edition (15) • Engage client in exercise — practice. goals. and correctly — at normal speed and at slower speed/in phases.2. and agility training Models in Resistance Training” (16) Knowledge of and the ability • Each exercise requires understand. training ACSM’s Resources for the Personal • Motor skills adaptations occur through Trainer. key Prescription. ACSM’s Guidelines for Exercise ment. • Demonstration involves modeling the exercise accurately. 33. lifting and car. 7th edition (18) • Chapter 30 Knowledge of the concept of • When physical training is stopped ACSM’s Resource Manual for detraining or reversibility of condi. wind) Prescription.. body position. Guidelines for Exercise Testing and of functional training exercises in. cycling. • Choice of modality based on avail- ability. ACSM’s Resource Manual for toms of overreaching/overtraining metabolic. and Thera-Band Academy (37) correctly — at normal speed and at slower speed/in phases. angles. concerns. and sufficient recovery time • Rest and/or decrease in volume can reverse effects Dwyer_Part1_Sec2. and limitations of the client Knowledge of the physiological • Forced exhalation against a closed ACSM’s Resource Manual for effects of the Valsalva maneuver glottis that results in increases in intra. Guidelines for Exercise Testing and and the associated risks thoracic pressure Prescription. (cont. demonstrate and instruct the client to perform exercises safely and effectively. rounding muscle anatomy. and specifics concerning the tech- nique used. SECTION 2 CPT Job Task Analysis 31 D. periodization Prescription. and foam rollers movement. 7th edition (18) functional performance ologic stimuli and adaptations to • Chapter 5 exercise are gradually reduced or lost. joint • Chapter 4 (e. • Signs and symptoms — physical. 7th edition (18) volving nontraditional equipment modes and techniques. Knowledge of signs and symp. resistance training. position. water. systems readjust in Guidelines for Exercise Testing and tioning and effects on fitness and accordance with diminished physi.g. swim. • Chapters 31. rying. running. inertia. ACSM’s Resource Manual for safely demonstrate a wide variety ing of joint range of motion and sur. 4th edition cine balls. • Model proper technique includ- ing alignment. goals.g. Trainer. details. experience.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of and ability to • Each exercise requires understand. 7th edition (18) and/or reverse the detrimental (planned volume and variation of • Chapters 33 and 37 effects work). 7th edition (18) • Increased blood pressure (BP) • Chapter 31 response. and • Chapters 13 and 18 safety considerations. specifics concerning the Trainer. changes in cardiac physiology Knowledge of the biomechanical • Understanding biomechanical laws ACSM’s Resources for the Personal principles for the performance and principles as it influences gait. • Communicate clearly and accu- rately how to perform and check for understanding. and physiological indicators Guidelines for Exercise Testing and and recommendations to prevent • Proper program design. ACSM’s Resource Manual for ming. 4th edition (10) of common physical activities ground force reaction. Pilates. balance precautions for individuals with health ACSM’s Resources for the Personal boards. Review proposed program with client. precisely. and external resistive forces Guidelines for Exercise Testing and yoga. medi. key points. walking. and 34 such as stability balls. Prescription. breathing. different Prescription. or reduced. functional training) (e. nutrition. ACSM Brochures (1) • Demonstration involves modeling the Perform Better (33) exercise accurately.indd 31 11/07/12 8:18 PM . resistance bands. biomechanics. needs.. • Clothing can restrict the maximum rate of evaporative cooling in the heat. ACSM’s Resource Manual for exercise attire (e.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of improper exercise • Intrinsic and extrinsic risk factors ACSM’s Resource Manual for form and/or techniques to • Improper biomechanics. break Prescription. weight. Knowledge of appropriate • Clothing should be comfortable. Review proposed program with client.acsm. excessive training. • Chapters 33 and 37 fatigue.org D.g. footwear.indd 32 11/07/12 8:18 PM . air spaces. light colored Footwear should fit properly. use esthetic learning styles mirrors for feedback • Auditory: learn through hearing. use of imagery. improper Guidelines for Exercise Testing and modify/prevent musculoskeletal training techniques. high intensity. speed of move- ment. breathable. images and diagrams. • Chapters 14 and 17 • Know number of reps lifter intends to do. Knowledge of communication • Visual: learn through seeing. and allows movement. auditory. (cont. Prescription. Adequate layers of insulation. watch. Dwyer_Part1_Sec2. cues for proper body alignment. and conditions particular exercise and surfaces. palpate muscle used. • Know plan of action if serious injury occurs. demonstrate and instruct the client to perform exercises safely and effectively. wind protection. 32 CERTIFICATION REVIEW • www. clear verbal pre- sentation • Kinesthetic: learn by direct involve- ment after short and concise expla- nation. practice without resistance to review movement pattern Knowledge of proper spotting • Goal of spotting is to prevent injury. not show Prescription. color. ACSM’s Resources for the Personal techniques for effective teaching stration. guide clients physically through movement. Covered area. excessive wear and be suitable for • Chapters 3 and 32 environments. Guidelines for Exercise Testing and layering for cold. 4th edition (10) and client retention with aware. • Chapters 31 and 33 • Good communication ACSM’s Resources for the Personal • Know proper hand grip positions. and area covered are important. verbal instruction and cuing. and kin. fabric weave. and proper fit are important. 7th edition (18) in heat) for specific activities. visual • Chapter 9 ness of visual. ACSM’s Resource Manual for positions and techniques for • Be in a position to assist client with lift Guidelines for Exercise Testing and injury prevention and exercise if unable to perform correctly. Trainer. 4th edition (10) • Know proper exercise technique. or possible loss of balance. 7th edition (18) assistance form. 7th edition (18) injury misuse of weight-training equipment. Trainer. ing a video. • Proper clothing is a primary mecha- nism for achieving thermal balance during heat and cold stress. common lifting and movement errors • Teach proper alignment or technique and monitor rehearsal of movements.. demon. 4th edition (10) body language during exercise language cues • Chapters 9.indd 33 11/07/12 8:18 PM . • Normal response — heart rate (HR). Trainer.5 of severe fatigue. stair-climbers. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of normal and abnor. increases ACSM’s Guidelines for Exercise unusual joint pain. • Feedback should be immediate. and provide feedback. and warranty information. 4th edition (10) performing resistance exercises • Line up joint with axis of rotation. Knowledge of proper and im. and/or physical. and 17 • Observe. Dwyer_Part1_Sec2. ACSM’s Resources for the Personal derstanding/comprehension and • Knowledge of common body Trainer. stationary cycles. chest pain. resistance machines. • Chapter 14 (e. Knowledge of proper and im. treadmills. 4th edition (10) using cardiovascular conditioning • Review manufacturer’s instructions • Chapter 15 equipment (e. 4th edition (10) flexibility exercises (e. demonstrate. • Exercises use full range of motion ACSM’s Guidelines for Exercise ity balls. relaxed. Monitor client technique and response to exercise modifying as necessary. SECTION 2 CPT Job Task Analysis 33 E. poor perfu. ACSM’s Resources for the Personal mal responses to exercise and systolic blood pressure (SBP). • Do not bounce or force a stretch while holding breath. body alignment. 9th edition (15) or change in heart rhythm. greeting Trainer.. dynamic..g. dizziness. Trainer. • Cues can be verbal. and supportive. free weights. • Chapters 9 and 17 back during and after exercise specific. SOB. • Provide cues for proper alignment and ACSM’s Resources for the Personal proper form and technique while posture based on biomechanics. and based on performance standards. • Use established rapport. Skill in effective communication. and ACSM’s Resources for the Personal proper form and technique while breathing Trainer. stabil. 4th edition (10) criteria for termination of exercise respiratory rate increase as work • Chapters 5 and 15 (e. leg cramps. controlled Testing and Prescription (GETP). • Instruct. ACSM’s Resources for the Personal including active listening. blood pressure (BP). Skill in interpreting client un. • Customer service skills on body lan. abnormal heart rate response) HR. calisthenics/body weight) manner and involve concentric and ec. and • Provide safety instructions for mount- elliptical trainers) ing and dismounting equipment. • Slowly reposition and allow muscle to recover. etc. Knowledge of proper and im. communication.g. bands. shortness of breath (SOB). partner • Exhale when you feel the muscle being stretching) stretched. • Proper posture. nonthreatening. wheezing.g. visual. guage. 10. and softened. 9th edition (15) centric muscle actions. clarifying. • Proper posture and alignment ACSM’s Resources for the Personal proper form and technique for • Emphasize proper breathing. 4th edition (10) and providing constructive feed. • Termination: abnormal response in Testing and Prescription (GETP). • Chapters 13 and16 stretching.g. • Chapter 4 sion.. resistance conducted in a deliberate. static • Hold endpoints. cuing. confirm observations ver- bally with client. It should also be objec- tive. • Chapter 7 • Provide safety instructions. • Do not stretch beyond limits. and Trainer.. physical or verbal manifestations • Box 4. an in. bilateral to • Chapters 13 and 14 (e.. 4th edition (10) grams to increase or maintain • Strength/power: reduced volume. 13. 4th edition (10) healthy adults.org F. other cardiovascular based on structural. add advanced exer. 9th edition (15) (CV) diseases. • Chapters 14–16 muscular strength and/or endur. • Balance: vary base of support. and pregnant duration. Modify FITT to improve or maintain the client’s physical fitness level. chronic back Guidelines for Exercise Testing and pain. Prescription. • Progressions: move from wide to ACSM’s Resources for the Personal ods to teach progression of exer. and range of baseline conditioning is established. physiological ef. short to long lever. and adapts to a given stimulus. 7th edition (18) monary disease. • Be wary of signs and symptoms of overtraining. seniors. supported to Trainer. and 19 who are medically cleared to ex.acsm. disease. single joint to compound lunge with resistance) exercises Knowledge of modifications • Hypertrophy: high volume — short ACSM’s Resources for the Personal to periodized conditioning pro. 4th edition (10) individuals with chronic disease cises and progress by increase inten. 13. 7th edition (18) trained will adapt and change (training • Chapters 31 and 33 two to three times per week for each body part). rest periods Trainer. use unstable surfaces. increase frequency. based on structural. smaller base of support. motion/flexibility increase intensity and vary modes (interval training). specificity.indd 34 11/07/12 8:18 PM . ACSM’s Resource Manual for pertension. Trainer. add advanced exercises Trainer. children and progress by increasing intensity or • Chapters 12. 9th edition (15) fects of maturation and/or condition • Chapter 8 Knowledge of specific exercises • Once competency of basic exercises ACSM’s Resources for the Personal and program modifications for is established. and chronic pain • Chapters 30 and 32 Knowledge of principles of pro. physiological ef. and 19 and adolescents. • Chapters 12. metabolic syndrome. balance. Dwyer_Part1_Sec2. Trainer. CV • CV endurance: once frequency and endurance. progression of standing unilateral. power. hypertrophy. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of specific exercises • Once competency of basic exercises ACSM’s Resources for the Personal and program modifications for is established. Knowledge of appropriate meth. 34 CERTIFICATION REVIEW • www. ACSM’s Guidelines for Exercise women • Modifications for specific population Testing and Prescription (GETP). chronic pul. simple lunge to walking lunge to walking to complex. arthritis. osteoporosis. Guidelines for Exercise Testing and achievement • Specificity: only muscles that are Prescription. • Progression: modify volume and add advanced exercises once competency is achieved.g. ACSM’s Guidelines for Exercise ercise — stable coronary artery • Modifications for specific population Testing and Prescription (GETP). diabetes mellitus. • Progressive overload: as the body ACSM’s Resources for the Personal gressive overload. 4th edition (10) program progression to avoid crease in stimulus is required for • Chapters 13 and 14 training plateaus and promote further adaptation and improvement ACSM’s Resource Manual for continued improvement and goal (increase load or volume). hy. change perturbations • Flexibility: use different modes and techniques. sity or duration. 4th edition (10) cises for all major muscle groups unsupported movement. fects of maturation and/or condition • Chapters 8–10 obesity. increased load and rest periods ance. Prescription. 13. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of effective and • Analyze effectiveness.e. motivation techniques. • Accept clients. number of Guidelines for Exercise Testing and of communication modes people reached. • Chapter 45 newsletters) • Monitor consistency. and behavioral strategies. and credibility of message delivery. Web site. written follow-up.. expressions. audience. telephone. verbal • Track response rate. 7th edition (18) (i. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of effective tech. 8. verbal • Chapters 7. and 17 teaching and training techniques instruction to optimize a client’s training • Kinesthetic: learn by direct session involvement.g. ACSM’s Resource Manual for feedback) • Establish best practices.indd 35 11/07/12 8:18 PM . visual. targeted praise. and number Prescription. 9. ACSM’s Resource Manual for timely uses of a wide variety cost. e-mail. ACSM’s Resources for the Personal of learners (auditory. verbal • Chapters 8 and 13 survey. moving. check Guidelines for Exercise Testing and motivation levels. of responses.. 4th edition (10) and client satisfaction (e. Create a positive exercise experience in order to optimize participant adherence by applying effective communication techniques. Seek client feedback to ensure satisfaction and enjoyment of the program. reliability. timeliness. 4th edition (10) nicate positive reinforcement and client-centered approach. demonstration. eye contact. • Chapter 48 • Timely follow-up and feedback • Positive reinforcement Knowledge of client goals • Use of assessments on a periodic ACSM’s Resources for the Personal and appropriate review and basis (4 wk to 3 mo) as a measure Trainer. alignment cuing Trainer. eye contact • Chapters 9 and 10 encouragement (i. experiencing Dwyer_Part1_Sec2. SECTION 2 CPT Job Task Analysis 35 G. 7th edition (18) • Chapters 45 and 48 DOMAIN III: LEADERSHIP AND EDUCATION IMPLEMENTATION A. and 17 motivation ACSM’s Resource Manual for • Consistency of workouts.e. self-efficacy. empathy) Knowledge of and skill in • Use of reflective statements to clarify ACSM’s Resources for the Personal engaging active listening and summarize client issues Trainer. • Use of assessments ACSM’s Resources for the Personal niques for program evaluation • Feedback vehicles both written and Trainer. head movements. 7th edition (18) database).. return on investment. 4th edition (10) modification of success for achieving goals and • Chapters 12. 4th edition (10) techniques • Nonjudgmental • Chapters 9 and 10 • Undivided attention • Eye contact • Empathy Knowledge of different types • Visual: learn through seeing. facial ACSM’s Resources for the Personal nonverbal behaviors that commu. positive Trainer. Guidelines for Exercise Testing and • Track programs year over year (client Prescription. Knowledge of verbal and • Positive body language. 4th edition (10) kinesthetic) and how to apply • Auditory: learn through hearing. . home • Chapter 45 exercise recommendations.acsm. • Chapter 8 fear.e. goal setting.indd 36 11/07/12 8:18 PM . • Identify solutions to common barriers: ACSM’s Resources for the Personal cise adherence and compliance personal. elicit social support and provide • Chapters 44. Trainer. 45. social. social support) results to establish success.g. weather) • Discuss and brainstorm solutions ACSM’s Resource Manual for such as scheduling workouts. 7th edition (18) effective strategies that support tions. support a desire to attain a goal. 4th edition (10) supportive. • Behavior change pyramid moves ACSM’s Resources for the Personal tion of health behavior change clients through stages to their goal. 36 CERTIFICATION REVIEW • www. • Chapters 7 and 8 readiness to change model. and ACSM’s Guidelines for Exercise incentives. variety of Guidelines for Exercise Testing and activities. • Chapters 8 and 9 • Prevention strategies: stress manage. evaluative. achievement recogni.org A. and programmatic. 7th edition (18) petitive events • Chapters 44–46 Knowledge of specific tech. provide healthy substitu.g.g. disadvantages of current behavior. 9th edition (15) • Chapter 11 • Table 11. 4th edition (10) (e. Trainer. T-shirt. alterna.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of different types • Corrective feedback should be ACSM’s Resources for the Personal of feedback (i. 4th edition (10) (e. • Strategies: motivational interviewing. Testing and Prescription (GETP). Prescription. • Intrinsic: remain important long after • Chapters 8 and 9 esteem) goal is achieved. and 46 and facilitate exercise adherence reinforcement ACSM’s Guidelines for Exercise Testing and Prescription (GETP). descriptive) and • All feedback should be nonthreatening. immediate Trainer. and theory eliminating cues that produce problem Guidelines for Exercise Testing and of planned behavior. places to exercise. motivation techniques. social ing a commitment. Prescription. reflective. injury.. identifying and ACSM’s Resource Manual for cognitive theory. (cont. and advantage to change Dwyer_Part1_Sec2. • Tracking progress and knowledge of ACSM’s Resource Manual for tion. etc. improved self. 4th edition (10) travel. rewarding Guidelines for Exercise Testing and achievement Prescription. clarifying. progres. incentive • Pleasant training environment • Chapters 8 and 9 programs. Guidelines for Exercise Testing and tive training environments. Trainer. goal setting. and to optimize a client’s training supportive.1 Knowledge of triggers to relapse • Plan for common lapses in healthy ACSM’s Resources for the Personal and prevention strategies behavior such as work pressures. and boredom. environmental. • Action-oriented process of mak. lack of knowledge. 7th edition (18) • Chapter 45 Knowledge of extrinsic and • Extrinsic: identify outside factors that ACSM’s Resources for the Personal intrinsic reinforcement strate. • Use goal setting to establish level of ACSM’s Resources for the Personal niques to facilitate motivation concern. session Knowledge of and the applica. 9th edition (15) • Chapter 11 Knowledge of barriers to exer.. and behavioral strategies. • Chapter 9 the ability to use feedback objective. Create a positive exercise experience in order to optimize participant adherence by applying effective communication techniques. Prescription. Trainer. 4th edition (10) gies (e.) and behavior.. 7th edition (18) sive plans. and com. ACSM’s Resource Manual for ment skills. time management. educating clients. 4th edition (10) models (socioecological model. behavioral. Trainer. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the influence of • Chronic adaptations to cardiovascular ACSM’s Resources for the Personal lifestyle factors. • Fundamentals of nutrition and fat • Chapters 5 and 6 on lipid and lipoprotein profiles metabolism • Table 5. • Take the stairs instead of elevator or from the American College of Sports ing. Updated Recommendation for Adults activity levels (e. SECTION 2 CPT Job Task Analysis 37 A. or doing house- hold chores. • Physical activity can be part of the routine activities of day-to-day living. program enjoyment. Medicine and the American Heart work) • Park at far end of parking lot when Association” (13) shopping. and overall awareness of health. including nutri.and fitness-related information. connecting goals to ACSM’s Resources for the Personal principles and lifestyle manage. Knowledge of specific. exercise Trainer. stair walk. • Pace while talking on the phone. 7th edition (18) methods to increase client • Appropriate music and intensity level • Chapter 45 engagement • Fun B. • Social support and participation of ACSM’s Resource Manual for age-appropriate leadership similar niches Guidelines for Exercise Testing and techniques. house cleaning..) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of strategies to • Walking or biking short distances “Physical Activity and Public Health: increase nonstructured physical when one would normally drive a car. Create a positive exercise experience in order to optimize participant adherence by applying effective communication techniques. Knowledge of health coaching • Goal setting. focus on what’s working. • Walk to the next office instead of sending an e-mail or phoning. 4th edition (10) tion and physical activity habits. • Take a walk for half of your lunch hour. deeper motivation.2 • Good sources of fats Dwyer_Part1_Sec2. parking farther away. (cont. and educational • Community-based programs Prescription. 4th edition (10) ment techniques related to ous attitude. create manageable weekly goals between sessions. walking or cycling to work. motivation techniques. adopt a being curi. • Use a pedometer to track the number of steps taken per day.indd 37 11/07/12 8:18 PM . such as farming. adherence. Trainer. • Get up and walk around for 10 min out of every hour while at work. • Get off one stop before destination and walk the rest of the way. Educate clients using scientifically sound health and fitness information and resources to enhance client’s knowledge base. and behavioral strategies. gardening. ask clients what they • Chapters 7 and 8 behavior change are willing to do. walking to catch a bus. bike to escalator.g. ) CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the value of car. • Explain the relationship between type. program enjoyment. lean body • BMI: technique of using weight rela. and behavior and balanced diet. quick energy source. • Explain the functions of carbohydrates ACSM’s Resources for the Personal bohydrates. growth and tissue maintenance. healthy food choices and gies for Weight Loss and Prevention modifying body composition food preparation. exercise. bulimia tive to height “ACSM Position Stand: The Female nervosa. occupational and leisure time activities as mean to increase physical activity. and • Chapter 6 activity storage forms. fats. • Chapter 12 mass.acsm. • Bulimia nervosa: eating disorder of usually normal weight individuals characterized by cycles of overeating and purging or other compensatory behaviors. bone. and carrier of essential nutrients.and fitness-related information. and overall awareness of health. Physical Activity Intervention strate- modification as a method for tion control. Knowledge of the relationship • Explanation of the strong correlation ACSM’s Resources for the Personal between body composition and between obesity and the increased Trainer. and body fat distribution • Lean body mass: term used to de.) other than fat. anorexia nervosa. intensity. Trainer. Dwyer_Part1_Sec2. trans- port of nutrients. acid–base balance. Athlete Triad” (14) scribe a collection of tissues (muscle. Educate clients using scientifically sound health and fitness information and resources to enhance client’s knowledge base. adherence. and proteins as as preferred fuel. Trainer. satiety. • Explain the functions of protein in hor- mone production. consisting of por. cushion for concussion forces. body proportion of fat and fat-free mass.org B. even though at least 15% below expected weight for age and height. which make up total body weight. • Anorexia nervosa: eating disorder characterized by restrictive eating due to being afraid of gaining weight. and body composition. frequency. 4th edition (10) mass index (BMI). Knowledge of the following • Body composition: explain the relative ACSM’s Resources for the Personal terms: body composition. 4th edition (10) fuels for exercise and physical protein sparing. and duration of exercise and caloric expenditure • Explain the common behavioral strat- egies such as nonsupervised and supervised exercise. caloric intake on of Weight Regain for Adults” (11) weight. (cont. • Explain the functions of fats as an insulation from extreme temperatures. 4th edition (10) health risk of chronic diseases • Chapter 12 Knowledge of the effectiveness • Explain the effectiveness a healthy “ACSM Position Stand: Appropriate of diet.indd 38 11/07/12 8:18 PM . fluid balance enzyme synthesis. etc. oxidation of fat. 38 CERTIFICATION REVIEW • www. formerly known as American Dietetic Dietetic Association) reduce the risk of chronic diseases. length and intensity of activity. and • Protein ⫽ 4 kcal ⭈ g⫺1 • Chapter 6 alcohol • Alcohol ⫽ 7 kcal ⭈ g⫺1 Dwyer_Part1_Sec2. Knowledge of the myths and • Explain scientifically based safe meth. and after exercise plasma electrolyte levels.. 7th edition (18) • Chapter 35 Knowledge of the number • Carbohydrate ⫽ 4 kcal ⭈ g⫺1 ACSM’s Resources for the Personal of kilocalories in 1 g of • Fat ⫽ 9 kcal ⭈ g⫺1 Trainer. (cont. dietary activity guidelines and issues associ. ACSM’s Resource Manual for supplements. • Guidelines explaining the different ChooseMyPlate. ACSM’s Resources for the Personal consequences associated ods of weight loss using the proper Trainer. adherence.S. and environmental conditions. and portions of USDA Food Guide Pyramid (39) (USDA) Food Guide Pyramid a balanced and healthy eating plan “USDA Dietary Guidelines for and American College of Sports • USDA Dietary Guidelines 2010 is the Americans” (40) Medicine (ACSM)–endorsed federal government’s evidence-based Academy of Nutrition and Dietetics Dietary Guidelines (American nutritional guidance to promote health. sources.g. • American Dietetic Association is the world’s largest organization of food and nutrition professionals. Knowledge of the Female • Explain the interrelationships between “ACSM Position Stand: The Female Athlete Triad energy availability.indd 39 11/07/12 8:18 PM . Association (20) and reduce the prevalence of over- weight and obesity through improved nutrition and physical activity. • Explain the goal of hydration after exercise is to replace any electrolyte fluid deficit. fat. fad diets. 4th edition (10) with inappropriate weight loss eating habits and appropriate physical • Chapter 6 methods (e. Knowledge of the U. 4th edition (10) carbohydrate. program enjoyment. menstrual cycle. • Chapter 6 tion.and fitness-related information. Educate clients using scientifically sound health and fitness information and resources to enhance client’s knowledge base. • Explain individual fluid replacement rate is based on individual sweat rates. 4th edition (10) physical activity is to prevent dehydra. formerly known as Department of Agriculture food groups. start activity hydrated and with normal Fluid Replacement” (17) ing.) CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the importance of • Explain the goal of prehydration is to “ACSM Position Stand: Exercise and maintaining hydration before. and osteopo- rosis and possible interventions and/or educational measures used to prevent or mitigate the effects. choice of beverages. ACSM’s Resources for the Personal • Explain the goal of drinking during Trainer. Athlete Triad” (14) and bone mineral density of women and girls who participate in athletics on the clinical manifestations of eating disorders. ated with diets based on extreme or Guidelines for Exercise Testing and starvation diets) exclusive principles. Prescription. overexercising. amenorrhea. SECTION 2 CPT Job Task Analysis 39 B. and overall awareness of health. dur. protein. 2. ment techniques. Strategies for Weight Loss and weight ture recommendations for weight loss Prevention of Weight Regain for and weight maintenance in minutes Adults” (11) and the associated caloric equivalent. and 21 injury and/or medical complica. Center” (45) (e. National Institute of “WebMD Healthy Living” (44) wellness-related resources and Health (NIH) Web site.indd 40 11/07/12 8:18 PM . Sports. 4th edition (10) dures in order to decrease client cise-related cardiovascular incident. or civic organizations. peer-reviewed “Mayo Clinic Health Information” (27) information journals. ACSM’s Health/Fitness Facility tions thereby minimizing Certified Standards and Guidelines. 7th edition (18) • Chapter 35 Knowledge of accessing and dis.acsm. “Stress Management Techniques” (36) guided imagery. Knowledge of community-based • Identify national and local programs “National Blueprint: Increasing exercise programs that provide targeted toward specific conditions. rotary “Exercise is Medicine” (24) cycling clubs) club. Physical Activity among Adults” (29) social support and structured age. AND MARKETING A. 19. “WebMD Stress Management Health ment and relaxation techniques mon relaxation and stress manage. • Chapters 11.org B. activities (e. adherence. walking clubs. • Identify competent and reputable ACSM’s Web site and resources (1. BUSINESS. and ACSM Web site. 40 CERTIFICATION REVIEW • www. and overall awareness of health. • Explain the differences between com. Personal Trainer negligence and 3rd edition (19) risk of liability • Chapter 2 • Table 2. massage • Knowledge of proper breathing “Relaxation Technique for Stress therapy) techniques Relief” (35) DOMAIN IV: LEGAL. progressive relaxation. sources of current information such as National Institute of Health (30. Educate clients using scientifically sound health and fitness information and resources to enhance client’s knowledge base.and fitness-related information.) CPT Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the ACSM’s • Weight loss ⫽ calories out ⬎ calories in “ACSM Position Stand: Appropriate guidelines for caloric intake for • Weight gain ⫽ calories in ⬎ calories out Physical Activity Intervention individuals desiring to lose or gain • Explain the physical activity expendi. golf leagues. and Nutrition (34) intramural sports.g. • Contact chamber of commerce. ACSM’s Resources for the Personal Trainer. program enjoyment. increased risk of experiencing exer. Obtain medical clearance for all clients prior to starting an exercise program. PROFESSIONAL.31) relevant health. exercise. Trainer..g. categories.1 Dwyer_Part1_Sec2. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of risk stratification • Properly identify those who pose an ACSM’s Resources for the Personal and medical clearance proce.. National Physical Activity Plan (32) “The Community Guide to Promoting Physical Activity” (25) Knowledge of stress manage. 4th edition (10) • Chapter 6 ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. sponsoring organizations. and others. (cont.3) semination of scientifically based. and level of fitness. sport President’s Council on Fitness. 5 and 11. • Minimize risk of exposure to liability.1 and 11. Trainer. services. • Medical examination and GXT not necessary for moderate exercise for moderate-risk clients Knowledge of the appropriate • May need to use a facility with ACSM’s Resources for the Personal level of supervision and monitor. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of reputable profes. • Chapter 11 • Moderate-risk clients are asymptom. Collaborate with various health care professionals and organizations in order to provide clients with a network of providers that minimizes liability and maximizes program effectiveness. • Establish a local network of health ACSM’s Resources for the Personal sional resources and referral care professionals. 4th edition (10) ing recommended for individuals • Chapter 11 with known disease based on • Figure 11.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the application • High risk clients are those who are ACSM’s Resources for the Personal of the ACSM risk stratification symptomatic or with known cardiac. programs. and referrals. procedures.1 and 11. 4th edition (10) process pulmonary. apprais- als.6 medical doctor (MD) supervision of • Tables 11. Obtain medical clearance for all clients prior to starting an exercise program.2 Knowledge of medical clearance • High-risk clients: recommended ACSM’s Resources for the Personal requirements prior to exercise medical exam and graded exercise Trainer.2 exercise test recommended • Moderate-risk clients: recommended medical exam and GXT with medical supervision prior to exercise program for vigorous exercise.6 atic and have two or more risk factors. • Figures 11.2 disease-specific risk stratification guidelines and current health status B. Knowledge of the scope of • Scope: fitness professional who ACSM Web site (7) practice for the Certified Personal develops and implements safe and ACSM’s Resources for the Personal Trainer and the need to practice sound programs through an individual. • Figures 11. medically qualified staff Trainer. • Tables 11. 4th edition (10) sources to ensure client safety • Establish policies. 4th edition (10) within this scope ized approach to exercise leadership • Chapters 1 and 21 in healthy populations and/or those individuals with medical clearance to exercise.5 and 11. Trainer.indd 41 11/07/12 8:18 PM . Dwyer_Part1_Sec2. (cont. 4th edition (10) testing and program participation test (GXT) prior to exercise program • Chapter 11 for moderate and vigorous exercise. SECTION 2 CPT Job Task Analysis 41 A. and • Chapter 11 and program effectiveness forms for matching clients with appro- priate professionals. or metabolic disease. Trainer. 3 sibilities) in a health and fitness and the roles of responders ACSM’s Health/Fitness Facility setting • Emergency medical services (EMS) Standards and Guidelines. Department of Health and • Up-to-date self-credentials and contact Human Services.S. and elevation American Red Cross First Aid/CPR/ procedures for exercise-related (RICE) for strains/sprains AED Participant Manual (21) injuries. and referrals. Collaborate with various health care professionals and organizations in order to provide clients with a network of providers that minimizes liability and maximizes program effectiveness. automated demonstration of practical skills AED Participant Manual (21) external defibrillator (AED). C. • Written plan that addresses major ACSM’s Resources for the Personal gency procedures (i. 4th edition (10) physician or allied health services practice • Chapter 11 such as physical therapy. fractures. 4th edition (10) procedures.indd 42 11/07/12 8:18 PM . and psycho. 7th edition (18) • Supine with legs elevated for fainting • Chapter 37 Dwyer_Part1_Sec2. strains/ • Direct pressure for bleeding • Chapters 5–8 sprains. signs. 3rd edition (10) ment location • Chapter 4 • Rehearsal of plan four times a year • Appendix D and Form 26 • Proper follow-up and documentation Knowledge of basic first aid • Rest.43) Knowledge of identifying in. and American Heart Association Basic cardiopulmonary resuscitation Life Support (BLS) or Lifesaver (CPR) certification Certification (23) Knowledge of appropriate emer. ice. 42 CERTIFICATION REVIEW • www. • Establish policies. Develop a comprehensive risk management program (including emergency action plan and injury prevention program) to enhance the standard of care and reflect a client-focused mission. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of and skill in obtain. written emergency • Explicit steps and instructions on how • Chapter 21 procedures. Prescription. compression. dietary • Establish local network of health care counseling.. contact information. Privacy (42. Health Information information. personnel respon. emergency equip. • Current certification that includes American Red Cross First Aid/CPR/ ing basic life support. appraisals. (cont. and logical and social services forms for matching clients with appro- priate services. syncope. • Knowledge of conditions. and exercise • Let professionals treat fractures ACSM’s Resource Manual for intolerance (dizziness.acsm. telephone emergency situations Trainer. and serious injuries out of scope of Guidelines for Exercise Testing and heat injury) training. stress management. 4th edition (10) with allied health and fitness • Contact prior to sending fax. such as bleeding. • Chapter 9 professionals • Secure network if using e-mail.org B. professionals.e. each emergency situation is handled • Box 21. programs. U. or ACSM’s Resources for the Personal dividuals requiring referral to a indicators that fall outside of scope of Trainer.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of effective and • Proper spelling and grammar used ACSM’s Resources for the Personal professional communication • Confidential cover sheet Trainer. procedures. weight management. and the legal • Current certifications. • Environmental conditions: basic first Prescription. full squats. Risk Management for Health/Fitness emergency procedures fessional liability insurance Professionals (9) • Chapter 11 Knowledge of potential musculo. low back pain.. (cont. ACSM’s Resources for the Personal exercises/postures and potential ment and joint position are critical for Trainer. facility cleanli.g. conform to ACSM’s Resources for the Personal in an exercise setting to ensure relevant laws. pro.g.. Knowledge of the responsi. palpitations/arrhythmias. hur. fainting/syncope.. 4th edition (10) implications for the Certified AED. Box 37. which are contraindi- cated by physician should be avoided. double-leg raises. hyperventila. hypogly- cemia/hyperglycemia. hypoten. equip.2 AED Participant Manual (21) pain. strain.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of precautions taken • Signage for potential risk. injury..6 Guidelines for Exercise Testing and sion/hypertension. • Tendonitis: inflammation of tendon tendonitis. straight-leg sit-ups. guidelines — Table 37. 7th edition (18) tion).. regulations. first aid guidelines — Table 37. and metabolic abnormalities aid — Table 37. basic Trainer. and standing positions. SECTION 2 CPT Job Task Analysis 43 C. Trainer. patellofemoral pain • Fracture: broken bone syndrome. signage. chest Table 37. • Metabolic abnormalities: basic first aid ACSM’s Resource Manual for tachycardia. plantar • Plantar fasciitis: chronic inflammatory fasciitis) condition that results in pain at the calcaneal insertion • Patellofemoral pain syndrome: com- mon disorder in young athletes that produces anterior knee pain Knowledge of contraindicated • Potential risks: correct body align. shin splints. fractures. maximum results and minimal risk of • Chapter 16 ercises (e. and clear floor space Standards and Guidelines. 4th edition (10) participant safety (e. familiarity of facility emergency • Chapter 21 Personal Trainer of carrying out plan. bradycardia.g.g. • Bursitis: inflammation of bursa • Chapter 3 sprain. floor surface) width. strains. limitations. • Strain: injury to a muscle Trainer.g. cardiovascular/pulmo. bursitis. bent-over-toe touch) • Any exercises. and pub. 4th edition (10) risks associated with certain ex.indd 43 11/07/12 8:18 PM . including CPR/ Trainer.5. • Duty of care ACSM’s Resources for the Personal bilities. knowledge tions: identification — Table 37. ACSM’s Resources for the Personal skeletal injuries (e. 4th edition (10) etal injuries (e. hypother- mia/hyperthermia) Dwyer_Part1_Sec2. sprains. • Circulation areas adjacent to physical 3rd edition (19) activity areas • Chapters 6 and 7 • Proper signage on any equipment or Risk Management for Health/Fitness areas of facility that are out of order or Professionals (9) unusable • Chapter 10 Knowledge of the following • Sprain: injury to a ligament ACSM’s Resources for the Personal terms related to musculoskel. • ADA requirements for passageway ACSM’s Health/Fitness Facility ness. 4th edition (10) of contusions.6 • Chapter 3 fractures). • Potential musculoskeletal injuries — American Red Cross First Aid/CPR/ nary complications (e. cervical and lumbar should be modified to safer joint hyperextension..g. • Cardiovascular/pulmonary complica. • Potentially harmful postures/exercises dler’s stretch. documentation of incident.8. lished standards • Chapter 21 ment placement. Develop a comprehensive risk management program (including emergency action plan and injury prevention program) to enhance the standard of care and reflect a client-focused mission.11 • Chapter 37 (e. • Open wounds — Chapter 7 American Red Cross First Aid/CPR/ ment and first aid techniques • Musculoskeletal injuries — Chapter 8 AED Participant Manual (21) associated with open wounds. 4th edition (10) tion plan. each emergency situation is handled • Chapter 21 and the roles of responders ACSM’s Health/Fitness Facility • EMS contact information.3 and 7. 3rd edition equipment location (19) • Rehearsal • Chapter 4 • Knowledge of fire safety and facility ACSM’s Guidelines for Exercise evacuation procedures Testing and Prescription (GETP). Chapters 2–4 ACSM’s Guidelines for Exercise vascular/pulmonary complica.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the initial manage.. 4th edition (10) cedures (e.indd 44 11/07/12 8:18 PM . • Chapter 7 condition of exercise equipment mentation of inspection and repairs • Tables 7. and 8 musculoskeletal injuries.g. Develop a comprehensive risk management program (including emergency action plan and injury prevention program) to enhance the standard of care and reflect a client-focused mission. Standards and Guidelines. • Breathing and cardiac emergencies — • Chapters 2–5. (cont. and monthly care for all ACSM’s Health/Fitness Facility components of an equipment equipment Standards and Guidelines. and metabolic disorders edition (15) • Chapter 7 ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. weekly. 44 CERTIFICATION REVIEW • www. Professionals (9) • Chapter 9 Knowledge of the need for and • Duty to public to provide safe facility ACSM’s Resources for the Personal use of safety policies and pro. 7th edition (18) • Chapter 37 Knowledge of the need for and • Daily.4 to reduce the potential risk of • Knowledge of equipment warranty • Appendix A injury and repair information • Supplements 3 and 4 • Follow manufacturer’s Risk Management for Health/Fitness recommendations. • Chapter 4 • Document system (training. cardio. 7.acsm. and programs Trainer. emergency procedure to providing safe environment ACSM’s Health/Fitness Facility training) and legal necessity • Address major emergency situation. 9th tions. thereof • Elicit instructions and roles of how to 3rd edition (19) respond. • Proper follow-up and documentation 9th edition (15) • Appendix B Risk Management for Health/Fitness Professionals (9) • Chapter 11 Dwyer_Part1_Sec2.org C. incident/accident • Emergency response system critical • Chapter 21 reports. service plan/agreement and how • Regular inspection and preventative 3rd edition (19) it may be used to evaluate the maintenance of equipment and docu. explicit steps and instructions on how Trainer. Risk Management for Health/Fitness instructions) Professionals (9) • Rehearsal 4 times a year • Chapter 11 • Available first aid and emergency equipment • Coordination with local EMS Knowledge of the need for and • Written emergency action plan with ACSM’s Resources for the Personal components of an emergency ac. emergency Standards and Guidelines. • Sudden illness — Chapter 5 Testing and Prescription (GETP). 6) tinuing education.indd 45 11/07/12 8:18 PM . • Chapter 37 the facility or program sistance should be clearly posted near Risk Management for Health/Fitness all phones. • Emergency drills convened four times ACSM’s Health/Fitness Facility rying out emergency procedures a year Standards and Guidelines. Participate in approved continuing education programs on a regular basis to maximize effectiveness. including communica. ACSM’s Guidelines for Exercise • Unsupervised facility: signage of Testing and Prescription (GETP). ACSM’s Health/Fitness Facility • Plans should include medical. what steps members should take in 9th edition (15) the event of a witnessed emergency • Appendix B situation. and other emergencies. Skill in demonstrating and car. 7th edition (18) • Chapters 31 and 33 D. ACSM’s Resource Manual for good communication Guidelines for Exercise Testing and Prescription. • Chapter 8 tion portion every 3 mo. ACSM’s Resource Manual for munication skills and the ability to munication to EMS and within facility Guidelines for Exercise Testing and inform staff and clients of emer. spotting. (cont. ACSM’s Resources for the Personal monitoring a client safely and ef. evacuations. professional keep current with science and prac. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the role of con. being alert. adult cardiopulmonary resuscitation (CPR) certification • American College of Sports Medicine (ACSM) Certification is valid for 3 yr. as part of the emergency action plan. Develop a comprehensive risk management program (including emergency action plan and injury prevention program) to enhance the standard of care and reflect a client-focused mission. during exercise testing and/or • Follow-up evaluation of personnel and 3rd edition (19) training response and documentation of drills • Chapter 4 ACSM’s Guidelines for Exercise Testing and Prescription (GETP). Trainer. ACSM’s Resources for the Personal resources. possible adverse effects. and • Knowledge of exercise being per. Prescription. 9th edition (15) • Appendix B Skill in assisting. formed.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of effective com. fire. increase professionalism. and enhance knowledge and skills in the field of health and fitness. 3rd edition (19) • Rehearse plan. • Obligation to public and clients to ACSM Web site (5. Emergency communication Professionals (9) devices must be readily available and • Chapter 11 working properly. and requirements for tice-related research Trainer. Standards and Guidelines. • Recertification: 45 credits Dwyer_Part1_Sec2. SECTION 2 CPT Job Task Analysis 45 C. proper • Chapters 14 and 17 and/or training positioning to assist lift. 4th edition (10) fectively during exercise testing common errors in performing. • Establish who is responsible for com. 4th edition (10) certification and recertification • Certification requirements: 18 yr • Chapters 1 and 2 old. high school diploma (general education development [GED]). 7th edition (18) gency policies and procedures for • Telephone number for emergency as. 4th edition (10) • Professional behavior established via • Chapters 1 and 2 code of ethics and scope of practice. ACSM’s Resources for the Personal tinuing education credits (CEC) • Identify credible health/fitness re. (cont. 4th edition (10) Personal Trainer exercise science. good communication skills. ACSM’s Resources for the Personal attire and professional behavior sional work environments. Dwyer_Part1_Sec2.org D. increase professionalism. Adhere to American College of Sports Medicine’s (ACSM’s) Code of Ethics by practicing in a professional manner within the scope of practice of a Certified Personal Trainer.6) for obtaining and maintaining con. • Scope: fitness professional who de- velops and implements an individual- ized approach to exercise leadership in healthy populations and/or those individuals with medical clearance to exercise Knowledge of appropriate work • Work attire may be dictated by profes.4) sional activities within the scope effective methods of exercise by ap.) Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the requirements • Identify ACSM-approved providers ACSM Web site (5. maintain high professional ACSM’s Resources for the Personal Ethics as well as the ACSM and scientific standards. Trainer. • Motivating individuals to begin and to continue with their healthy behaviors. Trainer. 3rd edition (10) Certified Personal Trainer scope public. and improving both the health • Chapters 1 and 2 of practice and well-being of the individual and the community. Participate in approved continuing education programs on a regular basis to maximize effectiveness. • Leading and demonstrating safe and ACSM Web site (1. and enhance knowledge and skills in the field of health and fitness. sources to obtain CEC in person • Chapters 1 and 2 approved CEC (workshops) and via Internet. safeguard the Trainer. 4th edition (10) and where one can obtain ACSM. 46 CERTIFICATION REVIEW • www. for CEC. ACSM’s Resources for the Personal of practice of the ACSM Certified plying the fundamental principles of Trainer. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the components • Code of Ethics: improve knowledge ACSM Web site (8) of both the ACSM’s Code of and skill. ACSM Journals (4) Knowledge of the continually evolving field of health and fit- ness and the need for Certified Personal Trainers to keep abreast of new research and applications in the field of exercise science E.acsm. ability to build relationships Skill in conducting all profes.indd 46 11/07/12 8:18 PM . • Chapters 1 and 2 • Writing appropriate exercise recommendations. Prescription. owners have lim- ited personal liability for the debts and actions of the LLC. corporation. • Use QuickBooks or Mind Your Own Microsoft Excel (28) ware to develop and manage Business (MYOB) software programs budget Dwyer_Part1_Sec2. Trainer. ACSM’s Resource Manual for late arrival policy. clearly de. • Develop management policies. Skill in market niches and the • Using demographics to identify niches ACSM’s Resources for the Personal components of a mission state.id=98277.00. Trainer. Guidelines for Exercise Testing and methods/plans) Prescription. and de- mands of stockholders • Limited liability corporation (LLC): simi- lar to a corporation.. • Individual contractor: provides services Trainer. business. 4th edition (10) independent contractor.. budgetary. and professional business tional policies. values. pro- viding management flexibility. S corporation) • Partner: two or more people with a contract filed with local or state gov’t • Corporation: formal business entity subject to laws. sole proprietorship. Guidelines for Exercise Testing and lines by national organizations.indd 47 11/07/12 8:18 PM . payment keting.e. business values. Develop a business plan to establish mission. and sales objectives.. 4th edition (10) includes establishing a budget • Revenue and expense management • Chapter 20 (i. ACSM’s Resources for the Personal ness objectives (i. gram or center.. 4th edition (10) fine business mission statement. services. service or location • Chapter 20 description) Skill in using spreadsheet soft.e. and the benefit of pass-through taxation. (from Internal Revenue Service [IRS] Web site: http://www. mar. pro.. 7th edition (18) • Results outcomes expected/projected • Chapter 19 for all categories • Measure key performance indicators. 4th edition (10) ment (i. mission statement. ACSM’s Resource Manual for membership/financial goals. benchmarks. • Create vision. SECTION 2 CPT Job Task Analysis 47 F. • Define philosophy and purpose of pro.irs.html) • S corporation: alternative for small business that combines advantages of the other business models. which • Establish a budget. Trainer. • Knowledge of industry standards for Guidelines for Exercise Testing and gram evaluation) goals and benchmarks Prescription. and opera. 7th edition (18) • Chapter 19 Skill in the development of busi. sales and pricing. Skill in the development of • Demographic and competitive analysis ACSM’s Resources for the Personal a basic business plan. cancellation policy. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of implementa. template. • Use mock business plans as a • Chapter 20 business. for an individual or business • Chapter 20 ship. Other features of LLCs are more like a partnership. 4th edition (10) ethical. goals. vision. partner. 7th edition (18) • Chapters 10 and 19 Knowledge of various business • Sole: one person owned business ACSM’s Resources for the Personal models (i.e. core ACSM’s Resources for the Personal tion methods for effective. • Chapter 20 practices • Collect and review the most recent ACSM’s Resource Manual for publications of standards and guide.gov/businesses/ small/article/0. regulations. based on client type. training needs. Trainer. billing.e. experi.. colorful. environment/location. business. brochures. • Chapter 20 tising. Guidelines for Exercise Testing and cess and sales checklist Prescription. PDF. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of management poli. hiring. press consumers. direct mail. Trainer. • Use online assistance for each ACSM’s Resources for the Personal ous marketing materials via com. Guidelines for Exercise Testing and Prescription. Develop marketing materials and engage in networking/business exchanges to build client base. blogs.acsm. eye-catching. print/video brochures marketing) Knowledge of various methods • External signage. social networking. 4th edition (10) standards) • Train and empower staff. • Chapter 48 ence. • Web sites. 4th edition (10) • Marketing: lead boxes.e. Microsoft • Marketing should not be too busy. ACSM’s Resources for the Personal for distribution and promotion of billboards. Trainer. Web sites. (cont. • Create positive image. releases. and expenses Knowledge of marketing ma. setting training • Establish training standards. radio..e. • Converts leads to prospects and pros.indd 48 11/07/12 8:18 PM . promote services.e. application.e. community involvement Trainer. 4th edition (10) puter applications (i. payment methods Trainer.org F. business cards. and increase resources. and pricing cancellation. 4th edition (10) (i. • Operational policies such as billing. sales. TV. 7th edition (18) • Pricing based on education. video clips. 7th edition (18) • Chapters 10 and 19 G.. Publisher) Dwyer_Part1_Sec2. Trainer. and multimedia ACSM’s Resource Manual for • Sales: eight-step sales generation pro. ACSM’s Resources for the Personal terials to promote the business pects to members.. marketing. adver. e. • Steps to hiring personal trainers ACSM’s Resources for the Personal tices (i. Develop a business plan to establish mission. Microsoft Power Point. 4th edition (10) the personal training business • Create a positive image and educate • Chapter 20 (i. ACSM’s Resource Manual for • Provide education to staff. • Chapter 20 Word. 48 CERTIFICATION REVIEW • www. feature newspaper articles) Skill in the development of vari. • Chapter 20 web pages. • Chapters 2 and 20 • Manage staff and business. referrals.) Knowledge or Skill Statement Explanation/Examples Resources CPT Skill in career development prac. and sales objectives. ACSM’s Resources for the Personal cies. budgetary. and targeted. . Prescription. • Regular inspection and preventative • Chapter 21 tenance plan. Dwyer_Part1_Sec2. Trainer. Trainer. 4th edition (10) licensed and nonlicensed health • Refer to appropriate health care • Chapter 21 care professionals providing re. 7th edition (18) • Types: gross. 4th edition (10) of injury and liability (i. • Higher standard level of care expected ACSM’s Resources for the Personal tinent to health care delivery by at medical facilities Trainer. breach of duty. etc. nonoffensive • Customer service skills • Chapters 1. Engage in healthy lifestyle practices in order to be a positive role model for all clients. ACSM’s Health/Fitness Facility level. ac. SECTION 2 CPT Job Task Analysis 49 H. • Chapters 8 and 17 ance (i. scope of practice. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of professional • Negligence is failing to do something ACSM’s Resources for the Personal liability and common types of that a reasonable. qualifications.indd 49 11/07/12 8:18 PM . tal factors. omission Risk Management for Health/Fitness • Duty of care. damages • Chapter 2 • Level of responsibility to protect from harm • Safe premises. 4th edition (10) impact client satisfaction/compli. ACSM’s Resources for the Personal fessional behavior (i. 4th edition (10) negligence seen in training would have done under same or simi. and 9 dress. • Model healthy lifestyle. Risk Management for Health/Fitness ment with varying degrees (danger.3 and 7. Professionals (9) tion. 7th edition (18) ment techniques • Chapter 48 Knowledge of equipment main. 2. Obtain appropriate personal training and liability insurance and follow industry-accepted professional. cleaning and maintenance ACSM’s Health/Fitness Facility safety considerations for each • Documentation of maintenance for Standards and Guidelines. compara.. prudent person Guidelines for Exercise Testing and would not have done. main. • Educated tive listening skills) • Current certifications Knowledge of environmental • Use facility standards and guidelines ACSM’s Resources for the Personal influences that may negatively to ensure proper range of environmen. • Chapter 21 environments lar circumstances or doing something ACSM’s Resource Manual for that a reasonable. Standards and Guidelines. personal hygiene. • Establish strategic alliances. • Chapter 10 tive. • Be prompt and prepared. Prescription. sensitivity) • Create facility policies to ensure com. 3rd edition (19) fortable.. Trainer. ethical. • Follow manufacturer’s ACSM’s Resources for the Personal tenance such to decrease risk recommendations.e. and business standards in order to optimize safety and to reduce liability. equipment usage. 4th edition (10) ing. Professionals (9) warning. substance-free. professional if not within scope of ACSM’s Resource Manual for habilitative services and exercise practice. scent comment cards.e. service schedule. Guidelines for Exercise Testing and testing and legal risk manage. caution) • Chapter 9 I.e. music choice/volume • Ask for feedback through surveys. safe atmosphere for all. not smok. politeness. 3rd edition piece) each piece of equipment (19) • Out of order sign if not in proper • Chapter 7 working condition • Tables 7. feedback books. causa. courtesy. contributory. prudent person Trainer. emer- gency preparedness Knowledge of legal issues per. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of appropriate pro.4 • Signage for proper usage of equip. 9. list all authors for works with three. movies. 50 CERTIFICATION REVIEW • www. keep it brief. Knowledge of documentation of • Part of code of ethics: Credentialed ACSM’s Resources for the Personal nonoriginal work professionals take credit. by legally securing copyright material and other intellectual property based on national and international copyright laws. ACSM Web site (1. • Highlight important points. including Trainer. or methods of opera- tion.2. and 17 calls. Sources” (22) • All nonoriginal ideas must be cited. systems. • Length of material will vary based on space and audience. media. Parenthetically.org I. texting. Copyright does not protect facts. dramatic. • Administrative time used for corre- spondence • If unavoidable. Engage in healthy lifestyle practices in order to be a positive role model for all clients.e. eating well. • Use templates as a starting point. novels. although it may protect the way these things are expressed. computer software. etc. 4th edition authorship. • Create an eye-appealing format and a catchy title. in-person conversation with proper sleep. Dwyer_Part1_Sec2. a form of intellectual prop. regular exer- others) cise. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of and application • Copyright. Respect copyrights to protect original and creative work. or five authors. ACSM’s Resources for the Personal of national and international erty law. • Chapter 1 musical. J. 4th edition (10) session (i. only for work they have ac. 4th edition (10) copyright laws authorship including literary. protects original works of Trainer.3) educational material • Discuss in laymen’s terms. On the reference page. and good self-care.. ideas. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of the need to avoid • Client deserves and pays for your full ACSM’s Resources for the Personal distractions during a training attention.indd 50 11/07/12 8:18 PM . Skill in developing original • Research a variety of sources. cell phone • Manage your energy level through • Chapters 1. songs. temporarily excuse yourself. Trainer. most common: au- thors last name and year of publica- tion. such United States Copyright Office (38) as poetry. and refer to other floor staff. four. and artistic works.acsm. and architecture. • Chapter 1 tually performed and give credit to the “Bates College: How to Cite contributions of others if warranted. with the understanding that they will disclose it only to authorized individuals.S. and wellness have a sys. prevent litigation disclosure) Knowledge of the Family • HIPAA: strict policies regarding safety ACSM’s Resources for the Personal Educational Rights and Privacy and security of private records Trainer. health • Chapters 10 and 21 files promotion. personal information is properly Services. 4th edition (10) ity with electronic and hard copy ensure that fitness testing. client per.43) training business resides in legitimate purposes and only when U. Department of Health and Human (HIPAA) laws depending on set. • Create a secure. client medical a safe environment. ACSM’s Resources for the Personal of client privacy (i. Safeguard client confidentiality and privacy rights unless formally waived or in emergency situations. vention of potential harm to a client’s Trainer. • Permitting only certain authorized indi- viduals access to information. maintain trust and provide • Chapters 10 and 21 credit protection. 4th edition (10) Act (FERPA) and Health Insurance • FERPA: policy for the stewards of • Chapter 21 Portability and Accountability Act education data to ensure students’ U. Knowledge of the importance • Protection against theft or injury. Health Insurance Portability ting and state that the personal safeguarded and is used only for and Accountability Act (42. Department of Education. Trainer. accurate. (ACSM) guideline: A facility should Trainer.S. Knowledge or Skill Statement Explanation/Examples Resources CPT Knowledge of practices/systems • American College of Sports Medicine ACSM’s Resources for the Personal for maintaining client confidential. SECTION 2 CPT Job Task Analysis 51 K. ACSM’s Resources for the Personal ing rapid access to client health and alphabetized filing system for ac. • Chapter 21 information Dwyer_Part1_Sec2. Risk Management for Health/Fitness tem that provides for and protects the Professionals (9) complete confidentiality of all user • Chapter 6 records and meetings.indd 51 11/07/12 8:18 PM . legal liability. • User records should only be released with an individual’s signed authorization. client reputation. pre. 4th edition (10) history and emergency contact tive client files.. 4th edition (10) sonal safety. Family absolutely necessary Educational Rights and Privacy Act (41) Risk Management for Health/Fitness Professionals (9) • Chapter 6 Skill in obtaining and maintain.e. current. [cited 2012 Sep 8]. Certified personal trainer Purdue University [Internet]. Physical activity and public Available from: http://www.gov/science/education. Robinson L. Loucks AB.org/access-public-information/ 20. Appropriate physical activity interven.acsm. Connaughton DP. American College of Sports Medicine.org/_frm/crt/New/certification_renewal_form.kettle . American College of Sports Medicine [Internet]. Nattiv A. Available Dwyer_Part1_Sec2. Donnelly JE. McInnis KJ. American College of Sports .acsm Concepts. Blueprint Partners tion strategies for weight loss and prevention of weight regain for [Internet]. Academy of Nutrition and Dietetics Web site [Internet]. National Institute of Health. Herbert DL. 4. American College of and-grants/resources/ Sports Medicine position stand. et al. [cited 2012 Mar 4]. American College of Sports Medicine. Segal J. Exercise and fluid replacement.agingblueprint. American College of 33. Alvar BA. Microsoft 2009. Tharrett SJ. American College of Sports Medicine 26. [cited Facility Standards and Guidelines.org/access-public-information/acsm. Evetock TK.htm Medicine [Internet]. [cited 2011 Sep 22].htm scope of practice.39(10):1867–82. [cited 2011 Sep 22]. National Institute of Health.nih. 2014. Available from: http://exerciseis 7. Philadelphia (PA): Lippincott Williams & Wilkins. with-excel-HA001045087.org/Content/NavigationMenu/MemberServices/MemberResources/ bellconcepts. Garber CE. better. Microsoft Excel.com 15.org College of Sports Medicine [Internet]. National blueprint: increasing physical activity among adults Medicine position stand. Bickhoff-Schemek J. American Red Cross First Aid/CPR/AED able from http://www. Quantity and quality of exercise ics. [cited 2012 Mar 4].indd 52 11/07/12 8:18 PM .org/partnership. Balance and stabilization training exercises. Available from: http:// 24. KettleBell Concepts Web site [Internet]. 2007. Med Sci Better [Internet].aspx and neuromotor fitness in apparently healthy adults: guidance for 31.org 14. et al.thecommunityguide.asp 2010–2011 edition. 3rd ed. cation. Bureau of Labor Statistics. Med Sci Sports Exercise. ACSM fit society page. American College of Sports Medicine.org/renew-your-certification [Internet]. Burke LM. et al. Research and training. [cited 2012 Mar 4]. Available from: www. 2. 28.htm health: updated recommendation for adults from the American 32. fitness workers. [cited 2012 Mar 4]. American College of Sports Medicine. (SC): National Physical Activity Plan [cited 2012 Mar 4]. Prescription. 2007.gov/resources- 16. Purdue Online Writing Lab. ACSM current comment 19. Sports & Nutrition [Internet]. for Exercise Testing and Prescription. Resources. Available from: http://www. Champaign (IL): Human 2011 Sep 22]. [cited 2012 Mar 4].acsm topics. 25.fitness. senior editor. Sports & Nutrition. Available from: http://www Management for Health/Fitness Professionals: Legal Issues and . NON-ACSM REFERENCES: American College of Sports Medicine [Internet]. ACSM journals.php CodeofEthics/Code_of_Ethics. Health information. ACSM’s Resources for the Personal Trainer. Eichner ER. Blissmer B.acsm. musculoskeletal.microsoft. National Institute of Health [Internet]. 203 p. Occupational outlook handbook. American Available from: www. Peterson JA.acsm. Exercise is Medicine certification. National Physical Activity Plan Web site [Internet]. The Guide to Community Preventive Services. ACSM’s Guidelines for Exercise Testing and 34. [cited 2011 Sep 22]. National Institute of Health [Internet]. American College of Sports 29. Relaxation technique for training. [cited 2011 Sep 22]. [cited 2012 Mar 4]. Diseases and conditions. Chicago newsletters/fit-society-page (IL): Academy of Nutrition and Dietetics. 7th ed. et al. Ratamess NA. senior editor. [cited 2011 Sep 22]. Baltimore (MD): fact-sheets/brochures Lippincott Williams & Wilkins.41(3):687–708.eatright.acsm. Promoting physical activity. American College of Sports Medicine [Internet]. 2011. information/brochures-fact-sheets/fact-sheets 3. Available from: http:// 23. Available from: http://www.edu/owl/resource/747/02/ Medicine [Internet]. et al. [cited 2012 Mar 4]. Available from: http://office 10. Perform Better. Available from: http://www. Available from: 8.gov/see_all_topics. for developing and maintaining cardiorespiratory. American Med Sci Sports Exerc.acsm. [cited 2012 Mar 4]. The Guide to Community . American College of Sports http://owl. . Progressive models in resistance 35. Mayo Clinic.41(2):459–71. health top- Sports Medicine position stand. American College of Sports Medicine. Office [Internet].htm 27. Active aging partnerships. Jakicic JM.org/access-public-information/brochures. Blair SN. Manore MM. American College of Sports Medicine. Available from: http://www. Exercise is Medicine.43(7):1334–59. Swain DP.bls renewing your ACSM certification. [cited 2011 Sep 22]. . Helpguide [Internet]. 2014. 2011. [cited 2012 Mar 4]. Haskell WL. 2009. Available from: ACSM certification/renewal form. Bushman BA.html College of Sports Medicine. Available from: http://www. American College of Sports Medicine. journals 22. et al. CPT 1. Med Sci in Sports Exerc.acsm. Perform Sports Medicine position stand. [cited 2012 Mar 4]. [cited Wilkins. [cited 2012 Mar 4]. Sawka MN. The female athlete triad. aged 50 and older. Lee IM. 52 CERTIFICATION REVIEW • www. American College of 30. College of Sports Medicine [Internet]. 2009. MLA In-Text Citations: the basics. Segal R. Health information.aspx 11. ACSM Risk Clinic [Internet]. Deschenes MR. 407 p. Community guide [cited 2011 Sep 22].com/index. ACSM’s Health/Fitness fact sheet. 2007. Available from: http://www. 5. Available from: http://www adults. Additional resources. ACSM brochures.cfm 12. Kinetics.39(2):377–90. Pate RR.org/resources.nih. American College of Sports Medicine. et al. ACSM’s Resource Manual for Guidelines from: http://www.org/pa/index. Certified personal trainer [Internet]. President’s Council on Fitness.org/acsm-certified-personal-trainer Preventive Services [Internet].physicalactivityplan.org/access-public. American College of Sports Medicine position stand.com/en-us/excel-help/manage-your-personal-budget- 4th ed. 2012 Mar 4]. Baltimore (MD): Lippincott Williams & Wilkins. Available from: http://health. 13. Available 18. Available from: http://certification. American Red Cross.org REFERENCES ACSM REFERENCES: 17. forms. Manage your personal budget with Excel. 21. Mayo 9. Participant Manual. Pescatello LS. Available Med Sci Sports Exerc. editor. 9th ed. [cited 2011 Sep 22]. Yardley (PA): Staywell. 2007. Med Sci Sports Exerc. Philadelphia (PA): Lippincott Williams & President’s Council on Fitness. Bureau of Labor Statistics 6.com/health-information/ Strategies. 181 p.purdue. Code of ethics of American http://www.39(8):1423–34.mayoclinic. Science edu- prescribing exercise. New York (NY): KettleBell [Internet]. from: http://www.gov/oco/ocos296. Certified personal trainer medicine.acsm. 2014.english. Columbia College of Sports Medicine and the American Heart Association. Avail. stress relief.perform Sports Exerc. htm Americans.S. Department of Health & Human Services. Family educational rights and relaxation. U. Stoppler MC. Department of Education [Internet].webmd. Department of Health & Human Services.S. Available from: http://www. U. U. U.html 4]. Department of Education.org/mental/stress_relief_meditation_yoga_ 41.hhs 39. [cited 2012 Mar 4].S.ed.com/ DietaryGuidelines. 43. 45.S. Theraband exercises.Available from: http://www [cited 2012 Mar 4]. Healthy living A–Z.com/a-to-z-guides/healthy- 40. [cited 2012 Mar 4]. U. [cited 2012 Mar .gov/ [cited 2012 Mar 4].choosemyplate 44.gov/offices/OM/fpco/ferpa/index MedicineNet [Internet]. Available from: http://www. Available from: http://www HIPPA privacy rule.thera-bandacademy. USDA center for nutrition policy . [cited 2011 Sep 22].S. Available from: http://www.S.cnpp.S. . emy [Internet]. Department of Agriculture. Available from: http:// . Mar 4]. U.gov/index. Available from: http://www.pdf [cited 2011 Sep 26]. U. Health information CPT 37. privacy.S. editor. Copyright Office Web site [Internet]. USDA dietary guidelines for living/default. Thera-Band Academy.html www.hhs. U. [cited 2012 Mar 4]. WebMD [Internet]. United States Department of Agriculture [Internet]. WebMD [Internet].htm privacy act. Washington (DC): U. WebMD.htm balance/stress-management/stress-management-relieving-stress Dwyer_Part1_Sec2.medicinenet. [cited 2012 36.htm 42.com/stress_management_techniques/page3. Sheil WC. Thera-Band Acad.indd 53 11/07/12 8:18 PM . Department of Agriculture.gov/ocr/ . U.gov/ [Internet].gov/ocr/privacy/hipaa/understanding/summary/privacysummary and promotion. United States Department of Agriculture [Internet]. Available from: www2. Summary of the Copyright Office.usda.copyright.S. Stress management health center. Department of Health & Human Services [Internet]. Available from: http://www.S.webmd. SECTION 2 CPT Job Task Analysis 53 from: http://helpguide. Department of Health & Human Services . Available from: http://www. [cited 2011 Sep 26].com/ privacy/ 38. Stress management techniques. WebMD. Dwyer_Part1_Sec2.indd 54 11/07/12 8:18 PM . groups increases the risk of low back pain? A) Acute exposure to the cold A) Quadriceps B) Hypothermia B) Hamstrings C) Heat exhaustion and heat stroke C) Hip flexors D) Acute altitude sickness D) Gluteus maximus 12. phosphorus. SECTION 3 CPT Examination CPT DIRECTIONS: Each of the numbered items or incom. 7. Which of the following stages define people having 4. Uncoordinated gait. Calcium. and elevated body temperature are signs and 5. Which of the following represents more than 90% the greatest risk of relapse? of the fat stored in the body and is composed of a A) Precontemplation glycerol molecule connected to three fatty acids? B) Contemplation A) Phospholipids C) Preparation B) Cholesterol D) Action C) Triglycerides (TG) D) Free fatty acids 11. potassium. vomiting. the elbow flexed at 90 degrees . A personal trainer fails to spot a client performing C) Skiing heavy incline dumbbell presses and the client D) Water exercise injures himself when the dumbbell is dropped on his face. headache. Which of the following medications is designed to ings would characterize hypertension in the adult? modify blood cholesterol levels? A) 100/60 mm Hg A) Nitrates B) 110/70 mm Hg B) ␤-blockers C) 120/80 mm Hg C) Antihyperlipidemics D) 140/90 mm Hg D) Aspirin 10. dizziness. Which of the following blood pressure (BP) read- 3. Which of the following terms represents an plete statements in this section is followed by answers imaginary horizontal plane passing through the or by completions of the statement. In which stage of motivational readiness is a person priate type of negligence displayed in this scenario? who is an irregular exerciser? A) Admission A) Precontemplation B) Commission B) Contemplation C) Omission C) Preparation D) Legal D) Action 9. and chloride are examples of .indd 55 11/05/12 9:59 PM . Which of the following exercise modes B) Frontal allows buoyancy to reduce the potential for C) Transverse musculoskeletal injury? D) Superior A) Cycling B) Walking 8. and lower portions? A) Sagittal 1. sulfur. Limited flexibility of which of the following muscle symptoms of . magnesium. Select the ONE midsection of the body and dividing it into upper lettered answer or completion that is BEST in each case. A) Adducts the ulna A) Macrominerals B) Internally rotates the radius B) Microminerals C) Internally rotates the humerus C) Proteins D) Flexes the ulna D) Vitamins 55 Dwyer_Part1_Sec3. Moving the hand from palm up to palm down with 6. sodium. Which of the following identify the appro- 2. When using the original Borg scale (6–20) for the D) 200 W general public. A) 7 and 10 A) Percentage body fat B) 12 and 16 B) Body composition C) 17 and 18 C) Body mass index (BMI) D) 19 and 20 D) Weight-to-waist circumference ratio 22. current smoker. BMI ⬍28 D) Decreased maximal heart rate D) HDL ⬎60 mg ⭈ dL⫺1. fasting blood glucose ⬎100 18. Which of the following water-soluble vitamins must bone porosity and fragility? be consumed on a daily basis? A) Osteoarthritis A) Vitamins A and C B) Osteomyelitis B) Vitamins A. exercise intensity should be main- 14. Rotation of the anterior surface of a bone toward 15. material incentives. and K C) Epiphyseal osteomyelitis C) Vitamins B complex and C D) Osteoporosis D) Vitamins A. current smoker. Which of the following health history combinations D) Setting goals would place an individual into the MODERATE- 17. Regular exercise will result in what chronic adapta- tion in cardiac output (CO) during exercise at the 25. and 3 g of protein? B) Lateral rotation A) 161 kcal C) Supination B) 168 kcal D) Pronation C) 177 kcal 23. D. can be reported as . female temperature? waist-to-hip ratio ⬍0.86 A) Decreased maximal oxygen uptake B) HDL ⬎60 mg ⭈ dL⫺1.0 kp? Assume analyzed examine .acsm. Relative proportions of fat and fat-free (lean) tissue tained between . Which of the following conditions is characterized by a decrease in bone mass and density. and use of specific contingency contracts are A) ⬍200 mg ⭈ dL⫺1 examples of . At what level is high-density lipoprotein (HDL) D) 193 kcal considered a risk factor in the development of car- 16. contains 5 g of fat. How many calories are contained in a food bar that the midline of the body is called . current smoker.indd 56 11/05/12 9:59 PM . Which physiologic response(s) would be expected RISK category for coronary artery disease (CAD)? to occur under conditions of high ambient A) HDL ⬍50 mg ⭈ dL⫺1. What could be an alternative to the contraindi- same workload? cated. high-risk yoga plough (supine legs overhead) A) Increase exercise? B) Decrease A) Squats to 90 degrees C) No change B) Flexion with rotation D) Increase during dynamic exercise only C) Double knee to chest D) Lateral neck stretches 19. that one revolution of the cycle ergometer flywheel A) Incomes CPT is 6 m long. and K Dwyer_Part1_Sec3. self. 56 CERTIFICATION REVIEW • www. What is a subject’s work rate in watts if he pedals 20. B) Outcomes A) 10 W C) Client progress notes B) 50 W D) Attendance records C) 100 W 21. Studies designed to measure the success of a pro- on a Monark cycle ergometer at 50 revolutions per gram based on some quantifiable data that can be minute (RPM) at a resistance of 2. B complex. diovascular disease? praise. producing 26. male B) Decreased heart rate at rest waist girth ⬎102 cm C) Increased heart rate at submaximal workload C) HDL ⬍40 mg ⭈ dL⫺1. B) ⬍110 mg ⭈ dL⫺1 A) Shaping C) ⬍60 mg ⭈ dL⫺1 B) Reinforcement D) ⬍40 mg ⭈ dL⫺1 C) Antecedent control 24. E. current smoker. 30 g of carbohydrates including A) Medial rotation 4 g of fiber.org 13. Verbal encouragement. D. HR can be measured by counting the number of C) Proprioceptive neuromuscular facilitation (PNF) pulses in a specified time period at one of several D) All of the above locations. Which of the following components of the exercise D) Graded exercise test (GXT) prescription work inversely with each other? A) Intensity and duration 31. . and typically requires a partner? D) All of the above A) Static B) Ballistic 32. which of the following items should be C) Mode and duration addressed? D) Mode and frequency A) Hospital emergency room contact information B) Cardiopulmonary resuscitation (CPR) training 37. making it too difficult to count at the 39. Which of the following risk factors for the develop- ment of CAD has the greatest likelihood of being 29. Information gathered by way of an appropriate A) CPR and American College of Sports Medicine health screening allows the personal trainer to de- (ACSM) Certified Personal Trainer (CPT) velop specific exercise programs that are appropri- B) Advanced cardiac life support and ACSM ate to the individual needs and goals of the client. because the thumb has its own pulse. Failure of a CPT to perform in a generally when taking the carotid pulse? acceptable standard is called . including the radial and carotid arteries. B) Cholesterol A) Management of programs or interventions C) Type 1 diabetes B) Application of cognitive-behavioral or D) Hypertension motivational principles C) Measurement 35. psychological influenced by regular exercise? theories provide a conceptual framework for A) Smoking assessment and . SECTION 3 CPT Examination 57 27. What is angina pectoris? likelihood of overuse injuries of bone. A) Discomfort associated with myocardial ischemia D) Children with exercise-induced asthma are B) Discomfort associated with hypertension often unable to lead active lives. psychological benefits of regular exercise in the A) Exercise programs should increase physical elderly? fitness in the short term and strength and A) Self-concept power in the long term. C) Advanced cardiac life support and ACSM A) Physical Activity Readiness Questionnaire Clinical Exercise Specialist (PAR-Q) D) Only physicians can perform fitness assessments. When exercise training children. To determine program effectiveness.indd 57 11/05/12 9:59 PM . C) 1 mo D) The HR should never be taken at the carotid D) 3–6 mo artery. Dwyer_Part1_Sec3. CPT B) Life satisfaction B) Strength training should be avoided for safety C) Stimulate appetite reasons. C) If the HR is taken at the carotid artery. B) Heart rate (HR) C) Exercise prescription 36. is time con- C) Emergency plan suming. A) When the HR is measured by palpation. professionals performing fitness as- D) All of the above sessments on others should possess which combi- nation of the following? 30. To maximize safety during a physical fitness B) Mode and intensity assessment. D) Self-efficacy C) Increasing the rate of training intensity more than approximately 10% per week increases the 28. program are likely to stop within . Which of the following is NOT true regarding the 33. Most sedentary people who begin an exercise carotid artery. At minimum. C) Negligence B) HR taken during exercise sometimes exceed D) None of the above 200 bpm. do not A) 1–2 d press too hard or a reflex slowing of the heart B) 3–6 wk can occur and cause dizziness. the A) Malpractice first two fingers should be used and not the B) Malfeasance thumb. Health Fitness Specialist (HFS) This is called the . Which of the following is a special precaution 38. Which of the following types of muscle stretching of the assessment administrator can cause residual muscle soreness. C) Discomfort associated with heartburn D) Discomfort associated with papillary necrosis 34. muscle fibers A) Flexibility of equipment to allow for different D) Myogenic precursor cell inhibition body sizes B) Ability of equipment to restrict range of motion 48. and muscular fitness an example of an . After 30 yr of age. Reasons for fitness testing of the older adult 46. flexibility. Feeling good about being able to perform an operator and the personal trainer activity or skill. 43. duration of 20–60 min. The ACSM recommendation for intensity. releases. A) Is a legal document A) Intensity of 60%–90% maximal heart rate B) Provides immunity from prosecution (HRmax). apparently healthy individuals includes . B) Shin splints A) Plyometrics C) Sleep deprivation B) Periodization D) Decreased physical conditioning C) Supersets D) Isotonic reversals 52. C) Affordability of equipment to allow for A) There is a perceived threat of disease. duration of 50. A measure of muscular endurance is . rearrangement D) Internal motivation outweighs external circumstances. such as finally being able to run a D) Body composition. and frequency of 5 d a week C) Number of curl-ups in 1 min D) Intensity of 60%–90% HRmax reserve. The informed consent document . what can occur? tendons followed immediately by an explosive A) An overuse injury concentric contraction is called . consent forms? A) Evaluation of progress A) To inform the client of participation risks. If a client exercises too much without rest days or 44. as B) Exercise prescription well as the rights of the client and the facility CPT C) Motivation B) To inform the client what he or she can and D) All of the above cannot do in the facility C) To define the relationship between the facility 41. The ACSM recommends that exercise intensity be prescribed within what percentage of oxygen 45. The Health Belief Model assumes that people will (ROM) engage in a behavior. changing out equipment periodically B) External motivation is provided. A method of strength and power training that develops a minor injury and does not allow time involves an eccentric loading of muscles and for the injury to heal. duration of B) Three-repetition maximum 15–45 min. skeletal muscle strength begins B) Intrinsic reward to decline. A) Extrinsic reward 47. 30 min. An important safety consideration for exercise C) A loss of muscle mass caused by a loss of equipment in a fitness center includes . and frequency of 7 d a week 51. What is the purpose of agreements. D) Mobility of equipment to allow for easy C) Optimal environmental conditions are met.acsm. primarily because of which of the C) External stimulus following? D) Internal stimulus A) A gain in fat tissue B) A gain in lean tissue 42. cardiorespiratory mile or to increase the speed of walking a mile. and frequency of 3 d a week A) One repetition maximum C) Intensity of 50%–70% HRmax. and include . 58 CERTIFICATION REVIEW • www. duration D) Number of curl-ups in 3 min of 20–60 min.indd 58 11/05/12 9:59 PM . duration. and frequency of cardiorespiratory exercise for 49. when .org 40. and frequency C) Provides an explanation of the test to the client of 3–5 d a week D) Legally protects the rights of the client B) Intensity of 85%–90% HRmax. is fitness. such as exercise. Which of the following personnel is responsible for uptake reserve (V̇O2maxR) range? program design as well as implementation of that A) 30% and 50% program? B) 50% and 70% A) Administrative assistant C) 40%–60% and 89% B) Personal trainer D) 75% and 100% C) Manager or director D) Health fitness specialist Dwyer_Part1_Sec3. Identify the appropriate self-directed evaluation time line. lower intensity.3–4 kg) from .5 kg) A) Shorter duration. and higher the consequences are severe and feel personally frequency of exercise vulnerable? D) Shorter duration. SECTION 3 CPT Examination 59 53. Implementing emergency procedures must include D) All of the above the fitness center’s . and allocation of resources to tool used as a quick health screening before each goal? beginning any exercise program. which of the following C) Clients would be categorized under the cognitive process D) Management and staff of the Transtheoretical Model? A) Stimulus control 62. Which of the following are changes seen as a result and cardiorespiratory fitness of regular chronic exercise? C) Body composition. higher intensity. low-fit or sedentary persons may benefit B) 5–8 lb ⭈ wk⫺1 (2. Which of the following is a possible medical B) Reinforcement management emergency that a client can experience during C) Self-reevaluation an exercise session? D) Self-liberation A) Hypoglycemia B) Hypotension 56. and higher D) 10–15 lb ⭈ wk⫺1 (4. identifies the steps needed to achieve the goals. the ACSM recommends weight loss of D) All of the above approximately . and gives the 59. Fitness assessment is an important aspect of the C) Hyperglycemia training program because it provides information D) All of the above for which of the following? A) Developing the exercise prescription 63. In commercial settings. C) 8–10 lb ⭈ wk⫺1 (4–4.and long-term goals. cardiorespiratory fitness.5–7 kg) frequency of exercise B) Longer duration. 54. What is the planning tool that addresses the D) Stages of Motivational Readiness organization’s short. muscular fitness. Generally. and muscular fitness B) Flexibility. The ACSM recommends how many repetitions 60. clients should be more B) Evaluating proper nutritional choices extensively screened for potential health risks.indd 59 11/05/12 9:59 PM .5–1 kg) 64. B) Health Belief Model C) Transtheoretical Model 65. body composition. higher intensity. higher intensity. Identify the CPT B) 8–12 reps recommended order of administration. and lower A) Learning theories frequency of exercise. You have examined your patient’s health screening (reps) of each exercise for muscular strength and documents and obtained physiologic resting endurance? measurements and you decide to proceed with a A) 5–6 reps single session of fitness assessments. C) 12–20 reps A) Flexibility. and higher 58. A) Management 55. While assessing the behavioral changes associated B) Staff with an exercise program. Which of the following assumes that a person will frequency of exercise adopt appropriate health behaviors if he or she feels C) Shorter duration. For individuals undertaking nonmedically B) Present medical status supervised weight loss initiatives to reduce energy C) Medication intake. priority. C) Diagnosing musculoskeletal injury The information solicited should include which of D) Developing appropriate billing categories the following? A) Personal medical history 57. A) 1–2 lb ⭈ wk⫺1 (0. A) Financial plan A) Minnesota Multiphasic Personality Inventory B) Strategic plan (MMPI) C) Risk management plan B) Ratings of Perceived Exertion (RPE-Borg scale) D) Marketing plan C) PAR-Q D) Exercise Electrocardiogram (E-ECG) Dwyer_Part1_Sec3. cardiorespiratory fitness. and flexibility B) Increased stroke volume at rest C) No change in CO at rest 61. body D) More than 20 reps composition. A) Decreased HR at rest muscular fitness. 78. Adults age physiologically at individual rates. Special considerations should be given to D) Primary curve the older adult when giving a fitness test because: A) Age may be accompanied by deconditioning 69. and sedentary lifestyle D) Tobacco smoking. and tobacco smoking A) A higher HR B) Homocysteine.indd 60 11/05/12 9:59 PM . such as coronary heart disease. An increase in both systolic BP (SBP) and diastolic and homocysteine BP (DBP) at rest and during exercise often accompa- nies aging. Many of the major health organizations in the United A) Increased arterial compliance and decreased States recommend a minimum of min of phys- arterial stiffness ical activity on most days of the week to achieve sig- B) Decreased arterial compliance and increased nificant health benefits and protection from chronic arterial stiffness diseases.org 66. swimming will result include . protecting organs and 73. Which of the following is an example of increasing tissues. 72. dyslipidemia. Which of the following will increase stability? and disease A) Lowering the center of gravity B) Age automatically predisposes the older adult B) Raising the center of gravity to clinical depression and neurologic diseases C) Decreasing the base of support C) The older adult cannot be physically stressed D) Moving the center of gravity farther from the beyond 75% of age-adjusted maximum heart rate edge of the base of support D) The older adult is not as motivated to exercise 70. A) Lordosis Therefore. the same. Which of the following is considered an abnormal D) Shy participant curve of the spine with lateral deviation of the vertebral column in the frontal plane? 75. Compared with running. and gender C) A lower CO C) Obesity.acsm. likely weak when slapping of the foot occurs during 76. Which of the following adaptations would NOT heel strike and/or increased knee and hip flexion be expected to occur as a result of long-term during swing are observed in running? aerobic training? A) Gluteus medius and minimus A) Decrease in resting HR (HRrest) B) Quadriceps femoris B) Increase in resting stroke volume C) Plantarflexors C) Increase in resting CO D) Dorsiflexors D) Increase in HRmax 71. Modifiable primary risk factors for CAD 77. Establishing specific expectations of what you are when moving from the right atrium to the right willing to do as a counselor and staying focused on ventricle? exercise and physical activity issues and behavioral A) Bicuspid valve skills related to exercise are strategies for handling B) Tricuspid valve which type of participant? C) Pulmonic valve A) Dissatisfied participant D) Aortic valve B) Needy participant C) Hostile participant 68. C-reactive B) A lower HR protein. Through which valve in the heart does blood flow 74. in even if exercise intensity is A) Hypertension. adults of any specified age will vary B) Scoliosis widely in their physiologic responses to exercise C) Kyphosis testing. tobacco D) A higher CO smoking. 60 CERTIFICATION REVIEW • www. diabetes mellitus (DM). advancing age. and providing support for the body are all self-efficacy by setting several short-term goals to functions of what tissue? attain a long-term goal? A) Collagen A) An application of cognitive-behavioral principles CPT B) Muscle B) Shaping C) Tendon C) A component of antecedent control D) Bones D) An explanatory theory 67. Producing red blood cells. dyslipidemia. lipoprotein (a). hypertension. C) Decrease in both arterial compliance and A) 30 arterial stiffness B) 60 D) Increase in both arterial compliance and C) 10 arterial stiffness D) 90 Dwyer_Part1_Sec3. Which of the following muscle groups is most as a younger person. BP usually increases because of . Based on his or greater strength gains compared with older CAD risk stratification. needs to be protected. Which of the following statements about A) Maximal assessment of cardiorespiratory fitness confidentiality is NOT correct? without a physician supervising A) All records must be kept by the program B) Submaximal assessment of cardiorespiratory director/manager under lock and key.g. address which of the following? A) Decreased TG and increased HDL A) Injury prevention B) Decreased total cholesterol and low-density B) Basic principles for exercise training lipoproteins (LDL) C) Metabolic calculations C) Decreased HDL and increased LDL D) Common exercise scenarios D) Decreased total cholesterol and increased HDL Dwyer_Part1_Sec3. SECTION 3 CPT Examination 61 79. deliver. 80. and use oxygen B) Include the costs to operate a program C) The ability to sustain a held maximal force or C) Are not necessary with fitness programs to continue repeated submaximal contractions D) Are included as part of the balance sheet in D) The functional ROM about a joint financial reports 90. (measured over 6 wk) of 132/86 mm Hg and a total D) Younger men and women demonstrate similar serum cholesterol of 5. The definition of cardiorespiratory fitness is . The amount of blood ejected from the heart per 81. fitness without a physician supervising B) Data must be available to all individuals who C) Vigorous exercise without a prior medical need to see it. tivities is appropriate? 82. In response to regular resistance training. assessment C) Data should be kept on file for at least 1 yr D) Vigorous exercise without a prior physician- before being discarded. B) No changes in the quality of life but an A) Nuclei increase in longevity B) Mitochondria C) Increased longevity but a loss of bone mass C) Myosin D) Loss of bone mass with a concomitant increase D) Sarcoplasmic reticulum in bone density 87. A male client is 42 yr old. participant’s name) 89. Emergency procedures and safety planning should blood lipids include . The primary effects of chronic exercise training on 84.indd 61 11/05/12 9:59 PM . and tissue metabolic facility expense systems to take in. which of the following ac- persons. blood A) Include the costs of equipment and building or vessels. Within a skeletal muscle fiber. CPT B) Osteoporosis B) Do not restrain the person but be sure that he C) Arthritis or she is in a safe area. Which of the following is a result of an older D) Ignore the person and allow the seizure to pass. 88. supervised exercise test D) Sensitive information (e. A) The maximal force that a muscle or muscle 83. Which of the following statements best describes group can generate in a single effort capital budgets? B) The coordinated capacity of the heart.4 mmol ⭈ L⫺1. A) Older men and women demonstrate similar A) Stroke volume or even greater strength gains when compared B) HR with younger individuals.. . respiratory system. C) CO B) Younger men have greater gains in strength D) End-diastolic volume than older men. He has a consistent resting BP than older women. person participating in an exercise program? A) Overall improvement in the quality of life 86. minute is referred to as . large amounts of and increased independence calcium are stored in the . What is the most appropriate action in assisting a progressive decline in bone mineral density and person having a seizure? calcium content in postmenopausal women? A) Hold the person down so that he or she does A) Osteoarthritis not hurt himself or herself. Which condition is commonly associated with a 85. D) Epiphysitis C) Place a wedge in the person’s mouth so that he or she does not swallow the tongue. His father died of a heart C) Younger women have greater gains in strength attack at age 62 yr. acsm. on evalu.0 lb C) Monitoring for arrhythmias in a person taking C) 26. B) The informed consent does not provide legal C) The potential for improving flexibility may be immunity to a facility or individual in the improved during cool-down as compared with event of injury to an individual. A) Infarction A) There is a perceived threat of disease. You B) 6 lb also notice that he is beginning to use accessory C) 11 lb muscles to substitute movements and to compen. C) Negligence. D) Only A and B of the above.9 lb maneuver B) 12. their level of daily activity. rate reserve [HRR]). A 35-yr-old woman reduced her caloric intake by A) Avoiding muscle strengthening exercises that 1. These symptoms may indicate . D) Between 1 and 2 min are recommended for an inadequate personnel qualifications. The metabolic syndrome includes dyslipidemia. How much weight will she lose involve low resistance in 26 wk? B) Avoiding activities that involve the Valsalva A) 8. consent. CPT B) Angina B) There is the belief of susceptibility to disease.200 kcal ⭈ wk⫺1. during cool-down. Which of the following statements regarding C) Abdominal obesity cool-down is FALSE? D) 25. Which of the following is a FALSE statement performed at a low-to-moderate intensity. such as increasing demand and oxygen supply is known as . when . how much weight will she lose or DBP is ⬎115 mm Hg in 26 wk if she integrated a 1-mi walk three times 93.indd 62 11/05/12 9:59 PM . D) 15 lb sate. A) 3 lb ation. A) Shortening the cool-down to ⬍5 min D) The consent form does not relieve the facility B) Eliminating resistance training completely or individual of the responsibility to do C) Prolonging the cool-down everything possible to ensure the safety of D) Implementing high-intensity (⬎85% of heart the individual. elevated BP. From question 97. 97. improper test administration. 96. and what other B) Rotator cuff strain or impingement component? C) Angina A) Amenorrhea D) Advanced stages of multiple sclerosis B) Laxative use 94. decreased ROM and strength are noted. Special precautions for patients with hypertension include all of the following EXCEPT . insufficient safety procedures are all items 95. A personal trainer should modify exercise sessions that are expressly covered by the informed for participants with hypertension by . warm-up.0 BMI A) The emphasis should be large muscle activity 100. 99.3 lb D) Avoiding exercise if resting SBP is ⬎200 mm Hg 98.0 lb diuretics D) 34. 62 CERTIFICATION REVIEW • www. A 62-yr-old. The Health Belief Model assumes that people will dium resulting from an imbalance between oxygen engage in a given behavior. obese factory worker complains of pain per week into her weight loss program? in his right shoulder on arm abduction. short-duration intervals Dwyer_Part1_Sec3. C) Ischemia C) The risk of disease is nonthreatening to the D) Thrombosis individual. A) A referred pain from a herniated lumbar disk insulin resistance. regarding an informed consent? B) Increasing venous return should be a priority A) The informed consent is not a legal document. and adequate cool-down. 92. A transient deficiency of blood flow to the myocar.org 91. or more double bonds. decreasing CO. thereby body. and dance activity all an important role in assisting enzymes (or may be adapted for water. both an aero- and connective tissues as well as electrolytes bic stimulus as well as activity to enhance mus- in body fluids. and chlo- for or irregularly exercising. voluntary act (commission). and angina pectoris). dividing it into front and back making the blood less “sticky. each individual plane is perpendicular to tensives (used to reduce BP by inhibiting the the other two. Transverse (used to reduce chest pain associated with The body has three cardinal planes. 5—B. the trainer failed to spot (omission) the client. Omission glycerol molecule connected to three fatty acid Negligence is a failure to conform one’s conduct molecules. imaginary vertical plane passing through Aspirin helps lower blood platelet coagulation the body. TG the midsection of the body and dividing it into Dietary fats include TG. sodium. and polyunsaturated fatty acids have two duty and of the consequences to the plaintiff. or microminerals (needed in very small of action represents a person who is currently amounts). The transverse plane represents an imaginary horizontal plane passing through 4—C. molybdenum. Hamstrings An adequate ROM or joint mobility is requisite 9—D. such as calcium. which resulted in injury. 3—C. 140/90 mm Hg for optimal musculoskeletal health. Preparation doses). hormones. mag- Preparation is an individual who is planning nesium. may even allow injured people an opportunity 6—A. properties of water. Various Minerals are inorganic substances that perform activities may be offered in a water-exercise various functions in the body. The fatty acids are identified by the to a generally accepted standard or duty. iodine. A TG is a 8—C. zinc. nese. copper. ␤-Blockers also are designed to plane is represented by an imaginary vertical reduce BP by inhibiting the action of adrenergic plane passing through the midline of the neurotransmitters at the ␤-receptors. especially cholesterol and LDL. cholesterol). Walking. sulfur. potassium. Activities that will enhance or Water exercise has gained in popularity because maintain musculoskeletal flexibility should CPT the buoyancy properties of water help to reduce be included as a part of a comprehensive the potential for musculoskeletal injury and preventive or rehabilitative exercise program. sterols (e. Macrominerals to exercise without further injury. Saturated fatty acids only have single bonds. phosphorus. Antihyperlipidemics control The frontal plane is represented by an blood lipids. Minerals are considered to be cular strength and endurance may be provided. or failure to act Monounsaturated fatty acids have one double (omission). Specifically. whereas the stage ride. and the midsagittal vasodilation). preferably Dwyer_Part1_Sec3. muscles. The sagittal plane divides the body ␤-receptor. Antihyperlipidemics Nitrates and nitroglycerine are antianginals 7—C.indd 63 11/05/12 9:59 PM . dividing it into right and left halves. Many play class.” halves. In this regard. To be classified as hypertensive. Gross amount of “saturation” or the number of single negligence (also referred to as reckless conduct or double bonds that link the carbon atoms. thereby promoting peripheral into right and left parts. In this situation. Water-exercise classes coenzymes) that are necessary for the proper typically should combine the benefits of the functioning of body systems. or willful/wanton conduct) is a conscious. and phospholipids. chromium. Water exercise and disability. and fluoride. either macrominerals (needed in relatively large 2—C. such as iron. ␤-Blockers are antihyper..g. in reckless disregard of the legal bond. manga- exercising. selenium. the SBP must limited flexibility of the low back and equal or exceed 140 mm Hg or the diastolic hamstring regions may relate to an increased pressure must equal or exceed 90 mm Hg as risk for development of chronic low back pain measured on two separate occasions. They also are buoyancy properties of water with the resistive found in cell membranes. upper and lower portions. SECTION 3 CPT Examination 63 CPT EXAMINATION ANSWERS AND EXPLANATIONS 1—D. TG represent more than 90% of the fat stored in the body. Movement occurs along these action of adrenergic neurotransmitters at the planes. jogging. acsm.0 kg. such as that which occurs when a breeze is bolic formula because it is asking for the subject’s created by running. and burnout is important for divide the work rate (kg ⭈ m ⭈ min⫺1) by 6. Work rate ⫽ CPT of relapse.0 kg ⫻ 30 m ⭈ min⫺1. It is are as follows: Write down the known values and necessary in the heat and humidity to become convert those values to the appropriate units — acclimated to the environment. Intrinsic 12—B. 10 W cooling and heat loss. midline of the body). Providing social support and praise are ⫽ 600 kg ⭈ m ⭈ min⫺1/6 the most important contributors to maintained ⫽ 10 activity. both intrinsic and extrinsic rewards. extension (the movement Compared with a cool and dry environment. vomiting. sickness. should be consequence for performing or not performing attempted. of abduction. The question asks for watts. Body composition refers to the relative proportions The exercise professional can emphasize that of fat and fat-free (lean) tissue in the body. the exercise prescription should lateral direction). 5 g ⫻ 9 kcal ⫽ 45 kcal from fat 11—C. Attempts to Reinforcement is the positive or negative rehydrate. If these conditions are present. The steps to answering this question unless the workload of activity is reduced. which may include articulating bones. Thus. Extrinsic or their long axis. Reinforcement exercise must be stopped. Action known values for the variable name: People in the action stage are at the greatest risk Work rate ⫽ 2. Positive consequences are rewards means possible. Angular movements decrease external rewards are the positive outcomes or increase the joint angle produced by the received from others. so exercise boredom. 16—B. sions and think they need to give it up. bad weather. This can include in the supine position with the feet elevated. decreases the joint angle. relapse situa- tions (e. therefore.org days apart. The four types of angular encouragement and praise or material movements are flexion (a movement that reinforcements such as T-shirts and money. the movement toward the Evaporation of sweat cools the skin. Heat loss by convection. 2. carbohydrates and it should not be used in dizziness. wiping away sweat would decrease evaporative 13—A. Planning for high-risk. 64 CERTIFICATION REVIEW • www.g. Heat exhaustion and heat stroke 3 g ⫻ 4 kcal ⫽ 12 kcal from protein Heat exhaustion and heat stroke are serious 26 g ⫻ 4 kcal ⫽ 104 kcal from carbohydrate conditions that result from a combination of the metabolic heat generated from exercise Total calories in the bar is 161 kcal. Internally rotates the radius rewards are the benefits gained because of the Rotation is a movement of long bones about rewarding nature of the activity. bringing the bones 17—C. Substitute the 10—D. An elevation of either the systolic or on a Monark cycle ergometer ⫽ 6 m). can be beneficial but not work rate. This question does not require the use of a meta. each is divided into the total body mass. The person should be placed that motivate behavior. Body composition increased demands on time) is also important. and elevated body determining calorie content of food.0 kp ⫽ diastolic pressure is classified as hypertension. accompanied by dehydration and electrolyte Fiber is a carbohydrate but. it will not 5 RPM ⫻ 6 m ⫽ 30 m ⭈ min⫺1 (each revolution occur by being sedentary. 14—B. temperature. 2. 161 kcal the “all-or-none” thinking sometimes typical of There are 4 kcal ⭈ g⫺1 of carbohydrate and people who have missed several exercise ses- protein and 9 kcal ⭈ g⫺1 of fat. Instruction about avoiding injury. determine the relative proportion of fat mass or fat- portunity and is not failure. Increased heart rate at submaximal workload closer together). Planning can help free mass.indd 64 11/05/12 9:59 PM . because it loss from sweating. Signs and symptoms is not absorbed. To a short lapse in activity can be a learning op. 60 kg ⭈ m ⭈ min⫺1. and adduction (the opposite be altered by lowering the work intensity. abduction (the movement workloads when exercising in the heat and hu- of a body part away from the midline in a midity. to develop coping strategies and to eliminate 15—A. there are no absorbable include uncoordinated gait. headache. opposite to flexion decreasing the joint angle a higher metabolic cost exists at submaximal between two bones).. Dwyer_Part1_Sec3. vacations. Write down the formula for work rate: Work rate ⫽ force ⫻ distance/time. and the body must be cooled by any a behavior. those who have recently begun an exercise pro- W ⫽ kg ⭈ m ⭈ min⫺1/6 gram. perhaps intravenously. hypercholester- thin-boned or petite. Outcomes can be very If a person has high serum HDL cholesterol helpful in marketing programs as well as in (⬎60 mg ⭈ dL⫺1). the sum of positive risk factors because high 21—B. Osteoporosis away from the midline is lateral rotation. respectively. Double knee to chest part of the participant. Risk factors for age-related bone relatives ⬍65 yr). women. primarily on the original Borg scale of 6–20. and inadequate Type 1 diabetes more than 15 yr or Type 2 dietary calcium intake. SECTION 3 CPT Examination 65 18—C. current smoker.2 mmol ⭈ L⫺1. rotation.indd 65 11/05/12 9:59 PM . A person success of a program in terms of quantifiable is placed in the moderate-risk category if he or measures (e. the rating of perceived Double knee to chest stretches are safe exertion (RPE) should be considered an alternative to the plough. subtract one risk factor from comparing one facility with another. because the person is performing the same 22—A. she has two or more major risk factors for CAD. or HDL ⬍35 mg ⭈ dL⫺1 or osteoporosis. producing bone porosity and fragility. Osteoporosis refers to a condition that is the forearm that results in the palm of the hand characterized by a decrease in bone mass and being directed backward (posteriorly). The RPE is particularly useful when neck rolls. sedentary lifestyle. Medial rotation amount of work and. responds with the Rotation is the turning of a bone around its CPT same CO. Squats to 90 degrees adjunct to HR measures. whereas rotation of the same bone 19—D. Dwyer_Part1_Sec3.9 mmol ⭈ L⫺1). of a program based on the outcome for a patient 24—C. however. diabetes in individuals older than 35 yr. Pronation clinicians to be an inevitable consequence of (the opposite of supination) is the rotation of aging. symptoms of. Although some learning is required on the 25—C. No change that will elicit an RPE within a range of 12–16 CO does not change significantly. BMI ⬍28 or client. ⬎45 yr. premature or surgically induced 0. level of change. susceptibility to fracture from minor trauma. 12 and 16 HDL levels decrease the risk of CAD. Outcome studies require quantifiable The low-risk category is asymptomatic and has data that can be analyzed — data that study the one or no major risk factor for CAD. density. ⬎55 yr). Other 20—B.g. having a low peak bone olemia (total cholesterol ⬎200 mg ⭈ dL⫺1 or mass at maturity. thus. Rotation of the anterior surface of the HR and higher stroke volume compared with bone toward the midline of the body is medial when the person was untrained. hyperten- loss and development of clinical osteoporosis sion (arterial BP ⬎140/90 mm Hg measured include being a white or Asian female. or known cardiac dis- age of clients who reach their goals are other ease. a family history of myocardial The age at which bone loss begins and the rate infarction (MI) or sudden death (male first- at which it occurs vary greatly between males degree relatives ⬍55 yr and female first-degree and females. that the own longitudinal axis or around another same CO is now being generated with a lower bone. bone loss is considered by most being turned forward (anteriorly). Every population that has been studied Supination is a specialized rotation of the exhibits a decline in bone mass with aging. It should be noted. HDL ⬍40 mg ⭈ dL⫺1. Outcomes risk factors contribute to the development of Outcomes are designed to measure the success CAD but are not primary risk factors. 23—D. Measuring client satisfaction. flexion with rotation is supine curl-ups with The ACSM recommends an exercise intensity flexion followed by rotation. Flexion with rotation is participants are incapable of monitoring their considered a contraindicated high-risk exercise pulse accurately or when medications such as and is not recommended. having a family history of 5. The RPE can be and lateral neck stretches are considered safe used as a reliable barometer of exercise alternative exercises to full squats and full intensity. A person in the high-risk category is someone length of time for change to occur. and metabolic disease. alcohol abuse and/or cigarette than 30 yr or in individuals who have had smoking. examples of outcomes. or percent- with signs. pulmonary disease. cigarette smoking. being on two separate occasions). An alternative to ␤-blockers alter the HR response to exercise. change in body composition). ⬍40 mg ⭈ dL⫺1 and it refers to the clinical condition of low Risk factors that contribute to the development bone mass and the accompanying increase in of CAD include age (men. and DM in individuals older menopause.. forearm that results in the palm of the hand Therefore. Application of cognitive-behavioral or lead to adoption of a physically active lifestyle motivational principles in the long term. Stimulate appetite should take place. A GXT sprouts. 66 CERTIFICATION REVIEW • www. All of the above as coenzymes in carbohydrate metabolism. Children who have maintenance. increase physical fitness in the short term and 29—B.indd 66 11/05/12 9:59 PM . The PAR-Q is a in citrus fruits. Theories provide a conceptual exercise-induced asthma often are physically framework for development.org 26—C. Angina-like symptoms often are programs for children and adolescents should felt in the chest area. and can be useful to measure the HR response. of programs or interventions. greater life satisfaction (older people who and posted emergency numbers. reported between the activity level of older 32—C. improved self-concept may occur and cause dizziness. of one announced and one unannounced drill. or physicians. posted emergency plans. brussel commonly used health screening tool. Hypertension program effectiveness. Within the field of behavioral Exercise has no effect on age and family change. exercise programs commonly report that they If HR is taken at the carotid artery. caused by ischemia. Strength training in youth Psychological theories are the foundation carries no greater risk of injury than compa- for effective use of strategies and techniques rable strength training programs in adults if of effective counseling and motivational proper instruction. of outcomes. not just measurement Regular exercise will decrease SBP and DBP. must be consumed for whom exercise is contraindicated. Vitamins C and B complex are can lead to identification of those individuals CPT water-soluble vitamins. emergency situations. exercise prescription. 27—C. without unwanted side effects). and than causing dizziness by pressing too hard. organ meats. parents. including a minimum and nucleic acid metabolism. reduced psychological stress (exercise is HR exceeding 200 bpm are no more difficult to effective in reducing psychological stress count at the carotid artery than at other sites. such as CPR happiness (strong correlations have been training. higher press too hard or a reflex slowing of the heart self-efficacy (older persons taking part in can occur and cause dizziness. cauliflower. Increasing the HR of training intensity more 28—A. health than sedentary persons). From on a regular basis. although some individuals variables and the behavior of interest. Contact exercise regularly have a more positive attitude information for the nearest hospital emergency toward their work and generally are in better room may be included in the emergency plan. and K and are stored in body fat after exercise leader or HFS with information that consumption. and excess amounts are that information. may choose to quit smoking after beginning Dwyer_Part1_Sec3. rather than unfit because of restriction of activity imposed management. Regularly scheduled practices of responses to metabolic pathways. Discomfort associated with myocardial ischemia than approximately 10% per week increases the Angina pectoris is a heart-related chest pain likelihood of overuse injuries of bone. a proper exercise prescription excreted. 33—C. Vitamins B complex and C 30—A. which is insufficient blood Increasing the rate of progression of training flow that results from a temporary or permanent more than approximately 10% per week is a reduction of blood flow in one or more coro- risk factor for overuse injuries of bone. a theory is a set of assumptions that history of heart disease and no direct effect on accounts for the relationships between certain cigarette smoking. Using the thumb and self-esteem (older adults improve their to count the carotid pulse may result in an inac- score on self-concept questionnaires following curate count. If the HR is taken at the carotid artery. D. E. Exercise nary arteries. Emergency plans should Older people who exercise regularly report include written. neck. PAR-Q Fat-soluble vitamins are composed of vitamins A well-designed health screening provides the A. broccoli. greater Maintenance of certifications. Psychological theories facilitate evaluation of 34—D. is an accepted professional practice. take care not can do everyday tasks more easily than before to press too hard or a reflex slowing of the heart they began exercising). or arm. and skill building for exercise adoption and supervision are provided. do not adults and self-reported happiness).acsm. Water-soluble vitamins are found also can be developed. but this is less of a safety concern participation in an exercise program). whole grain breads and cereals. by the child. shoulder. They serve as antioxidants as well 31—D. amino acid metabolism. simply a type of civil wrong. and then price. of progress. All of the above Similar improvements in aerobic fitness may be Fitness testing is conducted in older adults realized if a person exercises at a low intensity for the same reasons as in younger adults. the exercise setting. exercise but also rehabilitation. a partner typically is required. Exercise has no direct effect initiate exercise programs and. Static stretching is the most commonly a behavior. 3–6 mo increase HDL but it has limited influence on Most sedentary people are not motivated to total cholesterol. Intensity of 60%–90% HRmax. it is possible of the aerobic metabolic pathways also is that a person could be considered negligent. 40—D. Dwyer_Part1_Sec3. PNF stretching alternates contraction and relaxation of both 42—A. they are likely to stop within CPT loss and improve glucose tolerance for those 3–6 mo. the exercises These criteria include correct anatomic involved. considered together and are inversely related. Minimal rewarding nature of the activity. instructor–client relationship. procedures used by the staff. Positive consequences are rewards recommended approach to stretching. Fitness professionals have 20–60 min. A tort law is durability. and flexibility pieces involved in exercise testing. and the body sizes. participants in earlier with Type 2 diabetes. depends on the health and integrity of the ceed in reaching predetermined goals. Intrinsic point of individual discomfort and holding rewards are the benefits gained because of the that position for a period of 10–30 s. You must evaluate a Legal concerns can develop with the number of criteria when selecting equipment. such as listening to lectures and reading books 35—A. Negligence equipment to be used not only includes testing. It that motivate behavior. and circulatory systems. the managers and staff are obligated to meet a standard of care for exerciser safety. the purpose positioning. and education. professionals performing fitness in exercise. These movements can produce residual reinforcements such as T-shirts and money. and frequency of 3–5 d a week certain documented and understood responsi. Ballistic stretching uses repetitive received from others. emergency equipment. pool. if exercise on Type 1 diabetes but it can promote weight is initiated. 37—C. which may include bouncing-type movements to produce muscle encouragement and praise or material stretch. as reminders to exercise and developing social 36—A. Efficiency responsibilities are not followed. The ability to take in and to use oxygen bilities to ensure the client’s safety and to suc.indd 67 11/05/12 9:59 PM . for a longer duration or at a higher intensity including exercise prescription. Intrinsic reward Three different stretching techniques typically Reinforcement is the positive or negative are practiced and have associated risks and consequence for performing or not performing benefits. lungs. Extrinsic or risk of injury exists and it has been shown to external rewards are the positive outcomes be effective. Regular endurance exercise does 39—D. PNF 41—B. technique is effective but it can cause residual Creating a safe environment in which to muscle soreness and is time consuming. and program administration. CPR and ACSM CPT without the expectation of actually engaging At minimum. quality of design and materials. Intensity and duration support to help them establish a regular Intensity and duration of exercise must be exercise habit and be able to maintain it. and prescription. muscle soreness or acute injury. facilities and equipment for use by exercisers. In developing and operating the potential for injury exists when the partner. duration of accepted standard. evaluation for less time. and fitness facility. SECTION 3 CPT Examination 67 to exercise. Negligence is the failure to perform on the level of a generally 43—A. assisted stretching is applied too vigorously. locker room. motivation. whereas individuals in later stages assessments on others should possess CPR and depend more on behavioral techniques. Legal issues abound for fitness professionals cardiovascular. strength. This can include involves slowly stretching a muscle to the both intrinsic and extrinsic rewards. In general. Flexibility of equipment to allow for different agonist and antagonist muscle groups. necessary to optimize cardiorespiratory fitness. ability to adjust to different of the programs and exercises used. stages benefit most from cognitive strategies. If these heart. exercise is a primary responsibility for any Additionally. repair records. The 38—C. such ACSM CPT certification. This body sizes. 68 CERTIFICATION REVIEW • www. concentric (shortening) phase. The exercise prescription can by both the loss of muscle fibers and the be altered for different populations to achieve atrophy of the remaining fibers. back up to the starting position. It simply provides evidence that tal injury. A limitations associated with informed consent good manager monitors the safety of the pro. which. and risks associated with the health/fitness applications but may be appro- test or exercise program. the score is the total number of properly performed push- 47—C. and consents are docu. The concept of self- by an explosive concentric contraction. Plyometrics belief of susceptibility to disease and the threat Plyometrics is a method of strength and power of disease is severe. muscle fibers with no time limit).g. agreements and informed consents drafted by the body is lowered to the floor. intensity.acsm. and frequency of 3–5 d a week. The loss and mode or type of exercise. Negligence. The consent form priate for select athletic or performance needs. Maximal oxygen of strength with aging results primarily from a CPT uptake may improve between 5% and 30% loss of muscle mass. the participating in. documents. A loss of muscle mass caused by a loss of ups completed without a pause by the client. Provides an explanation of the test to the client controlled studies have shown no significant Informed consent is not a legal document. Manager or director the responsibility to do everything possible The characteristics of a good manager or to ensure the safety of the client. Number of curl-ups in 1 min 46—A. as Three common assessments for muscular well as the rights of the client and the facility endurance include the bench press. he or she is accepting some of upper body endurance (the client assumes a the responsibility and risk by participating in standardized beginning position with the body this program. The explosive nature of this type of a client nor does it legally protect the rights activity may increase the risk for musculoskele- of the client. duration of will engage in a behavior (e. in turn. for upper Agreements. duration. for by the client.indd 68 11/05/12 9:59 PM . healthy person. skeletal muscle strength for abdominal muscular endurance (the client begins to decline. However. strength loss directly to the frequency. All fitness facilities are strongly held rigid and supported by the hands and toes encouraged to have program or service for men and the hands and knees for women. However. This model also incorpo- training that involves an eccentric loading of rates cues to action as critical to adopting and muscles and tendons followed immediately maintaining behavior. usually is in the range of 30%–40%. the same results. Because of the who also purchases equipment and supplies. After 30 yr of age. exercise) when 20–60 min. This stretch-shortening cycle may allow an Motivation and environmental considerations enhanced generation of force during the are not a part of the Health Belief Model. is caused with training. director include designing programs and moni. does not relieve the facility or individual of 45—C. and the curl-up (crunch).. then pushed a lawyer for their protection. and the total number of lifts performed correctly and rights of the client and the facility. By 80 yr of age. Most well- 49—C. and insufficient safety she also guides the staff or clients through the procedures all are items that are not expressly program. the push-up. efficacy (confidence) is also added to this model. the loss of strength Dwyer_Part1_Sec3. If signed in time with the cadence). a practical resistance exercise alternative for procedures. body endurance (a weight is lifted in cadence ments that clearly describe what the client is with a metronome or other timing device. improper test administration. assess the success and value of the program. there exist a perceived threat of disease and a 44—A. difference in power improvement when com- It does not provide legal immunity to a paring plyometrics with high-intensity strength facility or individual in the event of injury to training. releases. legal counsel should be sought gram or facility and surveys clients and staff to during the development of the document. 50—C. There is a perceived threat of heart disease. inadequate toring the implementation of programs. Plyometrics should not be considered the client was made aware of the purposes.org The degree of improvement that may be is not linear. with most of the decline occurring expected in cardiorespiratory fitness relates after 50 yr of age. for an apparently 48—A. To inform the client of participation risks. He or personnel qualifications. the ACSM recommends an The Health Belief Model assumes that people intensity of 60%–90% HRmax. He or she is a good communicator covered by informed consent. the risks involved. it is recommended follow-up testing indicate progression toward that. in time with tility. 53—B. the metronome at a rate of 25 per minute done because the decline in HR is compensated for for 1 min. processes include five cognitive processes cise by increasing time. during moderate (or submaximal) Rosenstock. SECTION 3 CPT Examination 69 begins in the bent-knee sit-up with knees at 90 declines with regular exercise. out time for rest and recovery or develops a and social liberation) and five behavioral minor injury and does not reduce or change processes (counterconditioning. The ACSM recommends The purpose of the fitness assessment is that exercise intensity be prescribed within to develop a proper exercise prescription a range of 64%–70% and 94% of HRmax or (the data collected through appropriate fitness between 40%–60% and 89% of oxygen uptake assessments assist the HFS in developing safe.. it is possible to shape the desired again to see what change has occurred. duration. environmental reevaluation. intensity. and decreased intrinsic firing rate of the CPT apart. Lower intensities will elicit effective programs of exercise based on the a favorable response in individuals with very individual client’s current fitness status). 55—C. and then measure HRrest environment. helping that exercise allowing the injury to heal. Developing the exercise prescription intensity objectively. to low fitness levels. and individual goals. too quickly. A client exercises too much with. The ACSM recom. continued participation in an exercise program. Learning theories assume that exercise. fitness level.indd 69 11/05/12 9:59 PM . All of the above work to help explain and predict interven- The effects of regular (chronic) exercise can tions to increase physical activity. The Health Belief Model is a theoretical frame- 54—D. Little or no change occurs in CO at rest.000 kcal ⭈ d⫺1. probably degrees. reinforcement management. 10–15) that can be performed with a dietary regimen in an attempt to create at a moderate rep duration (⬃3 s concentric. self-liberation. Factors to consider when ments provide information needed to develop determining appropriate exercise intensity reasonable. an actual HRmax from fitness goals). medications. Stroke volume increases at rest client performs slow. and stimulus control). 8–10. the arms at the side. Dwyer_Part1_Sec3. attainable goals). and Choose a range of reps between 3 and 20 duration must be manipulated in conjunction (i. HRrest behavior. 1–2 lb ⭈ wk⫺1 (0. A second piece of tape is placed 10-cm tone. 52—C. self-reevaluation. Frequency.e. Progress toward include age. train the person for several partial behaviors and modifying cues in the weeks or months. By reinforcing individual’s HRrest. Because of the variability in evaluate the rate of progress (baseline and estimating HRmax from age. An overuse injury Key components of the Transtheoretical Model Overuse injuries become more common when are the processes of behavioral change. The model be classified or grouped into those that occur originated in the 1950s based on work by at rest. OR set a metronome to 50 bpm and the sinoatrial node. These people participate in more cardiovascular exer. 40%–60% and 89% Several methods are available to define exercise 56—A. you can measure an untrained many small simple behaviors. and palms facing because of a combination of decreased down with middle fingers touching masking sympathetic tone. controlled curl-ups to as a result of increased time for ventricular lift the shoulder blades off the mat with the filling and an increased myocardial contrac- trunk making a 30-degree angle. reserve (V̇O2maxR). 1–2 lb ⭈ wk⫺1. overall or attainment of a goal is a strong motivator for health status. fitness level. Health Belief Model consecutive days per week. recommended maximal rate for weight loss is assessment. Self-reevaluation 51—A. 3–5. and to motivate (fitness assess- a GXT be used. curl-ups as possible in 1 min). and during maximal effort work. or intensity (consciousness raising. dramatic relief. a caloric deficit of 500–1. whenever possible. The ⬃3 s eccentric) based on age. an overall complex behavior arises from For example. and ability. mends exercising each muscle group 2–3 non- 58—B. OR the client performs as many by the increase in stroke volume. increased parasympathetic tape.5–1 kg) The ACSM recommends that one set of The goal of the exercise component of a weight 8–12 reps of each exercise should be performed reduction program should be to maximize to volitional fatigue for healthy individuals. relationships. 8–12 57—A. caloric expenditure. The MMPI is a psycho. In addition. and then to the lungs to be or compound fractures. lower intensity. Individual goals. Bones respiratory fitness testing. because the elevated The bones of the skeletal system act as levers HR from those assessments may. and intensity. axial skeleton forms the longitudinal axis of Implementing emergency procedures is an the body and it supports and protects organs important part of the training of the staff. 70 CERTIFICATION REVIEW • www. bronchospasm.g. Some tests of mus- within the overall strategic plan. the fitness center management and 67—B. may benefit from multiple short-duration. sedentary persons or those with poor fitness 60—C. and flexibility low-intensity exercise sessions per day. All of the above having only two cusps. The PAR-Q is a screening tool for self-directed present medical status should be examined and exercise programming. muscular fitness. body composition. and higher exercise or during an exercise test. Assessing cardiorespiratory fitness marketing plans only address subsegments often uses measures of HR. hyperglycemia. or flaps. a personal then out to the systemic circulation. through the pulmonary semilunar valve to the fainting.acsm. Shorter duration. seizures. leaving the LV will pass through the aortic clients should be screened more extensively for semilunar valve to the ascending aorta and potential health risks. of which it cardiac symptoms. and assessment. muscular fitness. questions asked regarding the use of medica- logical scale. safe for the body through their arrangement in the and effective management of the situation axial and appendicular skeletal divisions. To get the best and most accurate information. The bones of 61—D. Blood for various purposes. cardiorespiratory frequency. In addition.. 63—D. Blood cells are training. cardiorespiratory fitness. blood and the relationship between duration. Management and staff the skeletal system provide structural support When an emergency or injury occurs. cular fitness and flexibility affect HR so they are inappropriate to administer before cardio. of forces that are generated by the skeletal muscles attaching to the bones.org 59—C. simple pulmonary arteries. All of the above right atrium. in turn. is made. BP. the blood passes through the Possible medical emergencies during exercise tricuspid valve to the right ventricle. analysis). Tricuspid valve staff all are included in the implementation of Blood from the peripheral anatomy flows to an emergency plan. limitations. hypo- oxygenated. so it is inappropriate to planning tool. it is found between Different types of health screenings are used the left atrium and left ventricle (LV). The tricuspid valve is so named tension or shock. physician. 66—D. affect for changing the magnitude and direction the cardiorespiratory fitness testing results. The E-ECG frequency of exercise would involve continuous electrical heart The number of times per day or per week that monitoring during exercise stress test used in a a person exercises is interrelated with both the clinical setting when deemed appropriate by a intensity and the duration of activity. Health and fitness programs. bleeding. PAR-Q medical history should be taken. as well as provides attachment for muscles. fitness. the heart through the superior and inferior venae cavae into the right atrium. In commercial settings. Dwyer_Part1_Sec3. be CPR certified and knowledgeable of first aid. Some 65—B. Body composition. and the following order of testing is recommended: time constraints also will determine frequency resting measurements (e. HR. safety plans. The bicuspid valve is a similar valve. and emergency The appendicular skeleton provides for attach- procedures should be a part of the staff ment of the limbs to the trunk. CPT measure or to rate perceived exertion during 64—C. then out include heat exhaustion or heat stroke. risk management efforts. The RPE-Borg scale is used to tions (both prescription and over-the-counter). From the 62—D. all exercise staff should formed in bone marrow. and other because of the three cusps. preferences. Strategic plan methods of body composition assessment are The strategic plan addresses strategic decisions sensitive to hydration status and some tests of the organization in defining short-and of cardiorespiratory and muscular fitness long-term goals and serves as the overarching may affect hydration.indd 70 11/05/12 9:59 PM . and flexibility. administer those before the body composition financial plans. In-services. The will assure the best care for the individual. Therefore. At minimum. Generally. hypoglycemia. some forms of cancer). because performed on most if not all days of the week. and sedentary allow the participant to reach steady state. 30 At any given intensity. working with some posterior curvature. specific expectations of what is possible and 69—A. to 71—C. in some cases. SECTION 3 CPT Examination 71 68—B. during swimming than exercise performed in intensity physical activity per day. adaptation function during stance and can lead to to a specific workload is often prolonged in increased lateral shift in the pelvis. followed weakness can lead to forward lean of the trunk by small increments in workload are recom- or knee hyperextension. Needy participant column. resolved before exercise goals can be achieved. lasting at least 3 min. Dorsiflexors additional help. DM. tobacco smoking. the same CO can be achieved with are the methods used within programs to a lower HR during swimming. An lifestyle appropriate test protocol should be selected to The primary modifiable risk factors for CAD accommodate these special needs. It is important by moving the center of gravity closer to the to remember that the exercise professional is center of the base of support. setting several small The vertebral column serves as the main axial short-term goals to attain a long-term goal is support for the body. exaggerated action with the exercise professional must be anterior curvature in the lumbar region. The adult vertebral likely to increase self-efficacy as the person column exhibits four major curvatures when successfully reaches each short-term goal on CPT viewed from the sagittal plane. it may be appropriate to refer that person for 70—D. To ensure that the toe does 75—A. and C-reactive protein. Test stages in graded exercise tests should be prolonged. CAD are advance age. hyperten- sion. the will convey significant protection against the body is in a prone position so that the heart’s major killers in modern society (e. fibrinogen tissue plasminogen activator. abnormal lateral deviation of the vertebral 74—B.g. A lower HR 72—A. when a standing position. Age may be accompanied by deconditioning not catch the walking surface. Scoliosis is an the way to attaining the long-term goal. the full effects of gravity. to establish remain in the original fetal positions. Often. step length. It is important. Weakness in the gluteus into consideration when selecting appropriate medius and minimus decreases their stabilizing fitness test protocols. lipoprotein (a). CO is not affected by training status. For example. such as running. sedentary lifestyle..indd 71 11/05/12 9:59 PM . even at rest. Dorsiflexor weakness leads to foot drop during heel strike. Thus. dyslipidemia. Stability would also be increased those issues. not a trained counselor. A primary curve refers to the thoracic and The needy person wants more support than sacral curvatures of the vertebral column that can be given. Because 73—A. improve motivational skills as suggested by the Dwyer_Part1_Sec3. homocys. of postural differences. and disease and these factors must be taken thereby. and. especially in the thoracic individuals is difficult. Obesity. cardiovas. knee and hip and disease flexion increases during swing. then. obesity. and family The amount of blood needed to sustain the history. Scoliosis assessment. Lordosis is an abnormal. Kyphosis is an abnormal increased Despite the best efforts. a primary goal of the needy by increasing the size of the base of support. sedentary. male gender. Increase in resting CO The primary nonmodifiable risk factors for At rest. Emerging risk factors for CAD are body’s functions at rest does not differ between numerous and include. An application of cognitive-behavioral of the higher stroke volume evident during principles submaximal swimming compared with Applications of cognitive-behavioral principles running. Quadriceps older adults (a prolonged warm-up. Issues related to inter- region. and DM. mended). Lowering the center of gravity to remain focused on the exercise or physical Lowering the center of gravity will increase activity issues and behavioral skills related to stability. individual is to gain attention. for example. or both. those who are trained and those who are teine. Weakness Age is often accompanied by deconditioning in the plantarflexors reduces push-off and. HR will be lower Research has shown that 30 min of moderate. While swimming. are tobacco smoking. pumping action does not have to overcome cular disease. stroke volume is at its maximal value. 76—C. In addition. 77—B. the endoplasmic or even greater strength gains when compared (sarcoplasmic) reticulum is particularly well with younger individuals. This professionals should understand how to avoid loss is accelerated in women immediately after emergencies. actions. cise. not the capital budget. 89—B. Submaximal assessment of cardiorespiratory There is no accepted minimal or maximal fitness without a physician supervising amount of time that data should be stored. Make the area safe for the person by various diseases). improved health status down or try to wedge anything into the victim’s (reduction in risk factors associated with mouth. and clearing any objects that he or she may contact. Capital budgets arterial stiffness are critical in determining whether to start a A decrease in arterial compliance and an program. 88—B. Osteoporosis is an important part of a facility’s emergency Advancing age brings a progressive decline in procedures and safety program. As a result. increased independence. All exercise bone mineral density and calcium content. CO. Benefits of such a program include convulsion pass. Injury prevention during exercise. but it 79—B. approximately 15% per decade in the sixth and which triggers the fiber to twitch or contract. facility expense. The coordinated capacity of the heart. however.acsm. 25–30 L ⭈ min⫺1 during maximal effort exer- increased muscle mass. deliver. Sarcoplasmic reticulum 81—A. How much in vigorous exercise and that a physician does it cost to start the program and to imple.2 mmol ⭈ L⫺1. classified discretion must be used when sharing data. and so on in the start-up. Data should be kept on file for at least 1 yr mal CO can be as high as 35–40 L ⭈ min⫺1. calcium the mid-40s. He is. Most older adults are not sufficiently active. with total serum cholesterol confidential (lock-and-key) manner and ⬎5. the safest lar participation in a well-designed exercise action is to not restrain the person and to let the program. before being discarded. Include the costs of equipment and building or is older than 40 yr of age. hyper- Clearly. Injury prevention often is overlooked. 86—D. is strength gains when compared with younger 5 L ⭈ min⫺1. maxi- 82—C. respiratory system. Consequently. developed so that it can store large amounts of Muscle strength peaks in the mid-20s for both calcium. overall improvement in the quality of life. and use oxygen Dwyer_Part1_Sec3. Overall improvement in the quality of life and 85—B. vessels. Decreased arterial compliance and increased budget. Basic principles for exercise menopause. older men and Under resting conditions. 80—A. With a convulsing seizure. include equipment. Most people having seizures display convulsing This population can benefit greatly from regu. Do not restrain the person but be sure that he increased independence or she is in a safe area. staffing. CO is a individuals in response to resistance training. 72 CERTIFICATION REVIEW • www. and tissue metabolic Operating a program is part of the operating systems to take in.indd 72 11/05/12 9:59 PM . Capital budgets are not included in increase in arterial stiffness with age can result the balance sheet. It is not safe to hold the person increased fitness. as “older” for exercise purposes because he 83—A. The patient has only one risk factor. These strength gains are related to improved In an untrained person.org 78—B. however. the amount women demonstrate similar or even greater of blood ejected by the heart per minute. CPT in elevated SBP and DBP both at rest and 84—A. In a well-trained endurance athlete. operations but not for emergency procedures. to a lesser extent. should supervise any maximal assessment of ment the first stage? Capital budgets usually cardiorespiratory fitness. However. seventh decades and by approximately 30% 87—C. When the motor neuron excites the genders and remains fairly stable through membrane (sarcolemma) of the fiber. As described previously. Muscle strength declines by is released from the sarcoplasmic reticulum. function of stroke volume multiplied by HR. data must be stored in a cholesterolemia. CO can increase to neurologic function and. Older men and women demonstrate similar Within skeletal muscle fibers. older adults are more training are important for general day-to-day susceptible to osteoporosis and bone fractures. blood initial marketing. CO per decade thereafter. it is facility expense recommended that he should have medical Capital budgets refer to the budgeting of clearance and an exercise test before engaging program implementation or facility. 300 kcal ⭈ wk⫺1 ⫻ 26 wk ⫽ 7. Decreased TG and increased HDL The Health Belief Model assumes that people Chronic exercise training has its greatest will engage in a given behavior. 96—D. before) exercise. Because she walks 1 mile abduction. The functional 95—C.500 ⫽ 2. the definition of cardiorespiratory fitness. SECTION 3 CPT Examination 73 The maximal force that a muscle or muscle provide time for some attention to flexibility group can generate in a single effort is the exercises. respiratory system.200 total kcal Low-resistance. 300 kcal ⭈ wk⫺1. Between 1 and 2 min are recommended for an adequate cool-down. large-muscle activity. The steps are The subdeltoid bursa. Rotator cuff strain or impingement No metabolic formula is needed. Avoiding muscle strengthening exercises that 1. and tissue metabolic effects that are associated with many antihyper- systems to take in. 90—A. Between 5 and her weight loss program. 98—C. when there Changes in total cholesterol or LDL cholesterol is a perceived threat of disease. and that the weight than by exercise training. 10 min will allow these changes to occur and Dwyer_Part1_Sec3. Now divide by 3. as follows: This process often leads to angina (symptoms) a. and this is accom- 7. Multiply 300 kcal by Such impingement of the rotator cuff is 26 wk to determine the total amount of common in assembly line workers performing calories she expends by walking: repetitive overhead tasks. This is usually owing to atherosclerotic lesions 97—A. as follows: and nerves become impinged between the a. The resulting pain leads to three times per week.9 or about In addition. The steps are both of which are the result of atherosclerosis. supraspinatus muscle. and use oxygen is tensive medications. Evidence of an effective cool-down question 22 ⫹ 2 lb from adding the walking) is an HR of ⬍100 bpm and a SBP within over 26 wk if she incorporated walking into 10 mm Hg of preexercise levels. blood enhance venous return and the hypotensive vessels.200 kcal ⭈ wk⫺1 ⫻ 26 wk ⫽ involve low resistance 31. she expends about decreased ROM. such as benefit on lowering TG and increasing HDL.500 to get the total pounds hypertension if they follow appropriate lifting she will lose: techniques and avoid the Valsalva maneuver. increasing daily levels of activity. No metabolic formula is needed. Health Belief Model. The individual will take action 91—C. One mile of walking or running expends coracoid and acromion process with shoulder about 100 kcal. 31. b.800 kcal by 3. muscle-strengthening exercises can be performed by those diagnosed with b.200 ⫼ 3.500 to see how many The primary purpose of cool-down is to pounds of fat this represents: increase venous return. 8.500 total kcal ⫽ 8. deliver. hemodynamic parameters (HR and 9 lb over 26 wk BP) and medications should be controlled.9 lb reducing blood flow or coronary artery spasm. Self-efficacy supply does not meet oxygen demand resulting (self-confidence) also plays a major role of the from decreased blood flow to the myocardium.22 lb or about 2 lb plished by low-intensity. she is eliminating by the number of weeks: 92—A. The ability to bility is increased when the body is warm and sustain a held maximal force or to continue the muscles and connective tissue are more CPT repeated submaximal contractions is the defi. Multiply the number of calories per week or MI caused by a thrombosis. Ischemia depending on whether the benefits of the Myocardial ischemia occurs when the oxygen activity outweigh the barriers.indd 73 11/05/12 9:59 PM .800 kcal 94—D. Only A and B of the above. This type of activity also aids the removal of So she would lose about 11 lb (9 lb from lactic acid. and muscle atrophy.800 kcal ⫼ 3. threat is severe. A prolonged cool-down of 5–10 min will The coordinated capacity of the heart. pliable as is the case after (vs. Divide 7. 11 lb 93—B. a belief that are influenced more by dietary habits and body they are susceptible to disease. disuse. Prolonging cool-down ROM about a joint is the definition of flexibility. The potential for improving flexi- definition of muscular strength. nition of muscular endurance. 48. Negligence. 43. 84. 65. 88. 19. 82. 26. improper test administration. 25. Professional. 100 86. 2. 12. 59. 18. 76. 98. 31. 38. 28. 16. 69. The informed consent is also not a in bulimia. 39. 23. 80. 5. 22.acsm. 32. 61. 1. and Assessment Implementation Marketing Percentage of Test 26% 26% 27% 20% Questions Question Numbers 9. 85. 4. 7. 33. Abdominal obesity is the major component inadequate personnel qualifications. 73.org 99—C. 3. 44. 13. 36. 77. Abdominal obesity Negligence. 24. 54. skills. 62. 47.indd 74 11/05/12 9:59 PM . 93. it does not provide legal im- munity to a facility or individual in the event 100—C. 70. CPT EXAMINATION QUESTIONS BY DOMAIN Use the following table as a guide to assist you in your studying process. 30. 74. 71. 63. Domain Number I II III IV Domain Name Initial Client Exercise Exercise Leadership Legal. 79. 83. 27. 8. 66. 51. 96 Dwyer_Part1_Sec3. 64. 92. Laxative use is common consent. 81. 97. 72. 90. 10. 37. 55. 42. 91. of an individual. Amenorrhea is part of the are expressly NOT covered by the informed CPT Female Athlete Triad. 40. 89 53. 29. legal document. 67. in- of injury to a person and it does not relieve adequate personnel qualifications. 21. 49. It is important to note that some questions can be classified as testing multiple domains by the knowledge. 45. 46. 41. 75. 52. 60. 20. 94. and in- of the metabolic syndrome and is a better sufficient safety procedures are all items that predictor of CAD. 17. 57. 11. 68. 35. 14. 6. 74 CERTIFICATION REVIEW • www. 99 95. 58. 78. 56. 50. 34. 87. and abilities (KSAs). Consultation and Programming and and Client Education Business. 15. improper test administration. and insuf- the facility or individual of the responsibility ficient safety procedures are all items that are to do everything possible to ensure the safety expressly covered by the informed consent. FACSM. PhD.indd 75 11/08/12 12:27 AM . Associate Editor 75 Dwyer_Part2_Sec4. PART 2 ACSM Certified Health Fitness Specialist (HFS) HFS MEIR MAGAL. ACSM-CES. indd 76 11/08/12 12:27 AM .Dwyer_Part2_Sec4. 5 in and a hip circumference of 38 in. Cardiorespiratory fitness assessment — Because she runs regularly. you get 16 mm. Body composition — You elect to use the 3-site Jackson-Pollock formula to determine body composition from skinfold thickness. and you mea- sured it recently at 112/68 mm Hg. 77 Dwyer_Part2_Sec4. does Vinyasa yoga twice weekly for an hour. and answer questions that she has pertaining to the upcoming assessments/ program. She is frustrated that she is gaining weight.indd 77 11/08/12 12:27 AM . Her resting heart rate (HRrest) averages 54 bpm when taken first thing in the morning and her fasting blood glucose is 80 mg dL1. 2. and total cholesterol/high-density lipoprotein (HDL) ratio numbers are on the higher side of normal. you have her complete your club’s informed consent form for fitness testing and obtain the following data: 1.5-mile run test. Giselle. Downing. has been working out at the club for nearly 5 yr but has never taken advantage of the fitness testing or exercise prescription services that the club offers.5-mi run test and find it to be 112/68 mm Hg. triglycerides. low-density lipoprotein (LDL) cholesterol. She has decided that she wants guidance from you. is not fitting into her clothes well.000-member athletic club in your city. she cross-country skis twice weekly in place of the tennis and road biking. For the triceps skinfold. fatigues quicker than she used to with exertion. you get 26 mm. SECTION 4 HFS Case Studies Note: HFS certification candidates should also review the case studies found in Part 1. ACSM Certified Personal Trainer (CPT). FACSM HFS. trunk flexion test. ACSM-HFD You are a health fitness specialist at a 5. Giselle runs 3 times a week for 50 min. Muscular flexibility — You have Giselle perform the sit-and-reach. Giselle is a nonsmoking. Her resting blood pressure (BP) has always been ideal. and plays tennis once weekly for 90 min. and for thigh. Both her mother (age 72 yr) and father (age 71 yr) are obese and on lipid-lowering and BP medications but have no symptoms of cardiovascular disease. and is going through perimenopause. PhD. She parents two very young children and works full-time.and short- term goals. determine her long. you choose to have Giselle perform the 1. It takes her 10 min and 9 s to complete the test. Her total cholesterol. road bikes once weekly for 2 h. can’t seem to run as fast. You have her complete a health history questionnaire. DOMAIN I: HEALTH AND FITNESS ASSESSMENT CASE STUDY Author: Julie J. for suprailiac. Her father has Type 2 diabetes. You measure her BP at rest before she warms up for the 1. you get 18 mm. A member. 3. Once you determine that she is clear to participate in fitness testing by stratifying her risk. She obtains a score of 15 in. 44-yr-old Caucasian female who currently weighs 135 lb (she HFS weighed 125 lb 1 yr ago) and is 5 ft 5 in tall with a waist circumference of 30. does not have good energy. In the winter. and her HDL-cholesterol value is 45 mL dL1.I Author’s Certifications: ACSM-CPT. Which of the following statements best characterize tered when there are multiple tests? Giselle’s muscular endurance scores and need for A) Resting values. 90th percentile B) Hamstrings D) 51 mL kg1 min1. NO — not balanced HFS 2. Obesity class II C) High 4. What are Giselle’s muscular strength percentiles tory.5 kg m2. She does 20 push-ups and 60 curl-ups. She lifts 65 lb (one repetition maximum [1-RM]) on the bench press and 170 lb (1-RM) on the leg press.5 kg m2.I 1. 75th percentile A) Calf C) 42 mL kg1 min1. body composition. B) Push-ups Very good and Curl-ups cardiorespiratory fitness. work? ance. Normal fall into? B) 49. body A) Push-ups Excellent and Curl-ups composition 90th percentile. ⬃94th percentile B) Heart disease only B) 20% body fat. 78 CERTIFICATION REVIEW • www. YES — near balanced put her in? 7. BOTH strength and respiratory fitness.0 kg m2. ⬃47th percentile D) Hypertension only D) 29% body fat. 80th percentile C) Cancer only C) 26% body fat. Obesity class III A) Very low C) 19. flexibility. YES — perfect balance by the 1. Normal B) Low D) 37. cardio. A) 35th and 65th percentiles. ups 20th percentile. Using the Jackson-Pollock body density formula D) Very high and the population-specific percent body fat for- 9. Muscular endurance — You have her perform two tests: push-ups from the knees per- formed consecutively without rest and curl-ups (crunch) until either Giselle reaches 75 curl-ups or the cadence is broken.acsm. What risk category did Giselle’s waist circumference A) 22. work on strength B) Resting values. body composition. flexibility. work on strength endurance C) Both Push-ups Need improvement and Curl- C) Resting values. 35th percentile flexibility in which muscle group? B) 38 mL kg1 min1. there must be have good balance between upper and lower body sufficient time allowed for heart rate (HR) and strength based on these percentiles? BP to return to baseline between tests. The sit-and-reach test is the best measure of A) 31 mL kg1 min1. muscular strength and muscular endurance need work endurance. what is her body fat percentage and what risk of? percentile does this put her in? A) Health risk A) 16% body fat. muscular strength and 90th percentile. although the order of the cardiorespira- 6. work on muscular endurance only first. What is her body mass index (BMI) and what D) Upper back category does that put her in? 8. NO — not balanced consumed per unit of time (V̇O2max) as estimated C) 35th and 35th percentiles. MULTIPLE-CHOICE QUESTIONS FOR CASE HFS.5-mi run test and what percentile does this D) 25th and 30th percentiles. muscular strength and endur. 5. 5. cardiorespiratory fitness.indd 78 11/08/12 12:27 AM . Metronome for curl-ups is set at 40 bpm. Muscular strength — Giselle performs upper body (bench press) and lower body (leg press) exercises. What is her relative maximal volume of oxygen B) 22nd and 49th percentiles. flexibility D) Push-ups Very good and Curl-ups 80th D) Resting values including body composition percentile. ⬃32nd percentile Dwyer_Part2_Sec4. What does waist circumference alone evaluate the mula.5 kg m2. and for bench and leg press respectively? Does she flexibility are not established. What order MUST fitness assessments be adminis.org 4. 99th percentile C) Low back 3. muscular strength and endurance. Her mother has a history of diabetes mellitus.8 mL kg1 min1). 5 curl-ups. triglycerides 232 mg dL1. gestions will you offer to her in order to lose the etry data such as hydrodensitometry (underwater weight. On today’s visit. Smith states that she has a past medical history of a heart murmur and hyperten- sion. SECTION 4 HFS Case Studies 79 10. A) Diastolic is first of two Korotkoff sounds and D) Systolic is first of two Korotkoff sounds and systolic is point before no more Korotkoff diastolic is point before no more Korotkoff sounds. Other health-related physical fitness parameters included: sit and reach at 32 cm (the sit- and-reach box has a zero point at 23 cm). B) Systolic is 10 mm Hg above first Korotkoff sound and diastolic is point before no more Korotkoff sounds. LDL 110 mg dL1. sounds. She has been contemplating this decision for approximately 6 wk but is now sure that she wants to begin the exercise program. DISCUSSION QUESTIONS FOR CASE HFS. circumferences. which reported her percent fat to be 38. Her max HR reached 165 bpm and her maximum BP was 198/100 mm Hg. What do you think is the reason for the 10-lb risk of chronic disease. married female who worked at a local grocery store for 25 yr. how did you determine the systolic diastolic is 10 mm Hg below last Korotkoff and diastolic values based on Korotkoff sounds? sound. Smith completed the Balke Treadmill exercise test in 10:00 (V̇O2max 27. and feel better about herself? What can she work on based on all of her initial fitness assessment data? DOMAIN II: EXERCISE PRESCRIPTION AND IMPLEMENTATION CASE STUDY Author: Shawn Drake. Dwyer_Part2_Sec4. When you measured Giselle’s BP at rest to be C) Systolic is first of two Korotkoff sounds and 112/68 mm Hg. and skinfolds OR densitom. She is not involved in an exercise program but would like to start exercising after her health care provider encouraged her to lose weight. Which is better to determine body composition and 2. All par- ticipants of your exercise facility must have an initial exercise test and you are the Health Fitness Specialist (HFS) performing the test. PT.indd 79 11/08/12 12:27 AM . Ms. weighing) or plethysmography? run faster. ACSM-PD HFS Ms. fit into her clothes better. have more energy. She states that she can come to the facility three times per week for 1 hr each visit. PhD HFS. Smith is a 66-yr-old. Her fasting blood lipid profile were measured as follows: total cholesterol 190 mg dL1. HDL-C 30 mg dL1. Ms. anthropometric data such as weight gain in the past year for Giselle? What sug- BMI. She weighs 271 lb and is 64 in tall. her HRrest was 85 bpm and her resting BP was 168/92 mm Hg.I 1. She stated that she smoked cigarettes for 20 yr but quit 10 yr ago after her father passed away. You measured her body composition with the Bod Pod.II Authors Certifications: ACSM-RCEP. and 0 push-ups. Based on Ms. Should Ms. Based on Ms. Smith to have a graded exercise test (GXT) her time commitment. He is married and the father of three children (two boys.3 mL kg1 min1 category would she be? A) Well above average 6. How many kilocalories would Ms. Smith’s history. Felden is a 39-yr-old black male who enters your fitness center and asks about joining the facility and starting an exercise program. Smith consult a physician prior to design an exercise prescription for Ms.indd 80 11/08/12 12:27 AM . Based on Ms. Smith’s curl-up score. ACSM/NCPAD-CIFT Mr. is it necessary that a physician supervise the GXT? DOMAIN III: COUNSELING AND BEHAVIORAL STRATEGIES CASE STUDY Author: Brian Coyne. His height is 68 in. Smith burn if B) Above average exercising at the 60% intensity level for 30 min? C) Average A) 259 kcal D) Below average B) 300 kcal C) 327 kcal 3. the most he has weighed is 268 lb. D) 502 kcal which fitness category would she be ranked for trunk forward flexion (assume the sit-and-reach 7.7 mL kg1 min1 C) High B) 18. one girl) whom he says he has a hard time keeping up with. intensity. time.II 1. what stage of change is A) Excellent Ms.4 mL kg1 min1 2.III Author’s Certifications: ACSM-RCEP. During your initial interview with Mr.acsm. his current weight is 265 lb. According to the Transtheoretical Model of box has a zero point at 23 cm)? Behavior Change. Smith’s cardiovascular assessment (Balke Treadmill). what level of risk C) Good would you classify Ms. he states his weight has fluctuated over the last couple of years with different diets he has tried. Smith’s sit-and-reach score (cm). 80 CERTIFICATION REVIEW • www. and at a moderate-intensity level? Is it necessary for type) based on her current health/fitness status and Ms. prior to initiating a moderate-intensity exercise program? If so.org MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY HFS. MEd HFS. What is Ms. which fitness category would she be ranked for maximal aerobic power? HFS A) Excellent B) Very good DISCUSSION QUESTIONS FOR CASE STUDY HFS. Smith using beginning her exercise program if she will begin the FITT framework (frequency. Implement a weight management program and 2. Smith? B) Very good A) Precontemplation C) Good B) Contemplation D) Fair C) Preparation D) Action 4. Felden. Based on Ms. Dwyer_Part2_Sec4.II 1. which fitness D) 23. Smith’s target V̇O2R if prescribing a A) Low 60% intensity level? B) Moderate A) 16. Smith for atherosclerotic D) Fair cardiovascular disease? 5.1 mL kg1 min1 D) Unknown C) 20. Felden works up to 50 h wk1. What is one cardiovascular fitness assessment you 7. A) HDL D) Ask him how he plans to implement the life- B) Stress style modifications he desires to make and C) Hypertension understand the benefit of a regular exercise D) Exercise history program. At this point. Felden have? modifications. high cholesterol. What positive risk factors does Mr. what stage do HFS exercise in your facility? you think Mr. This year. but he has only played in college alumni rugby games. Mr. he states he was told he has high BP. Mr. Felden tried to jog to get in shape but did not really enjoy doing it on his own. When he gets up in the morning. lisinopril. Felden played high school football and rugby in college so he is familiar with strength training. is tired when he gets home from work. Prior to marrying his wife. Felden before he toward compliance using the health beliefs model? starts his exercise program in your facility? A) Provide him with a schedule of all group exer- A) What medications he is currently taking cise classes offered at the fitness center. HDL 41 mg dL1. What would be the first questionnaire you ask 5. Mr. Since then. sits on the sofa. Mr. Felden has brought his latest laboratory results with him (total cholesterol 242 mg dL1. SECTION 4 HFS Case Studies 81 During your interview with Mr. Felden past exercise history and using Mr. Based on Mr. Felden usually eats dinner. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY HFS. he has decided not to play because it is in 2 wk. LDL 134 mg dL1. Mr. Mr. Felden does not feel well rested.indd 81 11/08/12 12:27 AM . How would you first suggest moving Mr. prediabe- tes. He does not know how he will fit it into his current lifestyle though. which have become harder to play in each year. Felden is in? A) Informed consent A) Precontemplation B) Physical Activity Readiness Questionnaire B) Contemplation (PAR-Q) C) Preparation C) SF-36 Quality of Life survey D) Action D) DASI (Duke Activity Score Index) 6. triglycerides 184 mg dL1). and a family history of cardiovascular disease with his father having had a heart attack at the age of 50 yr. He states he becomes very short of breath chasing his children around the yard. they exercised together and did so until the last trimester of his wife’s first pregnancy. Felden 2. Felden is very adamant about starting an exercise program. His wife has encouraged him in the past few years to become physically active on a regular basis. and does not even feel like walking the fam- ily dog with his wife and/or children. 4.III 1. Felden perform before prescribing see positive change in? him an exercise program? A) BP A) Submaximal exercise test with electrocardio- B) Cholesterol levels gram (ECG) monitoring C) Weight B) Maximal exercise test without EKG monitoring D) Sedentary lifestyle C) 1-RM squat D) 1. What else would you ask of Mr. and watches TV after dinner before going to bed. He is able to sleep in his bed but only sleeps a few hours at a time before waking up. Felden to complete before allowing him to Prochaska’s Stages of Change model.5-mi walk/run Dwyer_Part2_Sec4. and simvastatin. After college. He also states he is a former smoker and drinks one to two 12 oz beers per day. In the past. B) Prior medications he is no longer taking B) Encourage him to schedule exercise into his C) His level of motivation daily routine. Mr. and he cannot keep up with his children running around the yard. he has done minimal physical activity but is now worried about his health. Felden. D) How consistently he takes his medications C) Set goals that will take him 3 mo to attain with consistent adherence to the prescribed lifestyle 3. What risk factors would you focus on initially to would have Mr. His current medications include aspirin. and productivity. Felden’s motiva. As fitness director. In addition. the end of 3 wk B) Set monthly goals and remind him of them B) At least 3 d wk1 of exercise the first 3 wk of each week. you have been asked to set up the fitness evaluation policies and procedures for your employees to follow.III 1. 9. week by the end of 4 wk D) Set daily goals. PhD HFS. What tools could you use to increase the likelihood of his success? DOMAIN IV: LEGAL/PROFESSIONAL CASE STUDY Author: Matthew W. you have elected to hire 4. How many hours of overtime based pay for a given position? must you pay an employee who works 52 h during A) Decreased employee morale a given week? B) Increased employee turnover A) 12 C) Decreased employee retention B) 17 D) Increased employee productivity C) 22 D) 0 Dwyer_Part2_Sec4. The general manager has asked you to hire all of the positions necessary for the operation of a successful and profitable fitness department. Felden’s in incorporating Mr. 3 times a some effort to attain.000 ft2) health and fit- ness facility.indd 82 11/08/12 12:27 AM .acsm. Which position will you most likely compensate 3. What short-term exercise goal would you have for tion to continue exercising each week? Mr. Felden to examine his motives for coming to his family into his exercise program and adherence see you? to the program? 2. 82 CERTIFICATION REVIEW • www.IV Author’s Certifications: ACSM-HFD HFS You have recently been hired as the fitness director at a midsize (⬃35. How will you decide the pay rate for various posi- with commission rather than hourly wage? tions you are hiring? A) Massage therapists A) Arbitrarily B) Personal trainers B) Based on what you were paid when you had C) Weight floor personnel the position D) A and B only C) Perform a job pricing analysis E) All of the above D) Based on national/state normative statistics E) C and D 2. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY HFS. How would you help facilitate Mr. you will be the direct supervisor for all of the employees you hire and will be responsible for their payroll. D) 5 d of moderate physical activity in the first week of his program DISCUSSION QUESTIONS FOR CASE STUDY HFS. Felden during his exercise program? A) Set 3-mo goals and remind him of them each A) 60 min of moderate aerobic exercise per day by week. his program C) Set weekly goals that are attainable but take C) 20 min vigorous activity per day.org 8. The grand opening for the facility is scheduled in 1 mo from today. Why would you decide to institute performance- two full-time staff. How would you create an environment that enabled 3.IV 1. Parrott. schedules. How would you assist Mr. Rather than hiring a number of part-time staff for weight floor supervision. The newly acquired club is a 35. Dwyer_Part2_Sec4. SECTION 4 HFS Case Studies 83 5. Which of the following should be included as part 8.V Author’s Certifications: ACSM-HFS You are the fitness director and group exercise coordinator for a large. task of fitness testing for all members. successful multipurpose health/fitness center that has recently purchased another local fitness center that declared bankruptcy a few months ago. members. Which strategy would be the best way to ensure trainers as independent contractors versus fitness testing confidentiality while maintaining employees? accurate recordkeeping? A) Reduced tax liability for the club A) Create a hardcopy of fitness test results and place B) Increased professionalism in the fitness it in a file cabinet in the fitness testing room.000 memberships.800–3. that’s the most important fitness test to the D) All of the above. D) Share results verbally with the member. then. D) All of the above C) Avoid caffeine the day of the assessment. trainers C) Hand the member a copy of his or her results D) Better long-term retention of training staff and keep no other records of the test.IV 1. DOMAIN V: MANAGEMENT CASE STUDY Author: Frederick Klinge. What is the primary advantage to hiring personal 7.000. Your company is planning a gradual renovation of the acquired club while keeping the facility operational. Which of the following is NOT a pretest instruction of the fitness testing program? you would provide to the client? A) Informed consent A) Wear comfortable. The newly acquired club has 1. B) Provide member with fitness evaluation against C) Create a handbook outlining testing protocols normative data. thereby D) Memorize body composition analyses because enhancing retention. and train your staff accordingly. D) Avoid hydration the day of the assessment. Which of the following strategies would result in the most organized fitness testing program? 9. DISCUSSION QUESTION FOR CASE STUDY HFS. B) Pretest evaluation (risk stratification) B) Avoid strenuous physical activity the day of the C) Flexibility assessment assessment. C) Establish a friendly relationship.indd 83 11/08/12 12:27 AM . MBA HFS. Other health/fitness businesses in the local area include a 25-yr-old YMCA (average monthly dues rate of $55) and three newer 24/7 gyms (average monthly dues rate of $29). The overall condition of the facility is good and the activity areas and equipment are up-to-date and fully functional. A) Present a professional image of the B) Assign your most talented personal trainer the organization. department B) Create an electronic file of fitness test results and C) Independent contractors are usually better save the file on a password-protected computer.100 active memberships. 10. Write a sample job description for a personal include any or all pertinent components to hiring trainer in a commercial fitness setting.000 ft2 fitness-only facility. Which of the following is one of your primary goals A) Memorize the protocol and perform all fitness for the fitness assessment program? testing personally. loose-fitting clothing. and it is your understanding that the facility has the capacity to handle 2. 6. Be sure to for this position. HFS destroy the hard copy of results. The facility is located in a middle-class residential neighborhood with a median household annual income of $57. acsm. The renovation project will include upgrading the studio’s sound system and installing a new state-of-the-art stu- dio floor surface. camp classes. including the hiring of a group exercise coordinator for the new club. or HFS B) $27. You have received approval to offer 60 classes per C) Medicine balls week and you plan to use a mix of current instruc. Hearing protection safety is an important topic group exercise instructor. which of the following are A) 75 dB important considerations? B) 90 dB A) Selected exercises should be an effective way C) 105 dB to increase flexibility.101 related field C) $71. what is the instructors. the previous management discontinued group exercise classes on Friday. Selected ancillary equipment may include which of the following? A) Step benches B) Spin class cycles Dwyer_Part2_Sec4. and Sunday. Given the in- development (GED) equivalent formation earlier. D) A and B body sculpting. and sports performance classes. expense projection for the first 12 mo of operation health. when training new group exercise instructors. The group exercise studio is spacious and is in good shape. and you strictly adhere to a 3% merit recommended formal education for a group exer- raise policy. exercise instructor depending on the demo- B) Demonstration of exercise modifications is graphic makeup of each class. According to . exercise science. D) Sound level should be determined by the group balance.V 1. yoga classes. Annual dinator to supervise the group exercise program at performance evaluations are performed for all the new facility. An important part of your task is putting together a staff for the new group exercise program. strength. The group exercise studio will be one of most C) Exercises must be safe for the 25–45-yr-old age highly used spaces in the newly acquired facility.760 D) No formal education is recommended for D) $73. Part 5.312 C) 4-yr degree in fitness. and a circuit training class using a 10-piece selectorized weight machine circuit. only a professional certification E) $84. Your company follows a strict policy of “safety of your New Instructor Orientation program for the first” when it comes to member participation in newly acquired club should list which maximum programs. necessary to accommodate all participant skill E) None of the above levels and abilities. You will be hiring a full-time group exercise coor- cates the average per-class pay rate is $23. and there are currently 22 classes per week. or related field from an for the group exercise program at the new club? accredited college or university A) $26.920 combined with at least 3 yr of experience as a 2. When selecting exercises appropriate for class decibel level? a group or individuals. or cardiovascular endurance. what is the most accurate payroll B) 2 yr post–high school education in fitness. body sculpting. D) Strength bands tors from your club as well as new hires. You have been asked by the company cise coordinator in the health/fitness industry? controller to submit a pro forma projection for an- A) High School diploma or general education nual group exercise instructor wages. recreation.913 the position. 84 CERTIFICATION REVIEW • www. Saturday. low-impact aerobics. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY HFS. kick- boxing.indd 84 11/08/12 12:27 AM . demographic because this group compromises The new group exercise program will include boot the majority of most group exercise classes. The previous group exercise program consisted of basic step aerobics. coordination. Due to staffing cutbacks.org You have been assigned the task of revitalizing the group exercise program of the newly acquired club. A recent E) All of the above analysis of your facility’s group exercise staff indi- 4. 3. nication environment. and your company has had success in tracking class participation and organizing class marketing programs via Web-based social media participation information for effective program platforms like Facebook. To assure success of the group exercise program A) Target Market Surveys at the new facility. You need to what is planned and expected of the employee solicit input and feedback from existing members for the upcoming year. A) To look for opportunities to keep the meeting D) The first step of a process evaluation is always social in nature. reviewing the program goals and objectives. gram. what they don’t like about the program. an important objective C) A cost-benefit analysis should part of any pro- is . DISCUSSION QUESTIONS FOR CASE STUDY HFS. etc. include .indd 85 11/08/12 12:27 AM . blogs. When it comes were appropriate and effective. 8. Keeping track of group exercise class participation group exercise participants and get them involved numbers an important source of information for in the new program format. to performance evaluations. What analysis. some creative ways to use social media and other Web-based programs to promote your new group exercise program? Dwyer_Part2_Sec4. it is important to be consistent B) Health Screening and Fitness Assessments with process evaluation on the program. Twitter. It is very important for the new club to retain as B) To base most of your management feedback on many existing members as possible. It is important to engage the club members and 2. cess evaluation. You are responsible for instructing the new club’s B) Process evaluation can demonstrate whether group exercise coordinator on how to perform procedures were followed and whether they employee performance evaluations. 7. SECTION 4 HFS Case Studies 85 6. Which of C) Participant Surveys the following statements is true regarding program D) Health Care Usage Reports process evaluation? A) Process evaluation assesses effectiveness by measuring whether program goals and objectives have been met.V HFS 1. The new club has a ongoing program evaluation. what the members like about the pro- performance. regarding the quality of the existing group exercise C) To bridge the gap between present and ideal program. allowing for a relaxed commu. D) To compare an employee’s performance to other Methods for acquiring this type of information employees performing the same job function. Discuss methods of Web site. 2014. whereas partial curl-up categories are in 3—A.726 22. ACSM’s 3. There is also a classification for women age 40–49 yr with formula available to calculate V̇O2max from the 26% fat is ⬃47th percentile.6 of ACSM’s GETP9. 22. the 3-site Jackson-Pollack body density formula tion should be obtained first. Box 4.651 m tall. Squaring 1.3 contains pressure (BP). cardio.0000023 (60)2 2—D. by 2. Percent Body Fat (496/Body Density) 451 9th ed. or a 1. blood ACSM’s GETP9.74 mile. Chapter 4 contains the BMI for.0254. senior editor. 2014. the percentile and a 99th percentile ranking. Baltimore (MD): Lippincott Williams tered. Dwyer_Part2_Sec4. Chapter 4. pounds was used for weight instead of kilo- ity are not established. be very important. (383/10.0009929 (sum health-related components of fitness (i. Resting measurements such as heart rate (HR). ACSM’s Prescription. senior editor. 1—D. so taking 61. hundredth of a minute so 10:09 would be 10.9% round to 26% distance of 1. Time must be in the nearest Guidelines for Exercise Testing and Prescription. 1.e.726.0001392 (44) 1.651 2.5 kg m2. the organization of the testing session can and Wilkins. 99th percentile 0. folds)2 0. Normal Table 4.54 instead of 2. Table 4. depending on what physical 4—C. The 49. centiles were 35th and 65th and her muscular mula of kilogram body weight divided by height endurance categories came out at very good in meters squared.040022 ACSM’s GETP9.4 of ACSM’s GETP9 is: Resource: Pescatello LS. and over the 90th percentile (60 curl-ups).5-mi run test: V̇O2max (mL kg1 min1) Resource: Pescatello LS. Push-ups Very good and Curl-ups Resource: Pescatello LS. and disease risk. Baltimore (MD): Lippincott Williams With data: Body Density 1. 51 mL kg1 min1. and flexibility). The 19. states: “When multiple tests are to be adminis. Finally.5 (483/Time). senior editor.acsm. work on strength Guidelines for Exercise Testing and Prescription. 2014.15 9th ed.5 is incorrect because lb is divided time allowed for HR and BP to return to base. but sufficient HFS time should be allowed for HR and BP to return The population-specific formula for body fat to baseline between tests conducted serially. well because the meters are not squared.2. muscular fitness. V̇O2max 3. Table 4.I 1.5 and Wilkins. 5 kg m2. 26% body fat. 9th ed.” percentage for Caucasian females age 18–59 yr found in Table 4.15. height. Resting values including body composition Chapter 4. of 3 skinfolds) 0.0 is wrong as line between tests.1 lists classifications for BMI first although the order of the cardiorespiratory.11 contains and Wilkins. Table 4. 5—B. senior editor.0001392 (age) body composition. Chapter 4 Guidelines for Exercise Testing and Prescription.I Multiple-Choice Answers for which is the conversion from inches to meters Case Study HFS. weight.15) 51 mL kg1 min1. and flexibil. 86 CERTIFICATION REVIEW • www.4/2. Chapter 4. and body composi.org HFS CASE STUDIES ANSWERS AND EXPLANATIONS CASE STUDY HFS.099421 0. ACSM’s 90th percentile. 9th ed. categories for women age 40–49 yr for push- ups. there must be sufficient grams. Research has not for women using triceps.099421 and Wilkins. Chapter 4. So. ACSM’s Guideline for Exercise Testing and Resource: Pescatello LS.indd 86 11/08/12 12:27 AM .2 (20 push-ups is between the range of 15–23) 61. 0. a 12-min run Density) 451 25.0009929 (60) 0. MATH WORK: 135 lb/2. Five feet 5 in tall is 65 in . 37. Baltimore (MD): Lippincott Williams because 9 s/60 s 0. 2014. ACSM’s Guidelines for Exercise Testing and Prescription.5-mile run time of 10:09 gives a V̇O2max of 51 mL kg1 min1 In Table 4.8 states that With data: Percent Body Fat (496/Body a Balke treadmill time of 25:00. ⬃47th percentile fitness components are to be evaluated. and thigh: established an optimal testing order for multiple Body Density 1. Because her muscular strength per- ACSM GETP9.4 kg.12..5 is incorrect because muscular strength and endurance. 9th edition (GETP9).0000023 (sum of 3 skin- respiratory [CR] endurance. Baltimore (MD): Lippincott Williams ACSM’s GETP9. In ACSM’s GETP9. suprailiac. Talk about healthy snacks and total kilocalories Resource: Pescatello LS. 2014. waist circumference thresholds effectively iden- 9th ed. its relationship to predict the incidence c. Chapter 4. 9th ed. Define anthropometric and densitometry.9 puts her into the 35th percentile. Guidelines for Exercise Testing and Prescription.” 6—A. LS. complexity.10 has her leg press percen- tiles.9 includes 9th ed. 8—B.” your clients misinformation. the different BMI categories. Perhaps you need to refer her to a registered dietician who is comfortable working with active individuals. Pros and cons of each technique Resource: Pescatello LS. Research has demonstrated that Guidelines for Exercise Testing and Prescription.5–35. Hamstrings Study HFS. Giselle’s 1-RM for bench press was 65 lb 10—D. She exer- ACSM’s GETP9.” e. 2014. Prior to this make sure that you’ve at the age 30–39 percentile column. senior editor. calibration. c. Low b. always double Korotkoff sound and slowly release pressure at check your work as you do NOT want to give rate equal to 2–5 mm Hg s1. Lippincott Williams and Wilkins. Baltimore (MD): Lippincott Williams to check various hormone levels to make sure and Wilkins. senior editor. which you find in Table sounds.I ACSM GETP9. Table 4. Determine margins of error with each technique. d. you were accidently looking sounds. ACSM’s eaten each day and total kilocalories burned off Guidelines for Exercise Testing and Prescription. 2014. Chapter 4. diastolic is point before no more Korotkoff to get a ratio of 0. in (70–89 cm) falls into a low-risk category. SECTION 4 HFS Case Studies 87 it is evident that Giselle needs to focus more 9—A. NO — not balanced Resource: Pescatello LS. 1. a. senior editor. Resource: Pescatello LS.3 shows cises quite a lot and is still gaining weight so per- that a waist circumference between 28. e.indd 87 11/08/12 12:27 AM . amount of time- of low back pain is limited. each day via resting metabolic rate and physical 9th ed. and Wilkins. Baltimore (MD): Lippincott Williams percentiles for women age 40–49 yr for bench and Wilkins. Systolic is first of two Korotkoff sounds and so divide 65 by 135. ever. 9th ed. 2014. d. Discussion Question Answers for Case 7—B. which puts Korotkoff sounds is heard and diastolic BP is her in the 65th percentile. 2014. Health risk on her muscular strength than her muscular ACSM’s GETP9. which is her body weight. Cost. Chapter 4 states that “waist cir- endurance at this point. Baltimore (MD): Lippincott Williams HFS and Wilkins. senior editor. ACSM’s GETP9. ACSM’s primary issue. Baltimore (MD): Lippincott Williams tify individuals at increased health risk across and Wilkins. 4. Discuss energy balance with Giselle. senior editor. of health risk because abdominal obesity is the Resource: Pescatello. assess low back and hamstring flexibility. press and Table 4. 2014. Chapter 4 states that “the sit. 35th and 65th percentiles. Correlation of each to disease string flexibility than low back flexibility. Suggest to Giselle that she see her gynecologist 9th ed. how.0 haps it is her diet that needs the major overhaul. Outline Guidelines for Exercise Testing and Prescription. ACSM’s 2. Table 4. The sit-and-reach required for each technique test is suggested to be a better measure of ham. Baltimore (MD): Lippincott Williams activity. ACSM’s Guidelines for Exercise Testing and Prescription. She should retest these cumference can be used alone as an indicator values periodically with you her HFS. that she does not have some sort of hormonal abnormality going on. ACSM’s Resource: Pescatello LS. Perhaps Giselle needs to add two compo- nents into her training plan that are lacking: (a) speed work or higher intensity running Dwyer_Part2_Sec4. ACSM’s Guidelines for Exercise Testing and Prescription. Outline of discussion under body composition and-reach test has been used commonly to a.48. b. Her 1-RM ACSM’s GETP9 states that “systolic BP is for leg press was 170 lb so divide 170 by 135 the point at which the first of two or more body weight to get a ratio of 1.26. Be careful inflated cuff pressure to 20 mm Hg above first when looking up data on tables. senior editor. If you answered B as the point before the disappearance of Korotkoff the correct answer. 16. behavior change by completing her initial exer- 9th ed. 2014. ACSM’s She has started to make small steps toward Guidelines for Exercise Testing and Prescription. 2014. senior editor. Smith would be ranked in the “good” category (65%) for maximal aerobic power. Smith 9th ed. High and Wilkins. HFS Using Table 4.12 in ACSM’s GETP9. 2014.1 mL kg1 min1 and Wilkins. which would 75th percentile for Giselle (⬃21%). ACSM’s Guidelines for Exercise Testing and Prescription. 88 CERTIFICATION REVIEW • www. but 3 cm should be subtracted (35 cm 3 cm 32 cm). begin her program. senior editor. Excellent 18. 6—C. 32 cm Rationale: Ms. and Wilkins.5 mL classification for risk.8 in ACSM’s GETP9. CASE STUDY HFS.23 L min1 normative data would rank Ms. Discuss losing weight gradually. Because a sit-and-reach box that has a zero point at 23 cm.1 mL kg1 min1 123 kg 1L/1. Baltimore (MD): Lippincott Williams would be ranked in the below average and Wilkins. You could calculate an ideal body weight at the her increase her metabolic rate. burn more kilocalories and hopefully she will g. Therefore. Smith in the 2. Resource: Pescatello LS. She is not currently active but intends to become active in the next 6 mo.9 kcal L1 excellent fitness category for trunk forward 10. mL 2.454 and Wilkins. Dwyer_Part2_Sec4.II Guidelines for Exercise Testing and Prescription. 123.60] 3.58 mL kg1 min1] 3.5 mL kg1 min1 Resource: Pescatello LS. The speed work will help fat too low.9 kcal min1 flexion. Ms.0 kg 3—A. intensity desired] V̇O2rest cular. Ms. subtract 3 cm from each 10.II Multiple-Choice Answers for Resource: Pescatello LS. 2014. she will move into the “action” stage of change. no more than fit into her clothes better. ACSM’s Case Study HFS. The excellent category 7—C. senior editor. Below average Guidelines for Exercise Testing and Prescription. See Figure 2. which will hopefully 1–2 lb wk1 and not getting her weight or body help her self-esteem. The increased muscle mass may help f.org days and (b) strength training. pulmonary. Baltimore (MD): Lippincott Williams Convert pounds to kilograms: 271 lb 0. Baltimore (MD): Lippincott Williams cise test. senior editor.9 kcal min1 30 min 327 kcal value in Table 4. Smith has a known heart murmur.23 L min1 4. 9th ed. Baltimore (MD): Lippincott Williams 1—C. senior editor. According to ACSM risk classification. 2014. kg1 min1) 0.16 in ACSM’s GETP9.acsm.1 mL kg1 min1 Ms. ACSM’s 2—D. 5—B. classes.000 Rationale: Using Table 4. which Rationale: V̇O2R [(V̇O2max V̇O2rest) % is a major sign that is suggestive of cardiovas. Preparation is 35 cm. Smith is currently preparing to would be ranked as excellent.5 mL Guidelines for Exercise Testing and Prescription. or metabolic disease. Once she begins her exercise program. Resource: Pescatello LS. Baltimore (MD): Lippincott Williams V̇O2R 18.3 in ACSM’s GETP9 for logic model for V̇O2R [(27. (30th percentile) category for curl-ups. 4—C. 18. Rationale: 9th ed. 327 kcal Resource: Pescatello LS.indd 88 11/08/12 12:27 AM . The only her to regain her running speed and may also strength she gets now is in her Vinyasa yoga help with self-efficacy.8 mL kg1 min1 3. ACSM’s V̇O2R [14. Good Rationale: Using Table 4. kg1 min1 9th ed. and flexibility). medical) and assist you your fitness center wanting to start an exercise in risk stratifying him. current American College of Sports Medicine will be key components of the exercise prescrip. Although resistance A typical daily exercise program would include a training may not be an effective means for reducing 5–10 min warm-up. tolerance. Prevention of Weight Regain for Adults” (2009). An initial exercise prescrip. CASE STUDY HFS. however. intensities to avoid delayed onset muscle soreness and to The exercise prescription should address the increase exercise adherence. This shows that he has a certain level also be used to identify how lifestyle modifica. muscular endurance. Felden to start exercise. ing an exercise program. and BP. For this client.200–2. As exercise sessions increase five components of fitness (cardiopulmonary en. should need to ask him because he came to tory (physical activity.III Multiple-Choice Answers for 2—A. submaximal or maximal test). Mr.indd 89 11/08/12 12:27 AM . “Appropriate Physical Activity Intervention Strategies for Weight Loss and Muscular Two times 50% of 1 10 reps Thera- strength/ a week 1-RM of at least Band. His motivation level will 9th ed. his initial interview. Exercise should be kept at low chronic disease risk factors are plausible. SECTION 4 HFS Case Studies 89 Discussion Question Answers for Frequency Intensity Time Type Case Study HFS. in duration and the client has success with her current durance. An exercise test is recom- tion example is shown in the following table. ACSM’s tional interviewing activity with him during Guidelines for Exercise Testing and Prescription. (ACSM) recommendations state that individuals tion to enhance weight loss and reduce chronic HFS at high risk with symptoms or diagnosed disease disease risk. 30–40 min of exercise followed by percent fat. Body composi. Motivation is also im- sent. program. it is not something you assist you in gaining more about his recent his. endurance eight free An effective behavior weight loss program in. They may have an influence on his exercise After having the client sign an informed con. should consult with their physician prior to initiat- rent flexibility levels. HR. 2014. can be gleaned through conducting a motiva- Resource: Pescatello LS. The HFS should choose an effective behavior pulmonary a week (intermittent) treadmill weight loss program as recommended by ACSM’s endurance Position Stand. of motivation. Three times 60% 30 min Bike/ 1. Flexibility Two times Mild dis. Baltimore (MD): Lippincott Williams also be monitored during the early stages of his and Wilkins. moderate intensity of aerobic exercise. Dwyer_Part2_Sec4. exercise program. This questionnaire can program. Felden’s motivation level tions can benefit his risk of mortality. muscular strength. The mended prior to starting her exercise program and client wishes only to exercise three times a week a physician should supervise the exercise test (both for 1 h. other health benefits such as decreased 5–10 min of cool-down. cardiopulmo. Diet restrictions should follow basic nu- tritional guidelines as set forth by and United States Department of Agriculture (USDA) Dietary Guidelines for Americans. PAR-Q prior to allowing Mr. Ms.III Current medications are important to know 1—B. Smith needs to maintain her cur. What medications he is currently taking Case Study HFS. 3 30 s Static a week comfort hold stretching ance. discuss advantages of increasing number of body composition. different weights cludes moderate-intensity physical activity for muscle (1–3 lb) 150–250 min wk1 with an energy equivalent groups of 1. days per week in the exercise program.000 kcal wk1 along with moderate diet restrictions that lead to negative energy bal. senior editor. you would have him complete a PAR-Q to portant. This program tion is addressed by tracking the kcal per session should progress to reach the target of 250 min wk1 of and dietary intake. nary endurance and muscular strength/endurance 2.II Cardio. Yes. Set weekly goals that are attainable but take 5—C. Mr. ACSM’s the beginning of an exercise program can set Guidelines for Exercise Testing and Prescription. ent’s adherence to the exercise program. senior editor. 2014. Preparation some effort to attain. senior editor. Felden is past the precontemplation and Detailed Answer: Short-term goals are easier contemplation stages. they 1 Consistent exercise will be the easiest risk fac- are not a positive risk factor. Felden is preparing to make changes to his Guidelines for Exercise Testing and Prescription. ACSM’s Guidelines for Exercise Testing and Prescription. Baltimore (MD): Lippincott Williams Improvements in BP from exercise programs and Wilkins. the client may not be seeing the practi- 6—D. and Wilkins.org 3—C. 2014. they with Mr. 2014. A moderate-intensity exercise program is usu- Through all of this. ally easier for clients to become accustomed stand the benefit compared to the cost of the to. the dosage can be Guidelines for Exercise Testing and Prescription. but the noticeable exercise test with EKG monitoring. you understand that he is are something he or she can attain and move preparing to act on his thoughts. Baltimore (MD): Lippincott Williams practitioner and client’s part to set daily goals. 2014. Resource: Pescatello LS. 90 CERTIFICATION REVIEW • www. Once completing his program this. ACSM’s Mr. Long-term goals can be set. 2014. he or she has relatively easy short-term goals niques and proper communication techniques to attain. A maximal differences will not be seen without dietary exercise test without EKG monitoring would modifications as well. tioner on a daily basis. Expecting too much at Resource: Pescatello LS. so it cannot be assumed his program. Baltimore (MD): Lippincott Williams an exercise program initially can hinder a cli- and Wilkins. program. It hopefully will have a positive although there is a chance it plays a factor in impact on his weight. it is important for him to have and Wilkins. Getting a client to make thoughts and has inquired about joining the lifestyle modifications is usually easier when HFS fitness center. however. can take up to 6 mo to see noticeable change. forward with success. style modifications he desires to make and there should be someone that the client reports understand the benefit of a regular exercise to monitor progress. At least 3 d wk1 of exercise the first 3 wk of fications into his lifestyle. Felden. setting goals that are attainable that allow for progress to be made. With any goal setting. senior editor. thus. 9th ed. Daily Guidelines for Exercise Testing and Prescription. Felden should under.5-mi walk/run with medications. Stress is not tor to see an improvement in at the start of discussed earlier. Exercise will have a benefi- Mr. Too vigorous 9th ed. His high cholesterol levels are being treated 4—D. Mr. senior editor. 2014. Baltimore (MD): Lippincott Williams 9th ed. lifestyle and discussed what he wanted to do. an idea of how he will integrate those modi- 9—B. ACSM’s hopefully in the future. not be done (especially with his family history). Baltimore (MD): Lippincott Williams and Wilkins. it would be good to encourage Mr. decreased or the medication can be stopped. Sedentary lifestyle HDL are not low at 41 mg dL . 8—C. 9th ed. however. senior editor. and Resource: Pescatello LS. high BP is being treated with medication. goals are good. Guidelines for Exercise Testing and Prescription.indd 90 11/08/12 12:27 AM . He has acted on his for clients to attain. ACSM’s Resource: Pescatello LS. his burned during physical activity/exercise. His sedentary behavior his caloric intake to make up for the calories would be a positive risk factor. also. 1. but it takes much effort by the 9th ed. ACSM’s his or her lifestyle modification program. Baltimore (MD): Lippincott Williams At this point. Resource: Pescatello LS. Felden does not need to do a submaximal cial effect on this as well. One of the keys of behavior modification is exercise program. senior editor.acsm. if he does not increase cardiovascular risk. Using active listening tech. His exercise history is not. Hypertension 7—D. 9th ed. Felden to schedule exercise into his daily routine. but they should not initially be the focus of Resource: Pecatello LS. The goals take effort. Dwyer_Part2_Sec4. up the client for potential failure. and Wilkins. Ask him how he plans to implement the life. family and their dog would be a good way to incor- porate daily exercise into his lifestyle. Felden to play games with the vators. Felden could use a calendar or daily planner to and potentially help increase his compliance to the schedule his exercise time each day. Champaign (IL): Human 1—D. 2007. also encourage Mr. 12 Case Study HFS. SECTION 4 HFS Case Studies 91 Resource: Pescatello LS. On the days when Mr. Felden does not feel like walking or exer- 1. — Education. center and to promote increased physical activity gram. children. experience. All of the above • Department • Reporting relationship 6—C. Felden should be afraid to get diabetes.indd 91 11/08/12 12:27 AM . ACSM’s and encourage Mr. Felden. Create an electronic file of fitness test results • Work schedule and save the file on a password-protected • Job summary computer. 2—E.V Multiple-Choice Answers for Resource: American College of Sports medicine. Guidelines. Case Study HFS. Felden should understand In order to promote exercise outside of a fitness his internal motivation to start the exercise pro. $73. Also incorpo- Discussion Question Answers for rating the family with the exercise program would Case Study HFS. Outline • Date 4—D. create a checklist for each day that includes an ex. All of the above.913 Kinetics. C and D 1. Avoid hydration the day of the assessment. days of the week. • Salary range 7—B. skills • Physical environment and working conditions CASE STUDY HFS. Increased employee productivity • Job title 5—D. Mrs.IV Multiple-Choice Answers for 9—D. Mr. Create a handbook outlining testing protocols • Exempt status and train your staff accordingly. certifications. This would increase his overall activity 2. III allow them to help motivate him. 41. Case Study HFS. 36. If he is being truthful with himself. need for him to continue his exercise program. He needs to reiterate to himself why he started his cising. A and B Only Discussion Question Answer for HFS 2—A. Promote good communication between ercise session on most. Mr. Felden to believe that there is a Guidelines for Exercise Testing and Prescription. p. 7th ed. 2014. Mr. he can during the day. Baltimore (MD): Lippincott Williams 3. p. 9th ed. materials and statistical data to help demonstrate CASE STUDY HFS. Dwyer_Part2_Sec4. Felden and the children can use the medical diagnoses he is at risk for as moti. Resource: American College of Sports Medicine.IV 10—A. Mr. None of the above ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. Resource: American College of Sports Medicine.V: ACSM’s Health/Fitness Facility Standards and Guidelines. 3rd ed. 3rd ed. Encouraging Mr. his family could be his external motivation. and their children to facilitate The exercise practitioner could also use educational an increase in physical activity in the household. Reduced tax liability for the club 1—D. Felden to take walks with his and Wilkins. Champaign (IL): Human Kinetics.IV 3—E. senior editor. exercise program. his wife. 2007. He could also exercise program. 2014. Baltimore (MD): Lippincott Williams and ACSM’s Health/Fitness Facility Standards and Wilkins. if not all. — Describe duties and responsibilities • Job requirements 8—D. 2014. 2. 3rd ed. Enlist or recruit a high-level staff member. displayed in the group exercise activity HFS ACSM’s Resource Manual for Guidelines for areas. and participation analysis capability. stand company marketing strategy and profession- Baltimore (MD): Lippincott Williams and alism guidelines when creating tweet information. only a professional certification photos of members enjoy different class activities.. The 4th ed. Les Mills Baltimore (MD): Lippincott Williams and Club Count software) that provides class scheduling Wilkins. 7th ed. Champaign (IL): Human feedback regarding classes that the club offers. plan a “photo-taking initiative” featuring position. Spin class cycles Develop a Facebook promotion strategy for the Resource: American College of Sports Medicine. Kinetics. Discussion Question Answers for Class attendance numbers are input into an Case Study HFS. The group exercise coordinator should under- Exercise Testing and Prescription.g. group exercise program. Some software 7—B. Dwyer_Part2_Sec4. determining if participa- a “challenge” promotion featuring the group ex. This information can then be exported to separate spreadsheet for analysis. schedule templates to URL Web sites. Make sure to get the proper permis- Resource: American College of Sports Medicine. Baltimore membership application form..org 3—B. a club gift certificate drawing is held for based on seasonal participation patterns.. Feature special classes and ACSM’s Health/Fitness Facility Standards and guest instructors. combined with at least 3 yr of experience as a Post these photos on Facebook and on the club Web group exercise instructor. sions to use member likeness for club promotional ACSM’s Resource Manual for Guidelines for efforts. 5—C. program on Twitter. Ensure that member- (MD): Lippincott Williams and Wilkins. then blog about his or her class experi. This language can often be included in Exercise Testing and Prescription. Solicit member comments and Guidelines.. In each class the GM then adjust minimum attendance requirements attends. Wilkins. (e. homepage and create signage promoting the Twitter Resource: American College of Sports Medicine. It is important to analyze average example. Using group exercise class in- 4—D. 2014. It is important to be consistent Resource: American College of Sports Medicine. page 606 computer terminal connected to club management 8—C Participant Surveys software systems. spinning. tion meets a predetermined minimum attendance ercise program. ship staff explains the photo permission clause and provides a decline option for member. club general manager.g. p.V Excel (or similar software program) spreadsheet 1. 92 CERTIFICATION REVIEW • www. class participants. To base most of your management feedback on coming input for Twitter information. initiative.2 Members love to read their names and see their photos on Facebook. Promote the what is planned and expected of the employee group exercise Twitter account on the club Web site for the upcoming year. Exercises must be safe for the 25–45-yr-old age Group exercise coordinator takes on the daily demographic because this group compromises responsibility of tweeting about the group exercise the majority of most group exercise classes. 27. boot camp. It is also important to set minimum participate in every group exercise class on the club attendance requirements based on the type of class schedule. to participate in class attendance figures. Use existing club management software module Resource: ACSM’s Resource Manual for that allows for separate group exercise class check- Guidelines for Exercise Testing and Prescription.acsm. step) and ence on the club Web site. 7th ed. Group exercise coordinator should work closely with membership and marketing departments. recommend at least one per ACSM’s Resource Manual for Guidelines for day. for for analysis. in information — participate checks into class via 4th ed. mind/body. Process evaluation can demonstrate whether packages can import member information from club procedures were followed and whether they management software systems and also export class were appropriate and effective. 7th ed. 2014. Table 5. The general manager (GM) will requirements. Use a separate software package (e.indd 92 11/08/12 12:27 AM . wel- 6—B. No formal education is recommended fo the structors. Resource: ACSM’s Resource Manual for Each participant signs a class participation sheet Guidelines for Exercise Testing and Prescription. made available near the entry of the exercise area. site homepage. with Twitter tweets. 2007. Exercise Testing and Prescription. pages 603–604 instructor performs a head count prior to class start- ing and these two numbers are compared/averaged. and 2. Determine participant’s readiness to take part in a health-related physical fitness assessment and exercise program. ACSM’s Guidelines for Exercise procedures and tools that provide accu.1 • The form should be explained verbally. (ACSM) risk stratification including genetic 9th edition (7) and lifestyle factors related to the devel. health/medical history the purpose and the risks of the 9th edition (7) procedures. history He or she must be liable and respon.4 of disease. sign/symptoms • Exercise history • Figures 2. B. • Table 2. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of preactivity screening • Consider self-guided methods.4 conditions. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of risk factor thresholds for • Consider positive and negative risk ACSM’s Guidelines for Exercise American College of Sports Medicine factors. rate information about the individual’s factor assessment 9th edition (7) health/medical history. 2. ACSM Certified Personal Trainer (CPT).1–2. current physical activity habits. SECTION 5 HFS Job Task Analysis Note: HFS certification candidates should also review the knowledge.3 opment of cardiovascular disease (CVD) 93 Dwyer_Part2_Sec5.1. present. 4th edition (4) sible for informing the health fitness • Chapter 2 specialist (HFS) of any problems expe- rienced (past. and during the assessment) that may increase the risk of the test or prohibit participation. and medications HFS Knowledge of the key components • Content and extent may vary.indd 93 11/07/12 11:56 PM . • Cardiovascular disease (CVD) risk Testing and Prescription (GETP). Implement assessment protocols and preparticipation health screening procedures to maximize participant safety and minimize risk. DOMAIN I: HEALTH AND FITNESS ASSESSMENT A. and abilities (KSAs) found in Part 1. ACSM’S Health-Related Physical Fitness Assessment Manual. risk factors. Fitness Assessment Manual. skills. 4th edition (4) • Chapter 2 Knowledge of the limitations of • The participant is playing a major role ACSM’s Health-Related Physical informed consent and health/medical in the informed consent process.2. • Figure 3. ACSM’s Guidelines for Exercise included in informed consent and • Participant should be familiar with Testing and Prescription (GETP). current medical • Medical evaluation • Tables 2. Testing and Prescription (GETP). g. sultation with medical personnel prior • Be aware of clarifications/significance.3 obesity. • Be aware of conditions that may post.g. extreme breathlessness at rest or during exercise. Testing and Prescription (GETP). consultation with medical personnel conditions. pone or terminate an exercise session. (cont. changes in the pattern of discom- fort during rest or exercise..acsm. osteoporosis. • Tables 2. Determine participant’s readiness to take part in a health-related physical fitness assessment and exercise program..2 propriate changes in resting heart rate criteria based on signs and symptoms. and high risk Testing and Prescription (GETP). medical clearance before administration classifications. Knowledge of risk factors that may be • Consider the benefits of regular ACSM’s Guidelines for Exercise favorably modified by physical activity physical activity and/or exercise. exercise-induced asthma/bron- chospasm.2 Dwyer_Part2_Sec5.2.org B.2 and/or blood pressure [BP].5 and 5.2 and 10. fainting. 9th edition (7) to exercise testing or training (e. neck. measures. and metabolic disease • Be aware of clarifications/significance. • Tables 10.g. symptoms. inap.1 asthma. emphysema) HFS Knowledge of the metabolic risk fac. 9th edition (7) • Table 2. diabetes • Chapter 10 or glucose intolerance. • Be aware of clarifications/significance. ACSM’s Guidelines for Exercise tors or conditions that may require con.1 and 2. 3. claudication) Knowledge of the pulmonary risk fac. Testing and Prescription (GETP). 9th edition (7) prior to exercise testing or training • Chapter 10 (e. • Consider nine major signs and/or ACSM’s Guidelines for Exercise tors or conditions that may require con. inflammation/pain.. • Tables 2. Testing and Prescription (GETP).3 exercise program quire exercise testing in asymptomatic participants prior to the commence- ment of an exercise program. habits 9th edition (7) • Box 1..indd 94 11/07/12 11:56 PM . acute or chronic pain. and 10. chronic bronchi- tis.4.2 Knowledge of cardiovascular risk fac. ACSM’s Guidelines for Exercise factors or conditions that may require toms that are associated with these Testing and Prescription (GETP). pulmonary. Testing and Prescription (GETP).1 discomfort in chest. 94 CERTIFICATION REVIEW • www. metabolic syndrome.g. osteoarthri- tis. 9th edition (7) of an exercise test or participation in an • Be aware of conditions that may re. symptoms. • Boxes 4. sultation with medical personnel prior • Be aware of spirometry-related 9th edition (7) to exercise testing or training (e. rheumatoid arthritis. new onset • Table 10. sultation with medical personnel prior 9th edition (7) to exercise testing or training (e. or arm. moderate.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the major signs or • Consider nine major signs and/or ACSM’s Guidelines for Exercise symptoms suggestive of cardiovascular. low back pain) Knowledge of ACSM risk classification • Be aware of the differences between ACSM’s Guidelines for Exercise categories and their implications for low. • Nine major signs and/or symptoms ACSM’s Guidelines for Exercise tors or conditions that may require con. shoulder. • Be aware of the different termination • Table 2. dizzy spells. hypoglycemia) Knowledge of the musculoskeletal risk • Be aware of common signs and symp. Testing and Prescription (GETP). 3 disease and/or the presence of known tions/significance of each chapter. Evaluation.4 Knowledge of the components of a • This process should be thorough and ACSM’s Guidelines for Exercise health history questionnaire (e. Detection. the NCEP’s recommendations for cholesterol testing and management.1 (JNC7). impaired Testing and Prescription (GETP).1 limitations. Dwyer_Part2_Sec5. (cont.2 and 2.3 cardiovascular. • Chapter 2 • Figure 2. signs or symptoms suggestive of car. moderate. Testing and Prescription (GETP). myocardial infarction. Pressure Education Program Guidelines Prevention. Testing and Prescription (GETP). and 13 tein cholesterol (LDL-C). ence health and may affect exercise Guidelines for Exercise Testing lesterol (TC).indd 95 11/07/12 11:56 PM . major factors. 7th edition (8) cholesterol (HDL-C). syncope.2 dyspnea. • Table 2. • Guideline may be adjusted periodically. • Chapters 6. orthopedic • Box 3. Testing and Prescription (GETP). bolic disease status and high risk classifications. medical clearance prior to exercise and • Consider risk classification. low-density lipopro. and smoking and alcohol use) Skill in risk classification of participants • Consider positive and negative risk ACSM’s Guidelines for Exercise using CVD risk factor thresholds. National Cholesterol Education Program and Treatment of High Blood 9th edition (7) (NCEP) /Adult Treatment Panel (ATP) Cholesterol in Adults. • Chapter 4 muscular strength and muscular endurance.g. triglycerides. glucose tolerance.3 and 2. and meta.2 Guidelines. tachycardia. claudication. fitness testing test. prescribed medications. Knowledge of medical supervision • When recommended to have a medi. and flexibility. • Figure 2. hypertension. and Prescription. self-guided or ACSM’s Guidelines for Exercise documents to determine the need for professionally guided screening forms. 9th edition (7) atherosclerosis. pulmonary. and current medical history. • Tables 2. stress and anxiety levels.. ACSM’s Resource Manual for including but not limited to total cho. Determine participant’s readiness to take part in a health-related physical fitness assessment and exercise program. • Differentiate between low. SECTION 5 HFS Job Task Analysis 95 B. Skill in reviewing preactivity screening • Review. and ischemia Knowledge of recommended plasma • Adapted from the “Third Report of the ACSM’s Guidelines for Exercise cholesterol levels for adults based on Expert Panel on Detection.4 composition.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of medical terminology • Consider key medical terms that influ. ACSM’s Guidelines for Exercise recommendations for cardiorespiratory cal doctor (MD) supervision during a Testing and Prescription (GETP). nutritional habits. Evaluation. Knowledge of recommended BP levels • Adapted from “The Seventh Report ACSM’s Guidelines for Exercise for adults based on National High Blood of the Joint National Committee on Testing and Prescription (GETP). cardiorespiratory fitness. 9th edition (7) to select appropriate physical fitness • Consider various physical fitness • Chapter 2 assessment protocols assessment protocols such as body • Figures 2. when applied. or metabolic symptoms and be aware of clarifica. and 9th edition (7) Treatment of High Blood Pressure • Table 3. one should be in close proximity 9th edition (7) and readily available. pulmonary.” ATP III outlines • Table 3. family 9th edition (7) history of cardiac disease. Testing and Prescription (GETP). past include past and present items. ACSM’s Guidelines for Exercise impaired fasting glucose. high-density lipoprotein prescription and outcome. • Consider nine major signs and/or 9th edition (7) diovascular.” HFS • Guideline may be adjusted periodically. activity patterns. 7. and 4. gram (ECG). diabetes • Parts II–IV mellitus.6. Fitness Assessment Manual.. pulmonary disease) Skill in analyzing and interpreting infor. 9th edition (7) fitness sure the components of health-related • Chapter 4 physical fitness. 9th edition (7) • Tables 4. 9th edition (7) • Chapter 4 Knowledge of the effects of common • For each class of common medication ACSM’s Guidelines for Exercise medications and substances on exercise and substances. Knowledge of selecting the most • Consider specific fitness goals. the components of health-related fitness analyze and interpret data. • Chapter 8 Dwyer_Part2_Sec5. caffeine. diseases and conditions (e. etc. and individuals with population and healthy population with 9th edition (7) special considerations special considerations. Testing and Prescription (GETP).. heart 3rd edition (2) disease. • Review pretest instruction and follow ACSM’s Guidelines for Exercise cedures of fitness testing protocols appropriate test order. blood pressure. mental conditions. and exercise capacity. antihyperten. and Prescription. and environ. ACSM’s Guidelines for Exercise appropriate testing protocols for • Consider injury history. antianginals. fitness — cardiorespiratory fitness.indd 96 11/07/12 11:56 PM . • Use appropriate criterion-referenced ACSM’s Guidelines for Exercise mation obtained from assessment of and normative standard tables to Testing and Prescription (GETP). ACSM’s Resource Manual for • Review equipment manuals for Guidelines for Exercise Testing specifics. alcohol.17 Skill in modifying protocols and • Be aware of the differences between ACSM’s Guidelines for Exercise procedures for testing children. ACSM’s Health-Related Physical and proper use of fitness testing lected data. • Appendix A hypoglycemics. older adults. Select and prepare physical fitness assessments for healthy participants and those with controlled disease. review Chapter 3 Testing and Prescription (GETP). each participant based on preliminary 9th edition (7) screening data • Chapter 4 Knowledge of calibration techniques • To ensure the accuracy of the col. testing (e. cold tablets. bronchodilators. 7th edition (8) • Chapter 20 Knowledge of the purpose and pro. 4. Diseases and Disabilities. diet pills.) 4th edition (4) must be calibrated prior to the testing • Chapter 1 session. nicotine) Knowledge of the physiologic and • Review pathophysiology.5–4.13. 7th edition. rate. equipment ment (stationary bikes. of ACSM’s Resource Manual for 9th edition (7) body composition. and muscular endurance Prescription. hypertension. adoles. treadmills. flexibility. • Box 4. 4. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the physiological basis • If detailed exercise physiology review ACSM’s Guidelines for Exercise of the major components of physical is warranted. electrocardio. HFS Knowledge of test termination criteria • These indications apply for exercise ACSM’s Guidelines for Exercise and proper procedures to be followed tests but could also be applied for any Testing and Prescription (GETP). for the components of health-related • Be aware of different modes to mea.8–4.1–4. exercise ACSM’s Exercise Management metabolic responses to exercise responses.g.g.3. psychotropics. antiarrhythmics. ACSM’s Guidelines for Exercise sequencing equipment to be used. devices and related equip. 96 CERTIFICATION REVIEW • www. after discontinuing health fitness tests health-related physical fitness compo.acsm. cents. testing an apparently healthy Testing and Prescription (GETP). muscular Guidelines for Exercise Testing and • Chapter 4 strength. 9th edition (7) nents tests.org C. obesity.15–4.5 Knowledge of fitness assessment • These may apply to related forms. recognize drug name Testing and Prescription (GETP). Testing and Prescription (GETP). and the effects of exercise for Persons with Chronic testing associated with each chronic training for each chronic condition. and related brand and effect on heart 9th edition (7) sives. Testing and Prescription (GETP). bradycardia. • Glossary. Knowledge of the BP response to • Be aware of abnormal responses to ACSM’s Guidelines for Exercise exercise exercise such as a drop in SBP and Testing and Prescription (GETP). Testing and Prescription (GETP). other reputable clinical exercise physi. 9th edition (7) • Chapter 6 Knowledge of the rating of perceived • Be aware of the limitation of the ACSM’s Guidelines for Exercise exertion (RPE) RPE scale. 2nd edition (12) cardia.7 be used with caution. SECTION 5 HFS Job Task Analysis 97 D. using different modes of exercise Fitness Assessment Manual. nology including angina pectoris. predicting maximal heart rate (HRmax).indd 97 11/07/12 11:56 PM . • Chapter 3 Knowledge of Korotkoff sounds for • Be aware of the significance and the ACSM’s Health-Related Physical determining systolic BP (SBP) and difference between the 4th (true DBP) Fitness Assessment Manual. appropriate cuff size. • Chapters 7 and 8 Knowledge of blood pressure (BP) • Be aware of different conditions and ACSM’s Health-Related Physical measurement techniques considerations that may affect resting Fitness Assessment Manual. 593–610 hyperventilation Dwyer_Part2_Sec5. substantial increase in DBP. • These terms could be found in any Clinical Exercise Physiology. Knowledge of the anatomy and • This information could also be found ACSM’s Resource Manual physiology of the cardiovascular and in any undergraduate or graduate level for Exercise Testing and pulmonary systems exercise physiology textbook. etc. for Exercise Testing and response to exercise • Be aware of the wide interindividual Prescription. 9th edition (7) • Be aware of the significance of rate. • Chapter 4 • The subjective measure of perceived • Table 4. diastolic BP (DBP) and the 5th (clinical DBP) Korotkoff 4th edition (4) sounds in respect to resting and • Box 3. and RPE moni. Prescription. Knowledge of techniques of • Be aware of the two common ana. Conduct and interpret cardiorespiratory fitness assessments. ACSM’s Guidelines for Exercise toring techniques before. • Chapter 6 pressure product. 9th edition (7) the RPE scale presents a wide interin. pp. ACSM’s Resource Manual measuring heart rate (HR) and HR tomical palpation sites. Testing and Prescription (GETP). 7th edition (8) • Chapters 1 and 3 Knowledge of cardiorespiratory termi. 7th edition (8) variability with respect to HR • Chapter 20 HFS responses during exercise and ACSM’s Guidelines for Exercise therefore the potential inaccuracy in Testing and Prescription (GETP). after cardiorespiratory fitness testing • BP should be measured at the hori. • Be aware that there are several tech. • Chapter 4 dividual variability and therefore should • Table 4. during. 9th edition (7) zontal level of the heart. and niques to measure HR. BP.1 exercise measurements. BP measurements such as body 4th edition (4) posture. arrhythmia. ment protocols and different protocols to determine 4th edition (4) cardiorespiratory performance. tachy. Knowledge of HR.4 exertion may be influenced by many factors and therefore should be used with caution. • Similar to HR responses to exercise. and ology textbook. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of common submaximal • Be aware of the pros and cons of ACSM’s Health-Related Physical and maximal cardiorespiratory assess. stroke. • Chapter 7 Dwyer_Part2_Sec5. Knowledge of the effects of myo.7 Skill in determining cardiorespiratory • Consider the pros and cons of using ACSM’s Health-Related Physical fitness based on submaximal exercise different modes of exercise and Fitness Assessment Manual. 4th edition (4) • Chapters 7 and 8 Skill in locating anatomic landmarks for • Palpate for the brachial artery prior to ACSM’s Resource Manual for palpation of peripheral pulses and BP attempting to measure BP. and RPE at • Consider the order of measurements ACSM’s Resource Manual for rest and during exercise during a submaximal or maximal Guidelines for Exercise Testing graded exercise test. hypertension. myocardial (significance) and progression of for Exercise Testing and infarction (MI).) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the pathophysiology • Be familiar with the different stages ACSM’s Resource Manual of myocardial ischemia. • Be aware of the multifaceted relation. ⭈ per unit of time (VO2max) methods provides some pros and cons 4th edition (4) HFS in respect to the level of difficulty and • Chapters 7 and 8 accuracy of performing the test. 7th edition (8) and hyperlipidemia • Be aware of the intimate relationship • Chapter 6 that each condition often has with one another. Prescription. MI. Guidelines for Exercise Testing and Prescription.org D. ship between atherosclerosis and for Persons with Chronic claudication. these conditions.g. 7th edition (8) • Chapter 20 ACSM’s Guidelines for Exercise Testing and Prescription (GETP). respiratory responses during exercise 3rd edition (2) • Chapters 6. and Prescription.acsm. stroke volume. 14. atherosclerosis. (cont.indd 98 11/07/12 11:56 PM . Each of the Fitness Assessment Manual. difficulty and accuracy of the results. exercise physiology textbook. ventilatory threshold) • Chapter 3 ACSM’s Guidelines for Exercise Testing and Prescription (GETP). Conduct and interpret cardiorespiratory fitness assessments. and dyspnea on cardio. BP. Knowledge of cardiorespiratory • This information could be found in any Exercise Physiology: Integrating responses to acute graded exercise other reputable exercise physiology Theory and Application (19) of conditioned and unconditioned textbook. hypertension. and 15 Knowledge of oxygen consumption • This information could also be found ACSM’s Resource Manual dynamics during exercise (e. 9th edition (7) • Chapter 6 • Box 6. ACSM’s Exercise Management cardial ischemia. 98 CERTIFICATION REVIEW • www. in any undergraduate or graduate level for Exercise Testing and HR. Prescription.1 Knowledge of methods of calculating • Be aware that there are several meth. • Chapter 5 participants Skill in interpreting cardiorespiratory • Consider the pros and cons of each ACSM’s Health-Related Physical fitness test results method in respect to the level of Fitness Assessment Manual. test results different protocols to determine 4th edition (4) cardiorespiratory fitness.. 7th edition (8) ventilation. cardiac output. 7th edition (8) • Chapters 1 and 20 Skill in measuring HR. Diseases and Disabilities. ACSM’s Health-Related Physical ⭈ maximal volume of oxygen consumed ods of calculating VO2max. 9th edition (7) • Chapter 4 • Table 4. and Guidelines for Exercise Testing ralis major. hamstrings. of the spine and common assessments primary and secondary spinal curves. and 4th edition (4) flexibility assessment protocols. muscles location. • Be aware of the relationship between ACSM’s Resource Manual for tion of the major muscles (e. • Chapters 9 and 13 proper spinal alignment Knowledge of the normal curvatures • Be aware of the difference between Basic Biomechanics. 7th edition (8) • Chapter 1 ACSM’s Health-Related Physical Fitness Assessment Manual. flexibility assessments analyze and interpret data. adductors. stabilizer 6th edition (16) • Chapter 6 Knowledge of the planes and axes in • Be aware that the starting position ACSM’s Resource Manual for which movement action occurs for recognizing planes and axis of all Guidelines for Exercise Testing movements in the human body is the and Prescription. • Be aware that there are other ACSM’s Resource Manual for absolute strength. flexibility assessment protocols strength. abductors. SECTION 5 HFS Job Task Analysis 99 E. medial. specific movements. 7th edition (8) assessments. 7th edition (8) biceps.. Conduct assessments of muscular strength. and and normative standard tables to Fitness Assessment Manual. muscular endurance. posture. and Prescription. performed by each muscle. Knowledge of the location and func.g. extension.5 circumduction. triceps. latissimus dorsi. and textbook. 4th edition (4) • Chapters 5 and 6 Knowledge of relative strength. lateral. and Basic Biomechanics. quadriceps. muscular endurance. rectus abdominis. hyperextension.30 spinae. • Chapter 1 • Figure 1. supination. stability. flexion. inferior. • Chapter 31 Knowledge of the anatomy of bone. adduction. trapezius. muscular endurance. muscular endurance. 4th edition (4) • Chapter 5 Knowledge of muscle action terms • Be aware of the different joints in the ACSM’s Resource Manual for including anterior. • Table 1. 6th edition (16) of postural alignment • This information could be found in • pp. base of any other reputable biomechanics 6th edition (16) support. and one repetition methods of measuring strength Guidelines for Exercise Testing maximum (1-RM) estimation using both static and isokinetic and Prescription. posterior. and Prescription. 7th edition (8) pronation. agonist.2 Knowledge of the interrelationships • This information could be found in Basic Biomechanics. balance. and gastrocnemius) Dwyer_Part2_Sec5. 283–284 any other reputable biomechanics textbook. gluteus maximus. • Be aware of the relationship these ACSM’s Resource Manual for skeletal muscle. antagonist. and connective tissues different systems have in respect to Guidelines for Exercise Testing human movement. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of common muscular • Be aware of the pros and cons of ACSM’s Health-Related Physical strength. erector • Figures 1. • Chapters 5 and 6 Knowledge of interpreting muscular • Use appropriate criterion-referenced ACSM’s Health-Related Physical strength. 7th edition (8) anatomical position. and flexibility.indd 99 11/07/12 11:56 PM . line of pull. • Chapter 1 internal and external obliques. • Be aware of the different roles • Chapter 1 abduction. rotation and associated movements. body in respect to planes and axes of Guidelines for Exercise Testing HFS superior. and Prescription.29 and 1. and using different common muscular Fitness Assessment Manual. pecto. among center of gravity. rotation. duel-energy X-ray absorptiometry [DEXA].29. 1-RM.acsm. 1. 9th edition (7) • Chapter 4 Dwyer_Part2_Sec5. and joints. and joints muscles.30 • Table 1. ACSM’s Resource Manual for muscles. hand grip strength. ACSM’s Resource Manual for their associated movement tion and the relationship to planes Guidelines for Exercise Testing and axes. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the advantages.3 and 1. muscular endurance using different common muscular Fitness Assessment Manual.. 100 CERTIFICATION REVIEW • www. and Prescription. muscular endurance. 7th edition (8) • Chapter 1 • Figures 1. Designing Resistance Training resistance (2–10 RM) vantages of using an estimation rather Programs. • Be aware of the pros and cons of ACSM’ Health-Related Physical advantages.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the major joints and • Be aware of each joint’s classifica. sit. and 1. flexibility tests.indd 100 11/07/12 11:56 PM .23. Conduct assessments of muscular strength. 4th edition (4) measurements • Chapter 4 ACSM’s Guidelines for Exercise Testing and Prescription (GETP). hydrostatic weighing. dis.. air difficulty and accuracy of the results. 4th edition (4) significance. and use. (cont. skinfold sites measurement in respect to accuracy. 7th edition (8) • Chapter 1 • Tables 1. skinfolds. and flexibility (e. 9th edition (7) • Chapter 4 Knowledge of procedures for • Be aware of the pros and cons of ACSM’s Health-Related Physical determining body mass index (BMI) each method in respect to the level of Fitness Assessment Manual. • Chapter 4 ACSM’s Guideline for Exercise Testing and Prescription (GETP). muscular endurance.5 Skill in conducting assessments of • Be aware of the pros and cons of ACSM’s Health-Related Physical muscular strength. composition techniques (e. and 4th edition (4) dynamometer.g. ibility assessments analyze and interpret data. muscular endurance. curl-ups. Guidelines for Exercise Testing and Prescription. and taking skinfold and circumference difficulty and accuracy of the results. and limitations of body each method in respect to the level of Fitness Assessment Manual. 3rd edition (13) than measuring 1-RM. • Chapters 5 and 6 and-reach) Skill in estimating 1-RM using lower • Consider the advantages and disad. Conduct anthropometric and body composition assessments. 4th edition (4) HFS • Chapters 5 and 6 F. and flexibility. and bioelectrical impedance) Knowledge of the standardized • Be familiar with the differences ACSM’s Health-Related Physical descriptions of circumference and between circumference and skinfold Fitness Assessment Manual.g. and flex. push-ups.org E. • Be aware of the adjacent bones. 4th edition (4) displacement plethysmography [BOD • Chapter 4 POD].4 Skill in identifying the major bones. • Chapter 5 Skill in interpreting results of muscular • Use appropriate criterion-referenced ACSM’s Health-Related Physical strength. and normative standard tables to Fitness Assessment Manual. agility. balance. Knowledge of the six motor skill– • Be aware of the fundamental differ..1 Dwyer_Part2_Sec5. reaction fitness components and skill-related 9th edition (7) time.2 • Tables 1. Conduct anthropometric and body composition assessments. Testing and Prescription (GETP). Knowledge of the benefits and precau. and waist-to-hip ratio • Chapter 4 Skill in locating anatomic landmarks • Consider the anatomic landmarks ACSM’s Guidelines for Exercise for skinfold and circumference differences between skinfold and Testing and Prescription (GETP).4 to previous publications of American • Figures 2. B.1 and 4. anaerobic) appropriate exercise prescription. intensity. • Collect baseline and follow-up data 9th edition (7) lifestyle. and power physical fitness components. waist related disease risk. in apparently healthy participants and • Be familiar with the risk that is asso. aerobic.2 Skill in interpreting the results of • Consider the process of calculating ACSM’s Guidelines for Exercise anthropometric and body composition skinfold measurement. (health and performance related). exercise history.3–1. participants tion of Guidelines for Exercise Testing 9th edition (7) and Prescription (GETP) when compared • Tables 2. cardiovascular. health. and the Testing and Prescription (GETP). Review preparticipation health screening including self-guided health questionnaires and appraisals. Knowledge or Skill Statement Explanation/Examples Resources HFS Skill in synthesizing prescreening • Be aware of the major changes to the ACSM’s Guidelines for Exercise results and reviewing them with preparticipation procedures in this edi. in order to provide individualized and • Chapter 4 agility. speed. waist circumference. BMI.indd 101 11/07/12 11:56 PM . measurements circumference sites. of exercise.g. quantity Testing and Prescription (GETP). sport. • Chapter 4 • Tables 4. functional ability. • Be aware of the basic components of ACSM’s Guidelines for Exercise and flexibility-based exercise an exercise training session. (cont. specific training. 9th edition (7) time. and frequency.1–2. balance. and physical fitness assessments. ACSM’s Guidelines for Exercise related physical fitness components: ences between health-related physical Testing and Prescription (GETP).4 College of Sports Medicine (ACSM). terns and the significance of BMI. 9th edition (7) circumference. Testing and Prescription (GETP). • Chapter 1 • Box 1. 9th edition (7) • Chapter 4 • Boxes 4.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the health implications • Be aware of the relationship between ACSM’s Guidelines for Exercise of variation in body fat distribution pat. SECTION 5 HFS Job Task Analysis 101 F. • Box 1. specifically. Determine safe and effective exercise programs to achieve desired outcomes and goals.6 Knowledge of program development • Consider client-specific fitness goals ACSM’s Guidelines for Exercise for specific client needs (e.3 and 4. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of strength. • Be familiar with the benefits of regular ACSM’s Guidelines for Exercise tions associated with exercise training physical activity and/or exercise. Testing and Prescription (GETP). assessments body density conversion to percent 9th edition (7) body fat. volume and progres.1–2. • Chapter 7 sion (FITT-VP) principles. Testing and Prescription (GETP). 9th edition (7) those with controlled disease ciated with physical activity and/or • Chapter 1 exercise.5 DOMAIN II: EXERCISE PRESCRIPTION AND IMPLEMENTATION A. and type. performance. coordination. clients inpatient and outpatient rehabilitation with increased risk. with aerobic exercise as well as mus. and • Chapters 7–9 for apparently healthy clients. in any undergraduate or graduate level 9th edition (7) exercise physiology textbook. and Prescription. 7th edition (8) ciples are important and valid. cardio. cardiac out. individual ercise prescription. arteriovenous oxygen difference • Chapter 3 (a-vO2 DIFF).. and Prescription. blood flow. relationship between the aerobic and Guidelines for Exercise Testing mance of various physical activities anaerobic systems as they relate to and Prescription. stretching. progressive overload. 9th edition (7) decrease morbidity and mortality • Chapter 1 rates. the physiological prin. be aware of client/ Guidelines for Exercise Testing differences and specificity of training. • Chapter 7 cool-down) Knowledge of the physiological princi. cise session (e. 7th edition (8) and how they relate to exercise exercise and be mindful of attainable • Chapter 31 prescription goals. ently healthy population. • Chapter 34 Knowledge of the principles of revers. • When determining an appropriate ex. Determine safe and effective exercise programs to achieve desired outcomes and goals. and Prescription. 7th edition (8) sure. reduce coronary Testing and Prescription (GETP). Guidelines for Exercise Testing ⭈ exercise put (CO [Q ]). and clients with programs. (cont.acsm. 7th edition (8) • This information could also be found in • Chapter 2 any reputable undergraduate or gradu- ate level biomechanics textbook. and Prescription. 9th edition (7) vascular. ACSM’s Guidelines for Exercise • This information could also be found Testing and Prescription (GETP). Testing and Prescription (GETP).indd 102 11/07/12 11:56 PM .org B. 9th edition (7) conditioning or sports-related exercise.2 benefits. Dwyer_Part2_Sec5. scription guidelines for strength. warm-up. Knowledge of the basic biomechanical • Be familiar with biomechanics and the ACSM’s Resource Manual for principles of human movement relationship to activities of daily living Guidelines for Exercise Testing (ADL) as well as to sport performance. 7th edition (8) • The adaptations that are associated • Chapter 32 with chronic exercise training improve ACSM’s Guidelines for Exercise physiological function. cular fitness exercise. patient goals. HFS controlled disease Knowledge of the components and • Be aware that these components ACSM’s Guidelines for Exercise sequencing incorporated into an exer. ACSM’s Resource Manual for ibility. • Chapter 6 Knowledge of the physiologic • This information could be found in ACSM’s Resource Manual for adaptations following chronic exercise any reputable exercise physiology Guidelines for Exercise Testing training textbook. • Although both the warm-up and cool.g. Knowledge of the role of aerobic and • Be very familiar with the intricate ACSM’s Resource Manual for anaerobic energy systems in the perfor. Knowledge of American College of • Be familiar with FITT-VP principles. stroke volume (SV). blood pres. artery disease (CAD) risk factors. ACSM’s Resource Manual for ples related to warm-up and cool-down down are often overlooked by many Guidelines for Exercise Testing professionals. 7th edition (8) the intensity and duration of different • Chapter 3 physical activities.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the physiologic changes • Be familiar with changes in heart rate ACSM’s Resource Manual for associated with an acute bout of (HR). should be incorporated in some form Testing and Prescription (GETP). and flexibility-based exercise lation with special consideration. and provide other health-related • Box 1. ACSM’s Guidelines for Exercise Sports Medicine (ACSM) exercise pre. and ventilation. healthy popu. • The information may apply to appar. Prescribe appropriate and Prescription. 102 CERTIFICATION REVIEW • www. Guidelines for Exercise Testing overtraining resistance exercise. clients.g. Testing and Prescription (GETP). and goals Knowledge of the minimal threshold • HFS should be aware that FITT-VP ACSM’s Guidelines for Exercise of physical activity required for health principles applies to aerobic. • Tables 7.g. Testing and Prescription (GETP). Knowledge of the advantages and • Both free weights and exercise ma. Implement cardiorespiratory exercise prescriptions using the frequency. • HFS is expected to be able to take ACSM’s Guidelines for Exercise tion guidelines for apparently healthy raw data that is collected during exer. time. Determine safe and effective exercise programs to achieve desired outcomes and goals. 9th edition (7) • Tables 7.5–7. cardiovascular equipment) guidelines. ACSM’s Guidelines for Exercise exercises pected to be able to properly instruct Testing and Prescription (GETP). be very familiar with the FITT-VP Testing and Prescription (GETP). skill level. risks. • Chapter 7 intensity. aerobic.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the psychological and • Be familiar with differences between ACSM’s Resource Manual for physiological signs and symptoms of overtraining from aerobic exercise vs. bursitis. C. • Be aware of the differences between Basic Biomechanics. and flexibility exercises. 7th edition (8) chines. and availability of time. fitness goals. 9th edition (7) cate relationship between frequency. current • Chapter 1 fitness level. and • Consider appropriate risk classification. and type (FITT) principle for apparently healthy participants based on current health status. toms of common musculoskeletal musculature and joint-related injuries. HFS Skill in implementing exercise prescrip..7 Dwyer_Part2_Sec5. tendonitis) any reputable undergraduate or gradu- ate athletic training textbook.5–7. 9th edition (7) and design safe and effective training • Chapters 7–9 programs. strain. 9th edition (7) on client experience. and flexibility 9th edition (7) exercises. • Chapters 7–9 Skill in designing safe and effective • HFS is expected to be able to take ACSM’s Guidelines for Exercise training programs raw data that is collected during Testing and Prescription (GETP). and 9th edition (7) clients with controlled disease provide a population specific exercise • Chapters 7–9 prescription. SECTION 5 HFS Job Task Analysis 103 B. Guidelines for Exercise Testing (e. time. (cont. benefits and/or fitness development resistance. ACSM’s Resource Manual for disadvantages of exercise equipment chines can be beneficial if used appro. diorespiratory fitness framework. cardiovascular training exercises based ate exercise prescription. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the recommended FITT • Health fitness specialist (HFS) should ACSM’s Guidelines for Exercise framework for the development of car.7 Knowledge of the benefits. more specifically. selectorized ma. interpret the results. Testing and Prescription (GETP). ACSM’s Guidelines for Exercise contraindications of a wide variety of • Consider individualized and appropri. the intri. 6th edition (16) injuries associated with exercise • This information could also be found in • Chapter 5 (e. • Chapter 31 Skill in teaching and demonstrating • Health fitness specialist (HFS) is ex.indd 103 11/07/12 11:56 PM . sprain. interpret the results. priately and when following published and Prescription. intensity. and type of exercise. resistance.. 7th edition (8) • Chapters 32 and 33 Knowledge of the signs and symp. exercise tests. and cise tests. and Prescription. clients with increased risk. free weights. 104 CERTIFICATION REVIEW • www. • Table 7. fitness goals.acsm. • Be aware of different prediction equa.3 Knowledge of calculating the caloric • 1 lb (0. • This information could be found in any other reputable exercise physiology textbook. deriving energy conversions. ACSM’s Guidelines for Exercise ⭈ ⭈ VO2R. caloric expenditure) • These formulas are most accurate 9th edition (7) HFS during a steady state exercise. 7th edition (8) properties of cardiac muscle exercise. ⭈ oxygen uptake reserve (VO2R). unit conversions.indd 104 11/07/12 11:56 PM . intensity including heart rate (HR). be used as primary method of pre. and Prescription. and prognostic 9th edition (7) application of a test. peak and/or affective variability should not 9th edition (7) heart rate (HRpeak) method. HRpeak method. VO2peak method.2 • Table 7. • Chapter 7 ume of oxygen consumed per unit of scribing exercise intensity. diagnostic. and the RPE scale • The HRR or VO2R methods may be 9th edition (7) preferable when compared to %HR • Chapter 7 ⭈ and %VO2. hemodynamic. time. other measures of perceived effort Testing and Prescription (GETP).g. Knowledge of the accuracy of HRR. 7th edition (8) • Chapter 31 Knowledge of the anatomy and • Be aware of the relationship between ACSM’s Resource Manual for physiology of the cardiovascular and these two systems in respect to Guidelines for Exercise Testing pulmonary systems including the basic normal function at rest and during and Prescription.1 equivalents (MET) method. peak metabolic • Table 7.500 kcal ACSM’s Resource Manual for expenditure of an exercise session • Be aware of the MET level equation Guidelines for Exercise Testing (kilocalories per session) of calculating caloric expenditure per and Prescription. Testing and Prescription (GETP). affective valence should not be used 9th edition (7) and MET.. ⭈ peak MET method.g..1 • Chapter 11 Knowledge of the applications of • Be aware that plyometric training ACSM’s Resource Manual for anaerobic training principles is also considered as a method of Guidelines for Exercise Testing anaerobic training. (cont. • Chapter 1 • Be aware of the relationship Exercise Physiology: Integrating between these two systems in Theory and Application (19) respect to upper limitation of aerobic • Chapters 5 and 6 performance.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of determining exercise in. • Chapter 28 Knowledge of methods for establish. tion for maximal heart rate (HRmax) Testing and Prescription (GETP).2 Knowledge of abnormal responses to • Be aware that these variables play ACSM’s Guidelines for Exercise exercise (e. as primary method of prescribing • Chapter 7 exercise intensity. Dwyer_Part2_Sec5.org C. and availability of time. peak vol. Implement cardiorespiratory exercise prescriptions using the frequency. intensity. cost of exercise.45 kg) of fat ⫽ 3. and type (FITT) principle for apparently healthy participants based on current health status. • Box 6. RPE. cardiac. • Chapter 7 • Figure 7. and the • Chapter 11 rating of perceived exertion (RPE) scale.1 Knowledge of metabolic calculations • Be aware of the different unit ACSM’s Guidelines for Exercise (e. • Be aware that the RPE scale and ACSM’s Guidelines for Exercise tensity using heart rate reserve (HRR).2 ⭈ time (VO2peak) method. ventilatory) therapeutic. • Box 7. a major role when assessing the Testing and Prescription (GETP). • Box 7.1 • Table 7. • Be aware that the RPE scale and other ACSM’s Guidelines for Exercise ing and monitoring levels of exercise measures of perceived effort and/or Testing and Prescription (GETP).7th edition (8) minute. equipment • If needed. • Be familiar with the significance of 9th edition (7) respiratory exchange ratio (RER) and • Chapter 4 the relationship to respiratory quotient (RQ). ⭈ • The HRR or VO2R methods may be preferable when compared to %HR ⭈ and %VO2. and type (FITT) principle for apparently healthy participants based on current health status. Skill in determining appropriate exer. Skill in teaching and demonstrating the • Consider the client-specific FITT-VP ACSM’s Guidelines for Exercise use of various cardiovascular exercise principles. consider consulting the 9th edition (7) specific manual of the cardiovascular • Chapter 7 exercise equipment. and • Chapter 7 exercise prescription MET (mL ⴢ kg⫺1 ⴢ min⫺1 → MET→ • Figure 7. Testing and Prescription (GETP). Skill in determining the energy cost. and availability of time. • Consider the conversions between ACSM’s Guidelines for Exercise ⭈ HFS absolute and relative oxygen costs relative and absolute VO2 Testing and Prescription (GETP). ACSM’s Guidelines for Exercise cise frequency. intensity. • Table 7. fitness goals. • If needed. consider consulting the 9th edition (7) specific manual of the cardiovascular • Chapter 7 exercise equipment. intensity. and type tween the different components of Testing and Prescription (GETP).5) and vice versa. time. and MET levels of various activi. Testing and Prescription (GETP). Testing and Prescription (GETP). • Be familiar with the interaction be. 9th edition (7) sity and time (duration) of the activity.3 Skill in identifying improper technique • Consider the client-specific FITT-VP ACSM’s Guidelines for Exercise in the use of cardiovascular equipment principles.1 /3. • Be aware that the RPE scale and other measures of perceived effort and/or affective valence should not be used as primary method of prescribing exer- cise intensity. for clients with various fitness levels FITT-VP principles. Implement cardiorespiratory exercise prescriptions using the frequency. specifically. time. (mL ⴢ kg ⴢ min → L ⴢ min⫺1 → ⫺1 ⫺1 9th edition (7) ⭈ ties and apply the information to an /1000 ⫻ body mass).) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the basic principles of • Be familiar with the concept of open. (cont. • Chapter 7 • Be aware of different prediction equa- tion for HRmax. relative VO2. ACSM’s Guidelines for Exercise gas exchange circuit spirometry.indd 105 11/07/12 11:56 PM . ⭈ (VO2). Dwyer_Part2_Sec5. SECTION 5 HFS Job Task Analysis 105 C. inten. org D.4 • Be aware of the different types of flex- ibility exercises. HFS Knowledge of safe and effective • There are many effective stretching ex. tion of a split routine. Knowledge of the minimal threshold • Be aware of the interaction between ACSM’s Guidelines for Exercise of physical activity required for health the intensity and the time of the Testing and Prescription (GETP). health status... variable resistance equipment. training sessions per week and fre. physiologic differences. Stretching for Functional stretches that enhance flexibility ercises that may involve major muscle Flexibility (9) groups and/or individual muscles. genetics. endurance in respect to the number of 9th edition (7) ance. eccentric. Knowledge of the types of muscle • Be aware of the pros and cons of ACSM’s Resource Manual for contractions (e. be mindful of Guidelines for Exercise Testing split routine) and modalities (e. Knowledge of acute (e.. load. 7th edition (8) variables (e. • Be aware of the interaction between ACSM’s Resource Manual for volume. and proprioceptive neuromuscular facilitation (PNF). habitual physical activity. sets. 106 CERTIFICATION REVIEW • www. • Chapter 31 pneumatic machines.1 • Be aware of the pros and cons of both free weights and variable resistance equipment.e. of muscular strength. and availability of time. and flexibility repetitions and the intensity (% of one • Chapter 7 repetition maximum [1-RM]).acsm. Knowledge of indications for water. muscular strength.g. intensity. Knowledge of the types of resistance • When choosing total body or a varia. time.. exercise prescription. periodization) of the training and periodization • Chapter 31 schedule. using each of the types of muscle Guidelines for Exercise Testing concentric. • Although aquatic exercise may be Therapeutic Exercise: From based exercise (e. • Box 7. Guidelines for Exercise Testing order of exercises) and chronic training • Be aware of the variation in volume and Prescription. bands) quency of training. the number of repetitions and the load.indd 106 11/07/12 11:56 PM . Theory to Practice (18) there are some notable disadvantages • Table 12. and Prescription. benefits and/or fitness development exercise.g. ballistic stretches. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the recommended • Be aware of the differences between ACSM’s Guidelines for Exercise FITT framework for the development prescribing muscular strength and Testing and Prescription (GETP). 7th edition (8) muscle groups • Prescribe appropriate exercise and be • Chapter 29 mindful of attainable goals. rest periods. dynamic.1 (i. and type (FITT) principle for flexibility. fitness goals.. non–weight-bearing exercise).g. be aware of Guidelines for Exercise Testing lar strength and/or endurance of major client/patient goals. • Chapter 5 • Be aware of the differences between static. muscular endur. and social and psychological factors.g. and Prescription. obesity) appropriate for some populations. ACSM’s Resource Manual for training programs (e. 7th edition (8) • Chapter 31 Dwyer_Part2_Sec5. 9th edition (7) • Minimal threshold intensity may vary • Chapter 7 and be affected by individual’s corti- cotropin-releasing factor level. free other variables such as number of and Prescription. and muscular endurance for apparently healthy participants based on current health status.. isometric) contractions..g. total body. repetitions. • Table 31. arthritis.g. 7th edition (8) weights. Knowledge of safe and effective • When determining an appropriate ACSM’s Resource Manual for exercises designed to enhance muscu. Implement exercise prescriptions using the frequency. age. 2 • Chapter 9 • Table 9. • Be aware of the positive and nega. this maneuver and Prescription. time. muscular strength.g. Theory and Application (19) • This information could be found in any • Chapter 3 other reputable exercise physiology textbook. Golgi tendon organ (GTO). • Chapter 3 cise or lack of it. SECTION 5 HFS Job Task Analysis 107 D. • Be aware of the differences between Exercise Physiology: Integrating ogy including atrophy. tive effects that these sensory organs Theory and Application (19) HFS muscle spindles. kinesiology. two leg exercise) Dwyer_Part2_Sec5. Knowledge of the stretch reflex.e. and the sliding-filament other reputable exercise physiology theory of muscle contraction textbook. ballistic and Basic Biomechanics. Theory and Application (19) characteristics of fast. and muscular endurance for apparently healthy participants based on current health status. Knowledge of the anatomy and • This information is fairly extensive and Exercise Physiology: Integrating physiology of skeletal muscle fiber. In both apparently healthy and Guidelines for Exercise Testing diseased populations.1 and 8. and PNF. can be prescribed as a form of resis. flexion. • Chapter 3 to flexibility ity training such as static. 7th edition (8) kinesiology. bounds) tance training exercises. extension.indd 107 11/07/12 11:56 PM . (e. intensity. box jumps. pro.. 6th edition (16) • This information could be found in any • Chapter 5 other reputable exercise physiology.and slow-twitch • This information could be found in any • Chapter 3 muscle fibers. and availability of time.1–7. • Intensity may be adjusted by varying different components of the same exercise (i.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of joint movements • This information could be found in any Basic Biomechanics. hyperplasia. other reputable kinesiology or biome. the height of the box. • Chapter 7 for them • Tables 7. • Chapter 31 and Key Terms Knowledge of the Valsalva maneuver • This maneuver should not be over. Knowledge of the physiology underly. (cont.. and type (FITT) principle for flexibility. • Chapter 3 leaps. Exercise Physiology: Integrating muscle soreness (DOMS) cytes rather than lactate accumulation. ACSM’s Resource Manual for • This information could be found in any Guidelines for Exercise Testing other reputable exercise physiology. the should be covered thoroughly. 7th edition (8) could lead to significant and dangerous • Chapter 22 hemodynamic-related alterations. • Plyometric exercises are considered Exercise Physiology: Integrating ing plyometric training and common as a form of anaerobic training and Theory and Application (19) plyometric exercises (e. or biomechanics textbook. and how they relate have on the different modes of flexibil. 6th edition (16) abduction) and the muscles responsible chanics textbook..1 Knowledge of acute and delayed onset • DOMS is related to microtears of myo. fitness goals.g. Implement exercise prescriptions using the frequency. and those terms and the prevalence Theory and Application (19) hypertrophy among humans in response to exer. dynamic flexibility. Exercise Physiology: Integrating prioceptors.3 • Chapter 8 • Tables 8. and Prescription. or biomechanics textbook. adduction. Knowledge of muscle-related terminol. one vs. ACSM’s Resource Manual for and its implications during exercise looked. and PNF. 2nd edition (15) bridges. 7th edition (8) periodization cycles. straight-leg sit-ups. linear and nonlinear periodization Guidelines for Exercise Testing mesocycles) and associated theories methods.. behind neck press/lat pull-down) Knowledge of prescribing exercise • This knowledge is vital when there ACSM’s Resource Manual for using the calculated %1-RM is a need to vary the intensity of the Guidelines for Exercise Testing exercise such as between different and Prescription. yoga plough. Knowledge of safe and effective core • Consider the use of different aids Strength Ball Training. cable twists) • Chapters 3 and 4 Skill in identifying improper technique • Lead and demonstrate the correct Advanced Fitness Assessment in the use of resistive equipment technique of using different resistive and Exercise Prescription. and the specificity of exercises in relationship to different periodization cycles.. hurdler’s stretch. fitness goals. • Chapter 31 Knowledge of periodization • Be aware of the differences between ACSM’s Resource Manual for (e. and water exercise • Appendices C and F equipment) Strength Ball Training. Explosive Lifting for Sports— Olympic weightlifting exercises priate for the client.acsm. and type (FITT) principle for flexibility.1 Skill in teaching and demonstrating • Differentiate between static. and macrocycle. • Consider appropriate exercise Advanced Fitness Assessment tions and potential risks associated techniques. macrocycles.g.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the contraindica. • Be aware of the relationship between volume. 7th edition (8) • Be aware of the differences • Chapter 31 HFS between microcycle. weights. equipment. • Chapters 22 and 31 Knowledge of spotting positions and • Spotter should be very familiar with ACSM’s Resource Manual for techniques for injury prevention and the given the exercise. double-leg • Appendices C and F raises. time. 4th edition (17) resistance bars. 2nd edition (15) • Chapters 3 and 4 Therapeutic Exercise: From Theory to Practice (18) • Table 12. mesocycle. intensity. stability and medicine balls). Enhanced Edition (23) • This information is fairly extensive and • Chapters 4–9 should be covered thoroughly.g.indd 108 11/07/12 11:56 PM . and Prescription. squats.g.e. 7th edition (8) safe exercise. Implement exercise prescriptions using the frequency. and availability of time. stability exercises (e.g. (cont. stability balls. Stretching for Functional appropriate exercises for enhancing ballistic stretches. and standing bent-over toe touch. and muscular endurance for apparently healthy participants based on current health status. (e. intensity. planks. Guidelines for Exercise Testing exercise assistance • Spotting is paramount for proper and and Prescription. Knowledge of safe and effective • Consider if these exercises are appro. bands... dynamic. muscular strength.org D. microcycles. and Exercise Prescription. 108 CERTIFICATION REVIEW • www. with muscular conditioning activities 4th edition (17) (e. crunch. Flexibility (9) musculoskeletal flexibility • Chapter 5 Dwyer_Part2_Sec5. (i. forceful back hyperextension.. e. between the different components of Guidelines for Exercise Testing work in response to individual changes FITT-VP principles. • Gradual progression may reduce the “ACSM Position Stand. body weight. Swiss balls.g. muscular endurance. Establish exercise progression guidelines for resistance. car.. Musculoskeletal. and endurance exercises (e. aerobic.indd 109 11/07/12 11:56 PM . and Exercise Prescription.and 9th edition (7) long-term goals. and flexibility cardiorespiratory fitness. time. fitness goals. Maintaining Cardiorespiratory. strength. SECTION 5 HFS Job Task Analysis 109 D. Testing and Prescription (GETP). Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the basic principles of • Regarding cardiovascular exercise ACSM’s Resource Manual for exercise progression prescription. • Chapter 7 Skill in recognizing the need for pro. 9th edition (7) • Chapter 7 Knowledge of the importance of • This information is vital to the adjust. periodization). • Chapters 30 and 31 • Be familiar with the interaction between ACSM’s Guidelines for Exercise the different components of FITT-VP Testing and Prescription (GETP). principles in respect to both resistance 9th edition (7) and cardiorespiratory exercises. (cont. and and Prescription. and availability of time. and Prescription. other major fitness equipment) 2nd edition (15) • Chapters 3 and 4 E. Exercise for Developing and • Client goals may be more achievable. be aware of the different Guidelines for Exercise Testing progression stages. and all Strength Ball Training. and flexibility activity to achieve the goals of apparently healthy participants. 7th edition (8) diorespiratory fitness. ological differences between muscular Guidelines for Exercise Testing lar strength. and Prescription. muscular endurance. resistive • Appendices C and F bands. 9th edition (7) • Chapter 7 HFS Knowledge of adjusting the frequency.. and muscular endurance for apparently healthy participants based on current health status. and type (FITT) frame. ACSM’s Resource Manual for that promote improvements in muscu. Testing and Prescription (GETP). 7th edition (8) in conditioning • Chapters 30 and 31 ACSM’s Guidelines for Exercise Testing and Prescription (GETP). ACSM’s Guidelines for Exercise performing periodic reevaluations to ment and development of sound exer. free • Lead by example! 4th edition (17) weights. Implement exercise prescriptions using the frequency. • Be familiar with the interaction ACSM’s Resource Manual for intensity. 7th edition (8) • Be aware of different methods to • Chapters 30 and 31 progress resistance exercises ACSM’s Guidelines for Exercise (i. and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise” (14) Dwyer_Part2_Sec5. muscular strength. assess changes in fitness status cise prescription as well as short. intensity.) Knowledge or Skill Statement Explanation/Examples Resources Skill in teaching and demonstrating • This information is fairly extensive and Advanced Fitness Assessment safe and effective muscular strength should be covered thoroughly. weight machines. time. and type (FITT) principle for flexibility. gression and communicating updates risk of cardiovascular disease (CVD) Quantity and Quality of to exercise prescriptions and musculoskeletal injury. • Chapter 4 Knowledge of the training principles • Be aware of the underlying physi. 9th edition (7) • Chapter 10 Dwyer_Part2_Sec5. fat-free mass (FFM).. and/or • Chapter 18 and Key Terms (LBM). weight mainte. minerals. MyPyramid. modifying body Guidelines for Exercise Testing cise. exer.g. anorexia nervosa. and Prescription. “USDA Center for Nutrition needs of participant populations mation. creatine. ACSM’s Guidelines for Exercise Testing and Prescription (GETP). lasting results. and Prescription. overweight. and current body fat • Chapter 35 percentage.g. their purported mechanisms improving performance. and 44 modification. bulimia. are barred from used in official • Chapter 14 efits (e. steroids. and behavior • Chapters 14. adipocyte. and associated risks and ben. United States disadvantages. and Prescription. 7th edition (8) mass index (BMI).acsm. children. Knowledge of weight management • Be aware of the differences between ACSM’s Resource Manual for terminology including but not limited to the different terms in respect to a Guidelines for Exercise Testing obesity. 110 CERTIFICATION REVIEW • www. ergogenic aid. bariatrics. Knowledge of energy balance • Be aware of various diet assess. • Chapter 35 eating. programs/approaches. • Many ergogenic aids are effective in Exercise Physiology: Integrating genic aids. herbal products. (HFS) needs to be fully aware of di- pregnant women) etary needs of the general population.indd 110 11/07/12 11:56 PM . body description of a disease condition. debilitating chronic conditions such 9th edition (7) as cardiovascular disease (CVD) and • Chapter 10 diabetes. the health fitness specialist Policy and Promotion” (27) (e. Guidelines for Exercise Testing including weight loss. and weight gain goals expenditure. competition. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of exercise prescriptions • Consider different weight loss ACSM’s Resource Manual for for achieving weight management. ACSM’s Resource Manual for and basic nutritional guidelines ments and their advantages and Guidelines for Exercise Testing (e. and body composition/anthropometrics..org F. exercise. and • Chapter 10 thermogenesis Exercise Physiology: Integrating Theory and Application (19) HFS • Chapter 11 Knowledge of the relationship • Be aware of the link between ACSM’s Guidelines for Exercise between body composition and health overweight and obesity and other Testing and Prescription (GETP). older adults. • Consider client’s caloric intake. lean body mass anthropometric assessment. vitamins. Knowledge of the unique dietary • In order to fully comprehend this infor. body ACSM’s Guidelines for Exercise fat distribution. but many Theory and Application (19) of action. • Be aware of the link between over- weight and obesity and other risk fac- tors such as hypertension. 15. Knowledge of common nutritional ergo. health history. Implement a weight management program as indicated by personal goals that are supported by preparticipation health screening. caffeine) Knowledge of methods for modifying • In many cases and in order to achieve ACSM’s Resource Manual for body composition including diet. Testing and Prescription (GETP).g. binge physiological descriptor. protein/amino acids. 7th edition (8) Department of Agriculture [USDA] • The assessment of nutritional status • Chapter 14 Dietary Guidelines for Americans) may serve as an important secondary tool to exercise prescription. and behavior modification composition requires simultaneous and Prescription. 9th edition (7) resting metabolic rate (RMR). women. percent fat. 7th edition (8) nance. metabolic syndrome.. 7th edition (8) use of diet. National Institutes of the definition of these terms. Knowledge of the consequences of • Proper and substantial weight loss is a ACSM’s Resource Manual for inappropriate weight loss methods long-term process. overweight and obesity in respect to Guidelines for Exercise Testing ated with it (e. and alcohol not equal. health history. body wraps. • Chapter 4 • This information is fairly extensive and should be covered thoroughly. 7th edition (8) distribution • Chapter 35 Dwyer_Part2_Sec5. American Dietetic Association.500 kcal ⫽ loss of 1 lb of Exercise Physiology: Integrating between kilocalorie expenditures and body mass. urine color and Theory and Application (19) and after exercise osmolality). 7th edition (8) vibrating belts. • Chapter 35 HFS cising.g. and Prescription. electric stimulators. (cont. saunas. hydration (i.. over exer. • Chapter 14 American College of Sports Medicine ACSM’s Guidelines for Exercise [ACSM]) Testing and Prescription (GETP).e. 7th edition (8) • This information could be found in any • Chapter 3 other reputable exercise physiology Exercise Physiology: Integrating textbook. Theory and Application (19) weight loss • This is common knowledge among • Chapter 11 exercise scientists. Knowledge of published position state. active lifestyle). dietary supplements. Guidelines for Exercise Testing (e. protein. very low calorie diets. Theory and Application (19) • Chapter 2 Knowledge of the effects of overall • The application of “proper diet” may ACSM’s Resource Manual for dietary composition on healthy weight vary based on such factors as age.g. Guidelines for Exercise Testing and Prescription. fad diets) Knowledge of the kilocalorie levels of • Energy content of different nutrients is ACSM’s Resource Manual for carbohydrate. subcutaneous fat and Prescription. • Chapter 9 • Be aware of hyponatremia and its association with overhydration.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of fuel sources for aerobic • Be aware of the interaction between ACSM’s Resource Manual for and anaerobic metabolism including the different fuel sources in respect to Guidelines for Exercise Testing carbohydrates. 7th edition (8) • Chapter 4 • Table 4. sweat suits.1 Knowledge of the relationship • Deficit of 3. Knowledge of the importance of main. and body composition/anthropometrics. fat. 7th edition (8) Health. and Prescription. fats. SECTION 5 HFS Job Task Analysis 111 F. • There are several ways to assess Exercise Physiology: Integrating taining normal hydration before. and Prescription. • Be aware of the difference between ACSM’s Resource Manual for ments on obesity and the risks associ. during. ACSM’s Resource Manual for between body fat distribution patterns gynoid (“pear shape”) Guidelines for Exercise Testing and health • Visceral vs. 7th edition (8) lifestyle vs. 9th edition (7) • Chapter 10 Knowledge of the relationship • Android obesity (“apple shape”) vs. and activity level (sedentary and Prescription. Implement a weight management program as indicated by personal goals that are supported by preparticipation health screening. and proteins both aerobic and anaerobic exercises..indd 111 11/07/12 11:56 PM .. Guidelines for Exercise Testing management gender. ) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the physiology and • Individuals who are overweight and/or ACSM’s Resource Manual for pathophysiology of overweight and obese are often present with comor. (cont. 7th edition (8) management and/or diet. 7th edition (8) of comorbidities and/or preexisting • Chapter 41 orthopedic limitations. (Table 7.3).7th edition (8) conditions. and body composition/anthropometrics. 9th edition (7) are overweight or obese. Knowledge of comorbidities and • Due to the potential existence of ACSM’s Guidelines for Exercise musculoskeletal conditions associ.g. Testing and Prescription (GETP).indd 112 11/07/12 11:56 PM . Guidelines for Exercise Testing obese participants bidities and/or debilitating orthopedic and Prescription. exercise. and type need to be greater than recommended Testing and Prescription (GETP). and/or behavior • Chapter 35 modification. behavioral lose weight may require some time Guidelines for Exercise Testing modification strategies) for weight and may involve additional exercise and Prescription. • Chapter 14 ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Skill in calculating the volume of exer. ACSM’s Guidelines for Exercise Testing and Prescription (GETP).acsm. 3rd edition (2) • Chapter 21 Knowledge of the recommended • The amount of physical activity may ACSM’s Guidelines for Exercise frequency.. 112 CERTIFICATION REVIEW • www. time. Implement a weight management program as indicated by personal goals that are supported by preparticipation health screening. diet. 9th edition (7) • Table 7. (FITT) framework for participants who for apparently healthy individuals. • Be aware of all the conversions ACSM’s Guidelines for Exercise cise in terms of kilocalories per session that are at the bottom of the table Testing and Prescription (GETP). • Chapter 10 modifications to exercise testing and prescription Skill in applying behavioral strategies • Be aware that the appropriate way to ACSM’s Resource Manual for HFS (e. other chronic and orthopedic issues. • Exercise should be coupled with • Chapter 10 sound nutritional and behavior change interventions. intensity. exercise. health history.org F. ated with overweight and obesity that additional medical intervention may be 9th edition (7) may require medical clearance and/or warranted.3 Dwyer_Part2_Sec5. 9th edition (7) • Chapter 10 Skill in modifying exercises for • Exercise prescription may need to be ACSM’s Resource Manual for individuals limited by body size individualized and modified based on Guidelines for Exercise Testing abilities and the presence or absence and Prescription. SECTION 5 HFS Job Task Analysis 113 G. Prescribe and implement exercise programs for participants with controlled cardiovascular, pulmonary, and metabolic diseases and other clinical populations. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of American College • This information is fairly extensive and ACSM’s Guidelines for Exercise of Sports Medicine (ACSM) risk should be covered thoroughly. Testing and Prescription (GETP), stratification and exercise prescription 9th edition (7) guidelines for participants with car- • Chapter 2 diovascular, pulmonary, and metabolic • Tables 2.2 and 2.3 diseases and other clinical populations • Figure 2.3 • Box 2.2 • Chapters 9 and 10 Knowledge of ACSM relative and • Be aware of the difference between ACSM’s Guidelines for Exercise absolute contraindications for initiating relative and absolute contraindications Testing and Prescription (GETP), exercise sessions or exercise testing in respect to the benefits vs. risks that 9th edition (7) and indications for terminating exercise are associated with exercise/testing. • Chapter 3 sessions and exercise testing • Box 3.5 • Chapter 4 • Box 4.5 Knowledge of physiology and patho- • Extensive prior knowledge of ACSM’s Resource Manual for physiology of cardiac disease, arthritis, cardiopulmonary physiology is highly Guidelines for Exercise Testing diabetes mellitus, dyslipidemia, hyper- recommended. and Prescription, 7th edition (8) tension, metabolic syndrome, musculo- • Chapter 6 skeletal injuries, overweight and ACSM’s Guidelines for Exercise obesity, osteoporosis, peripheral artery Testing and Prescription (GETP), disease, and pulmonary disease 9th edition (7) HFS • Chapter 10 Knowledge of the effects of diet and • Be aware of special considerations ACSM’s Guidelines for Exercise exercise on blood glucose levels in that may affect exercise such as hypo- Testing and Prescription (GETP), diabetics glycemia, blood glucose before, during, 9th edition (7) and immediately following exercise, • Chapter 10 hyperglycemia, polyurea, neuropathy, nephropathy, and retinopathy. Knowledge of the recommended • In order to fully comprehend this ACSM’s Guidelines for Exercise frequency, intensity, time, and type information, the health fitness special- Testing and Prescription (GETP), (FITT) principle for the development ist (HFS) needs to be fully aware of 9th edition (7) of cardiorespiratory fitness, muscular FITT-VP principles because they apply • Chapter 10 fitness, and flexibility for participants to apparently healthy individuals. with cardiac disease, arthritis, diabetes • This information is fairly extensive and mellitus, dyslipidemia, hypertension, should be covered thoroughly. metabolic syndrome, musculoskeletal injuries, overweight and obesity, osteo- porosis, peripheral artery disease, and pulmonary disease Skill in progressing exercise programs, • Rate of progression in both aerobic ACSM’s Guidelines for Exercise according to the FITT principle, in a and strength exercises should be Testing and Prescription (GETP), safe and effective manner individualized. 9th edition (7) • Chapter 7 Dwyer_Part2_Sec5.indd 113 11/07/12 11:56 PM 114 CERTIFICATION REVIEW • www.acsm.org G. Prescribe and implement exercise programs for participants with controlled cardiovascular, pulmonary, and metabolic diseases and other clinical populations. (cont.) Knowledge or Skill Statement Explanation/Examples Resources Skill in modifying the exercise prescrip- • To make appropriate modifications, ACSM’s Guidelines for Exercise tion and/or exercise choice for indi- the HFS needs to be fully aware of Testing and Prescription (GETP), viduals with cardiac disease, arthritis, FITT-VP principles because they apply 9th edition (7) diabetes mellitus, dyslipidemia, hyper- to apparently healthy individuals. • Chapter 10 tension, metabolic syndrome, mus- • To make appropriate modifications, culoskeletal injuries, overweight and one needs to fully comprehend the obesity, osteoporosis, peripheral artery physiology and pathophysiology of disease, and pulmonary disease these conditions. Skill in identifying improper exercise • To make appropriate modifications, ACSM’s Resource Manual for techniques and modifying exercise one needs to fully comprehend the Guidelines for Exercise Testing programs for participants with low physiology and pathophysiology of and Prescription, 7th edition (8) back, neck, shoulder, elbow, wrist, hip, these conditions. • Chapters 37 and 42 knee, and/or ankle pain • If warranted, consult with appropriate professional (i.e., AT and/or PT). H. Prescribe and implement exercise programs for healthy special populations (i.e., older adults, youth, pregnant women). Knowledge or Skill Statement Explanation/Examples Resources Knowledge of normal maturational • Knowledge of related exercise physiol- ACSM’s Guidelines for Exercise changes from childhood to old age and ogy is critical. Testing and Prescription (GETP), HFS their effects on the skeletal muscle, bone, • This information is fairly extensive and 9th edition (7) reaction time, coordination, posture, heat should be covered thoroughly. • Chapter 8 and cold tolerance, maximal oxygen con- ACSM’s Exercise Management sumption, strength, flexibility, body com- for Persons with Chronic Diseases position, resting and maximal heart rate, and Disabilities, 3rd edition (2) and resting and maximal blood pressure • Chapter 5 Knowledge of techniques for the • To make appropriate modifications, the ACSM’s Guidelines for Exercise modification of cardiovascular, flexibility, health fitness specialist (HFS) needs Testing and Prescription (GETP), and resistance exercises based on to be fully aware of FITT-VP principles 9th edition (7) age, functional capacity, and physical because they apply to apparently • Chapter 8 condition healthy individuals. • To make appropriate modifications, the HFS needs to fully comprehend the anatomical and physiological differ- ences between apparently healthy and healthy special populations. Knowledge of techniques for the • To make appropriate exercise ACSM’s Guidelines for Exercise development of exercise prescriptions prescription, the HFS needs to fully Testing and Prescription (GETP), for children, adolescents, and older comprehend the anatomical and physi- 9th edition (7) adults regarding strength, functional ological differences between these • Chapter 8 capacity, and motor skills populations. Knowledge of the unique adaptations • Extensive prior knowledge of related ACSM’s Guidelines for Exercise to exercise training in children, adoles- exercise physiology is critical. Testing and Prescription (GETP), cents, and older participants regard- • This information is fairly extensive and 9th edition (7) ing strength, functional capacity, and should be covered thoroughly. • Chapter 8 motor skills ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities, 3rd edition (2) • Chapter 5 Dwyer_Part2_Sec5.indd 114 11/07/12 11:56 PM SECTION 5 HFS Job Task Analysis 115 H. Prescribe and implement exercise programs for healthy special populations (i.e., older adults, youth, pregnant women). (cont.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the benefits and precau- • The risk of a cardiovascular event ACSM’s Guidelines for Exercise tions associated with exercise training during exercise is very low in Testing and Prescription (GETP), across the lifespan apparently healthy individuals. 9th edition (7) • The risk of a cardiovascular event • Chapter 1 during exercise is directly related to the intensity of the exercise and the sever- ity of diagnosed or undiagnosed occlu- sion cardiovascular disease (CVD). Knowledge of the recommended fre- • To make appropriate modifications, the ACSM’s Resource Manual for quency, intensity, time, and type (FITT) HFS needs to be fully aware of FITT-VP Guidelines for Exercise Testing framework for the development of car- principles because they apply to appar- and Prescription, 7th edition (8) diorespiratory fitness, muscular fitness, ently healthy populations. • Chapter 36 and flexibility in apparently healthy chil- • Children are not miniature adults and ACSM’s Guidelines for Exercise dren and adolescents therefore, exercise prescription should Testing and Prescription (GETP), be modified accordingly. 9th edition (7) • Chapter 8 Knowledge of the effects of the aging • Be aware of the effects of the aging Physiology of Exercise and process on the musculoskeletal and process as well as the effects of Healthy Aging (26) cardiovascular structures and functions physical activity or sedentary lifestyle • Chapters 1 and 2 during rest, exercise, and recovery on the musculoskeletal and cardiovas- cular structures. Knowledge of the recommended FITT • Be aware of any aging-related ACSM’s Resource Manual for HFS framework necessary for the devel- conditions that may affect exercise Guidelines for Exercise Testing opment of cardiorespiratory fitness, prescription. and Prescription, 7th edition (8) muscular fitness, balance, and flexibility • Chapter 36 in apparently healthy older adults ACSM’s Guidelines for Exercise Testing and Prescription (GETP), 9th edition (7) • Chapter 8 Knowledge of common orthopedic and • When prescribing exercise to older ACSM’s Resource Manual for cardiovascular exercise considerations adults, one needs to be aware of all Guidelines for Exercise Testing for older adults existing mental, physical, and medical and Prescription, 7th edition (8) conditions and respond accordingly. • Chapter 36 Knowledge of the relationship • The physical fitness components that ACSM’s Resource Manual for between regular physical activity and may improve with regular physical Guidelines for Exercise Testing the successful performance of activities activity are muscular strength and and Prescription, 7th edition (8) of daily living (ADL) for older adults endurance, cardiovascular endurance, • Chapter 36 balance, and flexibility. Knowledge of the recommended • To make appropriate modifications, the ACSM’s Resource Manual for frequency, intensity, type, and duration HFS needs to be fully aware of FITT-VP Guidelines for Exercise Testing of physical activity necessary for the principles because they apply to appar- and Prescription, 7th edition (8) development of cardiorespiratory fit- ently healthy individuals. • Chapter 36 ness, muscular fitness, and flexibility in • Prior to prescribing exercise in this ACSM’s Guidelines for Exercise apparently healthy pregnant women population, the HFS needs to be Testing and Prescription (GETP), aware of the physiological responses 9th edition (7) to exercise, contraindications for • Chapter 8 exercising, and other special consid- erations because they relate to this population. Dwyer_Part2_Sec5.indd 115 11/07/12 11:56 PM 116 CERTIFICATION REVIEW • www.acsm.org H. Prescribe and implement exercise programs for healthy special populations (i.e., older adults, youth, pregnant women). (cont.) Knowledge or Skill Statement Explanation/Examples Resources Skill in teaching and demonstrating • The HFS must be aware of the ana- ACSM’s Resource Manual for appropriate exercises for healthy tomical and physiological differences Guidelines for Exercise Testing populations with special considerations between these populations. and Prescription, 7th edition (8) • The HFS must modify the exercise • Chapter 36 accordingly. ACSM’s Guidelines for Exercise • Lead by example! Testing and Prescription (GETP), 9th edition (7) • Chapter 8 Skill in modifying exercises based on • To make appropriate modifications, ACSM’s Resource Manual for age, physical condition, and current the HFS needs to fully comprehend Guidelines for Exercise Testing health status the physiological differences between and Prescription, 7th edition (8) apparently healthy populations and • Chapter 36 healthy populations with special ACSM’s Guidelines for Exercise considerations. Testing and Prescription (GETP), 9th edition (7) • Chapter 8 I. Modify exercise prescriptions based on environmental conditions. Knowledge or Skill Statement Explanation/Examples Resources HFS Knowledge of the effects of a hot, • This information is fairly extensive and ACSM’s Guideline for Exercise cold, or high-altitude environment on should be covered thoroughly. Testing and Prescription (GETP), the physiologic response to exercise • This information could be found in 9th edition (7) any reputable exercise physiology • Chapter 8 textbook. Exercise Physiology: Integrating Theory and Application (19) • Chapter 10 Knowledge of special precautions and • By knowing the physiology as it ACSM’s Guidelines for Exercise program modifications for exercise in a relates to these conditions, one Testing and Prescription (GETP), hot, cold, or high-altitude environment may develop and implement some 9th edition (7) prevention strategies. • Chapter 8 Exercise Physiology: Integrating Theory and Application (19) • Chapter 10 Knowledge of the role of acclimatiza- • By knowing the physiology as it re- ACSM’s Guidelines for Exercise tion when exercising in a hot or high- lates to these conditions, one may Testing and Prescription (GETP), altitude environment develop an individualized exercise 9th edition (7) prescription using acclimatization pro- • Chapter 8 tocols to achieve optimal physical and Exercise Physiology: Integrating cognitive (in altitude) performances. Theory and Application (19) • Chapter 10 Knowledge of appropriate fluid intake • Be aware of techniques to assess hy- Exercise Physiology: Integrating during exercise in a hot, humid environ- dration (i.e., urine color and osmolality). Theory and Application (19) ments as well as cold, and high-altitude • Be aware of hydration needs prior to, • Chapter 9 during, and after exercise. Dwyer_Part2_Sec5.indd 116 11/07/12 11:56 PM SECTION 5 HFS Job Task Analysis 117 DOMAIN III: EXERCISE COUNSELING AND BEHAVIORAL STRATEGIES A. Optimize adoption and adherence to exercise programs and other healthy behaviors by applying effective communication techniques. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the effective and timely • The use of the mode of communica- ACSM’s Resource Manual for uses of communication modes (e.g., tion may be related to factors such Guidelines for Exercise Testing e-mail, telephone, Web site, as age, gender, ethnicity, locality, and and Prescription, 7th edition (8) newsletters) other subjective preferences. • Chapter 47 Knowledge of verbal and nonverbal • Because the behavioral aspect needs ACSM’s Resource Manual for behaviors that communicate positive to be addressed early in the interven- Guidelines for Exercise Testing reinforcement and encouragement tion, it is critical that positive rein- and Prescription, 7th edition (8) (e.g., eye contact, targeted praise, forcement and encouragement are • Chapter 46 empathy) communicated to your client. Knowledge of group leadership tech- • The information and the tools that are ACSM’s Resource Manual for niques for working with participants of being used to motivate and educate Guidelines for Exercise Testing all ages participants need to be adjusted to fit and Prescription, 7th edition (8) the group population. • Chapter 34 Knowledge of active listening • Consider more advanced consoling ACSM’s Resource Manual for techniques skills. Guidelines for Exercise Testing • Consider both listening and making and Prescription, 7th edition (8) reflective statements. • Chapter 46 Knowledge of learning modes • Using different modes to enhance The Kinesthetic Classroom HFS (auditory, visual, kinesthetic) task completion. Teaching and Learning through Movement (20) • Chapter 1 Knowledge of types of feedback • Feedback is vital to behavior modifica- ACSM’s Resource Manual for (e.g., evaluative, supportive, tion in an environment that supports a Guidelines for Exercise Testing descriptive) client-centered approach. and Prescription, 7th edition (8) • Chapters 45 and 46 Skill in using active listening • Consider more advanced consoling ACSM’s Resource Manual for techniques skills. Guidelines for Exercise Testing • The ability to listen, analyze, and com- and Prescription, 7th edition (8) municate is critical. • Chapter 46 Skill in applying teaching and training • Extensive knowledge of related be- ACSM’s Resource Manual for techniques to optimize participant train- havioral strategies to enhance physical Guidelines for Exercise Testing ing sessions activity participation is critical. and Prescription, 7th edition (8) • Program should be client centered. • Chapter 45 Skill in using feedback to optimize • Must be familiar with motivational and ACSM’s Resource Manual for participant training sessions behavior modification techniques such Guidelines for Exercise Testing as client-centered approach and active and Prescription, 7th edition (8) listening • Chapters 45 and 46 • Must be familiar with basic motiva- tional and behavior modification terms such empathy and rapport Skill in applying verbal and nonverbal • Vary the mode of communication ACSM’s Resource Manual for communications with diverse partici- based on age, gender, ethnicity, local- Guidelines for Exercise Testing pant populations ity, and other subjective preferences. and Prescription, 7th edition (8) • Chapter 47 Dwyer_Part2_Sec5.indd 117 11/07/12 11:56 PM 118 CERTIFICATION REVIEW • www.acsm.org B. Optimize adoption of and adherence to exercise programs and other healthy behaviors by applying effective behavioral and motivational strategies. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of behavior change models • This information is fairly extensive and ACSM’s Resource Manual for and theories (e.g., health belief model, should be covered thoroughly. Guidelines for Exercise Testing theory of planned behavior, socioeco- • These behavior change models and and Prescription, 7th edition (8) logical model, transtheoretical model, theories play a key role in the overall • Chapter 44 social cognitive theory, cognitive evalu- process of moving from sedentary to ation theory) physically active lifestyle. Knowledge of the basic principles in- • Have a client-centered approach. ACSM’s Resource Manual for volved in motivational interviewing • May involve various counseling skills Guidelines for Exercise Testing and Prescription, 7th edition (8) • Chapter 46 Knowledge of intervention strategies • The intervention strategy that may be ACSM’s Resource Manual for and stress management techniques used should depend on the individual Guidelines for Exercise Testing stage of change. and Prescription, 7th edition (8) • Chapter 44 Knowledge of the stages of motiva- • Be aware of the following: precontem- ACSM’s Resource Manual for tional readiness (e.g., transtheoretical plation, contemplation, preparation, Guidelines for Exercise Testing model) action, and maintenance. and Prescription, 7th edition (8) • Chapters 43 and 45 Knowledge of behavioral strategies for • This information is fairly extensive and ACSM’s Resource Manual for enhancing exercise and health behavior should be covered thoroughly. Guidelines for Exercise Testing change (e.g., reinforcement; specific, • Using sound and effective behavioral and Prescription, 7th edition (8) HFS measurable, attainable, realistic and strategies are key for enhancing exer- • Chapter 45 relevant, and time-bound [SMART] goal cise and health behavior change. setting; social support) Knowledge of behavior modification • Understanding these concepts play Behavior Modification: terminology including but not limited a major role in the overall process What It Is And How to Do It, to self-esteem, self-efficacy, anteced- of behavior modification and moving 9th edition (21) ents, cues to action, behavioral beliefs, from sedentary to physically active • Part II behavioral intentions, and reinforcing lifestyle. factors Knowledge of behavioral strate- • A successful weight loss program is ACSM’s Resource Manual for gies (e.g., exercise, diet, behavioral a lengthy and ongoing process that Guidelines for Exercise Testing modification strategies) for weight should include exercise, diet, and and Prescription, 7th edition (8) management behavior modification. • Chapter 35 Knowledge of the role that affect, • Many factors affect exercise ACSM’s Resource Manual for mood, and emotion play in exercise adherence (i.e., personal, behavioral). Guidelines for Exercise Testing adherence and Prescription, 7th edition (8) • Chapter 45 Knowledge of common barriers to • Recognizing and overcoming barriers ACSM’s Resource Manual for exercise initiation and compliance to exercise is a vital step in the de- Guidelines for Exercise Testing (e.g., time management, injury, fear, velopment of viable behavior change and Prescription, 7th edition (8) lack of knowledge, weather) program. • Chapter 45 Knowledge of techniques that facilitate • Many aspects are involved in facilitat- ACSM’s Resource Manual for motivation (e.g., goal setting, incentive ing motivation. Guidelines for Exercise Testing programs, achievement recognition, • The form of motivation could be de- and Prescription, 7th edition (8) social support) scribed as either extrinsic or intrinsic. • Chapter 45 Dwyer_Part2_Sec5.indd 118 11/07/12 11:56 PM Optimize adoption of and adherence to exercise programs and other healthy behaviors by applying effective behavioral and motivational strategies. and Prescription. and Prescription. ACSM’s Resource Manual for nonstructured physical activity levels sion to become more active Guidelines for Exercise Testing (e. ACSM’s Resource Manual for goals specific behaviors. • Relapse in exercising is usually due to ACSM’s Resource Manual for egies and plans of action an inevitable event (illness or injury. (cont. 7th edition (8) away.7 Skill in using imagery as a • The use of images for reinforcing and ACSM’s Resource Manual for motivational tool promoting physical activity Guidelines for Exercise Testing and Prescription. • Chapters 44 and 45 Skill in setting effective behavioral • Goal setting should be realistic. etc. • Chapters 10 and 11 Skill in applying the theories related to • This theoretical knowledge is fairly ACSM’s Resource Manual for behavior change to diverse populations extensive and should be covered Guidelines for Exercise Testing thoroughly. HFS tion • Scale must be explained prior to the 9th edition (2) commencement of the test. measurable. bike to work) • Chapters 36 and 45 Skill in explaining the purpose and • A valuable secondary tool to monitor ACSM’s Guidelines for Exercise value of understanding perceived exer. • Chapter 44 social cognitive theory. ACSM’s Resource Manual for trinsic motivation plays in the adoption ple of a form of extrinsic motivation. 7th edition (8) short term). 7th edition (8) • Relapse prevention may involve • Chapter 45 developing a restart plan. and Guidelines for Exercise Testing time frame specific (long term vs. and Prescription. ACSM’s Resource Manual for that support and maintain program cause it applies to different aspects of Guidelines for Exercise Testing adherence behavioral strategies to enhance physi.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the role extrinsic and in. 7th edition (8) • Consider decision-making theory. • Chapters 44 and 45 Knowledge of strategies that increase • May involve making a conscious deci. etc. and Prescription.). Skill in developing intervention • Applied to different health behavior ACSM’s Resource Manual for strategies to increase self-efficacy and change theories Guidelines for Exercise Testing self-confidence • Skill to recognize the degree of self.indd 119 11/07/12 11:56 PM . 7th edition (8) • Chapter 45 Skill in evaluating behavioral readiness • Use tools such as the self-motivation ACSM’s Resources for the to optimize exercise adherence assessment scale and physical activity Health Fitness Specialist (6) stages of change. SECTION 5 HFS Job Task Analysis 119 B. 7th edition (8) efficacy and self-confidence • Chapter 44 Skill in developing reward systems • The information is fairly extensive be.. the use of reinforcement or rewards system. • Program-based incentive is an exam. • Chapters 44–46 Dwyer_Part2_Sec5. target. Knowledge of applying health coaching • This topic is fairly extensive and may ACSM’s Resource Manual for principles and lifestyle management include strategies to enhance physical Guidelines for Exercise Testing techniques related to behavior change activity participation. etc.g. • Chapter 4 • Table 4. etc. Guidelines for Exercise Testing professional engagements. Knowledge of relapse prevention strat. Guidelines for Exercise Testing and maintenance of behavior change • A personal reward for behavior is and Prescription. exercise tolerance Testing and Prescription (GETP). stair walking. 7th edition (8) stress reduction techniques. and Prescription. 7th edition (8) cal activity participation. diet modification. and Prescription. parking farther • Related to behavior change and Prescription. 7th edition (8) an example of a form of intrinsic • Chapter 45 motivation. The Relaxation & Stress techniques and relaxation techniques ful for stress reduction and may be Reduction Workbook (11) (e. • Chapters 7–10 parently healthy populations.g. 7th edition (8) (e. • Chapter 48 golf leagues. the HFS needs to fully comprehend the physiology and pathophysiology of common chronic diseases conditions. the HFS HFS needs to fully comprehend the anatomical and physiological differences between apparently healthy and healthy special populations. • To make appropriate modifications. Provide educational resources to support clients in the adoption and maintenance of healthy lifestyle behaviors. body activity may include but not limited to Testing and Prescription (GETP). cycling clubs) Dwyer_Part2_Sec5. obesity. exercise. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the relationship be. • Chapter 45 Knowledge of community-based ex. intramural sports. walking clubs. chronic diseases (e. hypertension) • Dose response related Knowledge of the dynamic interrela. • These programs could be supported ACSM’s Resource Manual for ercise programs that provide social and organized by schools.indd 120 11/07/12 11:56 PM . Knowledge of stress management • Each of these techniques may be use. • To make appropriate modifications. stress. etc. 7th edition (8) strength-based exercises. Guidelines for Exercise Testing support and structured activities religious institutions. reduction in coro.g..org C. 120 CERTIFICATION REVIEW • www. composition. importance of research. ACSM’s Resource Manual for leadership techniques and educational gram to increase client engagement Guidelines for Exercise Testing methods to increase client engagement should be individualized and client and Prescription. Knowledge of modifications necessary • To make appropriate modifications. for diverse populations needs to be fully aware of FITT-VP 9th edition (7) principles because they apply to ap. and overall health improvement in cardiovascular and re.g. atherosclerosis. scientific literature to practical use. • Chapter 1 nary artery disease (CAD) risk factors. • Chapter 31 Knowledge of accessing and • Be aware of the concept and Exercise Physiology: Integrating disseminating scientifically based. severity and the number of common 9th edition (7) Type 2 diabetes. chronic diseases. dyslipidemia. massage therapy) one another. • Box 1. Theory and Application (19) evant health. mation Knowledge of specific. low back pain. • Chapter 1 arthritis. guided used individually or in conjunction with • Chapters 4–7 imagery. age-appropriate • The selection of an appropriate pro. • The benefits of regular physical ACSM’s Guidelines for Exercise tionship between fitness level. 9th edition (7) spiratory functions. Knowledge of the activities of daily • ADL may be affected negatively by ACSM’s Resource Manual for living (ADL) and how they relate to many chronic conditions and may be Guidelines for Exercise Testing overall health affected positively by endurance and and Prescription. rel. and • Have the ability to “translate” • Chapter 1 wellness-related resources and infor.acsm.. nutrition.2 and decreased in overall morbidity and mortality. work sites.. • There is an inverse relationship ACSM’s Guidelines for Exercise tween physical inactivity and common between physical activity and the Testing and Prescription (GETP). 7th edition (8) centered. ACSM’s Guidelines for Exercise to promote healthy lifestyle behaviors the health fitness specialist (HFS) Testing and Prescription (GETP). and Prescription. progressive relaxation. and Prescription. electrocardiogram 9th edition (7) to exercise (ECG). blood Testing and Prescription (GETP). and exercise capacity. • A client-centered approach should be ACSM’s Resource Manual for ing styles that may impact exercise adopted for all aspects that are related Guidelines for Exercise Testing sessions and exercise testing to exercise. appraisal threat during exercise • Consider the relationship between and Prescription. anxiety and exercise adherence. • The HFS must be able to make use of Exercise Physiology: Integrating exercise.. Guidelines for Exercise Testing mance. ACSM’s Resource Manual for of mental health states (e. • Chapter 17 ological responses to testing Knowledge of client needs and learn. and use Theory and Application (19) tion relevant health-related information. Dwyer_Part2_Sec5. drugs that may impact a client’s ability pressure (BP).) Knowledge or Skill Statement Explanation/Examples Resources Skill in accessing and delivering health. “Conflict Resolution Skills” (25) niques that facilitate communication niques that may be used to resolve a among exercise cohorts conflict. perfor. eating disorders) that may substantial improvement in psycho. Provide educational resources to support clients in the adoption and maintenance of healthy lifestyle behaviors. • Appendix A Knowledge of signs and symptoms • Affect wide range of populations. • Be aware of the effects of these ACSM’s Guidelines for Exercise mon over-the-counter and prescription medications on heart rate (HR). and Prescription. • Chapter 1 Skill in educating clients about benefits • The HFS must have the skill to access.g. nutritional. and simplify scientifically Theory and Application (19) sedentary behavior based. argument. Exercise Physiology: Integrating and risks of exercise and the risks of disseminate. SECTION 5 HFS Job Task Analysis 121 C. or disagreement. and wellness-related informa. health-related information. Provide support within the scope of practice of a health fitness specialist (HFS) and refer to other health professionals as indicated. 7th edition (8) testing) and how they may affect physi. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the side effects of com. Skill in communicating the need for • One should be able to evaluate and ACSM’s Resource Manual for medical. • Chapters 9 and 17 mental health professional Knowledge of symptoms and causal • Exercise has a positive effect on ACSM’s Resource Manual for factors of test anxiety (i. • Chapter 1 • Be able to explain complex informa- tion in layman’s terms. anxiety. (cont.. and 20 and sound responses. • Be aware of conflict resolution tech. and Prescription. 7th edition (8) procedures • Exercise prescription should be • Chapter 34 individualized. assess. symptoms of anxiety. nutritional. Knowledge of conflict resolution tech. Guidelines for Exercise Testing intervention and psychological statuses and pro. 17.e. 7th edition (8) HFS necessitate referral to a medical or logical functioning and quality of life.indd 121 11/07/12 11:56 PM . D. • Proper treatment will allow a Guidelines for Exercise Testing depression. 7th edition (8) vide and communicate appropriate • Chapters 15. or mental health assess physical activity. technology to locate. ). workers’ compensation. • Chapters 10 and 19 erty. and known Standards and Guidelines. religion. and Prescription. Knowledge of basic precautions taken • Safety is always first. for normal and at-risk participants 9th edition (7) • Chapter 2 Knowledge of emergency response • The procedures should be clearly ACSM’s Health/Fitness Facility systems and procedures employee stated. 122 CERTIFICATION REVIEW • www. negligence. department. and business interruption practice. “Performing Pre-Employment ground checks. 7th edition (8) Administration [OSHA] guidelines) • Chapter 19 OSHA Standards (29 CFR) 1910. prop. • Be aware of the following topics: mal.4 • Figures 2. and standards of practice. 4th edition (3) • Chapter 3 Dwyer_Part2_Sec5. Background Checks” (31) and drug and alcohol screenings Knowledge of employment verification • Laws may vary between states. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of employee criminal back. assistance program to all employees.4 ACSM’s Health/Fitness Facility Standards and Guidelines. • Most states have some additional laws that relates to sexual harassment and discrimination. and waiver of liability should be covered thoroughly.acsm. reviewed regularly. Knowledge of interviewing techniques • Avoid questions that may violate dis. employee. • This information is fairly extensive and ACSM’s Guidelines for Exercise medical release. “Title VII of the Civil Rights Act crimination laws (what is your sexual of 1964” (30) orientation. etc. or organization to reduce member. professional Medicare. and business risk. child abuse clearances.indd 122 11/07/12 11:56 PM . pant safety policy standards are paramount.1030(d)(4)(iii)(C) (24) Knowledge of insurance coverage • Be aware of insurance reimburse. 9th edition (7) • Tables 2. 7th edition (8) liability. Create and disseminate risk management guidelines for a health/fitness facility. • Laws may vary between states. “Performing Pre-Employment requirements mandated by state and Background Checks” (31) federal laws Knowledge of safe handling and dis. HFS Knowledge of sexual harassment poli.1–2. ACSM’s Resource Manual for common to the health/fitness industry ment and the role of Medicaid and Guidelines for Exercise Testing including general liability.1–2.org DOMAIN IV: LEGAL/PROFESSIONAL A. • Proper screening and emergency Testing and Prescription (GETP). 4th edition (3) • Chapter 3 • Table 3. • Applies to occupational exposure to ACSM’s Resource Manual for posal of body fluids and employee blood/body fluids or other potentially Guidelines for Exercise Testing safety (Occupational Safety and Health infectious materials and Prescription. ACSM’s Guidelines for Exercise in an exercise setting to ensure partici. Testing and Prescription (GETP).1 Knowledge of preactivity screening. • Must understand the federal law “Title VII of the Civil Rights Act cies and procedures prohibiting sexual harassment in the of 1964” (30) workplace. and business risk. and monthly care. principles because they relate to phys. daily. Dwyer_Part2_Sec5. and monthly care.indd 123 11/07/12 11:56 PM . ACSM’s Code of Ethics (5) Skill in developing and disseminating a • Chapter 1 provides a good introduc. and Prescription. 4th edition (3) • Chapter 8 Knowledge of preventive maintenance • Be aware of the differences between ACSM’s Health/Fitness Facility schedules and audits daily. Knowledge of the components of the • The ACSM Code of Ethics has five ACSM’s Guidelines for Exercise American College of Sports Medicine components. Guidelines for Exercise Testing the use of incident documents. every incident • Chapter 10 tion for the purpose of safety and risk (injury) should be documented. manual should include. Standards and Guidelines. ACSM’s Health/Fitness Facility management Standards and Guidelines. cise equipment to reduce the potential 4th edition (3) risk of injury • Chapter 7 • Tables 7. weekly. Standards and Guidelines. 4th edition (3) • In some states. (cont. 7th edition (8) ongoing safety training documenta. fibrillation related cardiac arrest. specialist (HFS).4 Knowledge of the legal implications • Be aware of tort and contract ACSM’s Resource Manual for of documented safety procedures. 4th edition (3) tor (AED) certification for employees. • Be aware of the differences between ACSM’s Health/Fitness Facility ods of evaluating the condition of exer. and ical activity legal issues. • The procedures should be reviewed regularly and known to all AED certi- fied employees. • CPR and AED certification is critical ACSM’s Health/Fitness Facility dures for cardiopulmonary resuscitation and required for health fitness Standards and Guidelines. 4th edition (3) • Chapter 7 • Tables 7. and warning signage. or organization to reduce member. employee. Standards and Guidelines. department. • Regardless of severity. a legislation was • Chapter 3 passed that requires health/fitness facilities to carry AED.3 and 7. Create and disseminate risk management guidelines for a health/fitness facility. weekly. SECTION 5 HFS Job Task Analysis 123 A. 4th edition (3) • Chapter 3 HFS Knowledge of documentation proce. 4th edition (3) • This information is fairly extensive and • Chapters 1–8 should be covered thoroughly. (CPR) and automated external defibrilla.3 and 7. • Chapter 3 Knowledge of AED guidelines for • AED plays a major role in the ACSM’s Health/Fitness Facility implementation resuscitative process in ventricular Standards and Guidelines.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the use of signage • Be aware of the differences between ACSM’s Health/Fitness Facility cautionary signage. danger signage. Testing and Prescription (GETP). Skill in developing and implementing • Because personnel in health/fitness Health Insurance Portability confidentiality policies facilities are exposed to confidential and Accountability Act of 1996 health-related information. the scope of practice 9th edition (7) Certified HFS scope of practice was adjusted and based on the Job • Appendix D Task Analysis (JTA). (ACSM) Code of Ethics and the ACSM • In recent years.4 Knowledge of techniques and meth. ACSM’s Health/Fitness Facility policy and procedures manual tion to what a policies and procedures Standards and Guidelines. HIPAA (HIPAA) (28) regulations should be used as a guide when developing such a policy. and facility cleaning and maintenance. 7th edition (8) cise testing. telephone procedures. fractures.) Knowledge or Skill Statement Explanation/Examples Resources Skill in maintenance of a safe exercise • Follow the recommended daily. • Be aware of different medical condi. and Prescription. • Chapter 3 Skill in training employees to identify • Employees should have the ACSM’s Health/Fitness Facility high-risk situations appropriate education. 124 CERTIFICATION REVIEW • www.. Guidelines for Exercise Testing needed during fitness evaluations. 7th edition (8) and exercise intolerance (dizziness. department. and first aid techniques procedures. proper sanitation. Standards and Guidelines. and Prescription. heat and cold injuries) emergency. certification. ACSM’s Health/Fitness Facility tion. 4th edition (3) tenance of exercise areas. and experience to identify high-risk 4th edition (3) situations. tion. and business risk. weekly.4–5. exer. written access to all written emergency guide. and Prescription. emergency • Be aware of the facility’s policies and ACSM’s Resource Manual for procedures. Guidelines for Exercise Testing emergency procedures. and overall • Chapter 5 facility maintenance) • Tables 5. Specialist Scope of Practice (1) implications of carrying out emergency the HFS must be familiar with each ACSM’s Resource Manual for procedures facility’s policies and procedures (place Guidelines for Exercise Testing of employment). Standards and Guidelines. Create an effective injury prevention program and ensure that emergency policies and procedures are in place.4 Skill in the organization.indd 124 11/07/12 11:56 PM . and exercise training tions/emergencies and the proper • Chapter 10 acute and emergency (if applicable) response. • Chapter 4 • Employees should be familiar with emergency response protocols. and human resource management lines for risk management and emer. Dwyer_Part2_Sec5..6 • Chapter 7 • Tables 7. appropriately recognize and treat the • Chapter 19 syncope. such and the health fitness specialist Guidelines for Exercise Testing as bleeding. Knowledge of basic first aid proce. • This information is fairly extensive ACSM’s Resource Manual for dures for exercise-related injuries. and/or monthly equipment Standards and Guidelines.g. 4th edition (3) ment policies and procedures. ACSM’s Health/Fitness Facility environment (e. communica.org A. required to implement risk manage. strains/sprains. employee. (cont. safety and main. 7th edition (8) responsibilities) in a health and fitness • Emergency plan should be current and • Chapter 19 setting documented. • Tables 19. B.e.acsm. equipment opera. HFS Knowledge or Skill Statement Explanation/Examples Resources Knowledge of emergency procedures • Staff should be familiar with and have ACSM’s Resource Manual for (i. 7th edition (8) • Chapter 10 Knowledge of safety plans.4 Knowledge of the HFS responsi. or organization to reduce member. (HFS) should have the knowledge to and Prescription. • To protect participants/clients and to ACSM’s Certified Health Fitness bilities and limitations and the legal minimize the risk of legal ramifications.2–19. Create and disseminate risk management guidelines for a health/fitness facility. • Be aware of both standards and guide. gency policies. personnel lines and procedures.3 and 7. 4th edition (3) lator (AED) techniques • Chapter 4 Skill in designing an evacuation plan • The plan should be developed as part ACSM’s Resource Manual for of the exercise program safety and Guidelines for Exercise Testing emergencies procedures. 7th edition (8) pulmonary complications (e.2–19. fairly extensive. • The HFS should recognize (have the ACSM’s Resource Manual for dures for exercise-related injuries.. fainting/syncope. • Table 19. • Regardless of severity. and Prescription.4 Knowledge of emergency documenta. hypotension/ responses. hypoglycemia/hyperglycemia. 4th edition (3) • Chapter 4 Dwyer_Part2_Sec5. signs. cardiopulmonary resuscitation CPR/AED certification with a practical Standards and Guidelines. 4th edition (3) • Appendix J Skill in demonstrating emergency pro.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of potential musculoskel. acute care (be skillful) to each of these and Prescription. • The knowledge of these conditions is ACSM’s Resource Manual for etal injuries (e.g. fractures. (cont. contusions. Standards and Guidelines. bradycardia. (CPR). cardiovascular/ • Be aware of the conditions. strains/sprains. conditions. and symptoms as well as acute • Chapter 19 cardia.. Standards and Guidelines.4 Skill in applying basic life support. dyspnea) and metabolic abnormalities (e. hypother- mia/hyperthermia) Knowledge of the initial management • The HFS should recognize and be able ACSM’s Resource Manual for and first aid techniques associated with to provide acute care for each of these Guidelines for Exercise Testing open wounds. • The HFS must have a current adult ACSM’s Health/Fitness Facility first aid.indd 125 11/07/12 11:56 PM . sprains. 4th edition (3) • Chapter 3 Skill in applying basic first aid proce.. Guidelines for Exercise Testing strains. and Prescription. and automated external defibril. 7th edition (8) cardiovascular/pulmonary complica. conditions. fractures). every incident ACSM’s Health/Fitness Facility tion and appropriate document use (injury) should be documented. • Chapter 19 HFS syncope. SECTION 5 HFS Job Task Analysis 125 B. • The HFS must be familiar with each ACSM’s Resource Manual for cedures during exercise testing and/or facility’s emergency policies and Guidelines for Exercise Testing training procedures. tachy. • Chapter 19 tions. and Prescription. 7th edition (8) • Chapter 19 ACSM’s Health/Fitness Facility Standards and Guidelines.2 hypertension. and Prescription. and metabolic disorders • Tables 19. musculoskeletal injuries. such knowledge) and be able to provide Guidelines for Exercise Testing as bleeding.g. 7th edition (8) and exercise intolerance (dizziness. 7th edition (8) • The HFS must have a current adult • Chapter 19 CPR/AED certification with a practical ACSM’s Health/Fitness Facility skills component. Create an effective injury prevention program and ensure that emergency policies and procedures are in place.2–19.g. heat and cold injuries) • Tables 19. skills component. and management techniques.indd 126 11/07/12 11:56 PM . organization.. Knowledge of techniques for tracking • Consider using focus groups. • There are other basic software systems that may assist facility accounting such as Quicken. Responsibilities” (29) exercise and health promotion program Knowledge of principles of financial • This information is fairly extensive and “Understanding the Basics” (32) planning and goal setting. ACSM’s Health/Fitness Facility and guidelines to efficiently hire. and credentialing requirements state. state. rules. • Employee benefits will vary widely from one employer to another. B. 126 CERTIFICATION REVIEW • www. state.g. and local • Staff qualifications and credentialing ACSM’s Health/Fitness Facility laws pertaining to staff qualifications requirements will vary from state to Standards and Guidelines. Manage human resources in accordance with leadership. ACSM’s Resource Manual for and evaluating member retention in-depth interviews. principles. and regulations of business administration.acsm. rules. institutional requires understanding of the basic budgeting processes. and evaluate • Be very familiar with federal. HFS Skill in applying conflict resolution • Negotiate and mediate in the interper.org DOMAIN V: MANAGEMENT A. surveys. 4th edition (3) employees and local laws pertaining to staff • Chapter 4 qualifications and credentialing • Tables 4. Knowledge of federal. Knowledge of basic software systems • This spreadsheet application is being Excel 2010 (22) that facilitate accounting (e. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of fiduciary roles and re. supervise. Knowledge of industry benchmarks for • This information is fairly extensive and “Understanding the Basics” (32) budgeting and finance requires understanding of the basic principles. Manage fiscal resources in accordance with leadership.2–4. • Be aware of Employee Retirement “Meeting Your Fiduciary sponsibilities inherent in managing an Income Security Act (ERISA). and feedback Guidelines for Exercise Testing systems. practices.5. Standards and Guidelines. argument. • Be very familiar with the facility poli. and management techniques. “Conflict Resolution Skills” (25) techniques sonal level (between employees and/ or members) in order to resolve a con- flict. Excel) updated periodically. and allocation of resources business administration.5. schedule. train. organization. and Prescription. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of industry benchmark • The information that is presented by Bureau of Labor Statistics compensation and employee benefit the BLS regarding compensation may (BLS) (10) guidelines vary from year to year. or disagreement. requirements. cies and procedures. 7th edition (8) • Chapter 48 Skill in applying policies.2–4. and regulations of forecasting. Dwyer_Part2_Sec5. 4th edition (3) • Chapter 4 • Tables 4. 4th edition (3) • Chapter 5 • Tables 5. Skill in administering fitness. and monthly equipment Standards and Guidelines. and local laws pertaining to business administration. state. establish policies and procedures for manual should include. because facility management rules Standards and Guidelines.. 4th edition (3) HFS the management of health/fitness • This information is fairly extensive and • Chapters 1–8 facilities should be covered thoroughly. Knowledge of facility and equipment • Be aware of the differences between ACSM’s Health/Fitness Facility maintenance guidelines daily. revenue generation) • Be very familiar with federal.3 and 7.6 • Chapter 7 • Tables 7.and • Be very familiar with the rules and “Understanding the Basics” (32) wellness-related programs within regulations of business administration. budgeting. and local laws ACSM’s Health/Fitness Facility laws as they relate to health/fitness fa. Knowledge of facility design and • This information is fairly extensive and ACSM’s Health/Fitness Facility operation principles should be covered thoroughly. management • Be aware that policies and procedures 4th edition (3) will vary from state to state. and local • Check federal. (cont. Standards and Guidelines. • Be aware of the differences between 4th edition (3) fitness only and multipurpose facili. and regulations. Standards and Guidelines. and regulations used to tion to what a policy and procedures Standards and Guidelines.4–5. as cold calling. cility management and regulation will vary from state to 4th edition (3) state. 7th edition (8) • Chapter 48 Skill in efficiently managing financial • Be very familiar with finance and ac. state. location. organization.g. • Chapter 5 Knowledge of federal. established budgetary guidelines C. maintenance. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of accepted guidelines. planning. • Chapter 5 Dwyer_Part2_Sec5. Manage fiscal resources in accordance with leadership.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of basic sales techniques • Be aware of common techniques such ACSM’s Resource Manual for that promote health. standards. weekly. “Understanding the Basics” (32) resources and performing related tasks counting management because it re- (e. and well. • Chapters 5 and 16 ties in respect to design and overall operations. fitness. Establish policies and procedures for the management of health/fitness facilities based on accepted safety and legal guidelines. ACSM’s Health/Fitness Facility standards. lates to business administration. etc. and management techniques. • Chapter 1 provides a good introduc. SECTION 5 HFS Job Task Analysis 127 B. drop box leads. Guidelines for Exercise Testing ness services and Prescription. resource al. state.4 Knowledge of documentation • Facilities should have written policies ACSM’s Health/Fitness Facility techniques for health/fitness facility and procedures.indd 127 11/07/12 11:56 PM . Dwyer_Part2_Sec5. initiate community • Chapters 15 and 17 involvement. commu. • Chapters 15 and 17 Skill in designing and writing promo. services. • Use tools such as developing alliances ACSM’s Resources for the nity awareness. price. • Chapters 15 and 17 Skill in applying marketing techniques • Use tools such as focus groups. • Chapters 15 and 17 Knowledge of target market (internal) • Assess internal factors that may ACSM’s Resources for the assessment techniques provide advantages or disadvantages Health Fitness Specialist (6) in meeting the needs of the target • Chapters 15 and 17 market (clients). maintain exercise equipment. • Marketing plays a major role in the ACSM’s Resources for the ing: product. placement. and sponsorship and with Home Owners Association’s Health Fitness Specialist (6) their relationship to branding initiatives HOA’s and realtors. Knowledge of public relations.org D. conduct regular evaluations. etc. ACSM’s Resources for the tional materials ing materials that will positively and Health Fitness Specialist (6) aggressively market the facility • Chapters 15 and 17 Skill in collaborating with community • Must be very familiar with strategic ACSM’s Resources for the and governmental agencies and alliance strategies Health Fitness Specialist (6) organizations • Chapters 15 and 17 Skill in providing customer service • Pivotal factor in health/fitness facilities ACSM’s Resources for the • Some ways to improve customer Health Fitness Specialist (6) service relate to providing superior • Chapters 15 and 17 service. cold calling. the state of Health Fitness Specialist (6) the economy. and facilities. etc. etc. in-depth interviews. etc. ACSM’s Resources for the sharp shooter method. • Must be very familiar with develop.acsm. Health Fitness Specialist (6) back systems. ACSM’s Resources for the that promote client retention surveys. • Chapters 15 and 17 Skill in applying marketing techniques • Must be very familiar with marketing ACSM’s Resources for the that attract new clients techniques such as lead boxes. HFS Knowledge of target market (external) • Assess external factors such as ACSM’s Resources for the assessment techniques offering by competitors. direct Health Fitness Specialist (6) mail. • Consider market trends. etc. ACSM’s Resources for the techniques cold calling. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of lead generation • Use membership referral. etc. and feed. Develop and execute a marketing plan to promote programs. etc. promotional Health Fitness Specialist (6) massages. Health Fitness Specialist (6) promotion • The management team should • Chapters 15 and 17 consider an array of marketing tools to promote the facility and fitness-related programs.indd 128 11/07/12 11:56 PM . Knowledge of advertising techniques • Consider scatter gun approach. lead boxes. 128 CERTIFICATION REVIEW • www. and viability of health/fitness facilities. Health Fitness Specialist (6) • Chapters 15 and 17 Knowledge of the four P’s of market. 2012. • Consider developing strategic alliances. Garber CE. 807 p. NON-ACSM REFERENCES: 462 p. 5. Kraemer WJ. CodeofEthics/Code_of_Ethics. Heyward VH. the use of other promotional Health Fitness Specialist (6) materials. ACSM’s Resource Manual for Guidelines Learning through Movement.). Hall SJ. Boston (CA): Pearson Education/Allyn & Bacon. United States Department of (IL): Human Kinetics. 172 p. Sports Medicine position stand. 156 p. Available from: http://www . 2006. 7th ed. ACSM’s Resources for the ing. ACSM’s Resources for the Health Fitness Specialist. Designing Resistance Training Programs. etc. American College of Champaign (IL): Human Kinetics. Liguori G. Basic Biomechanics. 577 p. ACSM’s Health-Related Physical 1334–59. Goldenberg L. etc. 2011. 6th ed. Fleck SJ. Blissmer B. 285 p. 2002.cfm&ContentID= Human Kinetics. for Persons with Chronic Diseases and Disabilities. 2008. Champaign Williams & Wilkins. Eshelman ER. direct mail. College of Sports Medicine. editor. Available from: http://www. [cited 2011 Sep 22]. 2011. Swain DP. Microsoft Corporation. Advanced Fitness Assessment and Exercise Prescription. Baltimore (MD): Lippincott Williams & Williams & Wilkins. Higgins M. Facility Standards and Guidelines. Available from: http:// Publications. Lippincott Williams & Wilkins. Armiger P. 4th ed. 2013. musculoskeletal. Martyn MA. 9th ed. senior editor. Thousand Oaks (CA): Corwin Press. The Kinesthetic Classroom : Teaching and 8. Kraemer WJ. Champaign (IL): Human Kinetics. 3rd ed. Champaign (IL): Human and neuromotor fitness in apparently healthy adults: guid- Kinetics. et al. etc. 691 p. fitness workers.. Davis M. 9th ed. Philadelphia (PA): Lippincott and Prescription. ACSM’s Exercise Management 3rd ed. ACSM’s Resources for the and techniques tions (meetings. Fitness Assessment Manual. American College of Sports Medicine. physical therapists. Ehrman JK. org/Content/NavigationMenu/MemberServices/MemberResources/ 4th ed. SECTION 5 HFS Job Task Analysis 129 E. 191 p. Use effective communication techniques to develop professional relationships with other allied health professionals (e. Available from: http://office Philadelphia (PA): Lippincott Williams & Wilkins. Occupational outlook handbook. conferences. Champaign 2010–2011 edition. Dwyer_Part2_Sec5. 2010. Philadelphia 6. Newton H.gov/oco/ocos296.microsoft. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of communication styles • In addition to face-to-face communica. [Internet]. 14.acsm. American College of Sports Medicine. • Chapters 15 and 17 REFERENCES ACSM REFERENCES: Labor [Internet]. Oakland (CA): New Harbinger Medicine [Internet]. The Relaxation & Stress fitness specialist scope of practice. Therapeutic Exercise: From Theory to Practice. 4th ed. [cited 2011 Sep 22]. Clinical Exercise Physiology. 2. Davis Company.org/AM/Template. 2nd ed.43(7): 4.htm 18. for Exercise Testing and Prescription. 20.com/en-us/excel/ 10. webinars. American College of Sports Medicine.indd 129 11/07/12 11:56 PM . McKay M. ACSM’s certified health 11.bls.htm HFS 1. Kuczala M.). 10829#HFI_Scope_of_Practice 2011 13. 203 p. 2014. Boston (MA): WCB/McGraw-Hill. Deschenes MR. American College of Sports Medicine. Strength Ball Training. ACSM’s Health/Fitness for developing and maintaining cardiorespiratory. 2011. etc. Code of ethics of American 16. Knowledge of networking techniques • Meet and maintain a relationship ACSM’s Resources for the with other allied health professionals Health Fitness Specialist (6) (conferences. [cited 2011 Sep 22]. A. 2011. Twist P. Pear J. 6th ed. Health Fitness Specialist (6) it is common today to use a wide • Chapters 15 and 17 range of electronic communications such as e-mails. Champaign (IL): _Instructor1&Template=/CM/ContentDisplay. Med Sci Sports Exerc. Deschenes MR. 19. Pescatello LS. Wilkins. ance for prescribing exercise. 377 p. Fleck SJ. physicians. nutritionists. 2004. 263 p. nurses). Behavior Modification: What It Is and How to Do It. Martin G.g. 371 p. Explosive Lifting for Sports—Enhanced Edition. www. Bureau of Labor Statistics. . Skill in planning meetings • Requires experience in advertis. 2009. 2nd ed. American College of Sports Reduction Workbook. 440 p. 22. 21. American College of Sports Medicine 2011.cfm?Section=HealthFitness 12. Baltimore (MD): 2010. Exercise Physiology: 7. 2007. senior editor. 23. Stretching for Functional Flexibility. tweets. [cited 2011 Sep 26].acsm. Baltimore (MD): Lippincott Williams & Wilkins. 2014. (IL): Human Kinetics. • Chapters 15 and 17 • Maintain communications (keep in touch). Quantity and quality of exercise 3. 488 p. 17. ACSM’s Guidelines for Exercise Testing Integrated Theory and Application. Microsoft Corporation 9. Philadelphia (PA): Lippincott 15. 369 p. 2009. [Internet]. Excel 2010. American College of Sports Medicine. Champaign (IL): Human Kinetics. (PA): F. Lengel T. 2014. S. bilities. Performing pre-employment Champaign (IL): Human Kinetics.S. Small Business Administration. U.org 24.S.S. [cited 2011 Sep 22]. 2008.gov/content/ and promotion. Equal Employment Opportunity Commission. Available from: http://www.indd 130 11/07/12 11:56 PM . Occupational safety 29. performing-pre-employment-background-Checks [cited 2011 Sep 26]. U. Available from: http://www.html U. Available from: http://www.gov/ebsa/publications/ 2011 Sep 22]. 274 p.acsm.osha. Title VII of 25.pdf HFS Dwyer_Part2_Sec5.gov/index. Equal Employment Opportunity [cited 2011 Sep 22]. United States Department of Labor [Internet].sba. Smith M.gov/laws/statutes/titlevii.S. 28.eeoc. USDA center for nutrition policy [cited 2011 Sep 22]. 130 CERTIFICATION REVIEW • www. [cited 2011 ber 1910. [cited Sep 26]. United States Department of Agriculture [Internet].hhs. U. Department of Agriculture.gov/pls/oshaweb/ fiduciaryresponsibility. U. U.show_document?p_table=standards&p_id=10051 30. Available from: http:// eq8_conflict_resolution.dol. Occupational Safety & Health Administration. Department of Health & Human Services starting-managing-business/starting-business/preparing-your [Internet]. Meeting your fiduciary responsi- and health standards: toxic and hazardous substances (standard num. U. 27. Available from: http://www. Summary of the Available from: http://www. Taylor AW. Conflict resolution skills.gov/ -finances/understanding-basics ocr/privacy/hipaa/understanding/summary/privacysummary. Johnson MJ.S.S. Physiology of Exercise and Healthy Aging.org/mental/ Commission [Internet].htm www.1030). United States Department Labor [Internet]. Small Business Administration [Internet]. Small Business Administration [Internet]. background check.S. Understanding the basics.S. . Available from: http://www.gov/category/navigation-structure/ HIPAA privacy rule. U. Department of Health & Human Services. U. the Civil Rights Act of 1964. Department of Labor. Helpguide [Internet]. Small Business Administration.html owadisp.choosemyplate 32. U.cfm 26. Available from: http://helpguide. Segal J. [cited 2011 Sep 22]. 31. [cited 2011 Sep 22].S.sba. Which of the following represents more than 90% 8.50 kcal C) Triglycerides B) 137.5 mL ⴢ kg⫺1 ⴢ glycerol molecule connected to three fatty acids? min⫺1.50 kcal groups increases the risk of low back pain? 9. (CPT). For adults with arthritis. A) 100/60 mm Hg C) Avoid all joint movement during periods of B) 110/70 mm Hg acute flares and inflammation. To promote weight loss. Which of the following medications is designed mal or submaximal exercise test in a low-risk adult? to modify blood cholesterol levels? A) Subject requests to stop A) Nitrates B) Shortness of breath B) ␤–Blockers C) A slight decrease in diastolic pressure C) Antihyperlipidemics D) Failure of heart rate (HR) to increase with D) Aspirin increased intensity 2.50 kcal D) Free fatty acids C) 9.indd 131 11/07/12 11:56 PM . B) Hamstrings A) At least 30 min on 3 or more days per week C) Hip flexors (moderate intensity) D) Biceps femoris B) At least 50–60 min ⴢ d⫺1 totaling 300 min ⴢ wk⫺1 4. ACSM Certified Personal Trainer in exercise intensity during submaximal exercise. systolic blood pressure (SBP) (mm Hg) should increase . If a 150-lb man exercised for 30 min on a Monark of the fat stored in the body and is composed of a HFS cycle ergometer at an intensity of 27. 7. cardiovascular endurance A) Quadriceps exercise should be performed for . readings would characterize hypertension in B) Physical activity should be completed at the the adult? same time every day. Which of the following would not terminate a maxi- 1. Which of the following blood pressure (BP) emphasized over increased intensity. C) 120/80 mm Hg D) All of the above. which of the following C) Transverse apply? D) Superior A) Progression in duration of activity should be 5. DIRECTIONS: Each of the numbered items or A) Approximately 10 mm Hg incomplete statements in this section is followed by B) 15–20 mm Hg answers or by completions of the statement. Select C) 25–30 mm Hg the ONE lettered answer or completion that is BEST D) 30–35 mm Hg in each case. Which of the following terms represents an (moderate intensity) imaginary horizontal plane passing through C) At least 20–25 min on 3 or more days per week the midsection of the body and dividing it (vigorous intensity) into upper and lower portions? D) At least 10 min on most days of the week A) Sagittal (vigorous intensity) B) Frontal 10. D) 140/90 mm Hg 131 Dwyer_Part2_Sec6.35 kcal 3. SECTION 6 HFS Examination Note: HFS certification candidates should also review the practice 6. Limited flexibility of which of the following muscle D) 5. For every one metabolic equivalent (MET) increase examination found in Part 1. what would his caloric expenditure be for A) Phospholipids the entire 30-min session? B) Cholesterol A) 280. C) ⬍60 mg ⴢ dL⫺1 A) 10 W D) ⬍40 mg ⴢ dL⫺1 B) 50 W 20. . Which of the following conditions is characterized B) Life satisfaction by a decrease in bone mass and density. vomiting. Which of the following is NOT true regarding the B) Decrease psychological benefits of regular exercise in the C) No change elderly? D) Increase during dynamic exercise only A) Self-concept 14. Rotation of the anterior surface of a bone toward B) Stroke volume the midline of the body is called .0 kp? Assume A) ⬍200 mg ⴢ dL⫺1 that 1 revolution of the cycle ergometer flywheel is B) ⬍110 mg ⴢ dL⫺1 6 m long. To determine program effectiveness. 18. What could be an alternative to the contraindi- C) 100 W cated.org 11. D) HR and blood volume D) Children with exercise-induced asthma are often unable to lead active lives.indd 132 11/07/12 11:56 PM . oxygen-carrying capacity of the arterial blood C) Increasing the rate of training intensity more and venous blood than approximately 10% per week increases C) Oxygen consumption and HR the likelihood of overuse injuries of bone.acsm. What is a subject’s work rate in watts if he pedals considered a risk factor in the development of on a Monark cycle ergometer at 50 revolutions per cardiovascular disease? minute (RPM) at a resistance of 2. As a result of regular exercise training. A) Dyslipidemia A) Acute exposure to the cold B) Hypertension B) Hypothermia C) Turbulence of blood flow within the vessel C) Heat exhaustion and heat stroke D) All of the above D) Acute altitude sickness 19. moderate intensity should be motivational principles maintained between . C) Measurement A) 8 and 12 D) All of the above B) 12 and 16 23. Dwyer_Part2_Sec6. producing C) Stimulate appetite HFS bone porosity and fragility? D) Self-efficacy A) Osteoarthritis 22. A) HR and stroke volume B) Strength training should be avoided for safety B) Stroke volume and the difference between the reasons. Uncoordinated gait. Regular exercise will result in what chronic B) Flexion with rotation adaptation in cardiac output (Q̇ ) during exercise at C) Double knee to chest the same workload? D) Lateral neck stretches A) Increase 21. At what level is high-density lipoprotein (HDL) 12. dizziness. C) Supination A) Exercise programs should increase physical D) Pronation fitness in the short term and strength and 17. high-risk plough exercise? D) 200 W A) Squats to 90 degrees 13. When using the original Borg scale (6–20) for B) Application of cognitive-behavioral or the general public. C) Maximal heart rate (HRmax) A) Medial rotation D) None of the above B) Lateral rotation 24. headache. stamina in the long term. which of the C) 17 and 18 following is NOT affected during maximal exercise? D) 19 and 20 A) Q̇ 16. Q̇ can be calculated by multiplying . psychologi- B) Osteomyelitis cal theories provide a conceptual framework for C) Epiphyseal osteomyelitis assessment and . A source of intimal injury thought to initiate the and elevated body temperature are signs and process of atherogenesis is . symptoms of . D) Osteoporosis A) Management of programs or interventions 15. 132 CERTIFICATION REVIEW • www. When exercise training children. Which statement is true regarding resistance to strengthen the chest and triceps? training in children? A) Chin-ups A) We now know that it is appropriate and B) Crunches effective to use maximal (one repetition C) Pec deck flyes maximum [1-RM]) resistance training D) Push-ups with children. condition of intensity and 30 min of vigorous-intensity 34.indd 133 11/07/12 11:56 PM . inflammation each day. At 6-MET intensity. B. A) Light D) If a child cannot perform a minimum of 8 reps B) Moderate with good form. single exercise using one’s own body weight as resistance could be performed 29. 30. highly repetitive exercise should be D) Only physicians can perform fitness encouraged in order to strengthen connective assessments tissues at the joint. Which would NOT be a special consideration for B) Advanced cardiac life support and ACSM exercise prescription in individuals with arthritis? Exercise Specialist A) Water exercise may help alleviate pain and C) Advanced cardiac life support and ACSM stiffness. Which statement is true regarding physical activity 33. focus mainly on the intensity classification of what? amount of resistance for the child. the resistance is too heavy and C) Hard should be reduced. C) Joint. C) Back extensions D) Children need to have several periods of 2 h or D) Upright rows more of inactivity during the day in order to have adequate rest. professionals performing fitness perform on each resistance exercise? assessments on others should possess which A) 8–10 reps combination of the following? B) 12–15 reps A) Cardiopulmonary resuscitation (CPR) and C) 6–8 reps American College of Sports Medicine (ACSM) D) 4 reps Health Fitness Specialist (HFS) 32. 27. an individual who has a 10- (reps) per exercise. D) Joint. Which of the following risk factors for the devel. morning C) Mode and duration exercise should be avoided due to significant D) Mode and frequency morning stiffness. Registered Clinical Exercise Physiologist B) Vigorous. At minimum. whereas the suffix “itis” stands for . In the term “arthritis. Which resistance exercise would strengthen both physical activity on most days of the week. 35. Which mode would be inappropriate for most opment of coronary artery disease (CAD) has the elderly (older) individuals? greatest likelihood of being influenced by regular A) Walking as part of a social group exercise? B) Aquatic (water) exercise in a group setting A) Smoking C) Plyometrics as part of a health club class B) Cholesterol D) Stationary cycling for those with poor balance C) Type 1 diabetes E) A. B) The child should perform 8–15 repetitions 36. How many reps should an elderly individual 26. B) Mode and intensity D) For those with rheumatoid arthritis.” the prefix “arth” stands for for children? . the biceps and latissimus dorsi muscles? C) Children should focus on just one or two A) Chin-ups modes of physical activity so as to develop B) Dead lifts exceptional skills in those areas. inflammation of physical activity lasting 15 min or more B) Diseased. Which of the following components of the exercise C) People with arthritis may be anemic due to regu- prescription work inversely with each other? lar use of nonsteroidal anti-inflammatory drugs A) Intensity and duration (NSAIDs) causing gastrointestinal bleeding. HFS 28. SECTION 6 HFS Examination 133 25. MET maximal capacity fitness level would be at an C) In terms of progression. D) Very hard Dwyer_Part2_Sec6. inflammation B) Children should perform 30 min of moderate. A) Children should participate in several bouts A) Paste. and D D) Hypertension 31. What at-home. Most sedentary people who begin an exercise B) Gradually increase in distance weekly with program are likely to stop within . In prevention of osteoporosis. If you want your client to exercise at 55%–70% activities of daily living (ADL)? of her maximum HR in today’s workout and she A) Reading and writing is 24 yr old and does not know her observed B) Lifting medium-weight items maximum HR. C) Gradually increase in distance every week by C) 1 mo about 10%. 134 CERTIFICATION REVIEW • www.2 miles) who is doing a long run each D) Decrease with isometric or increase with Sunday. overload. the SBP should C) Prone position exercises progressively with an increasing workload. D) 121–154 bpm what should you have on hand at all times? A) Sugar 45. what HR should be using today? C) Transferring (walking) A) 97–123 bpm D) Speaking B) 108–137 bpm C) 110–140 bpm 38. which is appropriate? Each Sunday run isotonic contractions should . From rest to maximal exercise. specificity. is C) Body Weight an example of an . redundancy A) Gluteal and quadriceps D) Overload. such as finally being able to run a B) Maximal SBP mile or to increase the speed of walking a mile. Which of the following types of muscle stretching B) NutraSweet (artificial sweetener) can cause residual muscle soreness. intensity. Which activity/activities below is/are considered as 44. 47.5 mph up a D) Weight-bearing grade of 5%? A) 8. duration strengthen? C) Specificity. Reasons for fitness testing of the older adult include long runs the last 2 mo. it is important to B) Exercise prescription regularly perform what kind of exercise? C) Motivation A) High-intensity D) All of the above B) Aquatic C) Low-intensity 49. progression 51.2 MET number.org 37. . What muscles does a “standing leg curl” exercise B) Frequency.2 MET straight HRmax formulas of calculating target heart C) 13. What exercises should be avoided after the first C) Proprioceptive neuromuscular facilitation (PNF) trimester for a pregnant woman? D) All of the above A) Upright exercises such as walking stairs B) Supine position exercises 46. Feeling good about being able to perform an A) Estimated maximal HR activity or skill.2 MET 42. a slightly lower distance Sunday every fourth A) 1–2 d B) 3–6 wk HFS week or so. intensity. is time C) Nitroglycerin consuming. D) 3–6 mo D) Rapidly increase distance weekly then avoid all 48. and typically requires a partner? D) Insulin A) Static B) Ballistic 39. Both the Karvonen (heart rate reserve) and the B) 10.acsm. Which grouping lists the three training principles C) External stimulus that you need to consider when prescribing exercise D) Internal stimulus for individuals? A) Overload. A) Be the same distance at about 20–22 miles. progression B) Hamstrings and calves C) Hamstrings only D) Calves only Dwyer_Part2_Sec6. What is this first number used in both formulas? 50. D) Sitting exercises such as cycling A) Increase B) Decrease 40.indd 134 11/07/12 11:56 PM .2 MET rate (THR) begin subtracting variables from a set D) 15. D) Gender A) Extrinsic reward B) Intrinsic reward 43. What is the energy cost of running at 6. When working with an individual with diabetes. A) Evaluation of progress 41. When periodizing training for a marathon C) Stay the same runner (26. holds his or her breath during a resistance training and frequency of cardiorespiratory exercise for exercise in hopes of temporarily enhancing his or apparently healthy individuals includes . it is recommend that for the general B) Periodization population to sustain weight loss in adulthood C) Supersets that they participate in at least min of daily D) Isotonic reversals moderate-intensity physical activity while not exceeding caloric intake requirements. HR D) To detail the rights and responsibilities of will be at the same rating of perceived the club owner to reject an application by exertion (RPE) observed at sea level. In the New Dietary Guidelines for Americans A) Plyometrics 2005. and frequency of 3 d a week D) Anginal C) Intensity of 50%–70% HRmax. D) After the cool-down C) To define the relationship between the facility operator and the HFS. D) Mobility of equipment to allow for easy A) There is a perceived threat of disease. when . 60. B) After you warm-up as well as the rights of the client and the facility. duration of A) Karvonen 20–60 min. What is the maneuver called where an individual 58. skeletal muscle strength begins C) The same to decline. which flexibility exercise would duration of 20–60 min. B) A gain in lean tissue A) Flexibility of equipment to allow for different C) A loss of muscle mass caused by a loss of body sizes muscle fibers B) Size of equipment to accommodate small and D) Myogenic precursor cell inhibition large clients C) Affordability of equipment to allow for 63. What is the purpose of agreements. If planning a 60-min walk (as opposed to D) HFS some dynamic/ballistic activity like gymnastics tumbling). a prospective client. duration. The Health Belief Model assumes that people will changing out equipment periodically engage in a behavior. duration of 15–45 min.indd 135 11/07/12 11:56 PM . releases. 56. C) Optimal environmental conditions are met. hamstrings. her strength? A) Intensity of 60%–90% HRmax. Which of the following personnel is responsible for A) 20–40 program design as well as implementation of that B) 30–60 program? C) 60–90 A) Administrative assistant D) 90–120 B) Exercise specialist C) Manager or director HFS 55. rearrangement B) External motivation is provided. C) Immediately after the completion of the B) To inform the client what he or she can and 60-min walk cannot do in the facility. when is the most important time to 61. A method of strength and power training that C) Straddle stretch involves an eccentric loading of muscles and D) Cross-legged standing toe touch tendons followed immediately by an explosive concentric contraction is called . An important safety consideration for exercise A) A gain in fat tissue equipment in a fitness center includes . Dwyer_Part2_Sec6. After 30 yr of age. If you prescribe that your client stretch his D) Intensity of 60%–90% HRmax reserve. and stretch in relation to the walk? consent forms? A) Before you warm-up A) To inform the client of participation risks. 54. and frequency of 5 d a week 53. and frequency of NOT accomplish this? 7 d a week A) Modified hurdler stretch B) Forward wall push stretch 59. and frequency of 3–5 d a week B) Diaphragmatic B) Intensity of 85%–90% HRmax. such as exercise. The ACSM recommendation for intensity. SECTION 6 HFS Examination 135 52. During exercise performed at high altitudes. primarily because of which of the following? 57. duration of C) Valsalva 30 min. A) Lower B) Higher 62. D) Internal motivation outweighs external circumstances. C) 12–20 D) More than 20 76. would be categorized under the cognitive process of the Transtheoretical Model? 70. attainable goals. The informed consent document . B) A regular schedule of exercise is established. A) 1-RM 73. A) Decreased HR at rest A) The benefit outweighs any potential risk. C) Increase days per week the muscle groups are trained. B) Increased stroke volume at rest B) The risk of orthopedic and cardiovascular C) No change in Q̇ at rest complications is increased. 68. how many sets of each resis- B) Shin splints tance training exercise are needed to improve C) Sleep deprivation muscular fitness? D) Decreased physical conditioning A) 1 B) 2 67. Which of the following is the recommended B) Three-repetition maximum rest interval between sets of resistance training C) Number of curl-ups in 1 min exercise? D) Number of curl-ups in 3 min A) 30 s B) 1–2 min 66. C) 60% and 90% A) There is social and health care provider support D) 70% and 100% for the individual. 136 CERTIFICATION REVIEW • www. . Which of the following resistance training exercises A) Is a legal document is an example of a multijoint exercise? B) Provides immunity from prosecution A) Bicep curls C) Provides an explanation of the test to the client B) Leg curls D) Legally protects the rights of the client C) Leg press D) Calf raises 65. The ACSM recommends that exercise intensity be C) 3 prescribed within what percentage of HRmax range? D) 4 A) 40% and 60% B) 50% and 80% 75. Which of the following are changes seen as a result of regular. 72. For higher intensity activities. exercise for muscular strength and endurance? HFS D) Individualized. which of the following cardiovascular complications. chronic exercise? 69. What is the recommended rep range when A) Stimulus control resistance training adults for general muscular B) Reinforcement management fitness? C) Self-reevaluation A) 1–5 D) Self-liberation B) 6–10 C) 8–12 78. For novice trainees. If a client exercises too much without rest days or C) 2–3 min develops a minor injury and does not allow time D) 3–4 min for the injury to heal. While assessing the behavioral changes associated D) There is no increased risk of orthopedic and with an exercise program. B) 8–12 E) All of the above. Which of the following is an example of how to A) Developing the exercise prescription progressively overload the muscular system via B) Evaluating proper nutritional choices resistance training? C) Diagnosing musculoskeletal injury A) Increase amount of resistance lifted.indd 136 11/07/12 11:56 PM . The ACSM recommends how many reps of each C) Muscle soreness and injury are minimal.acsm.org 64. and objectives A) 5–6 are identified. 77. A measure of muscular endurance is . Dwyer_Part2_Sec6. Fitness assessment is an important aspect of the D) 15–20 training program because it provides information for which of the following? 71. D) All of the above C) The risk of orthopedic and cardiovascular complications is minimal. D) Developing appropriate billing categories B) Perform more sets per muscle group. D) All of the above are examples of progressive overload. what can occur? A) An overuse injury 74. Exercise adherence is increased when . Compression. and muscular fitness D) Rotate. C) Split routines A) Management D) Pyramids B) Staff C) Clients 81.5 kg) B) Hypotension D) 10–15 lb ⴢ wk⫺1 (4. inflammatory. Which of the following is a possible medical approximately . beginning any exercise program. Which of the following assumes that a person will adopt appropriate health behaviors if he or she feels 89. and flexibility gradually moves to heavier weights and fewer reps D) Body composition. A client with scoliosis exhibits which of the following conditions? 88. and cardiorespiratory fitness 80. weights and high reps for the first set and then muscular fitness. Education recommended order of administration. Compression. cardiorespiratory fitness. The information solicited should include which A) Minnesota Multiphasic Personality Inventory of the following? (MMPI) A) Personal medical history B) RPE-Borg scale B) Present medical status C) Physical Activity Readiness Questionnaire C) Medication (PAR-Q) D) All of the above D) Exercise Electrocardiogram (E-ECG) Dwyer_Part2_Sec6. emergency that a client can experience during A) 1–2 lb ⴢ wk⫺1 (0. clients should be more tool used as a quick health screening before extensively screened for potential health risks. muscular fitness. Which of the following activities provides the the consequences are severe and feel personally greatest improvement in aerobic fitness for vulnerable? someone who is beginning an exercise program? A) Learning theories A) Weight training B) Health Belief Model B) Downhill snow skiing C) Transtheoretical Model C) Stretching D) Stages of Motivational Readiness D) Walking 84. cardiorespiratory fitness. Care for Injury A) Flexibility. Ibuprofen. Implementing emergency procedures must include B) Supersets the fitness center’s . Evaluate B) Flexibility. flexibility. Ice. You have examined your patient’s health screen- appropriate action calls for stabilization of the area ing documents and obtained physiologic resting and incorporating the RICE treatment method. Identify the A) Recovery. the ACSM recommends weight loss of 87. and you decide to proceed with a RICE is the acronym for which of the following? single session of fitness assessments. For individuals undertaking nonmedically super- D) Management and staff vised weight loss initiatives to reduce energy intake. In commercial settings. Elevation composition. the 85. cardiorespiratory for each successive set would be an example of fitness. demyelinating disease when muscle tension increases but the length of B) An abnormal curvature of the spine the muscle does not change? C) Softening of the articular cartilage A) Concentric isotonic D) Inflammation of the growth plate at the tibial B) Eccentric isotonic tuberosity C) Isokinetic D) Isometric 83.indd 137 11/27/12 12:46 AM .5–7 kg) C) Hyperglycemia D) All of the above HFS 82. Ice. SECTION 6 HFS Examination 137 79. Following an acute musculoskeletal injury. body composition. Care. and muscular fitness which of the following training style? A) Circuits 86.5–1 kg) an exercise session? B) 5–8 lb ⴢ wk⫺1 (2. Which of the following muscle actions occurs A) A chronic. B) Rest and Ice. A resistance training program that starts with light C) Body composition. measurements.3–4 kg) A) Hypoglycemia C) 8–10 lb ⴢ wk⫺1 (4–4. body C) Rest. Identify the appropriate self-directed evaluation 90. each goal? A) Frequency A) Financial plan B) Intensity B) Strategic plan C) Duration C) Risk management plan D) Intensity and frequency D) Marketing plan 99. When performing multiple fitness assessments in arteries is known as . Which of the following is a FALSE statement HFS regarding an informed consent? 94. identifies the D) Increased diastolic blood pressure (DBP) steps needed to achieve the goals. Dwyer_Part2_Sec6. and higher 97. and 95. improper test administration.org 91.acsm. What is the planning tool that addresses the orga. higher intensity. A) Bicuspid valve D) The consent form does not relieve the facility B) Tricuspid valve or individual of the responsibility to do every- C) Pulmonic valve thing possible to ensure the safety of the D) Aortic valve individual. Generally. During aerobic exercise. and higher B) Raising the center of gravity. A) Shorter duration. lower intensity. you would begin by taking nonexercise A) Atherosclerosis or resting measurements and then test . skeletal muscle? B) The informed consent does not provide legal A) Myosin immunity to a facility or individual in the B) Fascicle event of injury to an individual. priority. and gives the 98. A) Lowering the center of gravity. An exercise program for elderly persons generally time line. which of the following frequency of exercise responses would NOT be considered normal? D) Shorter duration. and lower A) Increased SBP frequency of exercise B) Increased pulse pressure 92.and long-term goals. higher intensity. The loss of elasticity (or “hardening”) of the 93. frequency of exercise C) Decreasing the base of support. C) Increased mean arterial pressure nization’s short. Which of the following will increase stability? from . B) Arteriosclerosis A) Flexibility C) Atheroma B) Cardiorespiratory endurance D) Adventitia C) Muscular strength D) Muscular endurance 100. 138 CERTIFICATION REVIEW • www. Which of the following is a contractile protein in A) The informed consent is not a legal document. and higher D) Moving the center of gravity farther from the frequency of exercise edge of the base of support. B) Longer duration. and allocation of resources to should emphasize increased .indd 138 11/07/12 11:56 PM . D) Muscle fiber inadequate personnel qualifications. Through which valve in the heart does blood flow insufficient safety procedures are all items when moving from the right atrium to the right that are expressly covered by the informed ventricle (RV)? consent. one session. C) Shorter duration. low-fit or sedentary persons may benefit 96. higher intensity. C) Myofibril C) Negligence. comprehensive preventive or rehabilitative 9—B. sterols (e. HFS 8—A. Activities that cise and by 5 kcal ⴢ min⫺1 (conversion of will enhance or maintain musculoskeletal L ⴢ min⫺1 to kcal ⴢ min⫺1) that equals to flexibility should be included as a part of a 280. Antihyperlipidemics through the midsection of the body and Nitrates and nitroglycerine are antianginals dividing it into upper and lower portions. and polyunsaturated fatty acids have a. limited flexibility of the solute). 7—C. and back halves.87 L ⴢ min⫺1.. low back and hamstring regions may relate to c. During dynamic exercise. Triglycerides of effort.5 mL ⴢ An adequate range of motion or joint mobil. b. dividing it lower level of fitness. an increased risk for development of chronic you can multiply that by 30 min of exer- low back pain and disability. and injury may also be reduced when the Dwyer_Part2_Sec6. Aspirin is used in a direct proportion to exercise intensity. sents the pressure in heart during diastole (rest). Approximately 10 mm Hg blood lipids.5 kcal total for the exercise session. kg⫺1 ⴢ min⫺1 (relative) and he weighs 68 kg. The transverse plane repre- Further. SBP will increase density lipoprotein (LDL). All of the above sented by an imaginary vertical plane passing Because adults with arthritis are usually at a through the midline of the body. dividing it into front for muscle soreness. A triglyceride is a glycerol molecule connected to three fatty acid molecules. the SBP must tensives (used to reduce BP by inhibiting the equal or exceed 140 mm Hg or the diastolic action of adrenergic neurotransmitters at the pressure must equal or exceed 90 mm Hg as ␤-receptor. discomfort.g. ity is requisite for optimal musculoskeletal that is equal to a V̇O2 of 1. 1 MET being roughly represent more than 90% of the fat stored in equivalent to the energy expended during rest. thereby decreasing Q̇. A slight decrease in diastolic pressure The fatty acids are identified by the amount During dynamic exercise. The increase in Dietary fats include triglycerides. especially cholesterol and low. and injury. SBP is expected to rise 5–10 mm Hg per MET cholesterol). 140/90 mm Hg angina pectoris). preferably vasodilation). Antihyperlipidemics control 6—A. ␤-Blockers also are designed to days apart. neurotransmitters at the ␤-receptors. Specifically. which helps to facilitate increase in blood 2—C. The 30–60 min ⴢ d⫺1. the body. (used to reduce chest pain associated with 5—D. and the midsagittal plane is repre- 10—D. the risk for muscle soreness. discom- sents an imaginary horizontal plane passing fort.5 kcal Monounsaturated fatty acids have one double The steps are as follows: bond. If he exercises at a volume of oxygen con- 3—B. 280.2) two or more double bonds. Hamstrings sumed per unit time (V̇O2 ) of 27. An elevation of either the systolic or reduce BP by inhibiting the action of adrenergic diastolic pressure is classified as hypertension.indd 139 11/07/12 11:56 PM . Movement occurs along these planes. Triglycerides flow to the exercising muscles. With an absolute V̇O2 of 1. ␤-Blockers are antihyper- To be classified as hypertensive. The frontal plane first will allow for a more graduate adaptation is represented by an imaginary vertical plane to the exercise program and minimize the risk passing through the body. Convert 150 lb to 68 kg (divide by 2. and each mote weight loss through the use of cardiovas- individual plane is perpendicular to the other cular endurance exercise. By definition. Transverse According to ACSM guidelines. At least 50–60 min ⴢ d⫺1 totaling 300 min ⴢ exercise program. DBP may not change of “saturation” or the number of single or much or even decrease slightly because it repre- double bonds that link the carbon atoms. 5 d ⴢ wk⫺1 (150–300 total sagittal plane divides the body into right and minutes per week).87 L ⴢ min⫺1 (ab- health. wk⫺1 (moderate intensity) 4—C. in order to pro- The body has three cardinal planes. one needs to exercise two. and phospholipids. Saturated fatty acids only have single bonds. The increase in SBP is due to the increase in Q̇. left parts. an increase in duration into right and left halves. SECTION 6 HFS Examination 139 HFS EXAMINATION ANSWERS AND EXPLANATIONS 1—C. to control for blood platelet stickiness. thereby promoting peripheral measured on two separate occasions. Signs and symptoms menopause. Heat exhaustion and heat stroke loss and development of clinical osteoporosis Heat exhaustion and heat stroke are serious include being a white or Asian female. 2. and elevated body temperature. The RPE position. clinicians to be an inevitable consequence of 18—D. bone loss is considered by most increases. Q̇ may fall as a result of a drop in Every population that has been studied venous return. whereas rotation of the same bone away m ⭈ min⫺1.0 kg. force ⫻ distance/time. Attempts to rehydrate. 12 and 16 intravenously. Risk factors for age-related bone 11—C. appropriate units — 5 RPM ⫻ 6 m ⫽ 30 m ⭈ min⫺1 (each revolution on a Monark cycle 16—A. can be used as a reliable barometer of exercise intensity. vomiting. so di. dietary calcium intake. Osteoporosis static exercise. During 14—D. headache. at which it occurs vary greatly between males and females. Supination vide the work rate (kg ⭈ m ⭈ min⫺1) by 6. If these conditions are present.0 kg ⫻ 30 m ⭈ min⫺1. Sources of this initial injury bone mass and the accompanying increase in are thought to be caused by dyslipidemia Dwyer_Part2_Sec6. 140 CERTIFICATION REVIEW • www. and inadequate ness. Medial rotation ergometer ⫽ 6 m). Write Rotation is the turning of a bone around its HFS down the formula for work rate: Work rate ⫽ own longitudinal axis or around another bone. that the with increasing exercise intensity. It should be noted. and avoided during periods of acute flares and The age at which bone loss begins and the rate inflammation. exercise must be stopped. perhaps 15—B. Above this point. The RPE is particularly useful when 12—A.acsm. however. Q̇ does not change significantly. increases in Q̇ are ac- when the person was untrained. Q̇ increases same Q̇. producing bone porosity and fragility. (the innermost of the three layers in the wall) and it refers to the clinical condition of low of the blood vessel. Pronation (the opposite of ⫽ 600 kg ⭈ m ⭈ min⫺1/6 supination) is the rotation of the forearm that ⫽ 10 results in the palm of the hand being directed 13—C. primarily 17—A. alcohol abuse and/or cigarette include uncoordinated gait. All of the above aging. should be attempted. having a low peak bone the metabolic heat generated from exercise mass at maturity. and the Although some learning is required on the body must be cooled by any means possible. subject’s work rate. No change backward (posteriorly). When the contraction is released. responds with the volume. the RPE should be con- The person should be placed in the supine sidered an adjunct to HR measures. Substitute the known Rotation of the anterior surface of the bone values for the variable name: Work rate ⫽ toward the midline of the body is medial rota- 2. the tunica intima density.indd 140 11/07/12 11:56 PM . part of the participant. Work rate ⫽ 60 kg ⭈ tion. counted for only by an increase in HR. thus. The steps to answering The ACSM recommends an exercise intensity this question are as follows: Write down the that will elicit an RPE within a range of 12–16 known values and convert those values to the on the original Borg scale of 6–20. 10 W participants are incapable of monitoring their This question does not require the use of a pulse accurately or when medications such as metabolic formula because it is asking for the ␤-blockers alter the HR response to exercise. having a family history of accompanied by dehydration and electro- osteoporosis. The question asks for watts. exhibits a decline in bone mass with aging. a rapid increase in Q̇ occurs as the venous return Therefore. Stroke volume same Q̇ is now being generated with a lower increases only until approximately 40%–50% of HR and higher stroke volume compared with V̇O2max. Osteoporosis refers to a condition that is Initial causes of CAD are thought to be an characterized by a decrease in bone mass and irritation of.0 kp ⫽ 2.org exercise is done at the same time of the day susceptibility to fracture from minor trauma. from the midline is lateral rotation. sedentary lifestyle. dizzi- smoking. is a specialized rotation of the forearm that results in the palm of the hand being turned W ⫽ kg ⭈ m ⭈ min⫺1/6 forward (anteriorly). HR and stroke volume because the person is performing the same Q̇ is calculated by multiplying HR and stroke amount of work and. or an injury to. being conditions that result from a combination of thin-boned or petite. with the feet elevated. premature or surgically induced lyte loss from sweating. During dynamic exercise. than approximately 10% per week increases the 20—C. cigarette smoking. hypercholester. Other increases. respectively. Within the field of behavioral farction or sudden death (male first-degree change. Strength training in youth car- flexion with rotation is supine curl-ups with ries no greater risk of injury than comparable flexion followed by rotation. higher self-efficacy tory of heart disease and no direct effect on (older persons taking part in exercise programs cigarette smoking. vasoconstrictor substances for effective use of strategies and techniques (chemicals that cause the smooth muscle cells of effective counseling and motivational in the walls of the vessel to contract. Application of cognitive-behavioral or motiva- responses. women. SECTION 6 HFS Examination 141 (elevated total blood cholesterol). Children who have exercise- Older people who exercise regularly report induced asthma often are physically unfit greater life satisfaction (older people who because of restriction of activity imposed by the exercise regularly have a more positive attitude child. toward their work and generally are in better health than sedentary persons). training as a result of an increase in contractil- als older than 30 yr or in individuals who have ity or in the size of the heart. hypertension psychological stress without unwanted (chronic high BP. Maximal stroke volume increases after 0. resulting skill-building for exercise adoption and in a reduction in the diameter of the lumen). of outcomes. between the activity level of older adults and Exercise has no effect on age and family his- self-reported happiness). immune 22—B. diabetes mellitus in individu. but it has limited influence on (older adults improve their score on self. framework for development. Hypertension ness (strong correlations have been reported Regular exercise will decrease SBP and DBP. of programs or interventions. ⬎45 yr. HRmax does not change significantly with olemia (total cholesterol ⬎200 mg ⴢ dL⫺1 or exercise training. Increasing the rate of training intensity more HFS CAD but are not primary risk factors. An alternative to the in the long term. Theories provide a conceptual and viral infections. Because HRmax had Type 1 diabetes more than 15 yr or Type 2 is unchanged and maximal stroke volume diabetes in individuals older than 35 yr. smoking. loss and improve glucose tolerance for those logical stress (exercise is effective in reducing with Type 2 diabetes. Dwyer_Part2_Sec6. Flexion with rotation is increase physical fitness in the short term and considered a contraindicated high-risk exercise lead to adoption of a physically active lifestyle and is not recommended. greater happi. either an elevation of SBP or side effects). Regular endurance exercise does cising). 25—D.9 mmol ⴢ L⫺1). hyperten. Exercise has no direct effect concept questionnaires following participation on Type 1 diabetes. or physicians. tumultuous and nonlami- tional principles nar blood flow in the lumen of the coronary Psychological theories are the foundations artery (turbulence). or HDL ⬍35 mg ⴢ dL⫺1 or age.indd 141 11/07/12 11:56 PM . and supervi- 21—C. and reduced psycho. not just measurement ⬎55 yr). strength training programs in adults if proper instruction. accounts for the relationships between certain tives ⬍65 yr). a family history of myocardial in.2 mmol ⴢ L⫺1. ⬍60 mg ⴢ dL⫺1 management. improved self-concept and self-esteem increase HDL. risk factors contribute to the development of 24—C. Squats to 90 degrees more than approximately 10% per week is a and lateral neck stretches are considered safe risk factor for overuse injuries of bone. total cholesterol. program effectiveness. although it declines with 5. Double knee to chest likelihood of overuse injuries of bone. Exercise alternative exercises to full squats and full programs for children and adolescents should neck rolls. although some individuals commonly report that they can do everyday may choose to quit smoking after beginning tasks more easily than before they began exer. to exercise. Maximal heart rate (HRmax) on two separate occasions). rather than 19—C. a theory is a set of assumptions that relatives ⬍55 yr and female first-degree rela. sion (arterial BP ⬎140/90 mm Hg measured 23—C. maintenance. Stimulate appetite sion are provided. parents. DBP measured on two different days). maximal Q̇ must increase. Risk factors that contribute to the development Psychological theories facilitate evaluation of of CAD include age (men. variables and the behavior of interest. Double knee-to-chest stretches are a safe Increasing the rate of progression of training alternative to the plough. but it can promote weight in an exercise program). exercise prescription. Crunches per exercise and increased only when the child strengthen the abdominals and hip flexors.4–8. and finally. deltoids. Vigorous. bathing. and enjoyable to enhance able to lift a medium weight. Intensity and duration strength or power so a higher number of Intensity and duration of exercise must be reps is performed. rhomboids. 37—C. water exer. hard ⫽ as decreased flexibility and balance prob- 6. Back extensions consequences.6–6. Muscular endurance is more important in this population than 27—A. but not the lats.indd 142 11/07/12 11:56 PM .org 26—A. 142 CERTIFICATION REVIEW • www. inflammation or more minutes of physical activity daily. It is ideal to have elderly individu. ing). Similar improvements in aerobic fitness may be 32—B. Moderate A person with a 10-MET maximal capacity 30—C.3 MET. elderly population. CPR and ACSM HFS 31—C. Children (inflammation) is taking place. and periods during the day that are sedentary biceps. Push-ups be performed with children because it may pro- Push-ups work both the chest and triceps. lems. light ⫽ older individuals due to joint issues as well 2. moderate ⫽ 4. exercise should be emphasized. highly repetitive exercise should be realized if a person exercises at a low intensity encouraged in order to strengthen connective for a longer duration or at a higher intensity tissues at the joint. 6–8 reps At minimum. and stationary cycling are all preferred Walking is the only one of these four that is modes for the elderly due to their low impact considered an ADL. Maximal (1-RM) resistance training should not 35—D. for less time.5 MET. transferring (walk- als exercise socially in a place that is acces. The prefix should not focus on just one or two modes. expect that preferred for children over continuous people who regularly medicate with NSAIDs exercise because this is the type of activity may develop anemia because of continuous they naturally self-select. dressing. convenient. and ease. Warm water exercise should be of physical activity lasting 15 min or more encouraged because it can promote physical each day. “Arth” means joint indicating where the “itis” it should not be continuous. Plyometrics as part of a health club class fitness level would have the following classifica- Plyometrics does not work well for most tions of intensity: very light ⬍2. instead focus on participation and proper technique. “arth” is not to be confused with the prefix Exposing them to a wide variety of physical “athero. primarily strengthen the lower back. and adherence. If a child cannot perform a minimum of 8 reps and hamstrings. Although children should attempt to accumulate 60 33—C. Transferring (walking) cise. mote injury as well as it may discourage young Chin-ups strengthen the lats. resistance. considered together and are inversely related. Finally.” which is Greek for gruel or paste. activity with less pain. Chin-ups Finally.8–4. Children should perform 8–15 reps biceps.6 MET. not the chest or triceps. toileting. Repetitive motion should be avoided because it could cause increased inflammation at the 28—A. 34—A. rhomboids. read. and trapezius should be reduced. Dead lifts do strengthen the lats but because this may promote negative health do not strengthen the biceps. children should not have prolonged HFS Chin-ups strengthen the lats. activities is suggested to enhance adherence.8 MET. Do not focus on the amount of the chest. Children should participate in several bouts affected joints. 29—D. an upright row does with good form. the resistance is too heavy and strengthen the biceps. Mornings should be Activity that is intermittent in nature is avoided due to stiffness. Walking. the glutes. Dwyer_Part2_Sec6. can perform the desired number of reps with whereas pec deck flyes primarily strengthen good form. write. and children.acsm. There would be a high risk of acute musculoskeletal injury. 36—B. it is not necessary for ADL. and very hard ⫽ ⱖ 8. and continence. professionals performing fitness Research supports that one set is all that is assessments on others should possess CPR and necessary to adequately strengthen in the ACSM HFS certification. speak. The six ADL are eating. Joint.7 MET. Although it is great to be sible. Active play versus blood loss via abdominal bleeding. Q̇ normally increases as 41—D. NutraSweet is not a real a systematic method of improving. and progression. vascular system. weight. specificity. in turn.70 ⫻ 196 ⫽ 137 bpm.55 and 0. specificity is being careful to choose seriously damage the individual or cause death. PNF is a stretching technique that combines The runner could become overtrained if the use of isometric contractions with passive he or she just built up to a longer distance static stretching. that the individual develops hypoglycemia. exercises that closely relate to the outcome Nitroglycerin is only given in the event of goal. Sugar 43—D. which gave too high of a value. PNF HFS or so. if exercise in terms of our HRmax. Then venous return. If increased too rapidly. sugar so it will do no good.e. which decreases Q̇. Additionally. and may multiply both 0. 3–6 mo. we estimate that we lose one beat initiate exercise programs and. Walking is a good exercise for incorrect because it subtracted her age from most pregnant women with no other special 200 instead of 220. Weight bearing workload increases.. progression You’d want to have sugar available in the case The three training principles are overload. 3–6 mo is the estimated maximum HR. whether it is high or low is to increasing workload. Failure of the SBP to increase as workload rosis. Sitting exercises such as riding a because it used 200 with no age adjustment. is more time consuming that same distance weekly will not allow the runner the other stretching techniques (static and to reach the race distance. important to keep bone mineral density high in SBP should increase with an increase in work- order to decrease risk of developing osteopo. Thus. they are likely to stop within nothing to do with SBP. Periodization must be done gradu- SBP is an indicator of Q̇ (the amount of blood ally. Intensity. Redundancy does The sugar will allow individuals with diabetes not have anything to do with it. exercise indicates an unhealthy vascular system. 220 with no age adjustment. therefore. indicates an abnormal response water. even if done gradually. 220-age). an not relevant in this case. What matters is if the abnormally elevated SBP response to aerobic exercise involves supporting the weight. items to consider with exercise programming. Increase mileage. Giving an extra dose of insulin could is used to. It has is initiated. participants in earlier stages benefit most from cognitive strategies. Doing the and. the runner may pumped out of the heart in 1 min) in a healthy become injured or overtrained. load. betic emergency unless it is absolutely 100% they are not considered training principles. specificity. Overload. Answer letter C is incorrect conditions. (i. Estimated maximal HR The number that you subtract from originally 47—D. Gradually increase in distance weekly with a slight lower distance Sunday every fourth week 45—C. and progression has to do with developing angina (chest pain). Dwyer_Part2_Sec6. Water exercise is not considered weight increases indicates that Q̇ is not increasing. which is position could cause mild obstruction of her estimated HRmax at her current age. known that he or she forgot to take his or her Overload is pushing the body beyond what it insulin. In general.55 ⫻ 196 ⫽ 108 bpm and the prone position may be uncomfortable if not 0. therefore never dynamic). or gender.70 to 196 bpm to cause BP to drop dangerously low. Exercise in get your answers: 0. Insulin should quency. With each year Most sedentary people are not motivated to of life (age). allowing them to prepare for the actual race 46—A. and duration are important never be given to a client who is having a dia. 108–137 bpm 39—B. SECTION 6 HFS Examination 143 38—A.indd 143 11/07/12 11:56 PM . 42—A. Supine position exercises You begin by subtracting her age of 24 yr Exercises in the supine (lying on your back) from 200. 44—B. 40—B. intensity. Answer letter A is contraindicated. bearing because of the buoyancy effect of the which. This stretching technique each week without a down week built in involves the use of a partner and a few cycles periodically. Although fre- to feel back to normal soon. So 220 ⫺ 24 ⫽ 196 bpm. because the peripheral Regularly participating in weight-bearing and central stimuli that control Q̇ normally exercises such as walking or running is increase with an increase in workload. bicycle are fine to do provided that the comfort and answer letter D is incorrect because it used level is adequate. the for speeds in excess of 5 mph): straddle stretch would work effectively too V̇O2 (mL ⴢ kg⫺1 ⴢ min⫺1) ⫽ Horizontal ⫹ provided there is no bouncing and no pushing Vertical ⫹ Resting past the point of tension into pain. they recommend ⫹ 3. Diaphragmatic is a type of deep-breathing Fitness testing is conducted in older adults exercise used to manage stress.18 mL ⴢ kg⫺1 ⴢ min⫺1 ease in adulthood. flexible. or explosive power activity but instead warming 50—B. Angina means for the same reasons as in younger adults.2 m ⭈ min⫺1 54—C. which if support to help them establish a regular exer.5 ⴢ V̇O2 (mL ⴢ kg⫺1 ⴢ min⫺1) 60 min. All of the above mula. which is unrelated. the poststretch following performing a behavior.2) loss.5 mL ⴢ kg⫺1 ⴢ min⫺1 55—D. however.acsm.8 ⫽ 174. Forward wall push stretch The standing wall push stretch would stretch 49—C. the prestretch is tive consequence for performing or not not crucial. 144 CERTIFICATION REVIEW • www. it gets high enough could cause an aneurysm cise habit and be able to maintain it. Dehydration is often an issue ers of a standing leg curl.2 MET primarily the calf region.2 ⫻ 0.18 mL ⴢ kg⫺1 ⴢ min⫺1 to MET: in at least 30 min daily. It would however be crucial to rewards. Instead. Positive consequences the cool-down is the best time to gain flex- are rewards that motivate behavior. 60–90 c. It takes both. and to reduce the risk of chronic dis- ⫽ 46.18 ⫼ 3. not at high altitudes. etc. and after training. such have hypertension. Intrinsic reward up for a steady activity like cycling. whereas individuals in later stages especially to an individual that may already depend more on behavioral techniques. There b. 13. 6. an antagonist muscle group and the glutes are during.5 hamstrings. Reinforcement is the positive or nega- running. however. In terms of endurance competition. Intrinsic rewards are the benefits prestretch following a warm-up for explosive gained because of the rewarding nature of activities.5 ⫻ 26.9) ⫹ 3. walking. Write out the running equation (accurate probably be the safest stretch. to rupture causing a stroke. swimming.2) legged standing toe touch would stretch the ⫹ (Speed ⫻ Grade ⫻ 0. Higher which may include encouragement and praise HR at high altitude will be higher than at sea or material reinforcements such as T-shirts level for the same perceived exertion because and money. it is very important not to bounce in order to avoid muscle strains. including exercise prescription. After the cool-down 46. the activity. This ibility as the muscles are very warm. Modified hurdler The steps are as follows: (with knee angled in instead of out) would a.5 mph) to meters per are certainly more effective. Solve for the unknown: They recommend 60–90 min moderate- HFS intensity activity daily to sustain the weight V̇O2 (mL ⴢ kg⫺1 ⴢ min⫺1) ⫽ (174. which are also generally dryer just one or the other. can include both intrinsic and extrinsic and pliable. Convert 46. safer hamstring minute: stretches than this last one. 1 MET ⫽ 3.9) weight gain in adulthood. Karvonen is the researcher who developed the THR zone for- 48—D. and education. as reminders to exercise and developing social intrathoracic pressure is increased. The quadriceps would be so make sure to adequately hydrate before. Dwyer_Part2_Sec6. chest pain. The cross- V̇O2 (mL ⴢ kg⫺1 ⴢ min⫺1) ⫽ (Speed ⫻ 0.indd 144 11/07/12 11:56 PM . To help manage body weight and prevent ⫹ (174. 53—B. they recommend engaging d. in exercise. Valsalva without the expectation of actually engaging The Valsalva maneuver is quite dangerous. evaluation of progress. Extrinsic or external rewards are the positive outcomes received from others. With a closed glottis.05 ⫻ 0.2 ⫻ 0.. not involved in this motion. 56—B. of the decreased supply of oxygen available. dynamic.5 ⫽ 13. Hamstrings and calves wise to properly acclimate to the race altitude The hamstrings and calves are the prime mov- prior to the race.2 MET If not warming up for a ballistic. it would be 51—B. motivation.org such as listening to lectures and reading books 52—C. Convert speed (6. and emergency equipment. quality of design and materials. lungs. the ACSM recommends an intensity of 60%–90% 63—A. ments and informed consents drafted by a The ability to take in and to use oxygen lawyer for their protection. repair records. Maximal oxygen uptake may of strength with aging results primarily from a improve between 5% and 30% with training. the risks involved.g. and consents are docu- pool. The equipment to be used not 61—A. also purchases equipment and supplies. locker room. ability to adjust to differ- by the client. procedures. There is a perceived threat of disease. he or she is accepting some of ent body sizes.indd 145 11/07/12 11:56 PM . By 80 yr of age. Most well- Belief Model. loss of muscle mass. All fitness facilities are strongly 58—A. strength. The consent form does not relieve the The characteristics of a good manager or direc- facility or individual of the responsibility to do tor include designing programs and monitoring everything possible to ensure the safety of the Dwyer_Part2_Sec6. The begins to decline. the loss of strength degree of improvement that may be expected is not linear. This model also training that involves an eccentric loading incorporates cues to action as critical to adopt- of muscles and tendons followed immedi- ing and maintaining behavior. this program. Motivation and environmental enhanced generation of force during the considerations are not a part of the Health concentric (shortening) phase. strength loss the frequency. Plyometrics a belief of susceptibility to disease. The concept ately by an explosive concentric contraction. and risks associated with the test or exercise 60—C. which. He or she is a good communicator who is a primary responsibility of any fitness facility. and circulatory systems. the managers and facility and surveys clients and staff to assess staff are obligated to meet a standard of care for the success and value of the program. for an apparently healthy person. exercise) when there exist a perceived threat of disease and 59—A. and frequency of 3–5 d a week. If signed anatomic positioning. manager monitors the safety of the program or ment for use by exercisers. is caused The exercise prescription can be altered for dif- by both the loss of muscle fibers and the atro- ferent populations to achieve the same results. SECTION 6 HFS Examination 145 57—A. depends on the health and integrity of the 62—C. in turn. releases. He or she body sizes. 64—C. It activity may increase the risk for musculoskele. duration. cardiovascular. However. and frequency The Health Belief Model assumes that people of 3–5 d a week. It simply provides evidence that the client priate for select athletic or performance needs. ent. Manager or director program.. A loss of muscle mass caused by a loss of heart. To inform the client of participation risks. and flexibility pieces but also rehabilitation. Agreements. intensity. duration of encouraged to have program or service agree- 20–60 min. also guides the staff or clients through the pro- Creating a safe environment in which to exercise gram. and then price. well as the rights of the client and the facility. Efficiency muscle fibers of the aerobic metabolic pathways also is neces- After 30 yr of age. and the Plyometrics is a method of strength and power threat of disease is severe. The loss HFS type of exercise. and mode or usually is in the range of 30%–40%. and the ing equipment. HRmax. exerciser safety. However. with most of the decline occurring in cardiorespiratory fitness relates directly to after 50 yr of age. A good In developing and operating facilities and equip. These criteria include correct rights of the client and the facility. controlled studies have shown no significant difference in power improvement when com. duration of 20–60 min. Intensity of 60%–90% HRmax. of self-efficacy (confidence) is also added to This stretch-shortening cycle may allow an this model. will engage in a behavior (e. was made aware of the purposes. Plyometrics should not be considered or individual in the event of injury to a client a practical resistance exercise alternative for nor does it legally protect the rights of the cli- health/fitness applications but may be appro. does not provide legal immunity to a facility tal injury. skeletal muscle strength sary to optimize cardiorespiratory fitness. The explosive nature of this type of Informed consent is not a legal document. phy of the remaining fibers. as only includes testing. training. Flexibility of equipment to allow for different the implementation of programs. Provides an explanation of the test to the paring plyometrics with high-intensity strength client. ments that clearly describe what the client is You must evaluate several criteria when select- participating in. the responsibility and risk by participating in durability. A client exercises too much force. and ability. cardio- the body is lowered to the floor. and individual preference for exercise HFS 90 degrees. An overuse injury By definition. Factors to con- insufficient safety procedures all are items that sider when determining appropriate exercise are not expressly covered by informed con. The risk of orthopedic and. for men and the hands and knees for women. or inten. 60% and 90% 72—C. Because of the limitations associated with overall health status.. Negligence. an actual HRmax from tion. endurance include the bench press. 8–12 reps of each exercise should be performed 65—C. the individual’s level of fitness. 8–10. Factors to consider the total number of properly performed push- when determining exercise intensity include ups completed without a pause by the client. The risk of orthopedic and cardiovascular held rigid and supported by the hands and toes complications is increased. progressive overload is a principle Overuse injuries become more common when of training that states that the stress on the people participate in more cardiovascular musculoskeletal system needs to progressively exercise by increasing time. and/or the number of exercise session that exercise allowing the injury to heal. in time with cular endurance and reduces the risk of muscu- the metronome at a rate of 25 per minute done loskeletal related injuries. Number of curl-ups in 1 min to volitional fatigue for healthy individuals. that. for upper 3–5. The rest of a range of 64%–70% and 94% of HRmax or the exercises are considered a single joint between 40%–50% and 85% of oxygen uptake movement. the length of the rest periods low fitness levels. sent. and a graded exercise test be used. legal counsel 68—B. for 1 min. 8–12 should be sought during the development of The ACSM recommends that one set of the document. the push-up. The ACSM recommends exercise because the movement occurs around that exercise intensity be prescribed within the hip.indd 146 11/07/12 11:56 PM . the ⬃3 s eccentric) based on age. 8–12 apart. estimating HRmax from age. it is recommended During resistance training. overload.acsm. perhaps. increase in order to keep producing greater sity too quickly. medications that may influence exercise per- for abdominal muscular endurance (the client formance. 2–3 min rest Dwyer_Part2_Sec6. 66—A. OR set a metronome to 50 bpm and the Eight to twelve (8–12) reps represent a rela- client performs slow. down with middle fingers touching masking tape. Lower intensities will elicit 73—C. palms facing and individual program objectives. per week. medications. knee. informed consent documents. and individual goals. risk of cardiovascular or orthopedic begins in the bent-knee sit-up with knees at injury. presence of with no time limit). reserve (V̇O2maxR). the score is high-intensity activity. fitness level.org client. 67—C. inadequate personnel qualifications. Three common assessments for muscular Choose a range of reps between 3 and 20 (i. The ACSM recom- in time with the cadence). Leg press Several methods are available to define exercise The leg press is considered a multijoint intensity objectively. the number of rep a minor injury and does not reduce or change or sets. 2–3 min a favorable response in individuals with very Generally. and ankle joints. whenever possible. total number of lifts performed correctly and assessment. A second piece of tape is placed 10 cm 70—C. Because of the variability in depends on the type of exercise performed. with a metronome or other timing device. This lift the shoulder blades off the mat with the low intensity allows the development of mus- trunk making a 30-degree angle. for mends exercising each muscle group two to upper body endurance (the client assumes a three nonconsecutive days per week. OR the client performs as many 71—D. standardized beginning position with the body 69—B. the arms at the side. then pushed vascular complications can be increased with back up to the starting position. improper test administra. fitness level. duration. and the curl-up (crunch). intensity include age.e. 10–15) that can be performed at a body endurance (a weight is lifted in cadence moderate-repetition duration (⬃3 s concentric. This could be achieved by increasing without time for rest and recovery or develops the intensity (resistance). 146 CERTIFICATION REVIEW • www. All of the above are examples of progressive curl-ups as possible in 1 min). controlled curl-ups to tively low intensity of 67%–80% of 1-RM. exercise. Elevation helps to decrease the blood flow and For example. The goal of the exercise component of a weight 78—A. reps. ensure that the healing process will begin. bleeding. progression toward fitness goals). during moderate (or submaximal) achieved by the use of elastic wraps or tape. and prevent Some are situational in nature such as social further injury. Developing the exercise prescription. Split routines entail exercising Key components of the Transtheoretical Model different body parts on different days or during are the processes of behavioral change. of exercise-related injuries. Compression. and pain. all in an effort to over- probably because of a combination of decreased load the muscle. attainable goals). reduce swelling. within a set of reps or from one set to the ronmental reevaluation. inflam- The effects of regular (chronic) exercise can mation. All of the above. decrease pain. 1–2 lb ⴢ wk⫺1 (0. Compression is at rest.000 cal ⴢ d⫺1. reduction program should be to maximize The purpose of the fitness assessment is to caloric expenditure. Frequency. Pyramids are performed processes include five cognitive processes either in ascending (increasing the resistance (consciousness raising. self-liberation.indd 147 11/07/12 11:56 PM . Compression also helps to be classified or grouped into those that occur reduce swelling and bleeding. Supersets tility. intensity. one in an exercise program. individual’s resting heart rate (HRrest). refer to consecutive sets for antagonistic mus- because the decline in HR is compensated for cle groups with no rest between sets or mul- by the increase in stroke volume. and develop a proper exercise prescription (the duration must be manipulated in conjunction data collected through appropriate fitness with a dietary regimen in an attempt to create assessments assist the health fitness special. Rest. The baseline weight training fitness level of a Progress toward or attainment of a goal is a novice trainee is quite minimal. and to moti- vate (fitness assessments provide information 74—A. These objectives can be met in support and time commitment. fashion. you can measure an untrained excessive pressure to the injured area. Compression. Pyramids person for several weeks or months. and strong motivator for continued participation in the beginning of the training program. In order for a RICE stands for Rest. and 81—A. and during maximal effort work. are personal (individualized). and next) or descending (decreasing the resistance social liberation) and five behavioral processes within a set of reps or from one set to the next) (counterconditioning. Self-reevaluation little or no rest. These different sessions. Basic principles of care for musculoskeletal injuries include the objectives for care 75—E. effective programs of recommended maximal rate for weight loss exercise based on the individual client’s current is 1–2 lb ⴢ wk⫺1. whereas others most cases by following “RICE” guidelines. SECTION 6 HFS Examination 147 interval between sets allows the exercising fitness status). Circuit weight training uses sympathetic tone. dramatic relief.5–1. Little or no change occurs in Q̇ at rest. helping relationships. occurred. Stroke volume increases at rest health benefits as well as modest improvements as a result of increased time for ventricular in aerobic capacity have been demonstrated filling and an increased myocardial contrac- as a result of circuit weight training. Various sinoatrial node. Therefore. All of the above. Ice. to evaluate the rate of progress muscles sufficient to recover. and then Various systems of resistance training exist HFS measure HRrest again to see what change has that differ in their combinations of sets. and resistance applied. increased parasympathetic a series of exercises performed in succession tone. The ist in developing safe. 1 needed to develop reasonable. HRrest declines with regular exercise. self-reevaluation. which may allow (baseline and follow-up testing indicate optimal performance during subsequent sets. and trainee to “stick” to an exercise routine. tiple exercises for a specific muscle group with 77—C. envi. which are to Different factors affect exercise adherence. Ice 76—D. Elevation muscular fitness. a caloric deficit of 500–1. is used to reduce swelling.0 kg) stimulus control). reinforcement management. train the 80—D. Dwyer_Part2_Sec6. set per exercise should be sufficient enough to stress the musculoskeletal system and improve 79—C. many Elevation. Rest will prevent further injury and of these factors must be met. and decreased intrinsic firing rate of the with minimal rest between exercises. Ice. and flexibility ming. simple or tions to increase physical activity. Inflammation of the growth plate are included in the implementation of an at the tibial tuberosity is a condition known emergency plan. Isometric small simple behaviors. running. Walking. all exercise staff should be CPR certi- elinating disease describes multiple sclerosis. Learning theories assume that an cardiac symptoms. ing. counter). affect potential health risks. cardiorespira.org 82—B. hyperglycemia. body composition. overall complex behavior arises from many 88—D. 86—D. facilitates the greatest improvements in aero- 85—C. occurs when muscle tension ronment. bronchospasm. and flexibility. All of the above cular fitness and flexibility affect HR. In-services. and cross-country skiing are examples of these the following order of testing is recommended: types of activities. Body composition.indd 148 11/07/12 11:56 PM . All of the above 83—B. Weight training should resting measurements (e. to improve muscular strength and muscular ment are sensitive to hydration status and some endurance. In addition. By reinforcing partial Isometric muscle action. respiratory fitness testing. 87—D. To get the best and most accurate information. so it is inappropriate to that is. Assessing cardiorespiratory fitness and enjoyment of the individual. bic fitness. movement. hypoten- originated in the 1950s based on work by sion or shock.. HR. At minimum. The MMPI is a psycho. therefore. In commercial settings. as Osgood-Schlatter disease. muscular fitness. with attention to the desired administer those before the body composition outcomes — and to maintain the participation assessment. BP. A chronic. bleeding. addition. cycling. so they Different types of health screenings are used are inappropriate to administer before cardio- for various purposes. blood not be considered an appropriate activity analysis). inflammatory.acsm. aerobic dance. Some tests of mus- 90—D. 148 CERTIFICATION REVIEW • www. demy. in turn. safety plans. fied and knowledgeable of first aid. Measures of static strength are specific logical scale. Kyphosis is a posterior tho. Management and staff present medical status should be examined When an emergency or injury occurs. a personal the cardiorespiratory fitness testing results. faint- work to help explain and predict interven. An abnormal curvature of the spine Implementing emergency procedures is an Scoliosis is a lateral deviation in the alignment important part of the training of the staff. Health Belief Model Possible medical emergencies during exercise The Health Belief Model is a theoretical frame. Therefore. Softening of the articular cartilage describes the fitness center management and staff all chondrosis. The RPE-Borg scale is used to to both the muscle group and joint angle being measure or to rate perceived exertion during tested. and other Rosenstock. because the elevated clients should be screened more extensively for HR from those assessments may. for enhancing aerobic fitness but should be tory fitness. include heat exhaustion or heat stroke. Lordosis is an anterior lumbar dures should be a part of the staff training. part of in a comprehensive exercise program Some methods of body composition assess.g. swim- muscular fitness. seizures. medical history should be taken. of the vertebrae. also known as static behaviors and modifying cues in the envi- muscle action. the length of the muscle does not 84—C. The model compound fractures. would involve continuous electrical heart 89—D. Dwyer_Part2_Sec6. hypoglycemia. stair climbing. Walking monitoring during exercise stress test used in Large muscle group activity performed in a clinical setting when deemed appropriate by rhythmic fashion over prolonged periods a physician. In curvature. cardiorespiratory fitness. The E-ECG eralize overall muscular strength is limited. object. safe and questions asked regarding the use of and effective management of the situation medications (both prescription and over-the- will assure the best care for the individual. these tests’ usefulness to gen- HFS exercise or during an exercise test. and emergency proce- racic curvature. PAR-Q change. it is possible to shape the desired increases with no overt muscular or limb behavior. rowing. These actions occur when with an The PAR-Q is a screening tool for self-directed attempt to push or pull against an immovable exercise programming. often uses measures of HR. The mode(s) of activity should be tests of cardiorespiratory and muscular fitness selected based on the principle of specificity — may affect hydration. During activation of the muscle. because they contain myofilaments. Tricuspid valve consent. and left ventricle (LV). then out through the pulmo- to do everything possible to ensure the safety nary semilunar valve to the pulmonary arteries. which are the contractile proteins. and sympathetic nervous system. followed by tests that stress the other energy systems. Negligence. of an individual. with exercise-induced stimulation of the financial plans. or both. The adventitia. Stability would also be increased intensity. Health and fitness programs. flexibility. goals. also called hardening of the 94—A. the outermost which are responsible for the contraction of the layer of the artery wall. lower intensity. provides the media muscle fiber. Individual temic circulation.indd 149 11/07/12 11:56 PM . Strategic plan by moving the center of gravity closer to the The strategic plan addresses strategic decisions center of the base of support. having only a person exercises is interrelated with both the two cusps. Increased frequency of exercise is generally one needs to consider the energy systems recommended for older adults to optimize that being involved during the exercise and cardiovascular as well as balance and flexibil- time for complete recovery. The The number of times per day or per week that bicuspid valve is a similar valve. the ascending aorta and then out to the sys- intensity exercise sessions per day. actin and myosin. SECTION 6 HFS Examination 149 91—C. it does not provide legal im- heart through the superior and inferior venae munity to a facility or individual in the event cavae into the right atrium. or flaps. Shorter duration. 93—A. Within accumulation of obstructive lesions within the muscle cells are cylinders called myofibrils. sin pulls the actin. Atherosclerosis is a cle fibers called muscle fascicles. during exercise. and strand. 99—B. Dwyer_Part2_Sec6. creased. by increasing the size of the base of support. Negligence. bridging between the two filaments. Actin is a thin filament that is twisted into a inadequate personnel qualifications. improper test administration. risk management efforts. of the organization in defining short. and in- and causes tension development. and stability. causing cross consent. Nonfatiguing tests ity adaptations. the blood passes through the tricuspid the facility or individual of the responsibility valve to the RV. is a loss of arterial elasticity and is The skeletal muscle consists of bundles of mus- associated with aging. the arterial wall. and higher The tricuspid valve is so named because of the frequency of exercise three cusps. Increased DBP long-term goals and serves as the overarching Because of the vasodilation associated planning tool. sufficient safety procedures are all items that are expressly NOT covered by the informed 95—B. which shortens the muscle inadequate personnel qualifications. 100—C. Flexibility 98—A. Myosin is a thick filament that has a tail insufficient safety procedures are all items and a head. that are expressly covered by the informed actin and myosin interact. 92—B. low. it is found between the left atrium intensity and the duration of activity. The myo. diastolic pres- marketing plans only address subsegments sure remains unchanged. Myosin arteries. Generally. Frequency When choosing the correct sequence of testing. and then to the lungs to be oxygenated. The myofibrils have this ability and intima with oxygen and other nutrients. and time con- 96—A. etc. Lowering the center of gravity straints also will determine frequency and the Lowering the center of gravity will increase relationship between duration. Arteriosclerosis Arteriosclerosis. Blood leaving the LV sedentary persons or those with poor fitness will pass through the aortic semilunar valve to may benefit from multiple short-duration. form of arteriosclerosis characterized by an Each fasciculus contains muscle cells. of which it is made. preferences.) should be HFS of exercise depends on the intensity of the performed first followed by tests that stress activity. weight. or fasciculi. The informed consent is also not a Blood from the peripheral anatomy flows to the legal document. frequency. higher-intensity activity should be the phosphagen system (shorter recovery) conducted over a shorter period of time. improper test administration. or even slightly de- within the overall strategic plan. From the right of injury to a person and it does not relieve atrium. The recommended duration (height.and 97—D. limitations. 81. 73. 59. 15. 98.indd 150 11/07/12 11:56 PM . 150 CERTIFICATION REVIEW • www. 67. 77. 35. 30. 48. 14. 92 27. 86. 79. 50. 12. 53. 38. 78. 94. 85. 46. 10. 91 HFS Dwyer_Part2_Sec6. 42. 6. 89. 83. 57. 61. 29. 88. 45. 71. 75. 7. 39. 26. 72. 4. 97. 9. 58. skills. 62. 82. 2. 95. 60. 36. 84. 47. 37. 63. 64. Domain Number I II III IV V Domain Name Health and Exercise Exercise Legal/ Management Fitness Prescription. 33. 13. 66. 76. 24. 56. 18. 44. 69. 52. 21. 90. 55.acsm. 65. 87. 11. 99 74. 49. 93 20. It is important to note that some questions can be classified as testing multiple domains by the knowledge. 96. 5. 3. 51. 31. 25. 40. 43. 8. 68. 100 22. 54. 28. Counseling Professional Assessment Implementation and Behavioral (and Ongoing Strategies Support) Percentage of 30% 30% 15% 10% 15% Questions from Domain Question 1. 34. 80. 32.org HFS EXAMINATION QUESTIONS BY DOMAIN Use the following table as a guide to assist you in your studying process. and abilities (KSAs). 41. Numbers 19. 16. 70. 23. 17. MS. PART 3 ACSM Certified Clinical Exercise Specialist (CES) PAUL SORACE. ACSM-RCEP. Associate Editor CES 151 Dwyer_Part3_Sec7.indd 151 11/08/12 12:26 AM . indd 152 11/08/12 12:26 AM .Dwyer_Part3_Sec7. ACSM Certified Health Fitness Specialist (HFS). medical College of Sports Medicine’s (ACSM’s) Guidelines for clearance from physician.I Author’s Certifications: ACSM-CES You are an exercise physiologist at a hospital-based wellness facility. atenolol (␤-blocker for BP). high-density lipoprotein cholesterol (HDL-C) ⫽ 41 mg ⴢ dL⫺1. his fasting blood measures were the following: total cholesterol ⫽ 192 mg ⴢ dL⫺1. you measured his resting heart rate (HRrest) at 58 bpm. Drew. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. At his initial consultation with you. to improve his risk factor profile. According to the most recent edition of the American D) Signed informed consent form. high BP. he states that he has previously been diagnosed with high cholesterol. Atenolol. what is physician supervision recommended prior to his beginning exercise at a 2. and glucose ⫽ 137 mg ⴢ dL⫺1. At his most recent doc- tor visit. PhD CES. recently joins your facility. SECTION 7 CES Case Studies Note: CES certification candidates should also review the case studies found in Part 1. triglycerides ⫽ 169 mg ⴢ dL⫺1. ACSM Certified Personal Trainer (CPT) and Part 2. Due to his waist girth and weight. He currently does no regular physi- cal activity. On his health history questionnaire. A client. He wishes to make the necessary changes to lose weight. He is currently on several medications includ- ing Lipitor (statin for cholesterol). He currently weighs 315 lb and is 5 ft 11 in tall. Hargens. medical clearance C) Increases his HRrest from physician. body composition estimation was not possible via skinfolds. and GXT with Exercise Testing and Prescription (GETP). and graded exercise test (GXT) D) Increases his exercise breathing rate 153 Dwyer_Part3_Sec7. and diabetes mellitus. and his resting blood pressure (BP) was 138/72 mm Hg. During your initial consultation with Drew. Drew is a 47-yr-old male. low-density lipoprotein (LDL) ⫽ 117 mg ⴢ dL⫺1. He realizes that he is not in good health and not physically active. and hopefully not go down the same path as his father. he discussed his desire to improve his overall health and to try to prevent a premature myocardial infarction (MI). and metformin (biguanide for glucose control). DOMAIN I: PATIENT/CLIENT ASSESSMENT CASE STUDY Author: Trent A.indd 153 11/08/12 12:26 AM . one of the medications that Drew is moderate-to-vigorous intensity in your facility? currently taking. He reports that his father previously was diagnosed with diabetes in his 40s and had a nonfatal heart attack at age 52 yr. His waist circumference is currently 127 cm. He also reports that no symptoms sug- gestive of ischemia. has which effect that needs to be CES A) Signed informed consent form only considered? B) Signed informed consent form and medical A) Increases his exercise tolerance clearance from physician B) Decreases his exercise heart rate (HR) C) Signed informed consent form.I 1. He was referred for blood analysis and a GXT.indd 154 11/08/12 12:26 AM . 2–3 d ⴢ wk⫺1. associated with a feeling of shortness of breath (SOB) (dyspnea) and profuse sweating (diaphoresis). Greg denies any other significant medical history prior to the current episode of chest pain. What do you believe to be Drew’s major health concern and should Drew’s main goal be as he begins his lifestyle program? DOMAIN II: EXERCISE PRESCRIPTION CASE STUDY Author: Donald M. He states that his exercise consists of hiking with his dog for 30–45 min. what stage of change is 137 mg ⴢ dL⫺1 does not reflect his usual level of Drew currently at? glucose control and that he usually “does better. with the brother currently being treated for high BP as the only sibling reportable medical history. and a nitrate (nitroglycerin lingual spray 0.” A) Precontemplation What follow-up test would you recommend that B) Contemplation would BEST determine Drew’s level of glucose C) Preparation control? D) Action A) Another fasted blood glucose test 5. After resting for 15 min in a chair. Subsequent Lexiscan nuclear test confirms a 75% occlusion of the right coronary artery (RCA) and an 80% occlusion of the circumflex artery (CXA).acsm. 154 CERTIFICATION REVIEW • www. Given what Drew has relayed to you in your initial he does not feel that his glucose reading of consultation with him. He currently is being treated for hypertension and hyperlipidemia. a 55-yr-old male. PhD CES.org 3. what potential C) A glycolated hemoglobin (HbA1C) test cardiovascular complication possibility exists with D) No follow-up test is needed his performing physical activity? A) Silent ischemia B) Hypoglycemia C) Ketoacidosis D) Peripheral neuropathy DISCUSSION QUESTION FOR CASE STUDY CES. A new patient. Drew states during his initial consultation that 4. fasting blood laboratory report. Greg. Greg reports never smok- ing.II(1) Author’s Certifications: ACSM-CES You are a clinical exercise physiologist in a cardiopulmonary rehabilitation department at a medical facility.3 kg ⴢ m⫺2 body mass index [BMI]).I 1. brother and sister. Greg reports that the symptoms subsided. has been referred by his physician to participate in a 12-wk exercise rehabilitation program due to a recent episode of chest pain and a positive GXT result. Cummings. Medical History Greg is a 55-yr-old male who has a height of 5 ft 9 in and weighs 178 lb (26. a hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitor (atorvastatin 20 mg OD). he developed substernal chest pressure that lasted for 20 min. He reports that while he was working in the yard (landscaping). A brief synopsis of Greg’s medical history. Dwyer_Part3_Sec7. His mother is still living with an unremarkable medical history. a diuretic (spironolactone 50 mg bid). He has been prescribed CES an angiotensin-converting enzyme (ACE) inhibitor (enalapril 10 mg OD). Given Drew’s extensive cardiovascular risk profile B) An oral glucose tolerance test and diagnosed metabolic disease. and recent GXT results is provided as follows. He reports a family history of his father having high BP and dying of a heart attack at the age of 58 yr. He has two younger siblings.4 mg prn). 4 14 144 2⫹ Chest pain.0 mm horizontal ST depression 7 3.0 1⫹ Chest pain 1.7 Sinus rhythm 4 2.7 10 94 Sinus rhythm 2 1. 1 PVC Dwyer_Part3_Sec7.7 10 110 168/88 10 4.indd 155 11/08/12 12:26 AM .71 mg ⴢ dL⫺1 GXT Results: Name: Greg Age: 55 yr HRrest 76 bpm Resting electrocardiogram (ECG) Normal sinus rhythm (NSR) Resting BP Supine 142/88 mm Hg Standing 140/88 mm Hg Rating of Perceived Metabolic Symptoms HR BP Exertion Equivalent (scales all Time Speed Grade (bpm) (mm Hg) (RPE) (MET) out of 4) ECG 1 1. SECTION 7 CES Case Studies 155 Blood Laboratory Analysis (Fasting): Glucose 94 mg ⴢ dL⫺1 Urea nitrogen 12 mg ⴢ dL⫺1 Creatinine 1.8 mg ⴢ dL⫺1 Cholesterol 171 mg ⴢ dL⫺1 Triglycerides 77 mg ⴢ dL⫺1 HDL cholesterol 46 mg ⴢ dL⫺1 Total protein 6.7 10 102 Sinus rhythm 3 1. 1.7 g ⴢ dL⫺1 Aspartate aminotransferase (AST) 36 U ⴢ L⫺1 Alanine aminotransferase (ALT) 42 U ⴢ L⫺1 Alkaline phosphatase (ALKP) 98 U ⴢ L⫺1 Total bilirubin 0 . CES 1 premature ventricu- lar contraction (PVC) 6 2.2 mmol ⴢ L⫺1 Chloride 105 mmol ⴢ L⫺1 Carbon dioxide 28 mmol ⴢ L⫺1 Calcium 8.0 mg ⴢ dL⫺1 Sodium 142 mmol ⴢ L⫺1 Potassium 4.5 12 125 Sinus rhythm.0 mm horizontal ST 1⫹ SOB depression.7 mg ⴢ dL⫺1 Direct bilirubin 0 mg ⴢ dL⫺1 LDL 99 mg ⴢ dL⫺1 Very low-density lipoprotein (VLDL) 15 mg ⴢ dL⫺1 Cholesterol/HDL 3.6 mg ⴢ dL⫺1 Unconjugated bilirubin 0.9 g ⴢ dL⫺1 Albumin 3.5 12 134 186/84 14 7.5 12 115 Sinus rhythm 5 2. II(1) 1.org Rating of Perceived Metabolic Symptoms HR BP Exertion Equivalent (scales all Time Speed Grade (bpm) (mm Hg) (RPE) (MET) out of 4) ECG 8 3. 5.5% grade C) 134 bpm C) 4. The use of ACSM’s metabolic calculations for the a good index of exercise intensity would be an treadmill would suggest which of the following as a exercise HR no greater than maximal safe workload for exercise training? A) 110 bpm A) 2.0 mm horizontal ST depression. According to the most recent edition of the ACSM’s GETP and based on Greg’s GXT results.5 mm horizontal ST 1⫹ SOB depression 9 3. 2.5% grade E) 150 bpm E) Cannot be determined from the data given 3.1 3⫹ Chest pain.acsm. which classes of medications prescribed to approximate maximum “safe” exercise MET level Greg may have an effect on his HR during exercise? he should exercise would be A) Antihypertensive medications A) 5 MET B) Antilipidemic medications B) 6 MET C) Antiangina medications C) 7 MET D) All of Greg’s medication classes may have an D) 8 MET effect on his HR during exercise.indd 156 11/08/12 12:26 AM . The use of ACSM’s metabolic calculations for GETP.0 mph and 15.0% grade B) ⬍124 bpm B) 3.4 14 158 194/84 18 10. 1 PVC 12 Recovery Supine 125 176/84 Chest pain Sinus rhythm Resolved 13 Recovery Supine 94 Sinus rhythm 14 Recovery Supine 84 156/88 Sinus rhythm MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. According to the most recent edition of the 4. 2.0 mph and 8. which classes of medications prescribed to the cycle ergometer would suggest which of the Greg may have adverse side effects during exercise? following as a maximal safe workload for exercise A) Antihypertensive medications training? B) Antilipidemic medications A) 375 kgm ⴢ min⫺1 CES C) Antiangina medications B) 450 kgm ⴢ min⫺1 D) All of Greg’s medication classes may have acute C) 535 kgm ⴢ min⫺1 adverse side effects during exercise. According to the most recent edition of the ACSM’s 6. E) 9 MET E) None of Greg’s medication classes may have an effect on his HR during exercise. Dwyer_Part3_Sec7.0 mph and 5. the GETP. 1 PVC 10 Recovery Supine 154 186/86 2⫹ Chest pain.0 mm horizontal ST 2⫹ SOB depression. According to the most recent edition of the ACSM’s ACSM’s GETP and based on Greg’s GXT results. D) 630 kgm ⴢ min⫺1 E) Only Greg’s antihypertensive and antiangina E) Cannot be determined from the data given medications may have acute adverse side effects during exercise.4 14 150 2⫹ Chest pain.0% grade D) 144 bpm D) 5. 2. 1.0 mm horizontal 1⫹ SOB ST depression 11 Recovery Supine 136 180/84 1⫹ Chest pain 1. 156 CERTIFICATION REVIEW • www.0 mph and 6. 0)(L) ⫽ 2. The test interpretation also indicated ⬃0. Body composition by skinfolds was estimated at 32% body fat and waist circumference was 42 in.4. He is a 55-yr-old male who currently weighs 193 lb and is 66 in. Based on these results. a resistance program of 12–15 RM Question 1. and BP. in height. He reports no symptoms of exercise intolerance except SOB when walking up hills. How could you use the rate pressure product as a developed for 6 mo and does not change his diet. He has been walking the dog for the last 4 wk each day but reports no other exercise. Dwyer_Part3_Sec7. His maximal oxygen consumption was estimated to be 6.6 MET. and glucose ⫽ 126 mg ⴢ dL⫺1. respectively. cholesterol. without a preexercise GXT. he is taking a diuretic (hydrochlorothiazide [HCTZ]) to control his BP. Upon receiving the results. If Greg followed the exercise program that you 2. HDL-C ⫽ 33 mg ⴢ dL⫺1. According to the most recent edition of the 9. According to the most recent edition of the 10. Fasting blood values were measured 2 wk ago as the following: total cholesterol ⫽ 227 mg ⴢ dL⫺1.II(2) Author’s Certifications: ACSM-RCEP. 8. Ross. if you DID NOT have the GXT initiated for Greg at which of the following results for Greg. His HRmax and BP were 130 bpm and 168/94 mm Hg. his physician has given approval for your client to start an exercise program. MS CES. His brother died of a fatal heart attack at age 60 yr.5–1 CES mm of ST depression in the lateral leads at peak exercise but no clinical signs of ischemia. you set up a meeting with your client to help in the develop- ment of an appropriate exercise prescription. According to the most recent edition of the ACSM’s GETP. He has recently joined your health/fitness facility to increase his fitness level and manage his weight. tool to use for the progression of Greg’s exercise what kind of changes would you tell him that he program? may expect in his blood chemistries? CASE STUDY Author: James H. which of the following initial repetition maximum (RM)? exercise MET levels would be appropriately safe? A) one repetition maximum (1-RM) A) 1 MET B) 6–8 RM B) 2–4 MET C) 8–12 RM C) 5–7 MET D) 12–15 RM D) 8–10 MET E) Any of the above levels of RM would be E) Patients with heart disease cannot exercise appropriate for Greg.6 and his forced vital capacity (FVC)(L) ⫽ 3. SECTION 7 CES Case Studies 157 7. The physician interpreted the test as equivocal because he did not reach 85% of predicted maximal heart rate (HRmax). triglycerides ⫽ 156 mg ⴢ dL⫺1. Based on the maximum MET level as determined in ACSM’s GETP. HRrest was 76 bpm and resting BP 132/88 mm Hg.indd 157 11/08/12 12:26 AM . His physician ordered a pulmonary function test with the following results: forced expiratory volume in one second (FEV1. You have a new client joining your facility. a resistance program may be ACSM’s GETP. ACSM-CES You are a clinical exercise specialist at a health/fitness facility. He is a current smoker (smokes one pack a day). Your client recently had a Bruce maximal exercise test ordered by his physician (due to SOB concerns). Currently. at what approximate percent of reserve represents approximately which percent range of volume of oxygen consumed per unit of time 1-RM for the upper body? (V̇O2R) is Greg working? A) 10%–20% A) 45% B) 30%–40% B) 55% C) 50%–60% C) 65% D) 70%–80% D) 75% E) 85% DISCUSSION QUESTIONS FOR CASE STUDY CES.II(1) 1. the optimal intensity D) 103–122 bpm of exercise for aerobic fitness benefits would be set at 6. who currently weighs 223 lb and is 68 in.org MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. and his waist circumfer- ence was 46 in.223 min C) 105. 1. moderate B) 7. HDL-C ⫽ 40 mg ⴢ dL⫺1. What risk stratification would you assign for your achieve a 30-lb loss and how many minutes of client? exercise might it take to do? (Use calculations from A) Low risk Question 6. Your client is about 131 lb of lean body mass and B) 3–5 d ⴢ wk⫺1 would need to lose about 30 lb of fat to attain a C) 5–6 d ⴢ wk⫺1 weight of 163 lb at 20% body fat. 12. What do you believe to be his major health concern developing his exercise prescription? and what exercise/physical activity program might you suggest he follow to manage that health concern? CASE STUDY Author: James H. Fasting blood values were recently measured as the following: total cholesterol ⫽ 197 mg ⴢ dL⫺1.5 mph and 2% grade GETP.II(3) Author’s Certifications: ACSM-RCEP. in height.235 min C) High risk B) 10. 158 CERTIFICATION REVIEW • www.indd 158 11/08/12 12:26 AM . He quitted 6 mo ago after smoking 23 yr of two packs a day. vigorous A) 107–127 bpm B) 149–162 bpm DISCUSSION QUESTIONS FOR CASE STUDY CES.0 mph and 2% grade achieve health benefits would be D) Cannot be determined from the data given A) 1–2 d ⴢ wk⫺1 7.) B) Moderate risk A) 105. A new patient CES referred to your program is a 45-yr-old male. MS CES. the recommended frequency of exercise to C) 3. His HRrest and BP were measured at 62 bpm and 142/78 mm Hg. He admits that he has not been exercising but has played golf once each week prior to his hospitalization for a lateral Dwyer_Part3_Sec7. moderate client would be D) 3–5. D) Apparently healthy A) 5. According to the most recent edition of the ACSM’s B) 1.0 mph and 4% grade 2. According to the most recent edition of the ACSM’s C) 97–108 bpm GETP.500 cal. Muscle strengthening and flexibility exercises B) Heart disease should include ⬎___________ d ⴢ wk⫺1 at a C) Diabetes _____________ intensity.632 min 4. respectively. What questions will you ask your client prior to 2.II(2) 1. An appropriate target heart rate (THR) for your C) 2. Given his health information provided. 16. when prescribing exercise.000 cal. triglycerides ⫽ 156 mg ⴢ dL⫺1. your client D) Cannot be determined from the data given likely has A) Metabolic syndrome 8. light 5. LDL ⫽ 125 mg ⴢ dL⫺1.II(2) 1. The use of ACSM’s metabolic calculations for the A) 20%–30% of one’s maximal oxygen uptake reserve treadmill would suggest which of the following B) 50%–85% of one’s maximal oxygen uptake reserve workloads as appropriate for an initial workload for C) 85%–95% of one’s maximal oxygen uptake reserve exercise training? D) 100% of one’s maximal oxygen uptake reserve A) 5.acsm. Ross. and glucose ⫽ 106 mg ⴢ dL⫺1. Approximately D) Daily how many calories would he need to lose to 3. ACSM-CES You are a clinical exercise specialist in a cardiac rehabilitation program.000 cal. respectively. SECTION 7 CES Case Studies 159 wall MI (heart attack) and had two stents implanted (1-Left Anterior Descending [1-LAD]. C) High risk A) 5. What primary goal will you recommend for your 5. His ejection fraction (EF) was estimated to be 54% during a stress echo. After a few weeks of exercise. During the consultation.0 mph and 0% grade D) Cannot be determined from the data given DISCUSSION QUESTIONS FOR CASE STUDY CES. The supervising physician concluded that the test was uninterpretable because the presence of a left bundle-branch block (LBBB). What risk stratification is appropriate for your patient with heart disease? 7. 1-circumflex) 6 wk ago. He wants to walk in the neighborhood near his 4. He is currently taking atenolol to lower his BP and Lipitor for high cholesterol. The patient was administered a physician-supervised Bruce exercise test 1 wk ago.0 mph and 4% grade D) Very high risk B) 1. What adaptations should be made for your patient CES formula for determination of MET levels on the using a treadmill test to prescribe exercise on a Bruce test is appropriate? cycle ergometer? Dwyer_Part3_Sec7. His maximal oxygen consumption was estimated using the ACSM’s walking metabolic calculations at 10 MET. How would you classify your patient’s disease risk house but doesn’t know what pace he should use. you suggest extra A) Lowest risk exercise sessions above the 3 d ⴢ wk⫺1 cardiac B) Moderate risk rehabilitation schedule. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. he stated that he wants to work out on his own but agreed to come to Cardiac Rehabilitation Program (CRP) because of his physician’s insistence. Do you think that the use of the ACSM’s walking 2. given his BMI and waist circumference? Choose a workload that is appropriate for him to A) Normal work at ⬃40% of peak volume of oxygen consumed B) Increased risk per unit of time (V̇O2peak). An appropriate THR for your client would be patient while at cardiac rehabilitation? A) 62–82 bpm A) Weight reduction B) 70–95 bpm B) Lowering fasting blood glucose C) 83–104 bpm C) Lowering lipids D) 80–100 bpm D) Maintenance of smoking cessation 6. No clinical signs of ischemia were noted during the exercise test. The use of ACSM’s metabolic calculations for 2. Your patient prefers bike C) Highest risk riding but does not have an exercise bike at home.II(3) 1. His HRmax and BP were 115 bpm and 208/86 mm Hg.indd 159 11/08/12 12:26 AM .II(3) 1. He reports that his father died of a heart attack at age 42 yr. What mode of exercise will you suggest for your the cycle ergometer would suggest which of the patient? following workload as appropriate for an initial A) Walking track workload for exercise training? B) Exercise bike A) 150 W C) Treadmill B) 75 W D) The one your patient most enjoys C) 25 W D) Cannot be determined from the data given 3. The test was terminated because of leg fatigue and dyspnea.5 mph and 2% grade C) 4. HDL-C ⫽ 50 mg ⴢ dL⫺1. She recently had pulmonary function tests performed by her pulmonologist with the following results: FVC ⫽ 1. she stated that she doesn’t exercise because of her dyspnea.11 MET. 160 CERTIFICATION REVIEW • www. Oxygen saturation was moni- tored by pulse oximeter throughout the test and was 86% at maximal exercise. What method of prescribing exercise intensity will 5. and her HRrest and BP were measured at 82 bpm and 128/80 mm Hg. LDL ⫽ 112 mg ⴢ dL⫺1. Her HRmax and BP were 150 bpm and 182/86 mm Hg. what is the work rate at maximal A) 50%–85% of heart rate reserve (HRR) exercise? B) 3–4 on a 4-point dyspnea scale A) 100 W C) 50%–85% of maximal oxygen consumption B) 75 W D) None of the above C) 25 W 2. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES.35 L ⴢ min⫺1. Her maximal oxygen consumption was estimated using the ACSM’s leg ergometer metabolic calculations at 3. During the consultation. The patient performed a physician-supervised maximal cycle ergometer test 2 wk ago. Her fasting blood lipids were measured last week as the following: total cholesterol ⫽ 177 mg ⴢ dL⫺1. The physician’s in- terpretation was negative for any signs of ischemia.II(4) 1. Ross. What mode of exercise will you suggest for your D) Cannot be determined from the data given patient? 6.0 ⫽ 0.II(4) Author’s Certifications: ACSM-RCEP. The patient’s use of albuterol shortly prior to exercise may impact _________________. she stated that she was at 3 on the 4-point dyspnea scale.5 packs a day. Her medications include albuterol and theophylline. What will be your recommendations for exercise would you classify your patient’s disease condition frequency for your pulmonary patient? given her pulmonary values? A) 2–4 d ⴢ wk⫺1 A) Mild B) 3–5 d ⴢ wk⫺1 B) Moderate C) 5–7 d ⴢ wk⫺1 CES C) Severe D) None of the above D) Very severe 4. According to the Global Initiative for Chronic D) Gastrocnemius and soleus muscles Obstructive Pulmonary Disease (COPD).60 L ⴢ min⫺1. and gluteal muscles D) Arm ergometer C) Abdominal and back muscles 3. in height. ACSM-CES You are the clinical exercise specialist in a pulmonary rehabilitation program. In the last minute of exercise. What muscle groups will you primarily emphasize A) Walking track with your pulmonary patient’s resistance training? B) Exercise bike A) Shoulder girdle and inspiratory muscles C) Treadmill B) Quadriceps. hamstrings.acsm. She exercised for 2 min. and glucose ⫽ 100 mg ⴢ dL⫺1. how 7. respectively. A) Symptoms of heart disease B) HR range C) Symptoms of dyspnea D) B and C Dwyer_Part3_Sec7. triglycerides ⫽ 136 mg ⴢ dL⫺1. which comes on after a couple minutes of exercise. She has not participated in regular physical activity for 30 yr but did like to garden and mow her own yard until the last couple years. respectively. Using the ACSM’s leg ergometer metabolic you use for your patient? equations.org CASE STUDY Author: James H. The new patient referred to your program is a 53-yr-old female who currently weighs 153 lb and is 58 in. and the test was stopped because of dyspnea.indd 160 11/08/12 12:26 AM . She was recently diagnosed with emphysema. She did not use supplemental oxygen during the exercise test. She recently quit smoking after 30 yr of 1. FEV1. MS CES. 50 CES yes Have sexual relations? 5. double tennis.75 yes Walk indoors. or pushing a power mower? 4. What adaptations should be made for your patient 2. SECTION 7 CES Case Studies 161 DISCUSSION QUESTIONS FOR CASE STUDY CES. However. bowling. 1989.II(5) Author’s Certifications: ACSM-CES. the initial MET C) 4–6 MET intensity prescription for a stable asymptomatic D) 10–12 MET Yes/No Question Weight Score yes Take care of yourself. basketball. exercise prescriptions are given without a comprehensive evaluation. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index).50 Total Adapted with permission from Hlatky MA. or carrying groceries? 3.II(4) 1. dress. or use the toilet? 2. and oxygen saturation for a person walking? during exercise bouts. or 6. whereas exercise programming is basic exercise advice based on a lim- ited evaluation. PhD.64:651–4.70 Do moderate work around the house like vacuuming. Wallace. such as around your house? 1.75 yes Walk a block or two on level ground? 2. or skiing? 7. including exercise testing. How would you adjust the MET intensity Rx for this C) Exercise testing was clinically nonessential patient (in Question 2) if he answered the following because coronary anatomy has been questions on the Duke Activity Status Index (DASI)? documented. A) 8–10 MET D) Stable disease B) 6–8 MET 2.50 yes Do heavy work around the house like scrubbing floors or lifting or moving heavy furniture? 8. ACSM-PD Exercise prescription is the development of a specific exercise program based on a compre- hensive evaluation. Am J Cardiol. Higginbotham MB et al. that is. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. Reasons for this scenario A) 1–2 MET include B) 2–3 MET A) Cardiac transplantation C) 2–4 MET B) When RPE will be used for exercise D) 3–5 MET prescription 3.50 yes Run a short distance? 8.00 Do light work around the house like dusting or washing dishes? 2. It is not unusual for patients with heart disease 50-yr-old post-MI patient with no prior exercise or to enter outpatient cardiac rehabilitation without pharmacological test available would be preliminary exercise test. dyspnea.indd 161 11/08/12 12:26 AM .75 yes Climb a flight of stair or walk up a hill? 5.II(5) 1. According to the ACSM’s GETP. CASE STUDY Author: Janet P. Discuss the importance of closely monitoring using a cycle ergometer test to prescribe exercise exercise intensity. FACSM CES.25 yes Participate in moderate recreational activities like golf. dancing. This scenario challenges your exercise prescription skills in an exercise programming environment. football. eat.00 throwing a baseball or football? Participate in strenuous sports like swimming. Dwyer_Part3_Sec7. Boineau RE. bathe. sweeping floors. in several cardiac rehabilitation settings. weeding. singles tennis.00 yes Do yard work like raking leaves. What if she had no pharmacologic myocardial 15 METs BY 14 perfusion imaging.0 MET vacuuming. jumping rope slowly outside of the outpatient rehabilitation setting? A) Estimate his HRmax with 220 ⫺ age and then 10 Brisk swimming. backpacking 6. How would you give him a THR for activities 9 Bicycling at a moderate pace.indd 162 11/08/12 12:26 AM . What would be the beginning exercise intensity for a Adapted with permission from Meyer J.73:591–6. 13 Any competitive activity including those which involve D) Don’t give him a THR without an exercise test. or carrying groceries D) 4. Do D. observe his RPE and Painting or light carpentry HR/BP response during the exercise at the 5 Walking briskly (i. jog 6 miles ⴢ h⫺1 use the Karvonen formula to give him a THR between 70%–85% intensity. and signs/symptoms Play tennis singles. Clinical Data. getting dressed. carry 20 lb upstairs 5. Using the VASQ. weeding. 4 mi in 1 h) selected MET. digging. A nomogram to predict exercise capacity from a Specific Activity Questionnaire and Walking down eight steps Clinical Data. working at a desk 1 CES 2 Taking a shower Reprinted with permission from Meyer J. Herbert W.. Ribisl P. Froelicher VF. HR/BP response. her predicted exercise capacity is D) 2–4 MET 7. Do D. bicycle up a hill. spading soil) ECG. Jog slowly.. pression with ⫹1 angina and hypokinetic lateral ven- tricular wall with 45% EF during her pharmacologic A) 1–2 MET myocardial perfusion imaging with dipyridamole? B) 2–3 MET A) 1–2 MET C) 2–4 MET B) 20 beats ⬎ HRrest D) 10 beats above standing HR C) 10 beats ⬍ HR at ST segment depression 9.5 MET Dwyer_Part3_Sec7. sawing wood. monitor his RPE. How would you adjust the initial intensity for the 6 CAPACITY 40 5 7 (METs) following response on the Veterans Administration 30 4 Specific Questionnaire (VASQ)? 3 6 20 2 1 5 Draw one line BELOW the activities you are able to do 4 routinely with minimal or no symptoms. 3 Walking slowly on a flat surface for one or two blocks A) 3 MET B) 3. what beginning exercise AGE QUESTIONNAIRE intensity would you give her? 13 (years) 12 A) 1–2 MET 13 90 12 B) 15 beats ⬎ HRrest 80 11 11 10 C) 10 beats ⬎ HRrest 70 10 9 D) 2–4 MET 9 PREDICTED 60 8 7 EXERCISE 50 8 8.acsm.e. continuously on level ground. Heavy carpentry.e. 8 miles ⴢ h⫺1 been exercising at in outpatient rehabilitation.org 4. climb stairs quickly. 2 1 Eating. Ribisl P. 3 MET chest discomfort. D) After a proper warm-up. or pushing estimated in Question 3 was safe for this patient? a power mower) A) After a proper warm-up. intermittent sprinting use RPE only. How would you confirm that the intensity 4 Light yard work (i. and signs/symptoms during the exercise 6 Playing nine holes of golf carrying your own clubs at the selected MET. Herbert W.73:591–6. carry 60 lb during exercise at the selected MET. B) After a proper warm-up. Running competitively. and fatigue. Am J Cardiol.5 MET A moderate amount of work around the house like C) 4. raking leaves. 7 Perform heavy outdoor work (i. Social dancing. washing the car RPE. 11 Cross-country skiing B) 20 beats above HRrest Play basketball full court C) Give him a THR no higher than the HR he has 12 Running briskly.e. mow lawn with push mower C) After a proper warm-up. Froelicher VF. walking briskly uphill. sweeping the floors. 162 CERTIFICATION REVIEW • www. observe his ECG. Am J Cardiol 1994. such as SOB.. 1994. rowing. A nomogram to predict exercise capacity from a Specific Activity Questionnaire and 65-yr-old woman who exhibited 1 mm ST segment de. monitor his ECG and 8 Move heavy furniture HR/BP response to the selected MET. hyperlipidemia. but over his lifespan. and Lexapro (escitalopram). He reports increasing fatigue and dyspnea in recent weeks as well as being more depressed. of 1–2 MET. chest sounds ⫽ coarse (but mild) bilateral crackles during inspiration. he smoked 2. Earl. peripheral arterial disease. A new patient. the following resting physiological data was assessed and recorded: HR ⫽ 109 bpm. You measured his body composition by skinfolds and the value predicted was 8% body fat. absolute intensity 1–2 MET.III CES 1. seen during the 6MWT. and this increased to 92% within 3 min of recovery.indd 163 11/08/12 12:26 AM . is a 72-yr-old male just starting the program and you are performing his initial assessment. He quitted smoking 6 mo ago. and bronchiectasis. His highest HR and BP achieved were 136 bpm and 148/78 mm Hg. Her HR and RPE are now lower at the initial work C) Increase her THR ⬎10 beats ⴢ min⫺1 with an rate. chronic bronchitis. Earl has COPD manifested by a combination of emphysema. Verrill. His peak SaO2 was 80% on 6 L ⴢ min⫺1 of oxygen. goals that he wishes to strive for during program participation. FAACVPR CES. and his wife stated that he had not been feeling “up to par” over the past few weeks. Other fitness tests you con- ducted demonstrated an average score for both upper body muscular strength (handgrip dynamometer) and leg endurance (30-s sit-to-stand test). to increase her physical work capacity? D) Keep her RPE at 11–14 but increase her relative A) Keep her RPE at 11–14 but increase her intensity 1–2 MET. and osteoarthritis. The first action for developing Earl’s initial C) Increase his supplemental oxygen flow to treatment plan (ITP) would be to 8 L ⴢ min⫺1 during his rehabilitation exercise to A) Formulate his exercise prescription based upon compensate for his lower exercise SaO2 values his 6MWT results. DOMAIN III: PROGRAM IMPLEMENTATION AND ONGOING SUPPORT CASE STUDY Author: David E. You conducted a 6-min walk test (6MWT) test today on Earl immediately after his initial assessment. ACSM-CES You are the clinical exercise physiologist at a local hospital pulmonary rehabilitation program. How would you progress her exercise program increase of 1–2 MET. He had moderate-to-marked dyspnea (2–3 on the 0–4 scale) at test termination and mild calf pain in both legs. Plavix (clopidogrel). percent saturation of arterial oxygen (SaO2) ⫽ 94%. BP ⫽ 106/56 mm Hg. respectively. Atrovent (ipratropium). She has had a normal response to the exercise B) Increase her RPE to 13–15 with an increase program exhibiting no ischemia or symptoms. Dwyer_Part3_Sec7. Earl currently weighs 131 lb and is 6 ft tall (BMI ⫽ 17. SECTION 7 CES Case Studies 163 10.5 packs of cigarettes per day for 60 yr. Advair Diskus (fluticasone and salmeterol). MS. He is on 3 L ⴢ min⫺1 of oxygen by nasal cannula in resting (sedentary) conditions. Earl was short of breath when he entered the facility. Niaspan (intermediate release niacin). Earl currently takes prednisone. a baby aspirin. During his initial assess- ment (while on 3 L ⴢ min⫺1 oxygen). osteoporosis. He walked 901 ft with one rest break (below average for his age category). and he increases his oxygen liter flow to 6 L ⴢ min⫺1 with exertional activities per physician order.III Author’s Certifications: ACSM-RCEP. He also has a history of blood clots in his lungs.and long-term 6MWT results with the medical staff. He rated his peak level of exertion as 15 on the Borg category scale and his peak dyspnea as 5 on the Borg dyspnea scale.8 kg ⴢ m⫺2). B) Call Earl’s pulmonologist and discuss his D) Develop his individual short. He arrives from a small town outside the city limits (45–55-min drive). MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. weight and muscle mass. dyspnea survey. QOL surveys. for outcomes tracking and to provide feedback for 4. depression D) 90 survey. 164 CERTIFICATION REVIEW • www. One commonly used tool to assess more lobes of the lung. A) Help provide immediate airway relief in the C) A diet and exercise plan to increase his body event of an asthma attack.0 values. grip B) 150 dynamometer test. Diet Habit Survey (DHS). C) Earl’s BMI puts him at a significantly lower risk 6. Assuming Earl completes 12–16 wk of pulmonary the airways. his physician? A) 60 A) 6MWT. B) Help loosen mucus in the airways for easier D) Pursed-lip breathing training to help him removal. D) Obese (class I) C) Include treadmill walking at 2. Which of the following statements is true regarding B) Have Earl perform a GXT to see if he has any factors to consider for Earl’s ITP? cardiac involvement that might be contributing A) Because Earl quitted smoking 6 mo ago. your initial assessment about these issues and B) Training techniques to improve Earl’s contact his physician with this information.acsm. there to these issues.indd 164 11/08/12 12:26 AM . rehabilitation participation. 30-s sit-to-stand test. level D) Bronchiectasis is structural damage to airway of dyspnea with activities of daily living (ADL). 30-s sit-to-stand test 5. which of the following D) Help provide long-term relief of dyspnea combination of follow-up tests would you perform through dilation of the airways. To address these assessment. depression survey problems.0 and FVC values. worsening C) 6MWT.org 2. Earl has complained recently of fatigue.8 mph with a 8. you give Earl of early mortality. surveys to assess his quality of life (QOL). A) Self-refer Earl to a psychologist or psychiatrist skinfold assessment for his depression. During your initial assessment. Earl has a smoking history of ______ pack per years. B) Normal weight B) Include recumbent cycling of 15–20 W at C) Overweight 30–40 rpm for 8 min. reassess his FVC and FEV1. lessen his dyspnea. upper and lower body strength should take D) Ask Earl’s pulmonologist to refer him to the precedence over techniques to improve his pulmonary function testing laboratory to 6MWT performance. QOL survey. Earl’s BMI classifies him as ___________ by expert A) Be deferred until Earl’s pulmonologist provides panel normative data. cartilage and muscle tissue involving one or and depression. 20–30 rpm for 8 min. B) Vitamin B and D supplementation to help 3. and some depression. dyspnea with ADL in pulmonary rehabilitation participants is A) The University of California at San Diego Shortness of Breath Questionnaire B) The Beck Depression-II survey CES C) The Ferrans and Powers’ QOL survey (Pulmonary Version) D) The Physical Activity Readiness Questionnaire (PAR-Q) Dwyer_Part3_Sec7. 10. you would D) Shuttle test. dyspnea survey C) 24 B) Submaximal GXT. follow-up recommendations based upon his A) Underweight initial assessment. The initial exercise prescription for Earl should 7. is no longer a need to focus on smoking C) Collect as much information as possible in cessation interventions. Prednisone is a drug prescribed to improve his FEV1. C) Help shrink the swelling and inflammation of 9. Specific components that categorize Earl’s ITP 1% incline for 10 min. would consist of all of the following except D) Include arm ergometry exercise of 10 W at A) A plan to address his worsening depression. skinfold dyspnea. Identify three barriers and elaborate on how 2.and long-term goals 2. client? Dwyer_Part3_Sec7. Which of the following are common symptoms of 3. List and discuss some short.IV Author’s Certifications: ACSM-ETT. C) Goals should be challenging. D) Goals should be specific. Which of the following is not a strategy or following? strategies used to increase self-efficacy? A) Emotional stress A) Experiencing successful completion of tasks B) Low-intensity exercise B) Modeling experiences C) Poor sleep C) Social persuasion D) A and B D) Challenging self with difficult goals E) A and C 5. Kimberly has been diagnosed with fibromyalgia syndrome (FMS).IV 1. FMS symptoms may be increased by which of the 4. ACSM-PD Kimberly is a 43-yr-old woman (65 in tall and 159 lb) who is an office manager at a large shipping company. A) Sleep disturbances behavior. How would you develop Earl’s exercise prescription from the results of his 6MWT? DOMAIN IV: LEADERSHIP AND COUNSELING CASE STUDY Author: Shala E. 3. FACSM CES. and completion? pulmonary rehabilitation program. compliance. B) Goals should have a reasonable time frame. or metabolic disease but considers her- self to be highly deconditioned. and environment all influence future B) Undue fatigue behavior? C) Diffuse soft tissue pain A) Transtheoretical model D) Depression B) Social cognitive theory E) None of the above C) Health behavior model F) All of the above D) Self-determination model 2.indd 165 11/08/12 12:26 AM . Kimberly has no known cardiovascular.III 1. How would you approach goal setting for this client. MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES.IV 1. Which of the following theories related to exercise clients diagnosed with FMS? behavior is based on the principle that the person. Davis. CES DISCUSSION QUESTIONS FOR CASE STUDY CES. each barrier impacts exercise compliance for this 3. SECTION 7 CES Case Studies 165 DISCUSSION QUESTIONS FOR CASE STUDY CES. She is divorced and has two school-aged children (8 and 11 yr old). Provide strategies to address the barriers identified. What problems do you foresee Earl having with that Earl should be trying to achieve throughout his program participation. She works 45 h ⴢ wk⫺1 and commutes 30 min each way daily. pulmonary. Her medications are limited to over-the-counter sleep aids and nonsteroidal anti-inflammatory drugs (NSAIDs). Kimberly has initiated multiple exercise programs with little success over the past 2 yr and complains of low motivation and depression-like symptoms. PhD. Which of the following is not part of the SMART F) B and C principles of goal setting? A) Goals should be realistic. ACSM-CES. present. or future physical or mental condition HIPAA protects any information that can be used to identify a person. Examples of a patient’s health information include the following: • Names • Addresses • Birth dates • Social security numbers • Information that is related to a past. • To process payments. Confidentiality in health care settings means that no one can view private health care information without a patient’s permission. A patient’s name or photograph cannot be used without the patient’s permission or consent. You must even be careful when telling others about the admission or discharge of a patient. Maynard. must obey HIPAA laws. The U. In the context of medical care. or the Privacy Rule. there is a difference in the meaning of the two words. 166 CERTIFICATION REVIEW • www. This law was passed to protect the use and release of a patient’s health informa- tion.org DOMAIN V: LEGAL AND PROFESSIONAL CONSIDERATIONS CASE STUDY Author: Timothy S. or services given to a patient. • Confidentiality relates to the protection of information. Examples of general health care operations include activities such as tracking and reporting data for quality assurance or use review. MS CES. Department of Health and Human Services created Standards for Privacy of Individually Identifiable Health Information.S. Using a patient’s name or photograph without consent violates the right to privacy and can lead to legal action. When sharing CES information. or on a computer. such as health insurers and medical billers. privacy means that no one has the right to interfere with a patient who is receiving care in a health care organization. Hospital staff must also obey HIPAA laws.V(1) Author’s Certifications: ACSM-PD The words privacy and confidentiality are often used to mean the same thing. Organizations that process health information. According to the HIPAA laws.indd 166 11/08/12 12:26 AM . and • To carry out general health care operations. as part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (HIPAA is pronounced HIP-ah). use the precautions defined by your organization’s policies and procedures to ensure a patient’s privacy and confidentiality. treatment. in writing. Do not share such information with anyone who is not directly caring for the patient. • Privacy refers to a person’s right to be free from interference by another person. This means that you can share health information with those who are directly involved in the care.acsm. The HIPAA privacy and confidentiality laws apply to health information that can be shared verbally. The law protects all citizens from unwanted invasion of their privacy. your organization does not need to ask a patient’s permis- sion to use or release health information that is needed • For treatment. Only share a patient’s medical or personal information with other health care workers on a need-to-know basis. Dwyer_Part3_Sec7. However. on subjects with suspected cardiac diseases. who has recently completed a stress test in your center. prison C) Only the employees of the hospital who are C) Criminal penalties of up to $150. Nancy. Nancy is a coworker. You C) Report the credit company to the Better routinely construct exercise prescriptions for these Business Bureau for inappropriate requests for subjects following the completion of these tests.V(1) 1.000 and 6 yr in of the employee’s limitation upon return to work. A visitor stops you in the hallway and begins to ask D) Tell that person that you will call them back you questions about the care of a patient.000 and 2 yr in employee’s limitations upon return to work. prison CES B) The employee’s coworkers so they may be aware B) Criminal penalties of up to $5. A) Provide them with the information because view patient medical records.indd 167 11/08/12 12:26 AM . read through it. You are assisting with the cardiac rehabilitation 5. True or False: A hospital or health clinic must the law to discuss the patient’s case with her. C) Tell your friend that it would be a violation of 3. his wife. SECTION 7 CES Case Studies 167 TRUE OR FALSE AND MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. cardiac rehabilitation program. information. D) Tell the visitor that you are very sorry. there is no need to question the woman because it is okay for health What should you do? care workers employed by your organization to re. You are working in a rehabilitation center where call to the human resources department or you assist with the performance of stress testing human resources manager. but you B) Speak with the patient and ask him if you may cannot release any patient-related information share his medical information with your friend without written consent from the patient to do so. because she is a big fan. You are assigned to help prepare a patient for of the stress test and what other tests have been his first independent exercise session in a new ordered for his wife because he is afraid that she surrounding after completing your hospital-based is dying. in prison Dwyer_Part3_Sec7. Your patient is a local politician who is well known to the community and What should you do? regularly in the news. Your best friend. who also A) Show the patient’s medical records to her works for your hospital in the radiology department husband. A credit card one of your patients’ medical records and begins to company calls and is asking about your coworker.000 and 8 yr directly involved with the care of that employee in prison may view the medical records on a need-to- D) Criminal penalties of up to $250. B) Do not answer any questions and transfer the 2. obtain a patient’s permission to release informa- D) Obtain the forms for the patient to sign tion before it can give information to the state allowing you to share this medical information health department about a patient’s exposure to with your friend. What should you do? C) Tell the visitor the stress test results and which A) Pull the chart to confirm the patient’s medical tests have been ordered for his wife. The visitor asks you to tell him the results 6. and the laboratory departments so that he can call and check on those tests. but do not history and diagnosis before sharing it so you tell him the results. Who is permitted to view the medical information 4. They claim Nancy is applying for a credit line and they want to verify some information. may be sure to be accurate. hears about this patient and calls you to ask why the B) Give the visitor the number to the stress test politician was in cardiac rehabilitation. True or False: At this point. A woman in and Wellness Center to answer the phone while work cloths and wearing a hospital badge picks up she has gone to get a cup of coffee. You are helping the department secretary for a Rehab department with patient orientation. Health care workers who violate privacy and con- about a hospital employee who is receiving care in fidentiality laws by selling a patient’s personal your department? information to another person or organization are A) The employee’s manager or supervisor may subject to what type of penalties? see the record so they may determine the A) Criminal penalties of up to $5. tuberculosis (TB).000 and 10 yr know basis. 7. when you have more time to talk. Centers for Disease Control and Prevention (CDC) for the use of standard precautions for the care of patients in all health care settings. excretions. and skin with cuts.indd 168 11/08/12 12:26 AM . These standards state that health care organizations must provide workers with information on what bloodborne pathogens are and how to prevent exposure to or contact with them. secretions. Standard precautions help prevent the spread of bloodborne pathogens from patient to health care worker and from health care worker to patient.S.V(2) Author’s Certifications: ACSM-PD The Occupational Safety and Health Administration (OSHA) developed Bloodborne Pathogen Standards for health care workers to decrease their risk of accidental contact with bloodborne pathogens. MS CES. and con- taminated items. True or False: A health care organization should nization’s Bloodborne Pathogen Exposure Control develop a Bloodborne Pathogen Exposure Control Plan is to reduce an employee’s risk of exposure to Plan after 60% of its employees have been exposed radiation. Unless otherwise directed. contami- nated items. 2. Dwyer_Part3_Sec7. Gown Use during procedures and patient care activities when contact of clothing or exposed skin with blood. or other openings.V(3) Author’s Certifications: ACSM-PD Use standard precautions when providing patient care or while handling items that may be contaminated with blood and body fluids. body fluids. body fluids. 168 CERTIFICATION REVIEW • www. or excretions may occur.osha. body fluids. after removing gloves. to bloodborne pathogens. To find out more about the OSHA’s requirements about bloodborne pathogens and an organization’s exposure control plan you may see this OSHA Web site: www. excretions.gov TRUE OR FALSE AND MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. An organizational Bloodborne Pathogen Exposure Control Plan should be developed to communicate information to employees about the following: • Bloodborne pathogens • Risk of exposure • How your organization plans to decrease and eliminate exposure to bloodborne pathogens • Hepatitis B vaccinations • Postexposure evaluation and follow-up • Communication of hazards to employees The exposure control plan should outline your risk of exposure to bloodborne pathogens based on the tasks you perform as an employee. Maynard. abrasions. secretions. MS CES. Maynard.org CASE STUDY Author: Timothy S. mucous membranes. Gloves Use when touching blood. CASE STUDY Author: Timothy S. True or False: The purpose of a health care orga. you should use standard precautions with every patient. CES Hand hygiene Perform after touching blood.V(2) 1. and between patient contacts. Standard Precautions Recommendations from the U. secretions.acsm. resuscitation bag.cdc. control especially frequently touched surfaces in patient care areas. clean. When using engineering controls. eye protection Use during procedures and patient care activities that are likely to cause (goggles). body fluids. For nurses. organi- CES zations should tell health care workers when to use warning labels and how to recognize contaminated material. Dwyer_Part3_Sec7. Use safety features when available. Labels OSHA requires that health care organizations educate workers on the disposal of waste that is contaminated with blood and body fluids. needlesticks during IV therapy are the most common cause of exposure to blood. Environmental Routinely care for. Patient placement Make it a priority to place a patient in a single-patient room if the patient is at increased risk for spreading an infection to others. or hand manipulate used needles. or maintain separation greater than 3 ft of space if possible. does not main- tain appropriate hygiene. Source: http://www. Place used sharps in a puncture-resistant container. or ship blood or other potentially infected materials The labels and signs should be fluorescent orange or orange-red. transport. Examples of engineering controls include the following: • Sharps disposal containers • Self-sheathing or retractable needles • Needleless intravenous (IV) systems A number of these controls isolate or remove the risk for exposure to bloodborne patho- gens using safety mechanisms. SECTION 7 CES Case Studies 169 Standard Precautions (cont. Patient Use a mouthpiece. or secretions. with lettering and sym- bols in a contrasting color. use a one-handed scoop technique only.gov Engineering Controls Engineering controls are used to reduce workplace exposure to bloodborne pathogens. especially during suctioning and endotracheal intubation. sharps If recapping is required. or is at increased risk for acquiring infection or developing an adverse outcome following an infection. Respiratory Instruct symptomatic persons to cover their mouth and nose when hygiene and cough sneezing or coughing. and disinfect environmental surfaces. OSHA recommends using warning labels on the following: • Containers of regulated waste • Refrigerators and freezers containing blood or other material that may be infected • Containers used to store. face shield splashes or sprays of blood. and perform hand hygiene.) Mask. perform hand hygiene after soiling of hands with respiratory secretions. Communicating Hazards to Employees Health care organizations must provide information to workers on the risks for exposure to bloodborne pathogens and methods for safe disposal of contaminated waste. Soiled patient care Handle in a manner that prevents transfer of microorganisms to others equipment and to the environment. Red bags or red containers may be substituted for labels. wear a surgical mask if tolerated. Needles and other Do not recap. and other ventilation devices to resuscitation prevent contact with mouth and oral secretions. bend. break.indd 169 11/08/12 12:26 AM . wear gloves if visibly contaminated. Material and Handle in a manner that prevents transfer of microorganisms to others laundry and to the environment. you should also use per- sonal protective equipment (PPE) to eliminate the risk of exposure to bloodborne pathogens. use tissues and dispose of them in a no-touch etiquette receptacle. As part of meeting this requirement. Exposure Incident What to Do Hands or skin Immediately wash the area with soap and water. hepatitis B virus.osha. laceration. What type of germ is a bloodborne pathogen? A) A germ that is carried in the blood that can 5. abrasion. hepatitis B virus. Which example of a work practice control decreases cause disease the risk of exposure to bloodborne pathogens? B) A germ that everyone is born with A) Recapping used needles as soon as possible C) A germ normally found in blood products B) Eating your lunch at your work station D) A cancer-causing germ C) Sorting dirty laundry. preventive treatment may be necessary and must be started within only a few hours of the exposure. and HIV Dwyer_Part3_Sec7.org Your organization also communicates about your risk for exposure to bloodborne patho- gens through information and training sessions. and HIV D) Flu virus.gov MULTIPLE-CHOICE QUESTIONS FOR CASE STUDY CES. and hepatitis C virus resistant container B) Poison ivy. in a patient’s room 3. or other mucosal surface • Needlestick. Any exposure incident Notify your supervisor of the exposure incident immediately. Which practice is included in standard precautions? 4. hepatitis C virus. or other piercing of the skin by an object contaminated with blood or other body fluids • Contact with contaminated blood or body fluid that enters a cut. Mucous membranes Flush the exposed area with water.V(3) 1.indd 170 11/08/12 12:26 AM . The exposure control plan should tell you about the free postexposure evaluation and follow-up care provided by your organization.acsm. 170 CERTIFICATION REVIEW • www. Which situation describes an exposure incident to a A) Using gloves when handling blood or body fluids potential bloodborne pathogen? to prevent exposure to bloodborne pathogens A) Testing blood glucose from a finger stick on a and washing hands between patient contacts patient with hepatitis B B) Wearing masks for every patient-related activity B) Touching the blood of a patient infected with C) Wearing shoe covers at all times to protect HIV with gloved hands shoes from contamination C) A splash of blood on intact skin D) Wearing eye protection at all times D) An accidental needlestick while changing a patient’s bed linens 2. hepatitis E virus. The patient involved in the exposure may require testing. mouth. or other lesion on your skin • Your organization’s exposure control plan describes specific steps to follow when you are exposed to contaminated substances in the workplace. In some cases. Source: http://www. such as bed linens. and human immu- nodeficiency virus (HIV) C) Hepatitis B virus. Training should address the following: • Your risk for exposure to bloodborne pathogens • Methods to reduce and eliminate exposure to bloodborne pathogens • What you should do if you are exposed to bloodborne pathogens What Is an Exposure Incident? An exposure incident happens when you have direct contact with blood or body fluid through the following: • Splash or spray to your eyes. Which viruses are bloodborne pathogens? D) Placing used needles and sharps in a puncture- CES A) TB. The postexposure evaluation and follow-up are confidential. ECG(1) 1) What is the rate? ____________________________ 3) Interpret the rhythm. BP ⫽ 102/84 mm Hg. What information must be included in your health exposure to bloodborne pathogens care organization’s exposure control plan? A) Your risk for exposure to bloodborne pathogens 10 How are bloodborne pathogens spread from an B) The needle size for different patient care infected person to a noninfected person? procedures A) Rough broken or open skin and mucous C) The correct steps to take to clean a patient’s room membranes D) How to draw blood from a patient B) Through contaminated air C) Through contact with personal items. II SHORT-ANSWER QUESTIONS FOR CES. What is the purpose of an exposure control plan? B) Patients who receive care within the health care A) To decrease the spread of the common cold organization among health care workers C) Nonmanagerial employees who are responsible B) To decrease the exposure of health care for direct patient care workers to secondhand smoke D) Materials management employees responsible C) To increase the use of contact precautions in for stocking supplies health care organizations D) To eliminate or decrease health care workers 7. ________________________ 2) Regular or Irregular? _________________________ CES Dwyer_Part3_Sec7.indd 171 11/08/12 12:26 AM . and Clinton A. PhD. CAB: ACSM-RCEP. His vitals are as follows: weight ⫽ 230 lb. such as 8.ECG(1) Authors’ Certifications: DK: ACSM-CES. ACSM-CES A 75-yr-old male patient with a recent history (2 mo ago) of coronary bypass surgery pres- ents to cardiac rehabilitation for his initial visit with the following rhythm. who must give input for C) Contact precautions decisions about safety devices? D) Health care precautions A) Leaders within the organization who make purchasing decisions 9. FACSM CES. Brawner (CAB). Which type of precautions must be followed for the telephone every patient whom you come in contact with? D) Through contaminated water A) Airborne precautions B) Standard precautions ECG CASE STUDIES Authors: Dennis Kerrigan (DK). SECTION 7 CES Case Studies 171 6. MS. According to OSHA. ECG(1) 1) Name the medication usually prescribed that C) CO is reduced. ACSM-CES A patient with a history of cardiac arrest and MI is walking on the treadmill in cardiac rehabilitation when you observe this rhythm. A) Lisinopril assuming he performed a sign. MS.ECG(2) Authors’ Certifications: DK: ACSM-CES. what actions should be taken? dysrhythmia? A) Continue to monitor. and grab the auto.acsm. PhD. B) Anxiety/stress C) Call an emergency code. What might be some potential causes of this dysrhythmia. and Clinton A. arrhythmia? 3) How should exercise be prescribed in this patient.org MULTIPLE-CHOICE QUESTIONS FOR CES. FACSM CES. Brawner (CAB). Assuming this patient has a history of this 2.ECG(2) 1) What is the underlying rhythm? _______________ 2) What is the dysrhythmia? ___________________ MULTIPLE-CHOICE QUESTIONS FOR CES. B) The “atrial kick” has negligible effect on CO.ECG(2) 1. D) All of the above D) Slow treadmill speed and call physician.indd 172 11/08/12 12:26 AM . 172 CERTIFICATION REVIEW • www. CES Dwyer_Part3_Sec7. CAB: ACSM-RCEP. Authors: Dennis Kerrigan (DK).and symptom- B) Warfarin limited exercise stress test prior to cardiac C) Metoprolol rehabilitation? D) Simvastatin A) RPE 2) What effect does this arrhythmia typically have on B) An HR 20–30 beats above rest cardiac output (CO)? C) 50%–85% of HRR A) CO is elevated due to the increased contractions D) The patient should not exercise with this in the atria. A) Caffeine B) Stop the exercise immediately. arrhythmia. C) Forgetting to take medications matic defibrillator. II SHORT-ANSWER QUESTIONS FOR CES. prevents a common complication due to this D) None of the above. CAB: ACSM-RCEP. course of action would you follow? D) Contact referring physician to verify the test A) Proceed with the stress test using a low-level ordered. PhD.ECG(3) Authors’ Certifications: DK: ACSM-CES. Brawner (CAB). Assuming the patient is asymptomatic at rest.and symptom-limited exercise stress test with ECG to evaluate a recent episode of angina while performing yard work. treadmill protocol. FACSM CES. CES Dwyer_Part3_Sec7. this could indicate an acute MI. what C) Attempt Valsalva maneuver.indd 173 11/08/12 12:26 AM .ECG(3) 1) What is the rate? ____________________________ 3) Interpret the ECG. 2. SECTION 7 CES Case Studies 173 Authors: Dennis Kerrigan (DK). and Clinton A.ECG(3) 1. ACSM-CES A 52-yr-old male without a history of heart disease is scheduled in your laboratory for a standard sign. MS. If the aforementioned patient B) Send patient directly to emergency presented with the observed ECG abnormality AND department. __________________________ 2) Regular or Irregular? _________________________ TRUE OR FALSE AND MULTIPLE-CHOICE QUESTIONS FOR CES. 12-Lead manual (simultaneous) I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II Speed 25 mm/sec Gain 10 mm/mV SHORT-ANSWER QUESTIONS FOR CES. True or False. severe chest pain. ECG(4) Authors’ Certifications: DK: ACSM-CES. 2. PhD. MS. Which of the following medications for what might you suspect? hypertension is he likely NOT taking A) Second-degree atrioventricular (AV) block. The following ECG was taken during stage IV of the Bruce protocol. you observe for the first time the following on the ECG. MS. 174 CERTIFICATION REVIEW • www.ECG(4) 1.ECG(5) Authors’ Certifications: DK: ACSM-CES. If the aforementioned ECG was taken during rest. ________________________ 2) Regular or Irregular? _________________________ MULTIPLE-CHOICE QUESTIONS FOR CES. PhD.org Authors: Dennis Kerrigan (DK).ECG(4) 1) What is the rate? ____________________________ 3) Interpret the rhythm. Brawner (CAB). ACSM-CES A 42-yr-old male with hypertension is undergoing a symptom-limited exercise stress test on a treadmill in response to a recent episode of syncope he experienced while running. II SHORT-ANSWER QUESTIONS FOR CES. FACSM CES. ACSM-CES A 53-yr-old female with ischemic cardiomyopathy is performing a symptom-limited exer- cise stress test in your laboratory. During stage III of the Naughton protocol. and Clinton A. CES Dwyer_Part3_Sec7. A) ACE inhibitor type I B) Diuretic B) Supraventricular tachycardia (SVT) C) Angiotensin 2 receptor antagonists C) Ventricular tachycardia D) ␤-blocker D) Both A and B 3. FACSM CES. and Clinton A. Based on the ECG alone and information given earlier.indd 174 11/08/12 12:26 AM . CAB: ACSM-RCEP.acsm. should the stress test be stopped? A) Yes B) No Authors: Dennis Kerrigan (DK). CAB: ACSM-RCEP. Brawner (CAB). ECG(5) 1) What is the rate? ____________________________ 3) Interpret the rhythm _________________________ 2) Regular or Irregular? _________________________ MULTIPLE-CHOICE QUESTIONS FOR CES. Authors: Dennis Kerrigan (DK). C) They are junctional beats. __________________________ 2) Regular or Irregular? _________________________ Dwyer_Part3_Sec7. What can be said about the ectopic beats? A) Stop the test immediately. ACSM-CES A 16-yr-old hockey player has an ECG as part of his preparticipation screening.ECG(5) 1. MS. C) Take an immediate BP.indd 175 11/08/12 12:26 AM . D) Administer a sublingual nitroglycerin.ECG(6) 1) What is the rate? ____________________________ 3) Interpret the ECG. The following is his resting ECG. B) Continue with the test. PhD. CAB: ACSM-RCEP.ECG(6) Authors’ Certifications: DK: ACSM-CES. D) They are both ventricular and supraventricular in nature. A) They are multifocal. 12-Lead manual (simultaneous) I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II Speed 25 mm/sec Gain 10 mm/mV CES SHORT-ANSWER QUESTIONS FOR CES. and Clinton A. B) They are unifocal. Brawner (CAB). What course of action should you take? 2. FACSM CES. SECTION 7 CES Case Studies 175 SHORT-ANSWER QUESTIONS FOR CES. Brawner (CAB). B) The athlete will likely play hockey next year after receiving treatment. Authors: Dennis Kerrigan (DK). ________________________ 2) Regular or Irregular? _________________________ TRUE OR FALSE AND MULTIPLE-CHOICE QUESTIONS FOR CES. what will likely happen with C) The athlete will no longer be able to participate this athlete? in sports.ECG(7) Authors’ Certifications: DK: ACSM-CES. MS. What are the testing implications of this ECG? effect on the test. Brawner (CAB). PhD. tachycardia. evaluation before returning to play. ACSM-CES A 32-yr-old apparently healthy male cyclist is self-referred for a maximal exercise test to assess his V̇O2peak and anaerobic threshold in preparation for an upcoming race. a V̇O2peak will be directly responsible for the rate. D) The athlete will likely undergo additional out any further workup. Dwyer_Part3_Sec7.ECG(8) Authors’ Certifications: DK: ACSM-CES. True or False.indd 176 11/08/12 12:26 AM . FACSM CES. A) The athlete will be cleared to participate with. The fol- lowing is his resting ECG. C) This is a benign finding. While on the recumbent cycle. Authors: Dennis Kerrigan (DK).acsm. CAB: ACSM-RCEP. FACSM CES.ECG(7) 1) What is the rate? ____________________________ 3) Interpret the rhythm. Based on the ECG.ECG(6) 1. 176 CERTIFICATION REVIEW • www. CAB: ACSM-RCEP. MS. A) Physician should be notified due to the D) There is a slight risk for atrial reentry likelihood of a complete heart block. blunted. you see the following on the monitor. The length of the PR interval is B) Due to the decreased CO. and Clinton A. and Clinton A. ACSM-CES CES An 84-yr-old female is exercising in cardiac rehabilitation for the first time.org MULTIPLE-CHOICE QUESTIONS FOR CES. PhD.ECG(7) 1. which will have no 2. II SHORT-ANSWER QUESTIONS FOR CES. B) Ventricular tachycardia B) Her pacemaker would interfere with an C) Third-degree AV block echocardiogram. D) Both A and C C) If present.ECG(8) 1. ischemia would not be undetectable by ECG alone due to the pacemaker depolarization. ________________________ 2) Regular or Irregular? _________________________ Dwyer_Part3_Sec7.indd 177 11/08/12 12:26 AM . FACSM CES. he complains of jaw pain and nausea. Why was the nuclear imaging specified? A) Sick sinus syndrome A) She is unable to walk very long on a treadmill. pain. You place him in a semisupine position with the upper body slightly elevated and attach an ECG. SECTION 7 CES Case Studies 177 SHORT-ANSWER QUESTIONS FOR CES.ECG(9) 1) What is the rate? ____________________________ 3) Interpret the rhythm. During her first three visits. her physician sends her for a Authors: Dennis Kerrigan (DK). Which of the following conditions might be the symptom-limited exercise stress test with nuclear reason she received a pacemaker? imaging. ________________________ 2) Regular or Irregular? _________________________ MULTIPLE-CHOICE QUESTIONS FOR CES. MS. ACSM-CES A 64-yr-old male with a history of an MI and stent 15 yr ago is exercising in your phase 3 car- diac rehabilitation program.ECG(9) Authors’ Certifications: DK: ACSM-CES. CAB: ACSM-RCEP. she experiences chest D) All of the above.ECG(8) 1) What is the rate? ____________________________ 3) Interpret the rhythm. While on the treadmill. and Clinton A. 2. PhD. 12-Lead manual (simultaneous) I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 II CES 25 mm/sec 10 mm/mV SHORT-ANSWER QUESTIONS FOR CES. Brawner (CAB). As a result. Which of the following medications may improve 2. and Clinton A.ECG(10) 1. Based on the ECG. A) Low blood glucose C) Prepare the crash cart.org MULTIPLE-CHOICE QUESTIONS FOR CES. Your patient suddenly loses consciousness. what was likely the cause of this? B) Notify the physician. While seated in recovery.acsm.ECG(10) Authors’ Certifications: DK: ACSM-CES. what regions of the heart are his jaw pain? ischemic? A) Nitroglycerin A) Inferior B) Plavix B) Septal C) Epinephrine C) Lateral D) Both A and C D) Both A and C Authors: Dennis Kerrigan (DK). FACSM CES.indd 178 11/08/12 12:26 AM . Brawner (CAB). What actions should you take? 2. II V5 25mm/s 10mm/mV 150Hz 7. you notice a change in the ECG. ________________________ 2) Regular or Irregular? _________________________ MULTIPLE-CHOICE QUESTIONS FOR CES. MS. PhD. A) Check the patient. 178 CERTIFICATION REVIEW • www. C) Seizure D) Low CO CES Dwyer_Part3_Sec7. B) Vasovagal response D) All of the above.1 12SL 237 CID: 2 SHORT-ANSWER QUESTIONS FOR CES.ECG(9) 1. ACSM-CES A 58-yr-old female has just completed a low-level exercise test as a predischarge require- ment following an ST elevated MI a few days ago. CAB: ACSM-RCEP.1.ECG(10) 1) What is the rate? ____________________________ 3) Interpret the rhythm. Resource: Pescatello LS. and Wilkins. Decreases his exercise HR Case Study CES. 2014. If exercise test data is available. 2014.I 9th ed. Baltimore (MD): Lippincott Williams Guidelines for Exercise Testing and Prescription. Baltimore (MD): Lippincott Williams and Wilkins.indd 179 11/08/12 12:26 AM . 2014. 2014. working to improve his body composition and glu- cose control through exercise and diet.33:e147–e167. which 1—B. All of Greg’s medication classes may have acute All speed units for equations should be in units adverse side effects during exercise. 4—C. senior editor. ACSM’s be prescribed at a workload below the ischemic Guidelines for Exercise Testing and Prescription. exercise should Resource: Pescatello LS. and GXT with physician supervision Resource: Pescatello LS. 3—D. and 3—C. tolerated. senior editor. CES be prescribed at an HR below the ischemic 9th ed. Baltimore (MD): Lippincott Williams goal should be to increase his physical activity as and Wilkins. senior editor.II(1) Multiple-Choice Answers for Statin drugs may commonly produce muscle Case Study CES. With his high body fat. ACSM’s If exercise test data is available. Baltimore (MD): Lippincott Williams and Wilkins. Drew’s main 9th ed. Baltimore (MD): Lippincott Williams and Wilkins. ⬍124 bpm Resource: Pescatello LS. senior editor. SECTION 7 CES Case Studies 179 CES CASE STUDIES ANSWERS AND EXPLANATIONS CASE STUDY CES. especially during rest. Resource: Pescatello LS. 2014. 2014. 9th ed. senior editor. 2014. ACSM’s 1. Signed informed consent form. senior editor.II(1) soreness and/or patients can develop rhabdo- myolysis (a muscle wasting condition). senior editor. 6 MET would affect exercise performance. of meter per minute. By Care. Baltimore (MD): Lippincott Williams threshold (⬍10 bpm). et al. Calculations: 9th ed. 2010.0 mph and 6. and Wilkins. 2014. ACSM’s 9th ed.I Multiple-Choice Answers for Case Study CES. Baltimore (MD): Lippincott Williams Note that nitrates may cause an increase in HR.5% grade Guidelines for Exercise Testing and Prescription. 3. CASE STUDY CES. 9th ed. The ACSM’s metabolic equation for walking is most accurate for speeds of 1. which is converted when Dwyer_Part3_Sec7. 5—A. ACSM’s Guidelines for Exercise Testing and Prescription. ACSM’s 5—B. Preparation also work to improve his BP. threshold (⬃1 MET). medical clear. diabetes related to his excess body fat. Discussion Question Answer for 2—B. 1—D. he Association: Joint Position Statement Diabetes is at high risk for cardiovascular disease (CVD).7 mph. exercise should Guidelines for Exercise Testing and Prescription.I Resource: Pescatello LS. Drew’s main concern at this juncture is his likely Guidelines for Exercise Testing and Prescription. Drew will 4—C.9–3. Silent ischemia ance from physician. 2—B. senior editor. An HbA1C test to improve his glucose control and body composi- Resource: Colberg SR. to maximize his caloric expenditure. Exercise and tion. his fasting glucose strongly suggests that Sports Medicine and the American Diabetes he has a Type 2 diabetes. Although Drew’s BP is in the “prediabetes” Type 2 Diabetes: The American College of category. Resource: Pescatello LS. ACSM’s Guidelines for Exercise Testing and Prescription. and Wilkins. Resource: Pescatello LS. Baltimore (MD): Lippincott Williams and Wilkins. ACSM’s Guidelines for Exercise Testing and Prescription. Antiangina medications 9th ed. 8.8 ⫻ Work Rate kgm ⴢ min⫺1) / 80.4 mL ⴢ kg⫺1 ⴢ min⫺1 Guidelines for Exercise Testing and Prescription. 3.8 ⫻ Work Walking Horizontal Rate kgm ⴢ min⫺1) / 80. for Cycle Ergometer Horizontal Component ⫽ example. functional capacity (FC) or the workload in 9th ed. 180 CERTIFICATION REVIEW • www.8 ⫻ speed ⫻ grade ⫽ 1.indd 180 11/08/12 12:26 AM . kg⫺1 ⴢ min⫺1 9th ed. min⫺1 ⫽ Resistance ⫹ Horizontal ⫹ Resting Workload Equivalent ⫽ 6 MET 18.5 Resting Component ⫽ 3.1 ⫻ (3. The vertical compo- nent equation is NOT valid for the metabolic Cycle Ergometer Total Equation mL ⴢ kg ⴢ cost of ground walking or running on grades.17 ⫽ Work Rate kgm ⴢ min⫺1 Walking Vertical 7—D.4 mL ⴢ kg⫺1 ⴢ min⫺1 534. senior editor. either the Guidelines for Exercise Testing and Prescription.1 ⫻ speed ⫽ 0. All grades should be in decimal form.1 MET] ⫽ 18. ACSM’s MET ⫽ 21.1 ⫻ 80.8 kg Dwyer_Part3_Sec7.1 MET ⫽ 6 MET ⫻ 3. 2014.9 mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ (1.200 kgm ⴢ min⫺1. Therefore.0 mph ⫻ 26.0 MET ⫺ 1.8 ⫻ Work Rate kgm ⴢ min⫺1)/Body Mass kg on a grade on a treadmill.9 % ⫽ 80.9 mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ (1. 535 kgm ⴢ min⫺1 9—B. metabolic equation is most accurate for work rates of 300–1. 55% Calculations: Workload Equivalent (Treadmill) ⫽ 6 MET Maximum FC ⫽ 10.5 ⫹ 3.3 mL ⴢ kg⫺1 ⴢ Initial load should allow 12–15 repetitions that min⫺1 can be lifted comfortably (⬃30%–40% of 1-RM for the upper body.acsm.5 mL ⴢ kg⫺1 ⴢ min⫺1 The vertical component is only valid for estimat- Cycle Ergometer Resistance Component ⫽ ing the metabolic cost of walking and running (1.0 MET Ergometer) ⫽ 21.3 mL ⴢ kg⫺1 ⴢ min⫺1/3. senior editor.454 ⫽ 54.5 mL ⴢ kg⫺1 ⴢ min⫺1 26.8 ⫻ 80.0 mL ⴢ kg⫺1 ⴢ min⫺1 CES ⫽ 9. 30%–40% V̇O2 mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ 3.5 mL ⴢ the lower body). Baltimore (MD): Lippincott Williams ⫽ 6. 2014.9 mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ 0. Baltimore (MD): Lippincott Williams V̇O2 mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ Resting ⫹ Walking and Wilkins. 10—B. 2014.4 m ⴢ min⫺1 Rate kgm ⴢ min⫺1 ⫽ 8.1 MET ⫺ 1 MET ⫽ 21.08 MET and Wilkins. senior editor.065 Resource: Pescatello LS. Baltimore (MD): Lippincott Williams MET needs to be reduced by 10%–15%. ACSM’s ⫽ 9.1 MET Workload Equivalent (Cycle Maximum Workload Question 1 ⫽ 6.8) 961 mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ 1.8 kg Component ⫽ 0.90 (10% reduction) V̇O2R% ⫽ [(6.15.549 ⫽ 0.5 mL ⴢ Guidelines for Exercise Testing and Prescription. 12–15 RM Component ⫽ 1. Horizontal ⫹ Vertical Components 8—B.5 ⫹ 8.0 mL ⴢ kg⫺1 ⴢ min⫺1 ⫻ 0. 9th ed.4 ⫹ 9. The and Wilkins.8 kg ⫹ 3. ACSM’s less on a cycle ergometer. 15% ⫽ 0.8 ⫻ Work ⫽ 0.4 ⫽ 21.5 V̇O2R ⫽ 10. 6—C. 2–4 MET Calculations: Initial MET level of exercise for a patient with If the initial GXT was completed on a treadmill. heart disease with no exercise or pharmaco- then the conversion to similar physiological logic test available should be 2–4 MET. aerobic stress will be approximately 10%–15% Resource: Pescatello LS. kg⫺1 ⴢ min⫺1 Resource: Pescatello LS.549 ⫻ 100 Greg’s Body Weight ⫽ 178 lb ⫻ 0.org you multiply miles per hour by the constant Resting Component ⫽ 3.4 m ⴢ min⫺1 ⫻ .0 MET) / 9. ⬃50%–60% of 1-RM for MET ⫽ V̇O2 mL ⴢ kg⫺1 ⴢ min⫺1/3.5 mL ⴢ kg⫺1 ⴢ min⫺1 11. 9th ed. 2. VLDL Effect of exercise alone on blood chemistries: 2. 6—C.0 mph and 2% grade 2—B. VLDL and/or anginal threshold 2. and Prescription. Outline of Discussion 1. 9th ed. Do you have SOB any other time other than Testing and Prescription. 5—D. 103–122 bpm (50%–85% of HRR) 9th ed. LDL • Total cholesterol 3. Baltimore (MD): walking up the hills? Lippincott Williams and Wilkins. 105.II(2) Resource: American College of Sports Medicine. Metabolic syndrome Case Study CES. 8—C. 3–5 d ⴢ wk⫺1 7—C.632 min Resource: Pescatello LS. 16. senior editor. Moderate risk Lippincott Williams and Wilkins. Baltimore (MD): Lippincott Williams and Wilkins. HDL • ␤-blockers’ possible effect on plasma glucose • Triglycerides • Statin drugs possible effect on liver enzymes • Plasma glucose 2. reserve Baltimore (MD): Lippincott Williams and Resource: Pescatello LS. ACSM’s Resource Manual for Guidelines for 1—B. 2014.II(2) Multiple-Choice Answers to 4—A. Weight loss. 7th ed. senior editor. ACSM’s Resource Manual for Guidelines for Exercise 1. Case Study CES. HDL • Cholesterol subfractions • Triglycerides 1. 2014. 2014. SECTION 7 CES Case Studies 181 Discussion Question Answers for Drug effect on blood chemistries: Case Study CES. LDL Concerns of drug side effects on blood chemistries: 3.000 cal. Moderate risk with more than one risk factor Discussion Question Answers for but undiagnosed heart disease. and Prescription. 2014. Baltimore (MD): 3—B. moderate ACSM’s Guidelines for Exercise Testing Resource: Pescatello LS. senior editor. Baltimore (MD): ACSM’s Guidelines for Exercise Testing Lippincott Williams and Wilkins. Dwyer_Part3_Sec7. Guidelines for Exercise Testing and Prescription.II(1) • Total cholesterol • Cholesterol subfractions 1.II(2) Resource: American College of Sports Medicine.indd 181 11/08/12 12:26 AM . 50%–85% of one’s maximal oxygen uptake Exercise Testing and Prescription. gradually increasing duration and frequency with the goal of increasing energy CES expenditure for weight loss. VLDL • Plasma glucose 2. 7th ed. LDL • Effect of exercise training on RPP indices 3. Outline of Discussion Effect of fat loss alone on blood chemistries: • Contributive indices to rate-pressure product • Total cholesterol (RPP) calculation • Cholesterol subfractions • Physiology of relationship of RPP to ischemic 1. Are you interested in quitting smoking? 2. 2014. 3. HDL • Use of RPP for exercise mode changes • Triglycerides • Use of RPP for exercise progression • Plasma glucose CASE STUDY CES. ACSM’s Wilkins. 2014. The Bruce protocol equation Resource: American College of Sports Medicine. 6—B. senior editor. senior editor. and Wilkins. 1. 2014. Baltimore (MD): Lippincott Williams need to be lower than on the treadmill especially at and Wilkins. it’s nearly impossible to determine grade on 9th ed. ACSM’s 2. Baltimore (MD): to use a handrail equation if the client holds on Lippincott Williams and Wilkins.0 mph and 0% grade comes closest to 4 MET: Guidelines for Exercise Testing and Prescription. Lippincott Williams and Wilkins. most roads. It is likely that the workload will 9th ed. MET level of ⬎7 MET metabolic systems but is designed to be used with steady-state exercise. Guidelines for Exercise Testing and Prescription. Resource: Pescatello LS. Resource: Pescatello LS. Severe Case Study CES. Walking track dynamics If a track is available and slow walking can be B.acsm. the onset of the program. 2014. ACSM’s 9th ed. senior editor. ACSM’s and Wilkins. and gluteal muscles 9th ed.indd 182 11/08/12 12:26 AM . Quadriceps. Discussion Question Answers for 9th ed. ACSM’s 4. 2014. Baltimore (MD): Lippincott Williams Case Study CES. Guidelines for Exercise Testing and Prescription. 5—C.org CASE STUDY CES. 9th ed. ACSM’s Guidelines for Exercise Testing and Prescription. CASE STUDY CES. 2–4 d ⴢ wk⫺1 Dwyer_Part3_Sec7. Remember Testing and Prescription. an appropriate exercise intensity.II(3) and Wilkins. The one your patient most enjoys or RPE as an adjunct method for monitoring at Assuming the equipment is available. so it’s important to give an ap- proximate speed and have them use HR ranges 2—D. 2014. senior editor. Lowest risk. leg ergometer. Resource: Pescatello LS. No. Baltimore (MD): Lippincott Williams and Wilkins. senior editor.II(3) Multiple-Choice Answers to 5—C. 25 W. None of the above 9th ed. Baltimore (MD): Lippincott Williams Resource: Pescatello LS. ever. 150 kg ⴢ m ⴢ min⫺1 A. 7—A. 9th ed. B and C gested or titration of oxygen saturation to HR Resource: Pescatello LS. senior editor. Baltimore (MD): Lippincott Williams and Wilkins. treadmill as a Resource: Pescatello LS. Attempt to improve respiratory muscle 2—A. hamstrings.II(4) Multiple-Choice Answers for 3—C. For moderate-to-severe COPD CES accomplished without desaturation. helps to maintain the ability to perform ADL.II(4) Resource: Pescatello LS. 60%–80% of peak work rates are sug. ACSM’s backup. ACSM’s Guidelines for Exercise Testing and Prescription. 2014. how. to the handrail during the test for a more accurate 4—D. ACSM’s monitoring or HR to dyspnea scale. 25 W 1—A. Weight-bearing exercises (such as walking) Guidelines for Exercise Testing and Prescription. 182 CERTIFICATION REVIEW • www. 4—D. Very high risk estimation. senior editor. 7th ed. He is not used to exercising especially on a lower Guidelines for Exercise Testing and Prescription. 4. 1—D.0 mph and 0% grade Resource: Pescatello LS. 2014. and Wilkins. The ACSM’s equation is used by many 3—A. is the most appropriate estimate of peak oxygen ACSM’s Resource Manual for Guidelines for Exercise consumption while using this protocol. 2014. Baltimore (MD): Lippincott Williams Guidelines for Exercise Testing and Prescription. 83–104 bpm (40%–80% of HRR) Case Study CES. Weight reduction 7—C. senior editor. Baltimore (MD): Lippincott Williams No exercise intensity has been defined. 2014.II(3) 6—C. ECG. The DASI: V̇O2peak (mL ⴢ min ⴢ kg⫺1) ⫽ 0. 1998. HR/BP response.indd 183 11/08/12 12:26 AM .18:458–63. walking is a weight-bearing exercise and SOB seems to be the limiting factor. J Cardiopulm Rehabil. It is likely that she will be able to work at a slightly exercise for the duration of exercise without de- higher intensity while walking because she has saturating ⱕ88%. sity was lowered if abnormal responses were ECG. so the bottom line is that the the patient to adjust to very low workload levels exercise intensity will need to be titrated to a work. The DASI may represent another intensities were chosen based on an interview tool useful in programming for patients with assessing activity in in-patient. J Cardiopulm Rehabil.64:651–4. Laubach CA. activity after heart disease.II(4) (V̇O2R) levels to prescribe intensity. workloads should be adjusted to make sure the patient can 1. Resource: Hlatky MA. In this case. In these cases.43 ⫻ gressed as well as those with preentry exercise (sum of weights for “yes”) ⫹ 9. and signs/symp. Klinger TA. and signs/symptoms detected. accordingly. Cardiac with you in the outpatient setting. patients. Hauck CA. Giving this Success of such practices depends on the knowl- individual an intensity of 2–4 MET would be only edge and skill of the clinical exercise physiologists. according to McConnell and col. and hemodynamic responses. There are several scenarios when exercise test- ing is not given prior to beginning outpatient 3—B. ECG. Cardiac rehabilitation without exercise tests 1—C. Use a pulse oximeter to monitor been walking but not using a lower leg ergometer. Gardner Case Study CES. RPE. estimated V̇O2peak is high. 6–8 MET cardiac rehabilitation. A brief self- 2–3 MET and was titrated to exhibit an RPE administered questionnaire to determine CES of 11–14. capacity based on daily physical function. 15%–31% of his physical work capacity. CASE STUDY CES.1 p. discharge. 2–4 MET not mentioned in the current edition of the How were these guidelines formed? The initial ACSM’s GETP.6 tests. also based on the signs/symptoms. oxygen saturation during exercise. 70%–85% was chosen based on Table 9. patients without preentry exercise tests pro. estimated V̇O2peak (mL ⴢ min ⴢ kg⫺1) ⫽ emergency medical management occurred for 44. no events requiring Thus. The progressions were 0.II(5) JK.7 MET those without preentry exercise testing. during exercise at the selected MET. More importantly. the science If you can document the patient’s physical of exercise prescription turns into the “art” of work capacity. functional capacity (the Duke Activity Status toms were monitored throughout the exercise Index).5–1 MET. Herman CE. However. Gardner for optimizing the limited exercise time he has JK. leagues. 1989. Am J Cardiol. After a proper warm-up. Hauck CA. HR. too low Resource: McConnell RR. outpatient setting to monitor the safety of the Dwyer_Part3_Sec7. 1998. The inten- 4—C. session to assure normal responses. An intensity of rehabilitation without exercise tests for post. In this case. monitor his RPE. bypass surgery patients.II(5) Multiple-Choice Answers for Resource: McConnell RR. SECTION 7 CES Case Studies 183 Discussion Question Answers for 2. may be helpful at the beginning of the exercise load that will allow her to exercise for a longer period program. BP.18:458–63. The DASI estimates physical work According to McConnell and colleagues. Rather than using HRR or oxygen consumption Case Study CES. The RPE stayed at Use all the variables you have available in the 11–14 for the progressions. It should be noted that the use of the DASI is 2—C. the intensity Rx can be adjusted exercise programming at the clinical level. 214. Herman CE. for post-myocardial infarction and post- cause coronary anatomy has been documented. myocardial infarction and post-bypass surgery as the patient was stable and asymptomatic. Klinger TA. so allowing will require more work. Exercise testing was clinically nonessential be.5 mL ⴢ min ⴢ kg⫺1 or 12. Boineau RE. of time without severe dyspnea or desaturation. Their beginning intensity ranged from Higginbotham MB et al. Laubach CA. (Not in guidelines) 40 It is not unusual for a single THR range be 30 given for every physical activity a patient Static Exercise 20 with CVD does in and out of the cardiac Arm Crank rehabilitation program. However. a general THR for all activities. Your focus related to lower exercise intensities (gray and on these variables would be similar to how light red dashed lines) than expected (dark red you monitor and interpret during the exercise dashed line). You 60 should never give him a THR higher than what 50 you’ve documented to be safe. Giving a single THR 10 Cycle Ergometer range for a diversity of physical activity is not 0 0 10 20 30 40 50 60 70 80 90 100 a good for controlling exercise intensity and VO2 Reserve (%) probably should not be done in a nonclini- cal population. 10 Cycle Ergometer tory and an estimated FC. The HR and BP will not exhibit the HEART RATE .edu/~k561/revo2. The less aerobic the exercise and Had she been given a dobutamine stress echocar- the smaller the muscle mass. which a THR could be given. it is often done with Reprinted with permission from http://www. In this case. Dipyridamole does not produce a linear Knowledge and understanding of the HR–V̇O2 increase in HR in which a THR to guide curve is an essential consideration when giving the intensity can be determined. but you will not 90 have increasing intensities up to 85% or max. The ECG is monitored for dysrhythmia and ischemia.org intensity you estimated for him. and abnormal hemodynamic 20 Static Exercise responses. The RPE gives you an idea of his effort. ECG. true for dynamic whole body cardiovascular exercise. 50% intensity is 50% of CES doesn’t provide enough information for an HRR. crease. warm-up. Normal 100 responses mean that the exercise is safe up 90 to the intensity of the workouts in outpatient rehabilitation. In this scenario. HR are given 2–4 MET intensity is appropriate for exer- to guide intensity because the HR is linear cise intensity when the chemical exercise test with V̇O2. the relationship diogram. this relationship only holds exercise prescription. However. Dwyer_Part3_Sec7. based on his medical his.iub the patient with CVD. testing. 0 HR and BP.acsm. You can compare resting. That is. given because it reflects the work of the heart and is given as an upper limit for heart work 6—D. the THR is . there would have been a linear HR in- changes. As illustrated in the figure to the right. In this case.VO2 RELATIONSHIP: RESERVE classic responses to graded exercise (increasing 100 intensities). 50 The purpose of the exercise test is to determine 40 a safe exercise intensity minimizing dysrhyth- 30 mia. 80 Heart Rate Reserve (%) 70 5—C. Give him a THR no higher than the HR he has 60 been exercising at in outpatient rehabilitation. estimated target Arm Crank intensity was given.indd 184 11/08/12 12:26 AM . as illustrated in the following figures. In other words. and signs and symptoms were 0 10 20 30 40 50 60 70 80 90 100 observed when the patient exercised at that VO2 Reserve (%) estimated intensity. Therefore. You can give him this intensity 80 Heart Rate Reserve (%) for activities outside of the outpatient setting or 70 you can give him an intensity 10% lower. the same HEART RATE . 2–4 MET in any situation. Then.VO2 RELATIONSHIP: RESERVE variables observed in an exercise test were ob- served without the formal exercise test. 184 CERTIFICATION REVIEW • www. RPE. ischemia. and target intensity responses. 50% the THR should be set at an HR lower than the as calculated with HR (black dashed line) is ST segment depression or ⫹1 angina exhibited.html. So. do we increase absolute exercise intensity. at 3. If the functioning. A nomogram to predict exercise capacity from HR range (max ⫺ rest) 60 80 a Specific Activity Questionnaire and Clinical Data. Do D. SECTION 7 CES Case Studies 185 7—D.5 MET would be maximal work for her the absolute work rate needs to increase to and 4 MET would be higher than her predicted 4. BP. (See next question. 1994. 214) for a pro- gression in the outpatient setting. If we keep her exercise intensity at 60%.1. Now that 7 EXERCISE she is 7 MET. dicted exercise capacity to find her physical Observe her HR.5 MET stant? Or do we increase both relative and ab- Draw a line from her age to the MET from the solute exercise intensities? questionnaire and extend the line to the pre- The progressions depend on the performance.1) A good question regarding progression in cardiac rehabilitation — Should a progres- How can that be? 2–4 MET is the intensity sion represent an increase in absolute inten- whether she shows abnormalities on a sity or relative intensity? Absolute intensity is myocardial perfusion imaging or doesn’t have the MET expenditure of the activity. For example. whereas any preentry exercise test. Giving her an exercise prescription relative exercise intensity is maintained at 60%. 2–3 MET physical work capacity increases it to 7 MET. 2–4 MET (Table 9. 1 5 4 3 Variable Initial Training 2 1 HRrest (/min) 90 70 HRmax (/min) 150 150 Adapted with permission from Meyer J. Froelicher VF. Am J Cardiol.2 MET (7 MET ⫻ 60%) to be 60% relative exercise capacity. capacity of 5 MET was given an exercise intensity of 60% or 3 MET. her HR range is 70 (rest) to 150 50 8 CAPACITY 6 40 5 7 (METs) (max). ECG. a patient with a physical work signs/symptoms response. the more aggressive the progression 15 METs BY can be. RPE. and signs/ work capacity. After 6 wk. the HR range of this 80 11 10 10 patient was 90 (rest) to 150 (max) when her 70 9 60 8 9 PREDICTED physical work capacity was at 5 MET. Herbert W. Because her Although HRmax does not change in exercise capacity is so low. Each exercise prescription is then titrated based on the HR. her 8—B. can increase in cardiac rehabilitated patients. 3.73:591–6. See the 3 6 20 2 calculations in the following table.5 MET. 30 4 her THR may decrease. and For example. Her predicted exercise capacity symptoms before making any decisions on or physical work capacity is 3.) intensity. THR at 60% (/10 s) 21 19 CES An increase of 1–2 MET is recommended in the ACSM’s GETP (Table 9. Ribisl P. good starting place. Keep her RPE at 11–14 but increase her (HR range ⫻ 60%) ⫹ resting HR 126 118 absolute intensity 1–2 MET. p. relative intensity is the percent intensity for the Intensities of 2–4 MET are conservative and a individual patient. HR range ⫻ 60% 36 48 10—A. increasing the MET in- 13 12 tensity is not always reflected by an increase 90 12 11 in THR. keeping the relative intensity con- 9—B. The more normal the responses. BP. increasing intensity.indd 185 11/08/12 12:26 AM . 3 MET is the intensity of her daily 7 MET) of her physical work capacity. ECG. the symptom-limited HRmax should be closer to the 1 MET than the 2 MET. the MET increase most populations. Because the line is drawn in the 3 MET The 3 MET work rate is now 42% (3 MET / category. Dwyer_Part3_Sec7. 14 AGE QUESTIONNAIRE (years) 13 On the other hand. not increase. and completion related to the following: and Wilkins. Baltimore (MD): Lippincott Williams Guidelines for Exercise Testing and Prescription. 6MWT results with the medical staff.and long-term and Wilkins. ACSM’s Guidelines for Exercise Testing and Prescription. Low body weight (increase upper respiratory improve his FEV1. issues Resource: Pescatello LS. goals that Earl should be trying to achieve through- out his pulmonary program: 4—B. senior editor. Vitamin B and D supplementation to help c. Resource: Pescatello LS. Baltimore (MD): Lippincott Williams • Incorporate nutrition education and Wilkins. ACSM’s Guidelines for Exercise Testing and Prescription. dyspnea survey Guidelines for Exercise Testing and Prescription.III Multiple-Choice Answers for Resource: Pescatello LS. 2014. and Wilkins.org CASE STUDY CES. 9—A. Call Earl’s pulmonologist and discuss his and Wilkins. Baltimore (MD): Lippincott Williams compliance. Collect as much information as possible in • Have physician look at his depression issues your initial assessment about these issues and • Have physician evaluate his SaO2 desaturation contact his physician with this information. 9th ed. Help shrink the swelling and inflammation of and Wilkins. 2014. Baltimore (MD): Lippincott Williams Guidelines for Exercise Testing and Prescription. 2014. 150 Short-term goals of pulmonary rehabilitation program Resource: Pescatello LS. ACSM’s eter test. Baltimore (MD): Lippincott Williams • Increase upper body strength and Wilkins. Baltimore (MD): Lippincott Williams 3—C. 2. 2014. a. 2014. Be deferred until Earl’s pulmonologist provides and Wilkins. Discussion Question Answers to Resource: Pescatello LS. Low compliance if he continues smoking 8—B. 2014. • Increase lower body strength 6—A. 9th ed. Long-term goals of pulmonary rehabilitation program 9th ed. 186 CERTIFICATION REVIEW • www. 2014. • Decrease level of dyspnea 9th ed. Bronchiectasis is structural damage to airway initial assessment. ACSM’s 9th ed. and Wilkins.indd 186 11/08/12 12:26 AM . Travel distance b. 2014. • Decrease depression/stress • Decrease level of dyspnea 5—C. and stretching program for osteoarthritis 7—A. the airways. senior editor. ACSM’s Case Study CES. 30-s sit-to-stand test. ACSM’s • Increase QOL Guidelines for Exercise Testing and Prescription. Underweight • Decrease leg pain with exercise prescription for CES peripheral artery disease (PAD) Resource: Pescatello LS. 2014. senior editor. Baltimore (MD): Lippincott Williams 2—A. senior editor. ACSM’s Guidelines for Exercise Testing and Prescription. Baltimore (MD): Lippincott Williams • Decrease joint pain with exercise prescription and Wilkins. Earl might have problems with program participation. Guidelines for Exercise Testing and Prescription. senior editor. 9th ed. senior editor. follow-up recommendations based upon his 10—D. 9th ed. 9th ed. Baltimore (MD): Lippincott Williams 1.acsm. ACSM’s more lobes of the lung.III Guidelines for Exercise Testing and Prescription. senior editor. The University of California at San Diego • Increase overall body weight/BMI Shortness of Breath Questionnaire • Increase lean body mass • Increase FC and 6MWT distance Resource: Pescatello LS. senior editor. The following are some of the short. senior editor. grip dynamom- Resource: Pescatello LS. Resource: Pescatello LS. cartilage and muscle tissue involving one or Resource: Pescatello LS. Baltimore (MD): Lippincott Williams 1—B. • Maintain smoking cessation 9th ed. 2014. 6MWT. senior editor.III Guidelines for Exercise Testing and Prescription. ACSM’s Case Study CES.0 and FVC values infections) Dwyer_Part3_Sec7. ACSM’s 9th ed. IV Kimberly. polar heart monitor) are a significant barrier.IV Multiple-Choice Answers for stiffness.5 mph achieved during 6MWT for THR range — this is • Find the MET equivalent for 2. Determine his f. In addition. Goals should be challenging. this mode of necessary to implement an effective exercise program.62 m / 6 min ⫽ 45. The following are the three barriers and its impact cant reduction in motivation toward physical on exercise compliance: activity.1 (45.1 / 3. His depression philosophy — no solid evidence to support an e.77 m ⴢ min⫺1 Step 3: 67 m ⴢ min⫺1 / 26. CES activity can be completed in various convenient settings. SECTION 7 CES Case Studies 187 d. 3. Suggestions to include b.8 ⫽ 2. etc. pedometer.indd 187 11/08/12 12:26 AM .77) ⫹ 3. but that pain may require exercise termination or 4—D.1 mL ⴢ kg⫺1 ⴢ min⫺1 OR Step 4: 8. A and C reduce the fatigue and pain response. Leg pain from PAD workload levels on the treadmill. discontinuous bouts of exer- muter schedule. All of the above types of exercise difficulty.3048 ⫽ 274. Dwyer_Part3_Sec7. undue fatigue. and morning demonstrated to increase adherence. arm g. A full-time job and primary child care respon- 2. thereby matching the work and com.5] ⫽ 8. c. In addition. 5—C. NuStep.3 MET Step 1: Convert feet to miles and minutes to hours Then. In addition.8 m ⴢ min⫺1 Step 1: 901 ⫻ 0. Challenging self with difficult goals selection of various modalities of exercise. Selecting types of exercise that Kimberly enjoys and sibilities place a time crunch on the client.62 m Step 2: Walking speed ⫽ m ⴢ min⫺1 / 26. from the ACSM’s metabolic h. has easy access to may alleviate some of the barriers Discontinuous bouts of activity with a focus that she presents. Social cognitive theory client that discomfort during exercise may occur. it is not uncommon to see a signifi- 1. prescribe exercise anywhere from 30%– Step 2: He walked 901 ft in 6 min 80% of this MET level (depending upon one’s Step 3: (X feet ⫻ 10) / 5280 ft (1 mi) ⫽ mph CASE STUDY CES. which has been tender points. In addition. His level of dyspnea actual entry starting MET level).IV bances coupled with chronic soft tissue discom- fort may make some exercise intensities and 1—F. Fatigue/pain her children in the exercise plan (biking alongside) Patients with FMS often complain of multiple would increase her social support. Time is higher in patients with FMS as compared to their apparently healthy counterparts.5 mph Step 3: [0. To develop Earl’s exercise prescription from the Use target RPE: 12–14 (Borg category scale) results of his 6MWT. cise may be warranted considering the numerous demands on Kimberly’s time. the client’s sleep distur- Case Study CES. Joint pain from osteoarthritis ergometer. Remind the 3—B. Depression/motivation Discussion Question Answers for Due to the primary symptoms associated with FMS and life demands currently placed on Case Study CES. Daily fatigue equations. 0% grade one technique (not validated at this time) OR To calculate his average walking speed: To calculate METS: Step 1: 1 mph ⫽ 26. Little skill and equipment (good on walking may alleviate the burden of time as walking shoes.8 Step 2: 274.5 mph. the incidence of depression a.5 ⫽ 2. shorter. Consideration of using low-intensity exercise with shorter bouts may 2—E. Use target dyspnea: 3–4 (Borg 10-point dyspnea scale) • Determine the speed that he is walking in mph Determine THR: Take 60%–80% of peak HR (901 / 6 min ⫽ X / 60 min) ⫽ 2. html Dwyer_Part3_Sec7. 188 CERTIFICATION REVIEW • www. such as If you need to give a patient’s health information HIV or TB.indd 188 11/08/12 12:26 AM . 1—False. If the patient health department. Penalties for Noncompliance Type of Noncompliance Type of Penalty Penalty Organizations that violate HIPAA laws Civil • $100 per violation • Up to $25. you must get authoriza- include cases of abuse. no civil penalties are filed.acsm. if your state privacy laws. cannot give you permission because of a mental • Other examples of mandatory reporting or physical condition. However. A patient’s family members and close friends. TB. Tell the visitor that you are very sorry. may enhance the effectiveness of the goal setting time line for implementation. CES A health care worker who purposely shares Criminal • $50. patient’s information without written permis- sion. but you for Case Study CES. Federal law requires an organization to contact other than those who have legal authority to the state health department when patients are make decisions for a patient. periodic measures. Developing a should be included with regular assessment to goal-setting contract with signature for client and allow for new strategies if necessary.000 per calendar year • If the violation occurs and an organization is using rea- sonable means to protect a patient’s health informa- tion and if actions to correct the problem are started within 30 d of the violation. 3—False. or have been exposed to. You cannot share personal health information A patient’s health information should only be with anyone without written permission from the shared with those involved in the case and patient. which often with the health care team to develop realistic goals.V(1) True or False and Multiple-Choice Answers 2—D. In addition.V(1) cannot release any patient-related information without written consent from the patient to do so.org 3. such as Civil and criminal penalties can be imposed on Virginia and Washington. patient’s record. tion from the patient’s legal representative. In some instances. have rights to privacy individuals who do not follow the HIPAA laws. CASE STUDY CES. You should ques. Make States. if patients or employees are exposed to communicable diseases. or use a Criminal • Fines up to $250. fessional practice standards. The client should be part of the goal-setting process CES provides a public proclamation. pro- sure that you know what your state laws re.000 patient’s health information to harm a • 10 yr in prison patient or for personal gain Adapted from Summary of HIPAA Privacy Rule at http://www. federal laws do not require patients’ tion the woman about her need to read this permission for release of their health information. your organization does not need to individuals who are not directly involved in to obtain permission from an individual the patient’s care. you must obtain written per- before giving health information to the state mission from the patient to do so. and confidentiality from their parents when HIPAA laws set the minimum requirements for they receive treatment for sexually transmitted privacy and confidentiality across the United diseases or desire to start birth control. or your organiza- quire for the release of health information to tion’s policies and procedures are stricter than the others.000 or releases a patient’s health information in • Up to 1 yr in prison violation of the HIPAA laws Individuals who sell.and long-terms goals and revisions to goals as warranted. Even minors who live in states.hhs. cannot view the diagnosed with.gov/ocr/privacy/hipaa/understanding/summary/index. transfer. such as mandatory have a clear need to know. HIPAA laws. plan. you must follow the stricter rules. • For example. reporting. both short. have the right to privacy in prison and confidentiality of their employment informa- tion. with anyone who does not have permission to know it.S. • Pocket masks and other ventilation devices Dwyer_Part3_Sec7. exposure to bloodborne pathogens in the work- place.hhs. or any other hazardous • Resuscitation bags materials. The sequence for donning PPE is very important to be adequately protected. https://www. mouth. Make sure that you read and the law to discuss the patient’s case with her. For Health care organizations are required by specific details of these methods. or masks Your health care organization is required to provide • Laboratory coats free PPE to you if you are at risk for exposure to • Eye protection bloodborne pathogens. the U.000 and 10 yr Employees.gov/HIPAAGenInfo/ CASE STUDY CES. Ensuring privacy and confidentiality is impor- tant when building a trusting relationship with 7—C.V(2) that it is used. Criminal penalties of up to $250.gov/ocr/privacy/ you can give. If you receive a call about the employment Individuals who willfully violate the privacy status of another employee. The purpose of the Exposure Control Plan is and to eliminate or minimize health care workers’ • Skin. SECTION 7 CES Case Studies 189 4—D. like patients.pdf bloodborne pathogens. PPE should prevent blood and other possibly infectious materials from passing through to 1—False. receiving penal- ties of up to $250. violation of all patients’ right to confidentiality and privacy. body fluids.cms. set poli- cies and procedures to prevent use or release The human resources department can best of health information.gov/ncidod/dhqp/pdf/ppe/ eliminates or reduces the risk of exposure to ppeposter1322.indd 189 11/08/12 12:26 AM . contact your supervisor or 2. please see this CDC OSHA to develop an exposure control plan that instruction: http://www. Resources: • Don’t discuss patient information in public 1.V(2) True or False and Multiple-Choice Answers Under normal conditions of use and for the time for Case Study CES. Department of Justice. your • Work clothes. such as hospitals and clinics. Equally as important is the 2—False. and undergarments. about its privacy and confidentiality policies 6—C. appropriate removal and disposal sequence for PPE. street clothes. Only the employees of the hospital who are patients whom you serve. and other mucous membranes. Your organization is handle this type of call to avoid breaking confi- also required to provide education to you dentiality rules. Examples of PPE include the following: CES • Gowns Personal Protective Equipment • Face shields. Do not answer any questions and transfer the call to the human resources department or HIPAA laws require that health care organiza- resources manager. This requirement is enforced • Gloves by OSHA for all health care workers who may have • Mouthpieces contact with blood. manager before giving information to others. eyes.cdc. not radiation. Therefore. tions. Accountability Act of 1996 • If you are unsure about what information http://www.000 and 10 yr in prison. transfer the call to and confidentiality laws will be prosecuted by one of your human resources personnel. Centers for Medicaid and Medicare Services. and refuse these requests. directly involved with the care of that employee may view the medical records on a need-to- • Never discuss a patient’s health information know basis. Tell your friend that it would be a violation of and procedures. such as the hallway and cafeteria. Health Insurance Portability and areas. understand your organization’s policies to prevent accidentally breaking these important You should tell your friends of why this is a rules. 5—B. 1992. 8—B. Ventricular bigeminy but this does not warrant withholding exercise. Continue to monitor. 9—D. fected person to a noninfected person when tient’s bed linens is called an exposure incident. Bloodborne pathogens are spread from an in- 4—D. 2—D. the referring physician should be notified. include nonmanagerial employees responsible ECG CASE STUDIES ANSWERS AND EXPLANATIONS CES.ECG(2) Although emotional distress and stimulants. OSHA requires health care organizations to 29 CFR 1910. Standard precautions include using gloves plan must describe your risk for exposure to when handling blood or body fluids to prevent bloodborne pathogens. the clinician should first “rule out” Teaching points: Ventricular bigeminy is a stable medication noncompliance before considering and non–life-threatening dysrhythmia. 2—A. such as caffeine. CES. while V̇O2peak is compromised with this condition because of the 1—B. Hepatitis B virus.1030. Warfarin reduced “atrial kick. Regardless. can lead to increased rates and ectopic 1—A. bloodborne pathogens. Atrial fibrillation see a physician before resuming cardiac rehabilita- Multiple-Choice Answers for CES.ECG(1) Short Answers for CES. All of the above. Standard precautions should be used for every patient whom you come in contact with. exposure to bloodborne pathogens and wash- ing hands between patient contacts. some patients may regularly have frequent ventricular activity without precipitating factors. Bloodborne pathogens are germs carried in the blood that can cause disease. blood and body fluids come in contact with 5—D. Resource: Occupational Safety and Health ample of an effective work practice control. sharps in a puncture-resistant container is an ex. 6—C. Irregular rhythm presenting with new onset atrial fibrillation should 3. Dwyer_Part3_Sec7. Administration. Regardless. None of the above HR method is not reliable because of the irregular 3—A.V(3) Multiple-Choice Answers for for direct patient care in the decision-making Case Study CES. Patients 2. hepatitis C virus. Rate is approximately 70 bpm is on some type of anticoagulation therapy. lation.Bloodborne Pathogen Standard.org CASE STUDY CES. The purpose of an exposure control plan is to eliminate or decrease the exposure of health 3—C. It is important to confirm that the patient 1. Patients secondary causes in a new onset.or 10-s strip. An accidental needlestick while changing a pa. 2.ECG(1) tion. A health care organization’s exposure control 1—A.ECG(2) Short Answers for CES. when measuring the HR with atrial fibril- patients with atrial fibrillation to prevent the for. the number of cardiac cycles should be mation of and to treat existing thrombi that result counted from a 6. 10—A. the 2—D. and HIV are care workers to bloodborne pathogens. RPE nature of this arrhythmia. Multiple-Choice Answers for CES. 7—A. Regarding exercise training. Although HR does increase with exercise. Placing used or contaminated needles and broken skin or mucous membranes. Because of the irregular Teaching points: Warfarin is often prescribed in rhythm. Sinus CES mias. as with any new onset arrhyth- 1. beats.” patients can still improve fit- ness.V(3) process regarding safety devices.ECG(1) due to the unorganized and weak contractions of the atria.acsm.indd 190 11/08/12 12:26 AM .ECG(2) with this may or may not report feeling “skipped beats”. 190 CERTIFICATION REVIEW • www. although associated with a greater likelihood 1. Sinus rhythm with a right bundle-branch block Teaching points: RBBB is not an uncommon (RBBB) finding in athletes. Sinus rhythm with left ventricular hypertrophy test with ECG only is typically not adminis- (LVH) and an LBBB tered due to the inability to diagnose ischemia. according to ACSM’s GETP. SECTION 7 CES Case Studies 191 CES. 1—B. CES. however. Regardless of the presence (or lack) of angina. Therefore. a symptom-limited exercise stress 3. physician to determine the underlying cause. The athlete will likely undergo additional eval- 2. 78 bpm 1—D. Contact referring physician to verify the test new occurrence of LBBB should be reported to a ordered. CES. is listed as a relative 2—A. As long as there is no un- derlying structural heart disease.ECG(3) Short Answers for CES. Regular Therefore. is not by itself dan- 2. More than one observed ven- tricular triplet. it would be abnormal and likely an SVT.ECG(5) Short Answers for CES. Sinus tachycardia age-predicted maximum HR is not a criterion for stopping at test. contraindication for stopping a stress test.ECG(3) Teaching points: Both LVH as well as LBBB can mask changes due to myocardial ischemia that 1. If this ECG were obtained Multiple-Choice Answers for CES. They are multifocal. Continue with the test. 2—True. Irregular gerous. Sinus tachycardia with a PVC and a ventricular should be noted. these guidelines. although an isolated triplet 3. Although his HR is close 2. it would likely not be 3—B. new onset LBBB in the presence of for CES. Supraventricular tachycardia (SVT) Finally. Regular uation before returning to play. most athletes are cleared to return to play. it is not an indication for stop- triplet ping a test.ECG(6) Multiple-Choice Answers for CES. 176 bpm of the Bruce protocol.ECG(6) 1. percentage of 3. not emanating from the sinoatrial (SA) node.ECG(4) Teaching points: The HR response in the ear- lier ECG is normal for someone during stage IV 1.ECG(3) angina may indicate an acute coronary event. The fact that these are multifocal PVC.ECG(6) CES Short Answers for CES.ECG(5) Teaching points: An isolated ventricular triplet. CES. Regular to his age-predicted maximum. 2.ECG(4) Short Answers for CES. 98 bpm are typically seen on a standard 12-lead ECG. 3. a 1—D. ␤-blocker hypertensive medications. No a type of ␤-blocker because they attenuate the chronotropic response to exercise.ECG(5) at different ventricular areas does not change 1—B. 115 bpm of ventricular tachycardia. Dwyer_Part3_Sec7. True or False and Multiple-Choice Answers However.indd 191 11/08/12 12:26 AM .ECG(4) at rest. if this individual was on anti- 2—D. because of the normal HR response during exercise. thus originating Multiple-Choice Answers for CES. indd 192 11/08/12 12:26 AM . 120 bpm Although left-sided chest pressure along with 2.e. or just excessive SOB can be anginal equivalents.ECG(8) Teaching points: Pacemakers are indicated when the heart’s natural pacemaker (i. angina by many. pain in the jaw. 2—D. the cause was likely not sick sinus syndrome. and aVF) and the lateral leads (V4. otherwise Multiple-Choice Answers for CES. third-degree block). The bradycardia is caused by enhanced vagal True or False and Multiple-Choice Answers tone (i. Sinus tachycardia with 2 mm of ST segment depres. V5. If present. 83 bpm node) does not depolarize properly. 1. Due to the fact that maker spike before QRS complex) this ECG is only ventricular paced. (i. Multiple-Choice Answers for CES. There is 1.ECG(9) If discontinuing exercise and rest do not relieve 1—A. Nitroglycerine the angina. or complete AV nodal block 3. between the sion in the inferior and lateral leads. shoulder blades.ECG(7) Teaching points: First-degree AV block is a benign finding in healthy individuals. Sinus with ventricular-paced rhythm (notice pace. Both A and C rapid absorption.e.ECG(9) depression in both the inferior leads (II. Sinus bradycardia with a first-degree AV block and PVC nodal disruptions that necessitate a pacemaker. are also benign. Isolated PVC 1—False. SA 1. the main mechanism of nitro- Teaching points: This is an example of classic glycerin in reducing the ischemic burden is the ST segment depression due to myocardial isch.ECG(7) Short Answers for CES. CES Dwyer_Part3_Sec7. Regular sinus syndrome.org CES.ECG(8) there would also be a pacer spike before the 1—C.ECG(8) Short Answers for CES. then the drug of choice would be nitroglycerin. CES. Typically.e. given sublingually for 2—D. parasympathetic influence). There is a slight risk for atrial reentry tachycardia. Third-degree AV block P wave. Regular concomitant left arm pain is considered classic 3. ischemia would not be undetectable myocardial ischemia. Regular degree AV block to develop more severe AV 3. 192 CERTIFICATION REVIEW • www. ventricu- lar pacemakers can hide ECG changes due to 2—C. as in sick 2. which is for CES.ECG(9) Short Answer Answers for CES.ECG(7) common in endurance athletes. 50 bpm no known risk for individuals who have a first- 2. III. The ECG reveals 2 mm of ST segment of the veins. reduction of preload on the heart from dilation emia. and V6). indigestion-type sensation. Similar to LVH and LBBB. by ECG alone because of the pacemaker depolarization... CES..acsm. All of the above. 125 bpm stopping a stress test.indd 193 11/08/12 12:26 AM . the clinician should always rule out ventricular tachycardia 2—D. When a patient loses 2. Low CO first because of its serious implications.ECG(10) plexes are also seen with rate-dependent bun- 1—D. Ventricular tachycardia immediate defibrillation is indicated. dle-branch blocks and aberrancies.ECG(10) Teaching points: Ventricular tachycardia can be a lethal arrhythmia and is an indication for 1. CES Dwyer_Part3_Sec7.ECG(10) Short Answers for CES. 3. Regular consciousness and a pulse cannot be obtained. Although transient changes leading to wide QRS com- Multiple-Choice Answers for CES. SECTION 7 CES Case Studies 193 CES. indd 194 11/08/12 12:26 AM .Dwyer_Part3_Sec7. freedom to withdraw. participant responsibilities. 9th edition (6) • If the participant is a minor. a legal • Chapter 3 guardian must sign the consent. content. • Various components of informed consent (e. Determine and obtain the necessary physician referral and medical records to assess the potential participant. DOMAIN I: PATIENT/CLIENT ASSESSMENT A.indd 195 11/07/12 11:57 PM . Physical Activity ACSM’s Guidelines for Exercise required for program participation Readiness Questionnaire (PAR-Q). 9th edition (6) • Chapter 2 CES 195 Dwyer_Part3_Sec8. etc.g. and abilities (KSAs) found in Part 1.) • Purpose. ACSM Certified Personal Trainer (CPT) and Part 2. purpose. Skill in assessing participant physician • Assess appropriateness of referral and ACSM’s Guidelines for Exercise referral and medical records to deter. risks. participation Medicine (ACSM) Health/Fitness 9th edition (6) Knowledge of the procedure to obtain Facility Preparticipation Screening • Chapter 2 physician referral and medical records Questionnaire. legal concerns.. Testing and Prescription (GETP). meet legal requirements answered. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of the procedure to obtain • Participant and/or guardian should ACSM’s Guidelines for Exercise informed consent from participant to have verbal explanation and questions Testing and Prescription (GETP). mine program participation status physician referral. informed consent 9th edition (6) participant’s medical history through • Must be treated as confidential and • Chapter 3 available documentation privileged information • Understand policy and procedures for obtaining medical records and Health Insurance Portability and Accountability Act (HIPAA) regulations. SECTION 8 CES Job Task Analysis Note: CES certification candidates should also review the knowledge. administration Knowledge of information and • American Heart Association (AHA)/ ACSM’s Guidelines for Exercise documentation required for program American College of Sports Testing and Prescription (GETP). Knowledge of the procedure to obtain medical history. skills. classify risk based on medical records/ Testing and Prescription (GETP). ACSM Certified Health Fitness Specialist (HFS). social weight-bearing activity. neu. • Understand resting and exercise ACSM’s Resource Manual for pulmonary. Guidelines for Exercise Testing heart and lung sounds and body composition testing (e. Chronic and auscultation sounds for normal ACSM’s Resource Manual for Respiratory Disease Questionnaire) and and abnormal heart and lung sounds Guidelines for Exercise Testing strategies for their use • Issues that may alter exercise testing and Prescription. identify/minimize • Chapter 29 Knowledge of validated tools for mea. diagnostic testing. any symptoms since their BMI and body fat percentage. description of discomfort/ • Know the anatomical landmarks for and Prescription. metabolic) consumed per unit of time (V̇O2). Knowledge or Skill Statement Explanation/Examples Resources Knowledge of normal cardiovascular.org B. 7th edition (7) CES Knowledge of participant-centered • Five factor model of personality. suicidal ideation) or surgery) and Prescription. and additional required testing and data. clinical testing and medical regimens/proce. 7th edition (7) measurements and their interpretation romuscular. • Chapter 11 associated with acute and chronic tion (e. anxiety. ischemia. cardio.acsm. Guidelines for Exercise Testing isolation. and Prescription.g. Guidelines for Exercise Testing Knowledge of abnormal responses/ quirements for various physical activi. pulmonary.. in hemodynamics. pulmonary. pulmonary. and Prescription. 7th edition (7) pain. muscular) ACSM’s Resource Manual for responses to exercise • Metabolic energy equivalent (MET) re. pulmonary. • Understanding clinical descriptions • Chapter 24 health-related quality of life. • Appendix A Knowledge of normal physiologic vascular. resting and exercise related to cardio. Knowledge of interpretation of ECGs abnormal responses/signs and symp. arrhythmias. pulmo. volume of oxygen ACSM’s Resource Manual for cardiovascular. and Prescription.. classes of mood disorders. identify normal resting ECG ACSM’s Resource Manual for surement of psychosocial health status and exercise ECG changes. vascular. leg exercise differences • Chapter 5 ciated with different pathologies (e. and effects of bed rest and inactivity on 9th edition (6) methods to counteract these changes the various body systems (e. Guidelines for Exercise Testing procedure.. weight.indd 196 11/07/12 11:57 PM . and metabolic anatomy and cardiovascular. 7th edition (7) Knowledge of instructional techniques • Coaching techniques to set achievable • Chapters 6–8 and 24–26 to assess participant’s expectations and goals and overcome potential obstacles ACSM’s Resource Manual for goals • Understanding medication effects on Guidelines for Exercise Testing Knowledge of commonly used medi. orthopedic issues) ECG lead placement. ties. inactivity. 7th edition (7) assessment tools (e. • Chapters 6–26 blocks. and dures can assess clinical progression Guidelines for Exercise Testing medical regimens/procedures of disease and/or exercise effects and Prescription. their needs and goals. arm vs. • Chapters 16 and 17 goal setting transtheoretical model. knee osteoarthritis may limit ACSM’s Resource Manual for illness (e. 7th edition (7) Knowledge of psychological issues selection and/or the exercise prescrip. Diagnostic and Statistical Manual of Mental Disorders (DSM ). subtypes of anxiety disorders Dwyer_Part3_Sec8.g.g. SF-36. depression. ACSM’s Resource Manual for progression. muscle hypertrophy ACSM’s Exercise Management telemetry electrocardiogram (ECG) • Knowledge of absolute and relative for Persons with Chronic interpretation contraindications to exercise and Diseases and Disabilities.g. and metabolic • Chapter 3 Knowledge of normal 12-lead and adaptations. pulmonary.g.. body mass index [BMI]).. 7th edition (7) Knowledge of cardiovascular. 7th edition (7) Knowledge of pertinent areas of a skinfolds. toms for cardiovascular. the program’s potential benefits. and metabolic • Chapter 45 and metabolic diseases diseases ACSM’s Guidelines for Exercise Knowledge of the effects of physical • Understanding of deconditioning Testing and Prescription (GETP). including bed rest.g. 196 CERTIFICATION REVIEW • www.. 7th edition (7) cation for cardiovascular.. and Prescription. infarction) and metabolic disease states ACSM’s Resource Manual for Knowledge of normal and abnormal • Height. and know/ Guidelines for Exercise Testing Knowledge of various behavioral identify dangerous arrhythmias. • Understanding of how diagnostic • Chapter 3 nary. 7th edition (7) signs and symptoms to exercise asso. 3rd edition (2) for abnormalities (e.g. Perform a preparticipation health screening including review the participant’s medical history and knowledge.g. and metabolic pathologies. previous injury. Guidelines for Exercise Testing Knowledge of anthropometric myocardial oxygen consumption. vascular. pulmonary. artifact. circumferences. and Guidelines for Exercise Testing physiology metabolic anatomy and physiology and Prescription.. • Chapter 18 participant’s medical history understand the difference between ACSM’s Resource Manual for (e. and Prescription. 9th edition (7) (e. and Prescription. and time-bound [SMART] goals). Guidelines for Exercise Testing symptom-limited maximal and submaxi. target heart rate achieved) and Training: A Statement for or abnormal (i. limita. muscle Testing and Prescription (GETP). • Chapters 16 and 17 mination of exercise testing • Set goals that are specific. Guidelines for Exercise Testing Knowledge of normal and abnormal tion. measur.e. Dwyer_Part3_Sec8. including of-life tools. American College of Cardiology ing. Young Men’s Christian Testing and Prescription (GETP). referral to and Prescription. application. application. • Evaluate arteries for adequate pulses ACSM’s Resource Manual for mon cardiopulmonary abnormalities and bruits.e. etc. • Knowledge of health-related quality. 7th edition (7) flexibility tic. and metabolic pathologies severity and prognosis. able. test protocols. their target populations.e. functional test. 7th edition (7) mal aerobic testing sults may effect program participation • Chapters 16 and 17 Knowledge of indications and contrain. and how re. and additional required testing and data. Association (YMCA) bench press test. disease diagnosis. and Prescription. know testing termination criteria. • Know how these conditions may ACSM’s Resource Manual for dications to exercise testing affect exercise adherence and motiva. time.. volume and progression ACSM’s Guidelines for Exercise CES healthy and patient populations (FITT-VP) principle for aerobic.. ACSM’s Resource Manual for • Determine testing protocols that are Guidelines for Exercise Testing safe and effective for the individual. the program’s potential benefits. basis synthesis of multiple national 9th edition (6) scientific/medical guidelines and posi. murmurs. strength and endurance. SECTION 8 CES Job Task Analysis 197 B. ECG interpretation. 7th edition (7) intake assessment • Techniques to appropriately acquire • Chapters 24 and 25 Skill in assessment and interpretation individual patient information that may ACSM’s Guidelines for Exercise of information collected during the influence patient participation status Testing and Prescription (GETP). and flexibility 9th edition (6) exercise based upon the goals. Testing and Prescription (GETP). baseline intake assessment • Interpretation of graded exercise 9th edition (6) Skill in formulating an exercise tests. and challenging but realistic (e. • Knowledge of exercise test modali. push-up test. 7th edition (7) (i. and Testing and Prescription (GETP). ACSM’s Resource Manual for Knowledge of testing and interpreta. Testing and Prescription (GETP). intensity. attainable. social support groups.g. and Prescription. Perform a preparticipation health screening including review the participant’s medical history and knowledge. curl up ACSM’s Guidelines for Exercise (crunch test). strategies for their use. American Diabetes Association • Clinical understanding of what • Chapters 3 and 5 [ADA] guidelines) exercise testing termination does to “Exercise Standards for Testing normal (i. assessment ventilatory responses 9th edition (6) Skill in selection. ACSM’s Guidelines for Exercise lines for treatment of cardiovascular. • Chapter 4 tion stands Skill in auscultation methods for com. • Chapters 4 and 5 tions. 7th edition (7) know the procedure and be able to • Chapters 21–23 effectively explain it to the individual. and return-to-work testing • Chapter 5 [ACC]/American Heart Association • Clinical understanding of absolute and ACSM’s Guidelines for Exercise [AHA] Joint Guidelines.. oxygen ACSM’s Guidelines for Exercise collected during the baseline intake saturation. 9th edition (6) sit and reach (trunk flexion). realis.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of functional and diagnos. for Chronic Obstructive Lung Disease ercise testing 9th edition (6) [GOLD].g. ties. and ability of the patient.indd 197 11/07/12 11:57 PM . Global Initiative relative indications for terminating ex.. and gas exchange and Testing and Prescription (GETP). the Guidelines for Exercise Testing Skill in data collection during baseline heart for heart failure. signs/symptoms) Health Care Professionals physiological markers from the American Heart • One repetition maximum bench press Association” (11) and leg press. and • Practice the frequency.. signs/symptoms) endpoints for ter. measurable. • Chapter 46 Knowledge of current published guide. range of • Chapter 4 motion in select single joints ACSM’s Guidelines for Exercise • Clinical understanding. blood pressure and heart rate • Chapter 6 program based upon the information response. lungs for emphysema. pulmonary. other health care professionals. ACSM’s Resource Manual for tic exercise testing methods. their needs and goals. (cont. • Chapter 6 monitoring of exercise testing for and type. Guidelines for Exercise Testing tion of muscle strength/endurance and specific. and Prescription. . and • Understanding of self-guided 9th edition (6) American Association of Cardiovascular screening for physical activity. limited to. Knowledge of indications and contrain. Knowledge of the participant’s risk fac. including variables that affect the decisions Testing and Prescription (GETP). curl up (crunch test). endurance. neuromuscular responses.org B. atrial fibrillation and flutter. blocks. and metabolic pathologies. CES termination of exercise testing cise abnormalities including. Guidelines for Exercise Testing treat • Understanding of clinical information and Prescription. sinus • Chapter 5 tion of muscle strength/endurance and bradycardia and tachycardia.) Knowledge or Skill Statement Explanation/Examples Resources Skill in muscle strength. ST cation for cardiovascular. metabolic • Chapter 3 clinical progression. 7th edition (7) infarction) functional testing. screening for physical activity. ACSM’s Resource Manual for and medical regimens/procedures to and muscular fatigue. Evaluate the participant’s risk to ensure safe participation and determine level of monitoring/supervision in a preventive or rehabilitative exercise program. push-up Testing and Prescription (GETP). the program’s potential benefits. ischemia. dry • Chapter 29 the skin. and 5 Knowledge of functional and diagnos. ACSM’s Guidelines for Exercise risk stratification criteria mendations. and level of supervision Testing and Prescription (GETP). pulmonary. indications of clinical progression.e.e. • Chapters 2. and metabolic) to determine level stratification.indd 198 11/07/12 11:57 PM . exercise testing recom. C. risk • Chapter 2 nary. ommendations based on risk category Testing and Prescription (GETP). 7th edition (7) marks for ECG lead placement. responses. bundle-branch blocks. and return-to-work • Chapter 29 Knowledge of normal and abnormal testing ACSM’s Guidelines for Exercise (i. and shave body hair (if necessary). pulmo. pulmonary. signs/symptoms) endpoints for • Be able to identify resting and exer. and metabolic disorder ACSM’s Guidelines for Exercise tic exercise testing methods. ven- Knowledge of commonly used medi. 7th edition (7) Knowledge of American College of necessary to assess disease status. their needs and goals. severity and prognosis. diagnosis. alcohol prep the landmarks. and exercise testing rec. symptom-limited maximal and submaxi. 198 CERTIFICATION REVIEW • www..g. 3. based on risk category 9th edition (6) dications to exercise testing • Understanding of cardiovascular. and additional required testing and data.. their cardiorespiratory responses. regarding administration of and 9th edition (6) mal aerobic testing exercise test • Chapter 5 Knowledge of interpretation of electro. Perform a preparticipation health screening including review the participant’s medical history and knowledge. YMCA 9th edition (6) Skill in patient preparation and ECG bench press test. depression and elevation. 7th edition (7) nary. arrhythmias. Dwyer_Part3_Sec8. sit and reach (trunk • Chapter 4 electrode application for resting and flexion). pulmo. American Heart Association (AHA). Testing and Prescription (GETP). • Understanding of self-guided 9th edition (6) tor profile (i. but not 9th edition (6) Knowledge of testing and interpreta. sinus flexibility arrest. • Knowledge of parameters of exercise ACSM’s Resource Manual for cardiograms (ECGs) for abnormalities test modalities. and patient populations test. range of motion in select ACSM’s Resource Manual for exercise ECG single joints Guidelines for Exercise Testing • Practice finding the anatomical land. and Prescription. and prema- and metabolic diseases ture ventricular and atrial contractions. has on the body. tricular tachycardia and fibrillation. risk • Chapter 2 and Pulmonary Rehabilitation (AACVPR) stratification. diagnostic testing. and ACSM’s Guidelines for Exercise tion screening algorithm possible methods of treatment Testing and Prescription (GETP). • Practice one repetition maximum ACSM’s Guidelines for Exercise and flexibility assessments for healthy bench press and leg press. and Prescription. cardiovascular. ACSM’s Guidelines for Exercise of exercise supervision using ACSM.acsm. (cont. These include the and Prescription. Knowledge or Skill Statement Explanation /Examples Resources Knowledge of applied exercise • Understand the acute and chronic ACSM’s Resource Manual for physiology principles responses and adaptations exercise Guidelines for Exercise Testing Knowledge of cardiovascular. • Chapters 6–8 and 24–26 Sports Medicine (ACSM) preparticipa. disease Guidelines for Exercise Testing (e. test protocols. and metabolic pathologies exercise testing 9th edition (6) (e. and moni. SECTION 8 CES Job Task Analysis 199 C. Disease [GOLD]. Young Testing and Prescription (GETP).. push-up ACSM’s Guidelines for Exercise Initiative for Chronic Obstructive Lung test. (cont. • Understand clinical significance in 9th edition (6) identifying normal resting ECGs.g. 7th edition (7) mias. Evaluate the participant’s risk to ensure safe participation and determine level of monitoring/supervision in a preventive or rehabilitative exercise program.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of current published guide. 7th edition (7) Skill in ECG interpretation and inter. explain it to the individual. • Clinical understanding of absolute and ACSM’s Guidelines for Exercise lines for treatment of cardiovascular. know test. and exercise termination criteria. • Chapter 10 preting exercise test results ing termination criteria and data collec. pulmonary. American Diabetes Men’s Christian Association (YMCA) 9th edition (6) Association [ADA] guidelines) bench press test. Global bench press and leg press. Testing and Prescription (GETP). and metabolic diseases • Clinical understanding. know dangerous arrhyth. know the Guidelines for Exercise Testing chronic disease procedure and be able to effectively and Prescription. curl up (crunch test). application. who requires physician supervision Testing and Prescription (GETP). ACSM’s Guidelines for Exercise tion during test stages. • Understanding of and management • Chapter 2 toring of exercise tests for apparently of testing protocols that are safe and ACSM’s Resource Manual for healthy participants and those with effective for the individual. application. abnormal ECG changes dur. • Chapters 21–23 ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. AHA vs. 9th edition (6) Skill in selection. and Prescription. Guidelines for Exercise Testing ing exercise. relative indications for terminating Testing and Prescription (GETP). 7th edition (7) • Chapter 29 CES Dwyer_Part3_Sec8. sit and reach (trunk • Appendix A flexion).indd 199 11/07/12 11:57 PM . • Chapters 4 and 5 normal changes with ECGs during ACSM’s Resource Manual for exercise. and basis of multiple national scien- tific/medical guidelines and position stands Skill in risk stratification using • Determine level of risk to evaluate ACSM’s Guidelines for Exercise established guidelines (ACSM. American College of Cardiology • Knowledge of one repetition maximum • Chapter 4 [ACC]/AHA Joint Guidelines. pulmonary. informal) during exercise testing. and range of motion in select single joints to evaluate muscle strength/endurance and flexibility • Understanding medications’ normal and abnormal effects on resting and exercise cardiovascular. volume of oxygen Testing and Prescription (GETP). relative indications for terminating Testing and Prescription (GETP). arm vs. • Metabolic energy equivalent (MET) and Prescription. and (DSM ). requirements for various physical activi. pulmonary. pulmo.. ACSM’s Guidelines for Exercise termination of exercise testing toms for cardiovascular. trans. sit and reach (trunk flexion). and/or meta. func. pulmonary. Testing and Prescription (GETP).. and neuromuscular responses ACSM’s Guidelines for Exercise resistance training. muscular) Guidelines for Exercise Testing signs and symptoms to exercise asso. Knowledge of tests to assess and and metabolic disease stated 9th edition (6) interpret muscle strength/endurance • Five factor model of personality. 7th edition (7) time. 9th edition (6) those with cardiovascular. surement of psychosocial health status consumed per unit of time (V̇O2). and response Guidelines for Exercise Testing and medical regimens/procedures to • Understanding of how diagnostic testing and Prescription. pulmonary. 200 CERTIFICATION REVIEW • www. tion for cardiovascular. and how to manipulate each principle • Chapter 7 nary. vascular. pulmonary. and behavioral assessment). leg exercise differences ACSM’s Guidelines for Exercise Knowledge of validated tools of mea. Statistical Manual of Mental Disorders Testing and Prescription (GETP). disease Testing and Prescription (GETP). meta. (prescription. neuro. • Chapter 3 cardiovascular. 7th edition (7) treat and medical regimens/procedures can • Chapters 6–8 and 24–26 Knowledge of the effects of physical assess clinical progression of disease ACSM’s Resource Manual for inactivity. diagnosis. strategies and metabolic diseases Dwyer_Part3_Sec8. Diagnostic and ACSM’s Guidelines for Exercise Knowledge of commonly used medica. • Chapter 2 diagnostic exercise testing methods. curl up ACSM’s Guidelines for Exercise CES to produce desired outcomes for (crunch test). including bed rest. progression/maintenance. 9th edition (6) metabolic diseases and their effect on subtypes of anxiety disorders • Chapter 5 exercise prescription • Knowledge of parameters of exercise ACSM’s Guidelines for Exercise Knowledge of exercise principles test modalities.g. classes of mood disorders. muscular fitness/ bolic. Develop a clinically appropriate exercise prescription using all available information (e. goals. clinical and physiological status. pulmonary. muscle hypertrophy Guidelines for Exercise Testing submaximal aerobic testing • Knowledge of absolute and relative and Prescription.indd 200 11/07/12 11:57 PM . and and/or exercise effects Guidelines for Exercise Testing methods to counteract these changes • Understanding of deconditioning and Prescription. ACSM’s Resource Manual for Knowledge of abnormal responses/ vascular. Young Men’s Christian Testing and Prescription (GETP). 7th edition (7) Knowledge of normal physiologic effects of bed rest and inactivity on • Chapter 5 responses to exercise the various body systems (e. 9th edition (6) Knowledge of functional and myocardial oxygen consumption. 9th edition (6) and supervision) for apparently healthy tional testing. and metabolic pathologies. muscular. pulmonary. severity and prognosis. test protocols.. pulmonary. and intensity of exercise and leg press. and metabolic adap. • Chapter 3 cardiovascular. and return-to-work testing • Chapter 4 participants and participants with car.acsm. push-up test. diagnostic testing. and flexibility and muscular fatigue. range of • Chapters 7–10 and metabolic diseases motion in select single joints Knowledge of the application of • Understanding medications‘ normal metabolic calculations and abnormal effects on resting and Knowledge of goal development exercise cardiovascular. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of applied exercise • Understand the acute and chronic ACSM’s Resource Manual for physiology principles responses and adaptations exercise Guidelines for Exercise Testing Knowledge of the frequency. and type (FITT) principle for cardiorespiratory responses. apparently healthy participants and Association (YMCA) bench press test. signs/symptoms) endpoints for abnormal responses/signs and symp. 7th edition (7) ciated with different pathologies (e. their to achieve desired exercise volume ACSM’s Resource Manual for clinical progression. • Clinical understanding of absolute and ACSM’s Guidelines for Exercise diovascular.g. • Chapter 5 and flexibility theoretical model.g. These include the and Prescription. exercise prescription • Understanding of FITT-VP principles 9th edition (6) Knowledge of cardiovascular. has on the body. in hemodynamics. • One repetition maximum bench press • Appendix A volume. intensity. bolic diseases exercise testing 9th edition (6) Knowledge of appropriate mode. cardio. ACSM’s Resource Manual for including symptom-limited maximal and tations. metabolic) ties.e.org DOMAIN II: EXERCISE PRESCRIPTION A.. Testing and Prescription (GETP). 7th edition (7) Knowledge of normal and abnormal contraindications to exercise and • Chapters 16 and 17 (i. obesity. Skill in interpretation of functional and • Design and implement an exercise ACSM’s Resource Manual for diagnostic exercise testing with applica. program that is safe and effective for Guidelines for Exercise Testing tions to exercise prescription the individual based on their functional and Prescription. measurable. ity of life. clinical and physiological status. risk classification. (cont. depression. Develop a clinically appropriate exercise prescription using all available information (e. dia. realistic. SF-36. social isola. 9th edition (6) scription based on a participant’s clini. the individual (novice vs. attainable. tive for the individual based on their • Chapters 4 and 7–10 cal status functional ability. • Develop an exercise program that is 9th edition (6) safe for the individual based on their • Chapters 9 and 10 clinical status yet effective to manage/ treat their risk factors/disease(s).g.. and ACSM’s Guidelines for Exercise known risk factors/disease(s). and Guidelines for Exercise Testing stepping and Prescription. spe- cific.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of behavioral assessment • Knowledge of the FITT-VP principle ACSM’s Guidelines for Exercise tools (e. health-related qual. and how results may affect exercise prescription • Know how these conditions may affect exercise program adherence and moti- vation. asthma. SECTION 8 CES Job Task Analysis 201 A.indd 201 11/07/12 11:57 PM . Chronic Respiratory Disease ercise session: warm-up. 7th edition (7) Skill in interpretation of muscular ability. CES Dwyer_Part3_Sec8. and behavioral assessment).g.. leg cycling. ACSM’s Resource Manual for ning. arm cranking. ACSM’s Guidelines for Exercise cations to exercise prescription • Design and implement a resistance Testing and Prescription (GETP). dyslipidemia. exercise Guidelines for Exercise Testing program design to help manage and Prescription. their target populations. risk factors/disease(s). 7th edition (7) chronic disease (hypertension. Skill in developing an exercise pre.g. ACSM’s Resource Manual for chronic obstructive pulmonary disease Guidelines for Exercise Testing [COPD]. stretching. • Chapter 46 betes. and known • Chapters 23–26 and 37–41 strength/endurance testing with appli. strategies for their use.) and Prescription. suicidal ideation) exerciser) and their goals. Testing and Prescription (GETP). risk classification. run. advanced ACSM’s Resource Manual for tion. anxiety. referral to other health care professionals. exercise) and cool-down ACSM’s Metabolic Calculations sociated with acute and chronic illness • Exercise program design specific to Handbook (3) (e.. 9th edition (6) Questionnaire) and strategies for use conditioning phase (or sports-related • Chapters 7–10 Knowledge of psychological issues as. training program that is safe and effec. and the components of a single ex. 7th edition (7) • Set goals that are specific. Testing and Prescription (GETP).g. 7th edition (7) • Understanding how to calculate and • Chapters 16 and 17 apply V̇O2 equations for walking. goals. etc. social support groups. and time-bound [SMART] goals).. • Application of health-related quality-of- life. measurable • Chapters 16 and 17 and challenging but realistic (e. and intensity of exercise cific. ences. cycling. dual-energy x-ray ACSM’s Guidelines for Exercise diovascular. ACSM’s Resource Manual for signs and symptoms to exercise • Metabolic energy equivalent (MET) re.g. including home exercise. surements and their interpretation myocardial oxygen consumption. and/or meta. SMART goals). muscular fitness/resistance absorptiometry. drodensitometry. attainable. chronic obstructive pulmonary 9th edition (6) Knowledge of disease-specific strate. stretching. pulmonary. obesity. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of applied exercise • Understand the acute and chronic ACSM’s Resource Manual for physiology principles responses and adaptations exercise Guidelines for Exercise Testing Knowledge of normal physiologic has on the body. insulin/glucose monitoring) asthma. 9th edition (6) Knowledge of participant-centered goal neuromuscular adaptations. ACSM’s Metabolic Calculations regarding their exercise prescription ness/resistance training. arm vs. and stepping to and Prescription. • Chapter 3 Knowledge of abnormal responses/ lar responses. and Prescription.g. 7th edition (7) participant program design to help manage • Chapter 46 Knowledge of the timing of daily activi.. arm cranking. realistic. spe.org B. “Pulmonary Rehabilitation: Joint and metabolic diseases ercise session: warm-up. circumfer.g. consumed per unit of time (V̇O2). neuromuscu. pulmonary. and muscular fatigue. leg Guidelines for Exercise Testing insulin pump use and adjustments. Testing and Prescription (GETP). 7th edition (7) CES prophylactic nitroglycerin) design the exercise program based on • Chapters 19 and 40 Knowledge of instructional strategies the patient’s ability (e. cardiovascular. Review the exercise prescription and exercise program with the participant... • Chapter 4 participants and participants with car. disorder [COPD].. and the components of a single ex. Testing and Prescription (GETP). and challenging but realistic (e. progression/maintenance.. Guidelines for Exercise Testing associated with different pathologies quirements for various physical activi.g. volume of oxygen ACSM’s Guidelines for Exercise Knowledge of anthropometric mea. and cool-down ACSM’s Guidelines for Exercise Knowledge of goal development • Understanding of FITT-VP principles Testing and Prescription (GETP). pulmonary. breathing techniques. diabetes. to produce desired outcomes for and time-bound [SMART] goals) 9th edition (6) apparently healthy participants and • Knowledge of the FITT-VP principle • Chapter 7 those with cardiovascular. running. maintenance and challenging but realistic (e. skinfold measurements. • Chapters 7–10 to provide the client with education cular strength/endurance. and flexibility exercise their clinical significance 9th edition (6) prescription • Set goals that are specific. and participant’s expectations and goals. and Prescription. and Prescription.. conditioning phase (or sports-related Guidelines” (9) bolic calculations exercise). (prescription.g. strategies and how manipulation of each affects 9th edition (6) Knowledge of terminology appropriate the exercise prescription for cardiovas. advanced Guidelines for Exercise Testing implementation and understanding by exerciser) and their goals. hy. • Chapters 7–10 Knowledge of appropriate mode. compliance. MET level) for improving exercise adoption and • Set goals that are specific. ACSM’s Guidelines for Exercise volume. ACSM’s Resource Manual for diovascular. and flexibility Handbook (3) Knowledge of instructional techniques • Exercise program design specific to ACSM’s Resource Manual for for safe and effective prescription the individual (novice vs. 7th edition (7) Knowledge of the frequency.g. and metabolic disease stated Guidelines for Exercise Testing bolic diseases • Body mass index (BMI). measurable. 7th edition (7) responses to exercise diorespiratory responses. measurable. • Chapter 46 time. toms for cardiovascular. 7th edition (7) (e. equations for walking.) • Appendix A gies and tools to improve tolerance of • Knowledge of calculating V̇O2 /MET ACSM’s Resource Manual for exercise (e. bioimpedance and Testing and Prescription (GETP). training.acsm. pulmonary. dyslipidemia. measurable. Testing and Prescription (GETP). These include the car. Dwyer_Part3_Sec8. ACCP/AACVPR Evidence-Based Knowledge of the application of meta. leg exercise differences • Chapter 3 metabolic) in hemodynamics. etc. muscular fit. muscle • Chapter 2 setting hypertrophy ACSM’s Guidelines for Exercise Knowledge of exercise principles • Knowledge of absolute and relative Testing and Prescription (GETP). chronic disease (hypertension. medications.indd 202 11/07/12 11:57 PM . and type (FITT) principle for car. ties. contraindications to exercise and 9th edition (6) and supervision) for apparently healthy abnormal responses/signs and symp. 202 CERTIFICATION REVIEW • www. ACSM’s Guidelines for Exercise ties with exercise (e. meals. exercise and Prescription. intensity. • Patient education on the benefits of exercise specific to the patient. (cont. and choose basic terms (e. to eating and blood sugar (energy levels). compliance. proper technique. incentives. environmental. • Practice communicating in a way that ACSM’s Resource Manual for ticipants from a wide variety of educa. 7th edition (7) Knowledge of risk factor reduction rational for implementation of an effec.. devel- oping exercise programs that meet the needs of the patient. • Be familiar with various programs and services that assist with improving car- diac. psycho. patient-centered approaches that consider the patient’s priorities. SECTION 8 CES Job Task Analysis 203 B. measurable. conve... SMART goals). environmental factors.. evening exercise. • Set goals that are specific. medication peak times and their effects ment.g. physical. Avoid “technical” terms Guidelines for Exercise Testing address these (e..indd 203 11/07/12 11:57 PM . 7th edition (7) Skill in effectively communicating • Describe/explain the exercise program • Chapter 47 exercise prescription and exercise so the patient will understand what ACSM’s Resource Manual for techniques they are doing and why. enjoyment. verbal. Skill in communicating with par. demographic) instead of pectoralis major). ACSM’s Resource Manual for niences. • Optimal times to exercise with relation weight management/Weight Watchers. 7th edition (7) mize patient compliance and adherence factors. including home exercise. chest and Prescription. and challenging but realis- tic (e. and hypoglycemia risk • Be able to respond/recommend the appropriate strategy to maximize exer- cise safety and the conditioning effect and minimize any adverse reactions. Guidelines for Exercise Testing goals written). and metabolic health. behavioral and Prescription. pulmonary.g. 7th edition (7) logical.g. etc. and participant’s expectations and goals. Guidelines for Exercise Testing and Prescription.g. • Chapter 35 programs and alternative community tive exercise prescription resources (e. 7th edition (7) • Chapter 45 CES Dwyer_Part3_Sec8. and psychoso- cial status • Develop patient-centered strategies to overcome exercise barriers. social • Chapter 47 in order to achieve patient goals support. visual. the patient will understand and will not Guidelines for Exercise Testing tional backgrounds be intimidated. Guidelines for Exercise Testing Skill in applying various models to opti. risk factors. physical therapy/back care) on exercise performance. stress manage. insulin use/ injection site recommendations. smoking cessation. and Prescription. • Chapter 46 Knowledge of instructional techniques • Communicating to participant via ACSM’s Resource Manual for to assess participant’s expectations and various methods (e. dietary counseling. and and Prescription. • Consider personal factors. theory. Review the exercise prescription and exercise program with the participant.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of common barriers to • Ability to educate individuals on a ACSM’s Resource Manual for exercise compliance and strategies to practical level.g. . quirements for various physical activi. pulmonary. their proper applications. in hemodynamics. dyspnea scale. muscle • Chapter 2 cation for cardiovascular. hypertrophy ACSM’s Guidelines for Exercise and metabolic diseases • Knowledge of absolute and relative Testing and Prescription (GETP). technique for exercise (e. Knowledge of lay terminology for contraindications to exercise and 9th edition (6) explanation of exercise prescription abnormal responses/signs and symp. and class organization. neuromuscular adaptations. 204 CERTIFICATION REVIEW • www. chest and Conditioning. technique. exercise plan. reporting symptoms. gait to eating and blood sugar (energy levels).. practical level. • Understanding medications‘ normal • Chapters 38–40 cise tolerance (heart rate/pulse. evening Guidelines for Exercise Testing their safe application and instruction exercise. 7th edition (7) Knowledge of tools to measure exer. CES • Warm-up. volume of oxygen ACSM’s Guidelines for Exercise ties with exercise (e.g. car. demonstrate proper Testing and Prescription (GETP). and Prescription. • Understand how to use and interpret these tools. 7th edition (7) diovascular. • Chapter 3 Knowledge of abnormal responses/ lar responses. medications. know how the measure- ments relate to exercise tolerance (e. • Appendix A exercise equipment/modalities and metabolic disease stated ACSM’s Guidelines for Exercise Knowledge of proper biomechanical • Optimal times to exercise with relation Testing and Prescription (GETP).. Instruct the participant in the safe and effective use of exercise modalities. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of applied exercise • Understand the acute and chronic ACSM’s Resource Manual for physiology principles responses and adaptations exercise Guidelines for Exercise Testing Knowledge of normal physiologic has on the body. metabolic) ties. conditioning exercise. • Chapters 13 and 14 • Be familiar with equipment settings ACSM’s Guidelines for Exercise and adjustments. training modalities 9th edition (6) • Be familiar with numerous resistance • Chapter 7 training exercises and stretches. Testing and Prescription (GETP). 9th edition (6) Knowledge of commonly used medi.. Guidelines for Exercise Testing of perceived exertion.org C. oximetry. leg exercise differences • Chapter 3 Knowledge of the timing of daily activi. Guidelines for Exercise Testing ated with different pathologies (e. blood and abnormal effects on resting and ACSM’s Resource Manual for pressure. 7th edition (7) pain scale) • Ability to educate individuals on a • Chapter 2 Knowledge of principles and applica. insulin use/ ACSM’s Resource Manual for endurance and flexibility modalities and injection site recommendations.acsm. 5. glucometry. 3rd edition (13) instead of pectoralis major).. arm vs. • Chapters 4. cool-down Dwyer_Part3_Sec8. insulin/glucose monitoring) myocardial oxygen consumption. and hypoglycemia risk and Prescription. Avoid “technical” terms Essentials of Strength Training tion of exercise session organization and choose basic terms (e. 9th edition (6) assessment.g. stretching. and muscular fatigue. and metabolic diseases and Prescription.g.indd 204 11/07/12 11:57 PM . • Chapter 10 Knowledge of the operation of various toms for cardiovascular. pulmonary. pulmonary. • Metabolic energy equivalent (MET) re. meals. blood glucose readings that are too low or too high for exercise). and Prescription.g. know common errors when 9th edition (6) using various exercise modalities. These include the car. rating exercise cardiovascular. consumed per unit of time (V̇O2). and common mistakes. proper weightlifting form) medication peak times and their effects • Appendix A Knowledge of muscle strength/ on exercise performance. 7th edition (7) responses to exercise diorespiratory responses. ACSM’s Resource Manual for signs and symptoms to exercise associ. and 10 • Knowledge of proper anatomical ACSM’s Guidelines for Exercise positioning to aerobic and resistance Testing and Prescription (GETP).g. neuromuscu. pulmonary. diovascular. attainable. ibility exercise prescription progression/regression. ACSM’s Guidelines for Exercise signs and symptoms to exercise traindications to exercise and abnormal Testing and Prescription (GETP). Guidelines for Exercise Testing ous exercise equipment/modalities and time-bound (SMART) goals with the and Prescription. specific. weightlifting form) Dwyer_Part3_Sec8. reporting symptoms. exercise. 7th edition (7) CES (e. Instruct the participant in the safe and effective use of exercise modalities. muscular principle and how to manipulate it based ACSM’s Guidelines for Exercise fitness/resistance training.. exercise plan. abnormal ECG changes during Guidelines for Exercise Testing Knowledge of the frequency.. and type (FITT) prin. insulin pump use and ad. developing and Prescription. and/or bolic) on exercise progression/mainte. exercise specific to the patient. overcoming barriers. • Chapters 7 and 10 metabolic diseases nance and supervision ACSM’s Resource Manual for Knowledge of disease-specific • Be able to respond/recommend the ap. posture. pulmonary. • Determine and identify normal resting Hypertension” (4) mal 12-lead and telemetry electro. Guidelines for Exercise Testing pants regarding the proper organization • Describe/explain the exercise program and Prescription.. prophylactic nitroglycerin) • Patient education on the benefits of Guidelines for Exercise Testing Knowledge of instructional strate. Implement the program (e. • Clinical understanding of the FITT-VP • Chapter 29 ciple for cardiovascular. pulmonary. associated with different patholo. cardiovascular. 9th edition (6) gies (i. values • Develop patient-centered strategies to • Chapters 38–40 clarification.g.g. 7th edition (7) intensity. pulmonary. and flex. realistic. SECTION 8 CES Job Task Analysis 205 C. Guidelines for Exercise Testing Skill in communicating with partici.g. DOMAIN III: PROGRAM IMPLEMENTATION AND ONGOING SUPPORT A. consider what is most important • Chapter 2 cal technique for exercise (e.g. Testing and Prescription (GETP). patient-centered approaches ACSM’s Resource Manual for Knowledge of strategies to that consider the patient’s priorities. minimize any adverse reactions. participants and participants with (cardiovascular. 7th edition (7) Knowledge of proper biomechani. goals setting) overcome exercise barriers. 7th edition (7) of exercise sessions so the patient will understand what • Chapter 47 they are doing and why. Guidelines for Exercise Testing strategies and tools to improve propriate strategy to maximize exercise and Prescription. 7th edition (7) pants from a wide variety of educa. 7th edition (7) tolerance of exercise (e. and/or meta. patient. (cont. and 9th edition (6) Knowledge of exercise supervision • Chapter 7 progression/maintenance and • Knowledge and clinical understanding of ACSM’s Guidelines for Exercise supervision for apparently healthy the effect of participants disease status Testing and Prescription (GETP). ECG. intimidated. develop ACSM’s Resource Manual for Knowledge of the operation of vari. maintenance. exercise prescription. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of abnormal responses/ • Knowledge of absolute and relative con. and metabolic • Chapter 2 metabolic) disease stated “Position Stand: Exercise and Knowledge of normal and abnor. balance. time. and psychosocial status and Prescription. 7th edition (7) gies for improving exercise adoption exercise programs that meet the needs of • Chapter 46 and maintenance the patient. and identify various arrhythmias.indd 205 11/07/12 11:57 PM . breathing safety and the conditioning effect and • Chapters 19 and 40 techniques. on changes in participants’ disease status. etc and Prescription. and Prescription. to the patient.. and goals).) Knowledge or Skill Statement Explanation/Examples Resources Skill in the observational assessment • Ability to assess a patient’s exercise ACSM’s Resource Manual for of participants technique. normal changes with ECG during ACSM’s Resource Manual for cardiogram (ECG) interpretation exercise. movements.. • Chapter 47 tional backgrounds tient will understand and will not be ACSM’s Resource Manual for Skill in communicating with partici. 9th edition (6) cardiovascular. ACSM’s Resource Manual for justments. counseling. pulmonary. gait. responses/signs and symptoms for car. education. measurable.e. and class organization. • Communicate in a way that the pa. risk Guidelines for Exercise Testing maximize exercise compliance factors. Dwyer_Part3_Sec8. 9th edition (6) nique.g. • Chapters 13 and 14 tests) to assess participants educational ACSM’s Resource Manual for goals/needs Guidelines for Exercise Testing • Establish rapport. and stepping to design the exercise and Prescription.g. and posture. risk patient safety parameters ACSM’s Guidelines for Exercise reduction. what the Testing and Prescription (GETP). Implement the program (e.g.g. and 10 Knowledge of the principles and • Knowledge of proper anatomical positioning ACSM’s Guidelines for Exercise application of exercise session to aerobic and resistance training modalities Testing and Prescription (GETP). various exercise monitoring tools/tech. questionnaires. • Chapters 4.indd 206 11/07/12 11:57 PM . 3rd edition (13) to do it. 7th edition (7) empathy. know common errors when using 9th edition (6) oximetry. telemetry.acsm. MET level) ACSM’s Guidelines for Exercise Skill in muscular strength/endur. leg cycling.g. ments relate to exercise tolerance ACSM’s Guidelines for Exercise pulmonary. 5. pulmonary.org A. Skill in educating participants on • Provide patients with an understanding ACSM’s Guidelines for Exercise the use and effects of medications of how their medications work. education. and the importance of medi. 9th edition (6) niques to optimize participant’s niques with specific attention to individual • Chapters 9 and 10 disease management. speak to the patient in • Appendix A Skill in communicating the exercise lay terms. blood glucose readings that are too Testing and Prescription (GETP). • Understanding of various resistance exer- cises and stretches: practice proper tech- nique. demonstrate proper tech. know how the measure.. running. (e. Essentials of Strength Training • Knowledge and understanding of various and Conditioning. and common mistakes. subjective assessments) various exercise modalities. cises and stretches: understand proper tech. ing. Guidelines for Exercise Testing problems associated with compre. and goal attainment • Understanding of various resistance exer. • Warm-up. 7th edition (7) endurance and flexibility training cardiovascular. and metabolic • Chapter 29 Knowledge of methods to assess diseases ACSM’s Guidelines for Exercise participant’s educational goals • Knowledge and clinical understanding of Testing and Prescription (GETP). surveys.. 3rd edition (13) methods (e. organization • Understand how to use and interpret 9th edition (6) Knowledge of commonly used these tools. Testing and Prescription (GETP). ance and flexibility training the patient will understand what they are 9th edition (6) doing and why. muscles/ • Chapter 7 joints involved. re. body alignment and posture. 7th edition (7) hension and performance of their program based on the patient’s ability • Chapter 47 exercise program (e. • Chapter 7 medications for cardiovascular. and metabolic diseases (e.. and goals). be familiar with muscles/joints involved and common mistakes. 9th edition (6) monitoring (e. Knowledge of counseling tech.. nique. ACSM’s Metabolic Calculations prescription and related exercise • Knowledge of calculating (V̇O2)/metabolic Handbook (3) programming techniques energy equivalent (MET) equations for ACSM’s Resource Manual for Skill in observation of clients for walking. counseling. Knowledge of exercise program low or too high for exercise). show interest and and Prescription. • Chapters 13 and 14 educate when necessary.g. listen actively. 206 CERTIFICATION REVIEW • www. then provide • Chapter 46 information and advice. cool-down ACSM’s Resource Manual for Knowledge of principles and • Understanding medications‘ normal and Guidelines for Exercise Testing application of muscular strength/ abnormal effects on resting and exercise and Prescription.. glucometry. 9th edition (6) calculations cation compliance. arm crank. conditioning • Appendix A oximetry. • Describe/explain the exercise program so Testing and Prescription (GETP). Testing and Prescription (GETP). stretching. (cont. exercise prescription.. • Chapter 7 • Ask for patient feedback to ensure they Essentials of Strength Training CES understand what they are doing and how and Conditioning.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of tools to measure • Be familiar with equipment settings and ACSM’s Guidelines for Exercise clinical exercise tolerance adjustments. heart rate. glucometry) exercise. body alignment. follow up with observation. Skill in the application of metabolic benefits are. etc. social support groups. depression. insulin use/injection site recommenda- tions. insulin/glucose monitoring) ciser) and their goals. 7th edition (7) Knowledge of the timing of daily activi. Guidelines for Exercise Testing 12-lead and telemetry ECG ment and skill to identify/minimize and Prescription. evening exercise. Continually assess participant feedback. pulmo. cardiovascular. and exercise tolerance. Heart Association (AHA)/American Testing and Prescription (GETP). asthma.g. • Exercise program design specific to the • Chapters 16 and 17 ties with exercise (e. general program participation. medication peak times and • Chapter 46 their effects on exercise performance. SECTION 8 CES Job Task Analysis 207 B. pulmonary. affect exercise adherence and motiva. 7th edition (7) participant’s medical history necessary and auscultation sounds for normal • Chapter 24 to screen during program participation and abnormal heart and lung sounds. symptoms associated with differ. and hypogly- cemia risk CES • Understand the dangers of missed doses of medication and the possible effects on exercise participation • Make necessary adjustments to the patients exercise program based on feedback (e. Guidelines for Cardiac nary. • Chapter 10 exercise and its progression obesity. and provide feedback to the participant about their exercise..g. can assess clinical progression of Prevention Programs. increase exercise variety) for optimal outcomes Dwyer_Part3_Sec8. chronic obstructive • Appendix A Knowledge of methods to provide pulmonary disease [COPD].. 9th edition (6) ent pathologies (i. medications. ACSM’s Resource Manual for ness (e. ACSM’s Guidelines for Exercise meals. and metabolic disease stated • Chapter 2 pulmonary. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of cardiovascular. metabolic) • Know the anatomical landmarks for ACSM’s Resource Manual for Knowledge of normal and abnormal electrocardiogram (ECG) lead place. Testing and Prescription (GETP).e.indd 207 11/07/12 11:57 PM . referral to • Appendix A other health care professionals. pulmonary. Knowledge of how medications or design to help manage chronic disease 9th edition (6) missed dose(s) of medications impact (hypertension.) ACSM’s Guidelines for Exercise participant feedback relative to their • Know how these conditions may Testing and Prescription (GETP). Guidelines for Exercise Testing Knowledge of the components of a • Understand the clinical descriptions and Prescription.. advanced exer. ACSM’s Guidelines for Exercise Knowledge of appropriate mode. and medical regimens/procedures to disease and/or effects of exercise 4th edition (8) treat • Knowledge of absolute and relative • Chapter 9 Knowledge of normal and abnormal contraindications to exercise and ACSM’s Guidelines for Exercise exercise responses and signs and abnormal responses/signs and symp. and metabolic pathologies. Physical Activity Readiness • Chapter 2 apparently healthy participants and Questionnaire [PAR-Q]. clinical signs and symptoms. social isolation. individual (novice vs. dyslipidemia. general program participation.. diagnostic testing. American ACSM’s Guidelines for Exercise those with cardiovascular. • Understanding of how diagnostic test. 9th edition (6) and clinical progress tion. exercise. Screening Questionnaire) and indi. 7th edition (7) levels). • Knowledge of and interpretation of Testing and Prescription (GETP).g. and intensity of exercise established exercise screening tools 9th edition (6) to produce desired outcomes for (e..g. 7th edition (7) interpretation artifact. their ing and medical regimens/procedures Rehabilitation and Secondary clinical progression. exercise program Testing and Prescription (GETP). diabetes. volume. ACSM’s Resource Manual for • Optimal times to exercise in relation Guidelines for Exercise Testing to eating and blood sugar (energy and Prescription. and clinical progress. and metabolic diseases College of Sports Medicine (ACSM) 9th edition (6) Knowledge of psychological issues Health/Fitness Facility Participation • Chapters 7–10 associated with acute and chronic ill. vidual medical history for program Guidelines for Exercise Testing suicidal ideation) participation and Prescription. toms for cardiovascular. identify normal resting ECG • Chapter 29 Knowledge of normal and abnormal and exercise ECG changes and know/ ACSM's Resource Manual for heart and lung sounds identify dangerous arrhythmias. mation and advice. lungs for emphysema. 7th edition (7) maintenance and supervision for appar.). 7th edition (7) these tools for measurements related • Chapters 46 and 47 to exercise tolerance (e. the Guidelines for Exercise Testing abnormalities heart for heart failure. etc. 7th edition (7) based on rating of perceived exertion • Chapter 29 [RPE] scales).. heart rate. and and/or metabolic diseases time-bound (SMART) goals. blood glu. ACSM’s Resource Manual for Knowledge of abnormal responses/ respirations. 9th edition (6) • Chapters 9 and 10 C. and clinical progress.org B. clinical signs and symptoms. cise intensity or duration).g. and exercise tolerance. niques.) ACSM’s Guidelines for Exercise Skill in communicating exercise tech. Guidelines for Exercise Testing signs and symptoms to exercise associ. etc. periph. car. exercise. blood pressure. (cont..) Knowledge or Skill Statement Explanation/Examples Resources Skill in auscultation methods for com. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of techniques to deter. through available documentation stratify 9th edition (6) Knowledge of normal physiologic • Know the normal responses to exer. 208 CERTIFICATION REVIEW • www. ACSM’s Resource Manual for for clinical assessment (e. and Prescription. realistic.. measurable. attainable. 7th edition (7) ated with different pathologies (e. pulmonary. • Chapter 46 setting realistic goals. pulmonary. • Knowledge of absolute and relative and Prescription. • Self-guided. and Prescription. exercise intensity and Prescription. metabolic) abnormal responses/signs and symp. and clinical patients‘ exercise program based on 9th edition (6) monitoring and progress feedback for optimal outcomes and • Chapter 2 Skill in applying and interpreting tools safety (e. ACSM’s Guidelines for Exercise Testing and Prescription (GETP). risk Testing and Prescription (GETP). • Make necessary adjustments to the Testing and Prescription (GETP). general program participation. pants with cardiovascular.g. • Chapter 46 ently healthy participants and partici. Reassess and update the program (e. • Evaluate arteries for adequate pulses ACSM’s Resource Manual for mon cardiovascular and pulmonary and bruits.g. etc. • Chapter 2 responses to exercise cise (e. Guidelines for Exercise Testing oximetry and glucometry. education. provide infor. pulmonary. heart rate. clarify and summarize their ACSM’s Resource Manual for focusing on participant goal attainment statements Guidelines for Exercise Testing Knowledge of exercise progression/ • Establish rapport. pulmonary. 7th edition (7) Skill in the assessment of normal and • Identify any of the nine major symp. program goals. Testing and Prescription (GETP). and client goals) based on the participant’s progress and feedback. and exercise blood pressure. peripheral fatigue. reduce or increase exer. Guidelines for Exercise Testing • Understand the practice and use of and Prescription. identify normal Guidelines for Exercise Testing based on participant’s signs and responses to exercise (e.. help set specific.g.indd 208 11/07/12 11:57 PM . ACSM’s Guidelines for Exercise Knowledge of participant’s educational toms for cardiovascular.g. and Prescription. show interest and and Prescription.acsm. professionally guided ACSM’s Guidelines for Exercise mine participant’s medical history screenings for physical activity. and provide feedback to the participant about their exercise. and how you ACSM’s Resource Manual for assess their progress.g. • Chapters 24 and 25 abnormal response to exercise toms of cardiovascular. telemetry. feedback. listen actively. 7th edition (7) rating scales) ogy on proper exercise technique. empathy. Continually assess participant feedback.. ask open-ended • Chapter 2 Knowledge of counseling techniques questions. and behavioral goals and methods to and metabolic disease states 9th edition (6) CES obtain them • Active listening.. ACSM’s Resource Manual for Skill in adjusting the exercise program or metabolic disease. Dwyer_Part3_Sec8.g. • Chapter 3 response eral fatigue.. perceived • Educate the patients in lay terminol. murmurs. respirations. 7th edition (7) symptoms. contraindications to exercise and • Chapter 3 diovascular. ACSM’s Resource Manual for cose readings that are too low or too Guidelines for Exercise Testing high for exercise. g. exercise program Testing and Prescription (GETP).. chronic obstructive ACSM’s Resource Manual for Weight Watchers.indd 209 11/07/12 11:57 PM . • Chapters 7 and 10 barriers. asthma. pulmonary.. pulmonary disease [COPD]. SMART goals with the patient. Knowledge of risk factor reduction design to help manage chronic disease 9th edition (6) programs and alternative community (hypertension. dyslipidemia. gait. • Appropriate rate of progression based ACSM’s Resource Manual for volume. 7th edition (7) exercise program (e. know recommenda.g. dietary counseling/ obesity. patients’ exercise program based on 9th edition (6) feedback and exercise responses • Appendix A for optimal outcomes and safety ACSM’s Guidelines for Exercise (e.. ACSM’s Guidelines for Exercise • Make necessary adjustments to the Testing and Prescription (GETP). adjusting exercise improving cardiac. and Prescription. smoking cessation. 7th edition (7) • Chapters 38–41 Dwyer_Part3_Sec8. Update: A Scientific Statement nique. are progressed. pulmonary. exercise.g. reduce or increase exercise Testing and Prescription (GETP). 7th edition (7) apparently healthy participants and verse effects once when exercises • Chapter 46 those with cardiovascular. 3rd edition (13) ness club. etc. SECTION 8 CES Job Task Analysis 209 C. body alignment and posture. (cont. goals ciser) and their goals and desired physi. positioning to aerobic and resistance • Chapter 2 and metabolic diseases training modalities ACSM’s Resource Manual for Knowledge of the application and in. oxim. social support groups).g. Reassess and update the program (e. 7th edition (7) Knowledge of proper biomechanical overcome exercise barriers. monitor for ad. pulmonary. intensity or duration). 7th edition (7) cation for cardiovascular.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of appropriate mode. joining a fit. diabetes.) Guidelines for Exercise Testing physical therapy/back care) • Develop patient-centered strategies to and Prescription. Guidelines for Exercise Testing Knowledge of commonly used medi. • Be familiar with various methods of • Chapters 35 and 48 etry and glucometry.g. and client goals) based on the participant’s progress and feedback. ACSM’s Resource Manual for weightlifting form) sider what is most important to the Guidelines for Exercise Testing Knowledge of clinical monitoring of the patient. and Prescription. and ACSM’s Resource Manual for intensity) metabolic health. • Knowledge of proper anatomical and Prescription. and attainment of participant’s goals • Understanding medications’ normal 9th edition (6) Knowledge of community resources and abnormal effects on resting and • Chapters 9 and 10 available to the participant following exercise cardiovascular.. and intensity of exercise on health status. and common Association” (15) mistakes. • Knowledge and clinical understanding Guidelines for Exercise Testing struction of muscle strength/endurance of various exercise monitoring tools/ and Prescription.. • Chapter 29 Knowledge of modification of the gramming with attention to individual ACSM’s Guidelines for Exercise exercise prescription for clinical changes patient safety parameters Testing and Prescription (GETP). • Chapters 7 and 10 resources (e.g. and Conditioning. Guidelines for Exercise Testing to produce desired outcomes for and exercise goals. “Resistance Exercise Update discharge from the program and metabolic diseases in Individuals With and Without • For various resistance exercises and Cardiovascular Disease: 2007 stretches: understand proper tech. develop • Chapter 46 technique for exercise (e. from the American Heart muscles/joints involved. ACSM’s Guidelines for Exercise setting) ological outcome. education. pulmonary. values clarification.g.. ACSM’s Guidelines for Exercise and metabolic diseases tions to enhance exercise adherence Testing and Prescription (GETP). exercise tolerance. overcoming individual (novice vs. con. Knowledge of strategies to maximize • Exercise program design specific to the 9th edition (6) exercise compliance (e. • Chapters 13 and 14 ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. advanced exer.. 9th edition (6) • Help facilitate a smooth transition • Chapter 7 from rehabilitation to continuing health Essentials of Strength Training CES behavior changes (e. telemetry. 7th edition (7) and flexibility modalities techniques to establish exercise pro. rating scales) in a manner that they understand. • Chapters 9 and 10 proper exercise technique. proper exercise technique and under. Reassess and update the program (e. know • Chapter 29 for clinical assessment (e. ACSM’s Resource Manual for niques. • Chapter 48 Skill in communicating exercise tech.g. and exercise their likes/dislikes with the program.g. exercise. the 9th edition (6) principles of exercise (e. exercise intensity based on rating of perceived exertion [RPE] scales). and client goals) based on the participant’s progress and feedback. appropriate exercise mode.... perceived stand progression. feedback. and the goals of the exercise program. telemetry. educate the patient Testing and Prescription (GETP).acsm. (e. education. blood glu- cose readings that are too low or too high for exercise. • Exercise program modifications based ACSM’s Guidelines for Exercise gram based on participant’s signs and on the patient’s exercise tolerance.indd 210 11/07/12 11:57 PM . electrocardiogram [ECG].g. setting realistic goals. current metabolic energy Guidelines for Exercise Testing sion and performance of their exercise equivalent [MET] level) of the patient and Prescription.g. 9th edition (6) responses and their adaptations/responses to the • Chapters 7 and 10 Skill in using metabolic calculations program “Compendium of Physical and clinical data to adjust the exercise • Practice adjusting exercise prescrip. CES Dwyer_Part3_Sec8.g. program goals. and clinical • Practice talking with the patient/ Guidelines for Exercise Testing monitoring and progress obtaining patient feedback to ensure and Prescription. Testing and Prescription (GETP).. ACSM’s Guidelines for Exercise oximetry and glucometry.. intensity level). and practice monitoring applicable clinical data (e... FITT-VP). and how you assess their progress. (cont.) Knowledge or Skill Statement Explanation/Examples Resources Skill in modifying the exercise pro. 7th edition (7) Skill in applying and interpreting tools they understand the program. blood pressure). • Understand the practice and use of these tools for measurements related to exercise tolerance (e. • Educate the patients in lay terminol- ogy on proper exercise technique. 210 CERTIFICATION REVIEW • www.org C. symptoms.g. 7th edition (7) program (e. Activities: An Update of Activity prescription tions to meet the physical abilities Codes and MET intensities” (1) Skill in observation of participant for and desired energy expenditure ACSM’s Resource Manual for problems associated with comprehen.g. Testing and Prescription (GETP). and Prescription. CES gression/maintenance. report incidents. and flexibility exercise programs. Skill in applying knowledge of medical • Contract law. sociated with different pathologies (i. pulmo. 6th edition (14) (e. cardiovascular. pulmonary. of disease and Prescription. strength.indd 211 11/07/12 11:57 PM . practice peer-developed and Prescription. pulmonary. and clini.. standardize billing. population and/or metabolic diseases Dwyer_Part3_Sec8. 5. and/or metabolic diseases ations for various clinical populations. • Chapter 2 diagnostic testing. stratification 9th edition (6) monary. abnor- mal responses. and 10 parently healthy participants and partici. cise progression of various patient pants with cardiovascular. malpractice. principle and components for exer. privacy protection of Drugs for the Heart. and medical man. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of physiological responses • Help the patient understand abnormal ACSM’s Guidelines for Exercise and signs and symptoms to exercise as. Knowledge of medical documentation health care data. conditioning 9th edition (6) for apparently healthy participants and phase (or sports-related exercise). • Chapter 2 Knowledge of exercise (as written • Explain the FITT-VP principle and the ACSM’s Guidelines for Exercise previously) principles (prescription. ACSM’s Resource Manual for documentation and regulations negligence. ACSM’s Guidelines for Exercise Knowledge of Health Insurance vascular. • Chapters 4. and supervision for ap. • Understanding of how diagnostic test. cool-down. responses/signs and symptoms for Testing and Prescription (GETP). and • Chapters 7–10 participants with cardiovascular. Knowledge of cardiovascular. 7th edition (7) lected during assessments. and metabolic Testing and Prescription (GETP). and plan. pro. and supervision) sion: warm-up. outcomes. guidelines. • Knowledge and use of the FITT-VP 9th edition (6) maintenance. professionally guided ACSM’s Guidelines for Exercise tory through available documentation screenings for physical activity. • Self-guided. metabolic) bolic disease.e. standards of Guidelines for Exercise Testing Skill in summarizing participants’ practice (e. stretching. Knowledge of exercise progression. or significant findings during the session. DOMAIN IV: LEADERSHIP AND COUNSELING A. special exercise consider. Educate the participant about performance and progression of aerobic. Testing and Prescription (GETP). risk Testing and Prescription (GETP). and meta. • Understanding medication effects • Chapters 6–8 and 24–26 and metabolic diseases on resting and exercise vitals. ing and medical regimens/procedures ACSM’s Resource Manual for agement regimens and procedures can assess clinical status progression Guidelines for Exercise Testing Knowledge of commonly used medi. informed consent. assess- ment. pul. SOAP notes) and insurance claims processing in the ACSM’s Resource Manual for health care industry Guidelines for Exercise Testing • Know how to document all data col. pulmonary. duration) of the ex- ercises performed. SECTION 8 CES Job Task Analysis 211 D. Maintain participant records to document progress and clinical status. and metabolic pathologies. and goal setting. communicate • Chapter 10 cal issues into an appropriate medical critical information in a timely manner) record • Practice documenting the details (mode. cardio. progress notes. 7th edition (7) exercise sessions. components of a single exercise ses.g. 7th edition (7) cation for cardiovascular. objective. Portability and Accountability Act diseases as well as side effects 9th edition (6) (HIPAA) regulations relative to • Promotion of access for consumers to • Appendix A documentation health insurance. testing • Chapter 10 and training.. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of participant’s medical his. pulmonary. ACSM’s Guidelines for Exercise nary. any issues.g. 9th edition (6) cardiovascular. pulmonary. SOAP notes — subjective. Tort law.. intensity. acsm. and hypogly.indd 212 11/07/12 11:57 PM . ing (e.. prescription. insulin pump use. • Demonstrate various exercise ma. 7th edition (7) compliance and associated strate.. scheduling) to improve adoption of exercise and maintenance • Knowledge of and skill in developing patient-centered strategies to over- come exercise barriers Skill in communication of exer.g. • Understand how to use and interpret ACSM’s Resource Manual for ical exercise tolerance (e. • Chapter 4 Dwyer_Part3_Sec8. education. Guidelines for Exercise Testing Knowledge of barriers to exercise tion to eating and blood sugar (energy and Prescription. 3rd edition (13) resistance training form) chines/modalities.) Knowledge or Skill Statement Explanation/Examples Resources Knowledge of tools for measuring clin. Guidelines for Exercise Testing glucometry.g. • Chapters 13 and 14 Knowledge of methods to educate adjustments. 7th edition (7) Knowledge of disease-specific strate. ACSM’s Guidelines for Exercise and flexibility modalities • Demonstrate numerous resistance Testing and Prescription (GETP). • Appendix A for improving exercise adoption and minology that they will understand. risk • Chapter 10 Knowledge of behavioral strategies factors and psychosocial status. proper technique. 212 CERTIFICATION REVIEW • www. insulin pump use and adjust. insulin/glucose monitoring) • Knowledge of techniques to educate and Prescription. Educate the participant about performance and progression of aerobic.g. Guidelines for Exercise Testing • Practice in recognizing adverse and Prescription. proper and Prescription. breathing techniques. discuss how the ACSM’s Guidelines for Exercise tolerance (e.. prophylactic the patient.. psychological. exercise program meet the needs of Testing and Prescription (GETP).g.. ACSM’s Resource Manual for maintenance • Optimal times to exercise with rela. their effects on exercise performance.g. medication peak times and • Chapters 19 and 40 gies (e. and flexibility exercise programs. Rehabilitation (10) ing. (e. Knowledge of exercise modalities and training exercises and stretches. gait assessment. modalities. and Prescription. physical. how and • Chapter 47 CES symptoms. and Conditioning. Guidelines for Exercise Testing meals. their 9th edition (6) the operation of associated equipment proper applications. ACSM’s Resource Manual for environmental) insulin use/injection site recommenda. blood glucose readings that are • Chapter 29 struction of muscle strength/endurance too low or too high for exercise). 7th edition (7) Knowledge of the application and in.. patients on the benefits of exercise • Chapter 2 gies and tools to improve exercise specific to the patient. breathing re. subjective rating scales) ments relate to exercise tolerance and Prescription. these tools. heart rate). evening exercise. and exercise when to progress). 7th edition (7) symptoms from exercise. common errors. • Describe/explain the exercise program ACSM’s Resource Manual for cise techniques. and Conditioning.g.. and Essentials of Strength Training participant in proper exercise program. proper setup. (cont. counsel. biomechanics. FITT-VP principle.. • Chapter 14 Knowledge of the timing of daily activi. and ACSM’s Guidelines for Exercise subjective/objective exercise monitor.. 7th edition (7) cemia risk • Chapter 37 • Explain how disease-specific adjunct ACSM’s Resource Manual for therapies and techniques can improve Guidelines for Exercise Testing exercise tolerance (e. Testing and Prescription (GETP). • Chapter 46 ment. Guidelines for Exercise Testing tions. and so the patient will understand what Guidelines for Exercise Testing progression they are doing and why (e. levels). proper • Chapter 2 movement and gait patterns. Pollock’s Textbook of • Knowledge and implementation of Cardiovascular Disease and behavioral strategies (e. patient-centered approaches 9th edition (6) nitroglycerin) that consider the patient’s priorities. ing for aerobic and resistance training ACSM’s Resource Manual for ties with exercise (e. rating of perceived exertion 9th edition (6) [RPE].g.org A. 7th edition (7) Skill in the assessment of participant technique. and Prescription. prophylactic nitroglycerin). strength. heart rate. medications. use a terminology ACSM’s Resource Manual for effort that they will understand. use ter. 7th edition (7) training. know how the measure. Essentials of Strength Training techniques (e.g. 3rd edition (13) ming and progression • Explain proper anatomical position.g. and common • Chapters 9 and 10 Knowledge of proper biomechanical mistakes.g.. Provide disease management and risk factor reduction education based on the participant’s medical history. refer to other health care ACSM’s Resource Manual for illness (e. and goals. bad weather). and Prescription. smoking cessation. establish rapport.g. • Understanding how to communicate ACSM’s Resource Manual for CES ticipants from a wide variety of in a way that the patient will under. • Chapter 46 Knowledge of goal development sults may effect program participation ACSM’s Resource Manual for strategies • Be familiar with various methods of Guidelines for Exercise Testing Knowledge of counseling techniques improving cardiac. and goals rapport. 7th edition (7) Skill in selection of participant out. pulmonary. and Prescription. depression. SF-36. etc. ask open. ACSM’s Resource Manual for of Cardiovascular and Pulmonary tic. consultations) ACSM’s Resource Manual for programs and alternative community methods to assess and educate Guidelines for Exercise Testing resources (e. suggest • Chapter 46 associated with acute and chronic alternatives. measur. strait-trait anxiety. ACSM’s Resource Manual for ended questions. attainable.. dietary counseling/ participant on risk factor reduction and Prescription.. videos. SECTION 8 CES Job Task Analysis 213 B. • Knowledge and implementation of 9th edition (6) cular. social support groups. and how re. standards on risk factors for cardiovas. and Prescription. measurable.g. Dwyer_Part3_Sec8.. 7th edition (7) measurable (e. Skill in communicating with par. Guidelines for Exercise Testing Rehabilitation [AACVPR] outcomes • Understand the key components of and Prescription. show interest. provide education that is ACSM’s Guidelines for Exercise Knowledge of published national applicable and timely for the patient Testing and Prescription (GETP).g. ble “high-risk” situations that may cause Guidelines for Exercise Testing Beck depression) a relapse in healthy behavior change and Prescription. and time-bound [SMART] goals). • Knowledge and attainment of national • Chapter 38 physical therapy/back care) standards of risk factor reduction for ACSM’s Resource Manual for Knowledge of strategies to improve cardiovascular..indd 213 11/07/12 11:57 PM . 7th edition (7) Knowledge of psychological issues (e. pulmonary. and referral to other health care professionals • Understand the core components of rehabilitation and assessment/ outcomes for each component. and Prescription. 7th edition (7) Knowledge of validated tools for metabolic health. and how results may affect program participation • Understanding of how these conditions may affect exercise adherence and moti- vation. needs.g. realis. • Chapters 16 and 17 methods (e. Guidelines for Exercise Testing know stages of change. Select outcomes Guidelines for Exercise Testing that are relevant to the patient and and Prescription. Guidelines for Exercise Testing backgrounds stand and will not be intimidated and Prescription. 7th edition (7) Knowledge of outcome evaluation able. establish Guidelines for Exercise Testing medical history.. 7th edition (7) reduction strategies for their use. • Knowledge and understanding the se. strategies for their use. handouts.. and meta. Guidelines for Exercise Testing participant compliance to risk factor bolic diseases. and challenging but realistic (e. 7th edition (7) Weight Watchers. American Association specific.. ACSM’s Resource Manual for status (e. ACSM’s Resource Manual for development based on participant’s ing and educating patients.g. 7th edition (7) • Knowledge of health-related quality-of.. vacations. social professional when appropriate Guidelines for Exercise Testing isolation. anxiety. pulmonary.g.g. needs.g. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of education program • Patient-centered approach to counsel. their target populations. • Chapter 46 measurement of psychosocial health • Skill and knowledge to recognize possi. • Chapter 47 come parameters lection of appropriate participant out. their target populations. listen actively. achieve a resting • Chapter 46 blood pressure of ⬍120/80 mm Hg). show empathy. and metabolic disease various methods of patient education • Chapters 3 and 10 Knowledge of risk factor reduction (e. • Chapter 48 life. 7th edition (7) model) counseling for health behavior: listen • Chapters 16 and 17 actively. ACSM’s Resource Manual for come parameters. and and Prescription. 7th edition (7) Knowledge of methods to educate recognize their stage of readiness • Chapter 46 participant in risk factor reduction to change. suicidal ideation) • Set goals that are specific. ACSM’s Resource Manual for counseling. and behavioral strategies. and Prescription. p. psychologi. 7th edition (7) • Help facilitate a smooth transition • Chapter 46 from rehabilitation to continuing health behavior changes (e. Behavior Modification: What It participant in motivational skills and centered approaches that consider the Is and How To Do It.g. 7th edition (7) gies that foster a positive environment veloping exercise programs that meet • Chapters 17 and 46 Knowledge of methods to educate the needs of the patient. • Chapters 44–46 come them.org C. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of current behavior facilita.. scheduling) Guidelines for Exercise Testing • Identify potential barriers to consistent and Prescription. cesses of change. 7th edition (7) participant motivation and implemen. develop patient-centered ACSM’s Resource Manual for strategies to overcome exercise Guidelines for Exercise Testing barriers and Prescription. risk factors. Create a positive environment for participant adherence and outcomes by incorporating effective motivational skills. ACSM’s Resource Manual for exercise adoption and maintenance patient education on the benefits of Guidelines for Exercise Testing Knowledge of communication strate... 462 compliance (e. • Knowledge and use of communication ACSM’s Resource Manual for cal. 7th edition (7) available for participant use following find activities or an environment that • Chapter 45 discharge from the program will be enjoyable for the patient (e. • Chapter 44 and coaching methods for improving propriate behavioral strategies (e. physical.g. Guidelines for Exercise Testing transtheoretical model) ness for change and Prescription. education. motivational readi. environmental) strategies that provide the patient with Guidelines for Exercise Testing Knowledge of community resources social support. and Prescription. patient.indd 214 11/07/12 11:57 PM . 214 CERTIFICATION REVIEW • www. communication techniques. health-belief model. social support groups) CES Dwyer_Part3_Sec8. • Understand stages of change.g.g. 7th edition (7) exercise and apply strategies to over. exercise specific to the patient.g.. and 9th edition (12) Knowledge of barriers to exercise psychosocial status) • xvii.acsm.g.. behavioral strategies patient’s priorities.. • Chapter 45 tation of behavioral strategies (e. ACSM’s Resource Manual for exercise in groups) Guidelines for Exercise Testing • Knowledge of educational methods for and Prescription. pro. de. 7th edition (7) Knowledge of behavioral strategies • Knowledge and skill in choosing ap. rewards/incentives. joining a fit- ness club. ACSM’s Resource Manual for tion theories (e. • Chapters 16 and 17 Dwyer_Part3_Sec8. joining a fit- ness club. Skill in collaborative decision making • Practice making decisions with the ACSM’s Resource Manual for Skill in interpretation of psychosocial patient.. and treatment procedures diagnostic testing and medical regi. clinical diovascular.g. pulmonary. eating disorders. cardio. screenings for physical activity. • Help facilitate a smooth transition from rehabilitation to continuing health behavior changes (e. 7th edition (7) regimens. Diagnostic and • Chapters 9 and 27 available for participant use following Statistical Manual of Mental Disorders ACSM’s Resource Manual for program discharge (DSM ). smoking cessation. (e. diagnostic testing. 7th edition (7) Knowledge of psychological issues • Be familiar with various methods of • Chapters 16 and 17 associated with acute and chronic improving cardiac.. referral to other health ACSM’s Resource Manual for Knowledge of accepted methods of care professionals Guidelines for Exercise Testing referral • Five factor model of personality. un- derstand the appropriate protocol for referral including documentation and staff involved.g. • Self-guided. and metabolic pathologies. ACSM’s Resource Manual for nary. and Prescription.. 7th edition (7) Knowledge of assessment tools to cise adherence and motivation. know how the measure. know who to refer to and suggest appropriate professional. 9th edition (6) Knowledge of commonly used medi. 7th edition (7) • Recognize signs and symptoms of • Chapter 46 various issues (e. Collaborate and consult with health care professionals to address clinical issues and provide referrals to optimize participant outcomes... glucometry. Guidelines for Exercise Testing subtypes of anxiety disorders and Prescription. make appropriate and Prescription. and Prescription. available documentation effects. pulmonary. deci. • Chapters 6–8 and 24–26 Knowledge of techniques to determine mens/procedures can assess clinical ACSM’s Guidelines for Exercise participant’s medical history through progression of disease and/or exercise Testing and Prescription (GETP). decision-making theory.g.g. Knowledge of tools for measuring • Understanding medication effects on 9th edition (6) clinical exercise tolerance (e. and ACSM’s Resource Manual for illness (e. • Chapter 35 resources (e. subjective rating vascular. pulmo. • Appendix A rate. metabolic health. pulmonary. depression. mental health states) that may require referral to another health care pro- fessional. blood glucose readings that are Guidelines for Exercise Testing physical therapy/back care) too low or too high for exercise). and Prescription. professionally guided • Chapter 2 cation for cardiovascular.indd 215 11/07/12 11:57 PM . anxiety.g. Understand how and Prescription. Guidelines for Exercise Testing assessment tools sional balance. 7th edition (7) Knowledge of community resources transtheoretical model. classes of mood disorders. risk ACSM’s Guidelines for Exercise and metabolic diseases stratification Testing and Prescription (GETP). and metabolic Guidelines for Exercise Testing progression. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of cardiovascular. 7th edition (7) referral when necessary. Guidelines for Exercise Testing suicidal ideation) • How these conditions may affect exer. dietary counseling/ ments relate to exercise tolerance ACSM’s Resource Manual for Weight Watchers.g. DSM-IV). and Prescription. medical pathologies. 7th edition (7) CES • Practice determining and understand.g. • Chapters 44 and 46 ing a patient’s psychosocial status ACSM’s Resource Manual for based on the results of assessments Guidelines for Exercise Testing tools (e. • Understand how exercise effects car. social • Chapters 16 and 17 measure psychosocial health status support groups. Knowledge of risk factor reduction • Understand how to use and interpret 9th edition (6) programs and alternative community these tools. heart resting and exercise vitals. pulmonary. SECTION 8 CES Job Task Analysis 215 D... social support groups). and metabolic ACSM’s Guidelines for Exercise scales) diseases as well as side effects Testing and Prescription (GETP). assisting the code team. (EMS).indd 216 11/07/12 11:57 PM . and know to fix the problem • Chapters 20 and 29 Knowledge of the operation. calibra.g. 7th edition (7) Administration (OHSA) brated)..g.g. 7th edition (7) of emergency medical equipment procedures for activation of emer. crash cart. following proper protocols. minimizing Guidelines for Exercise Testing American Association of Cardiovascular risk. Health Insurance Portability equipment. problems with the equipment Guidelines for Exercise Testing Occupational Health and Safety (e. 7th edition (7) • Chapter 19 CES Dwyer_Part3_Sec8. cation. be able to recognize ACSM’s Resource Manual for and Accountability Act [HIPAA]. and Prescription.. 7th edition (7) and pulmonary Rehabilitation • Understand how to maintain the • Chapter 10 [AACVPR]. activation of emergency medical system). Guidelines for Exercise Testing American Heart Association [AHA]) advanced cardiac life support (ACLS). Evaluate the exercise environment to minimize risk and optimize safety by following routine inspection procedures based on established facility and industry standards and guidelines. • Make sure you and your facility are ACSM’s Resource Manual for dustry standards and guidelines (e.. 7th edition (7) to perform periodic reviews of the • Chapter 19 emergency equipment to ensure it is operational Skill in the application of basic life sup.org DOMAIN V: LEGAL AND PROFESSIONAL CONSIDERATIONS A. Perform regular inspections of emergency equipment and practice emergency procedures (e. etc. • Chapter 19 gency response (i. participate in announced and Guidelines for Exercise Testing tor use unannounced emergency drills.. 216 CERTIFICATION REVIEW • www.) Guidelines for Exercise Testing • Knowledge of and skill to be able and Prescription. • Obtain and maintain CPR/AED certifi. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of government and in. and Prescription. proper documentation Guidelines for Exercise Testing Knowledge of standards for inspection • Knowledge of institutional policy and and Prescription. a treadmill that needs to be cali. tion. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of standards of practice • Cardiopulmonary resuscitation (CPR). and maximizing safety. automated external defibrillator (AED). 7th edition (7) Knowledge of local and institutional activating emergency medical service • Chapter 19 procedures for activation of the emer.e.g. basic ACSM’s Resource Manual for gency medical system first aid. ACSM’s Resource Manual for during emergency situations (e. Code Team. and maintenance of exercise equipment B. advanced cardiac life support procedures. and Prescription. or contact the appropriate personnel.acsm. and Prescription.. ACSM’s Resource Manual for EMS. ACSM’s Resource Manual for port procedures and external defibrilla. • Educate and knowledge of institutional ACSM’s Resource Manual for tive to documentation and protecting and federal regulations regarding Guidelines for Exercise Testing patient privacy (e. ethical.g.g. 7th edition (7) implications for rehabilitation programs • Follow peer-reviewed guidelines. maintain professional credentials. document your ser. insulin/glucose monitoring) and metabolic disease states ACSM’s Guidelines for Exercise Knowledge of commonly used medi. optimize safety. abnormal responses/signs and symp. HIPAA and protecting patient privacy. lay terminol. insulin use/injection site recommenda. and related symptoms. Essentials of Strength Training eases as well as side effects and Conditioning. Promote awareness and accountability and minimize risk by informing participants of safety procedures..indd 217 11/07/12 11:57 PM . Dwyer_Part3_Sec8. Testing and Prescription (GETP). pulmonary. risks. and how to correct them. D. ACSM’s Resource Manual for bilities and their implications related to understand your scope of practice. evening exercise. SECTION 8 CES Job Task Analysis 217 C. pulmonary. cations for cardiovascular. management cemia risk. Comply with Health Insurance Portability and Accountability Act (HIPAA) laws and industry-accepted professional. • Chapter 5 meals.g. and overall and Conditioning. 7th edition (7) vices. • Chapter 10 Knowledge of professional responsi. safer ones. 3rd edition • Educate patients in a way that they (13) understand you (e. demonstrate alternative exercises when needed for safe participation. and Prescription. • Appendix A techniques to ensure safety in partici. • Know common exercise errors. and Prescription. • Chapter 14 ogy). self-monitoring of exercise. pulmonary. and hypogly. and reduce liability. and metabolic dis. ACSM’s Guidelines for Exercise pant’s self-monitoring and symptom tions. ask for feedback to confirm that they understand how to self-monitor themselves. medications. and maintain • Chapter 10 equipment... written and elec. Skill in the instruction and modification • Educate participant in proper exercise Essentials of Strength Training of exercises to minimize risk of injury technique. • Appendix A exercise form to minimize risk cular. medication peak times and • Chapter 10 Knowledge of communication their effects on exercise performance. Knowledge of the timing of daily activi. Guidelines for Exercise Testing liability and negligence instruct patients. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of signs and symptoms of • Knowledge of absolute and relative ACSM’s Guidelines for Exercise exercise intolerance contraindications to exercise and Testing and Prescription (GETP). 3rd edition (13) form for safe and effective exercise train. 9th edition (6) Knowledge of contraindicated and • Understanding medication effects on • Chapter 10 higher risk exercises and proper resting and exercise vitals. Testing and Prescription (GETP). 7th edition (7) tronic medical records) • Conveys an understanding of the • Chapter 10 Knowledge of the use and limitations tests/exercises. body alignment. option to ACSM’s Resource Manual for CES of informed consent choose to participate Guidelines for Exercise Testing Knowledge of advanced directives and • Living will. report incidents. • Optimal times to exercise with rela. toms for cardiovascular. cardiovas. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of HIPAA regulations rela. identify high risk exercises and offer alternative. • Chapters 13 and 14 ing. personal directive and Prescription. tion to eating and blood sugar (energy 9th edition (6) and metabolic diseases levels). and business standards in order to maintain confidentiality. 9th edition (6) ties with exercise (e. 6th ed. senior editor. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of continuing education • Know what is required (e. 411 p. 4th ed. (IL): Human Kinetics. Haskell WL. Human Kinetics.org xvii. Exercise stan- 2006. ACSM’s Resource Manual for Guidelines 14. 218 CERTIFICATION REVIEW • www. 7th ed. Guidelines for Cardiac Rehabilitation and Secondary Dwyer_Part3_Sec8. 2008. 6. many Continuing Education Credits • Especially see Certification nance of professional credentials [CECs]) to maintain professional section Knowledge of total quality manage. Compendium of 9.104(14):1694–1740. Resistance exercise update in individuals with and without cardiovascular disease: NON-ACSM REFERENCES: 2007 update: A scientific statement from the American Heart 8.112:1363–96. how ACSM’s Web site (5) opportunities as required for mainte. Champaign (IL): Human Kinetics. certification(s). credible ACSM’s Resource Manual for health information. 2008. Whitt MC. 9th ed. 7. Behavior Modification: What It Is and How To Do Indianapolis (IN): American College of Sports Medicine. Skill in the practice and demonstration • Practice what you “preach”. American College of Sports Medicine. 12. Ainsworth BE. 1997. REFERENCES ACSM REFERENCES: Prevention Programs. Med Sci Sports Exerc.acsm. et al. Association. 2011. Knowledge or Skill Statement Explanation/Examples Resources Knowledge of common sources of • Be familiar with various. Essentials of CES and Prescription. Amsterdam EA. Circulation. and pro. American College of Chest Physicians/American Association of physical activities: an update of activity codes and MET intensities. Cardiovascular and Pulmonary Rehabilitation Guidelines Panel. 15. 3rd ed. Ades PA. ACSM’s Exercise Management guidelines.. 2001. LaMonte MJ. Promote a positive image of the program by engaging in healthy lifestyle practices. practice. 440 p. et al. Lippincott Williams & Wilkins 2014. Med Sci Sports Exerc. American Association of Cardiovascular and Pulmonary Reha. bilitation. senior editor.indd 218 11/07/12 11:57 PM . lations Handbook. Opie LH. Baltimore (MD): Lippincott Williams & Wilkins 11. Baltimore (MD): 2004. education. Moore GE. 2014. Circulation. Available from: http://www.36:533–553. exercise of a healthy lifestyle and be active regularly.acsm. Champaign 3. ACSM’s Metabolic Calcu. hypertension. Balady GJ. Philadelphia (PA): Saunders. maximize effectiveness. Drugs for the Heart. Pollock’s Champaign (IL): Human Kinetics. 1. for Exercise Testing and Prescription. and increase professionalism in the field. 3rd ed. Fletcher GF. Martin G. Champaign (IL): Wilkins. F. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based 2. Position stand: exercise and fessionals from the American Heart Association. for Persons with Chronic Diseases and Disabilities. Chest. Pear J. Boston (MA): Pearson Education/Allyn & Bacon. 2004. Williams MA. sources of information and professional Guidelines for Exercise Testing motion techniques organizations that will educate patients and Prescription. American College of Sports Medicine.g. Baltimore (MD): Lippincott Williams & Strength Training and Conditioning. Haskell WL.32:S498–S504. 2007. 2000. 2004. 10. cation to personal professional growth • Continuously improve the quality of your knowledge and skills through continuing education. 280 p. eat a healthy diet. 437 p. Select and participate in continuing education programs that enhance knowledge and skills on a continuing basis. Textbook of Cardiovascular Disease and Rehabilitation. American College of Sports Medicine. 111 p. 462 p. focus on areas for ment (TQM) and continuous quality professional growth/areas of current improvement (CQI) concepts and appli. Franklin BA. American • Chapter 47 Heart Association [AHA]).. [cited It. 2009. 5. National Strength and Conditioning Association. 2012 Jul 13]. American College of Sports and Medicine Web site [Internet]. Swain DP. Durstine JL. 9th ed. ACSM’s Guidelines for Exercise Testing 13.g.org E. 7th edition (7) on health and well-being (e. Pescatello LS. dards for testing and training: a statement for healthcare pro- 4.116: 572–584. set a good example. et al. eds. 3 d ⴢ wk⫺1. wall motion abnormalities. If a healthy young man who weighs 80 kg exercises B) Bronchitis at an intensity of 45 mL ⴢ kg⫺1 ⴢ min⫺1 for 30 min. D) Low intensity. short duration.. medications is an endogenous catecholamine that can 6. and 8. Individuals with diabetes should follow exercise examinations found in Part 1. Which of the following is a reversible pulmonary be used to increase blood flow to the heart and brain? condition caused by some type of irritant A) Lidocaine (e. small muscle C) Relative contraindications include patients groups. D) All of the above statements are true. and high frequency who might be tested if the potential ben- C) Moderate intensity. The follow- (CPT) and Part 2. initial exercise prescription for a patient who has B) Absolute contraindications refer to individuals had a heart transplant? for whom exercise testing should not be A) High intensity. ejection fraction. the following EXCEPT A) Avoiding injection of insulin into an exercising DIRECTIONS: Each of the numbered items or incom- muscle. and. Select the ONE lettered C) Exercising only when temperature and answer or completion that is BEST in each case. large muscle efit from exercise testing outweighs the groups. Which of the following statements regarding cardiac output? contraindications to graded exercise testing is A) Electrocardiography accurate? B) Radionuclide imaging A) Some individuals have risk factors that C) Echocardiography outweigh the potential benefits from exercise D) Cardiac spirometry testing and the information that may be 4. dyspnea. SECTION 9 CES Examination Note: CES certification candidates should also review the practice 5.g. long duration. 1. Which of the following techniques can be used to C) Atrioventricular (AV) block. coughing. CES B) High intensity. diagnose coronary artery disease and assess heart D) Premature ventricular contraction. ACSM Certified Health Fitness Specialist ing list of recommendations should include all of (HFS). C) Asthma five times per week. 3. and moderate duration relative risk. pollen) and characterized by bronchial B) Oxygen airway narrowing. A supraventricular ectopic rhythm that results from A) 9 wk a focus of automaticity located in the bundle of His B) 11 wk is an example of C) 13 wk A) Ventricular arrhythmia. how long (assuming an D) Pulmonary vascular disease isocaloric diet) would it take him to lose 10 lb? 7. humidity are moderate.indd 219 11/07/12 11:57 PM . Which of the following would be an adequate obtained. which of the following D) Avoiding exercise during peak insulin activity. D) 15 wk B) Junctional arrhythmia. small muscle performed until the situation or condition groups. possibly. and moderate duration 219 Dwyer_Part3_Sec9. 6 d ⴢ wk⫺1. and high frequency has stabilized. ACSM Certified Personal Trainer guidelines to avoid unnecessary risks. dust. plete statements in this section is followed by answers or B) Exercising with a partner. During a medical emergency. C) Atropine hypoxia and hypercapnia? D) Epinephrine A) Emphysema 2. large muscle groups. by completions of the statement. 5 kp for 60 min. 16. A 35-yr-old female client asks the exercise specialist following mechanisms is NOT responsible? to estimate her energy expenditure. fifth intercostal space D) Pharmacologic therapy 19. is represented on the maximal oxygen consumption (V̇O2max)? electrocardiogram (ECG) as a A) 25% A) P wave. myocardial ischemia by lowering myocardial duction in all-cause mortality can be obtained from oxygen demand. C) Persons with AICD can inactivate the AICD before high-intensity exercise to avoid the risk of shock. B) 55% B) QRS complex. is used to treat typical and variant physical activity with a daily energy expenditure of angina. The cardiac rehabilitation’s medical director orders C) Rapid weight loss a prerehabilitation ECG on a 50-yr-old man. She weighs A) The effect of exercise on other risk factors 110 lb and pedals the cycle ergometer at 50 rpm B) Reduced myocardial oxygen demand at rest with a resistance of 2.700 cal A) Dietary changes B) Increased exercise 18. Which of the following may be an INAPPROPRIATE C) 770 cal strategy for permanent weight loss? D) 1. postmyocardial infarction mortality? B) 80–100 kcal ⴢ d⫺1.acsm. fifth intercostal space C) Coronary artery bypass graft (CABG) surgery D) Midclavicular line. For previously sedentary individuals. A) ␤-Adrenergic blockers C) 150–200 kcal ⴢ d⫺1. 220 CERTIFICATION REVIEW • www. Cardiac impulses originating in the sinoatrial 15. causing threshold at approximately what percentage of their atrial depolarization. Which of the following treatment strategies are most precordial lead V4. C) Aspirin D) Nitrates 11. D) Dietary changes and exercise The exercise specialist performing the ECG notes the machine error message reads artifact in the 13. an exer- commonly used in patients with multiple vessel cise specialist would check which of the following disease who are not responding to other treatments? lead positions for adhesive contact? A) Percutaneous transluminal coronary A) Fourth intercostal space. right sternal border B) Coronary artery stent C) Midaxillary line. C) 75% C) ST segment. Which of the following statements BEST describes curvilinearly with the work rate until it reaches the exercise precautions for patients with an auto- near maximum at a level equivalent to approxi- matic implantable cardioverter defibrillator (AICD)? mately 50% of aerobic capacity. keeping the heart rate (HR) A) Stroke volume 10 beats or more below the activation rate for a B) HR shock. Exercise has been shown to reduce mortality in people with coronary artery disease. C) Cardiac output B) Persons with AICD are not at risk for an D) Systolic blood pressure inappropriate shock because most AICDs are CES set to an HR of 300 bpm. Which of the 17. D) 95% D) T wave. a 20%–30% re. To correct the artifact. Which of the following cardiac indices increases 14. B) Niacin D) ⬎400 kcal ⴢ d⫺1. but has NOT been shown to reduce A) 50–80 kcal ⴢ d⫺1. increasing only A) Persons with AICD must be monitored closely slightly thereafter? during exercise.org 9. The and at submaximal workloads specialist should report which of the following C) Reduced platelet aggregation caloric values? D) Decreased endothelial-mediated vasomotor tone A) 250 cal B) 510 cal 12. untrained individuals have an anaerobic node and then spreading to both atria. Healthy. D) Persons with an AICD can exercise at or above the cutoff HR but only if monitored by instantaneous ECG telemetry.indd 220 11/07/12 11:57 PM . left sternal border angioplasty (PTCA) B) Fourth intercostal space. Which of the following medications reduces 10. Dwyer_Part3_Sec9. 4–6 mo. The exercise specialist is orienting a 60-yr-old 30. An exercise specialist monitoring the ECG of a C) Mobitz type II cardiac rehabilitation patient observes QT-interval D) Third degree shortening and ST-segment scooping during exercise. You are asked to review an ECG strip for evidence can suspect that the patient is treated with which of of myocardial ischemia and/or injury. All of the following are major signs and symptoms and has a body mass index (BMI) of 32 kg ⴢ m⫺2. While monitoring the ECG of a cardiac rehabilita- from prolonged coronary artery blockage? tion patient. The exercise specialist is asked to risk stratify a B) Extreme heat 65-yr-old patient for exercise testing. In an ECG recording. dizziness. what kind of AV block C) Infarction are you observing? D) Thrombolysis A) First degree B) Mobitz type I 23. smokes two packs of cigarettes a day 21. A) The patient should avoid upper body resistance B) Waist-to-hip ratio ⬎0. All of the following are nonmodifiable risk factors for C) Right bundle-branch block the development of coronary artery disease EXCEPT D) Ventricular aneurysm A) Increasing age. D) High humidity orthopnea. B) Ischemia Based on this observation. shortness of affect which of the following blood lipid profiles? breath with chest wheezing. suggestive of cardiac or metabolic disease EXCEPT Based on this information. D) Tobacco smoking.. Dwyer_Part3_Sec9. and dysrhythmias. B) Low risk D) Bronchitis. CES B) Left ventricular hypertrophy 25. the specialist 29. All of the following statements are disease in males EXCEPT correct EXCEPT A) BMI ⱖ30 kg ⴢ m⫺2. slight chest pain. C) Family history. B) The clinician should observe for infection or 31.e. Q waves may be suggestive of what condition? D) The patient should avoid high-intensity A) Acute myocardial infarction exercise early in the rehabilitation period. D) Waist circumference ⬎35 in.95. 50%–85% of V̇O2max for 45 min will most favorably tion in blood pressure. A) No risk C) Orthopnea. B) Male gender. in which risk stratifica- A) Ankle edema. training because of sternal and leg wounds for C) Body fat ⬎25%. tion category would this individual fall? B) Claudication. and dryness and burning A) Lipoprotein (a) of the mouth and throat. combinations of ST-segment abnormalities C) The patient should be monitored for chest (i.indd 221 11/07/12 11:57 PM . All of the following are classifications of obesity patient entering cardiac rehabilitation after having and result in an increased risk for coronary artery CABG 3 wk ago. Which of the following best describes an irreversible necrosis of the heart muscle resulting 28. C) Moderate risk D) High risk 22. An aerobic exercise prescription of 5 d ⴢ wk⫺1 at from vacation with the following complaints: eleva. a progressive lengthening of the PR A) Thrombosis interval until a dropped QRS complex is observed. B) Triglycerides (TG) the exercise specialist would suspect that the patient C) Total cholesterol was exposed to which of the following environments? D) Low-density lipoprotein (LDL) cholesterol A) Extreme cold 27. Based on this observation. elevation and/or depression) and significant pain. Based on this information. The patient C) High altitude has shortness of breath with mild exertion. A 55-yr-old cardiac rehabilitation patient returned 26. On what the following medications? areas of the ECG should you focus? A) ␤-Blockers A) Q wave B) Calcium channel blockers B) PR interval C) Potassium C) ST segment D) Digitalis D) T wave 24. the presence of certain discomfort along the incision. SECTION 9 CES Examination 221 20. 56 L ⴢ min⫺1 training. C) Electrocardiography D) Radionuclide imaging 35. Which of the following is the proper emergency walking on a treadmill at 3. is characteristic risk factor for the development of coronary artery of which of the following? disease? A) Angina A) Tobacco use B) Aortic aneurysms B) Dyslipidemia C) Exercise-induced asthma C) Family history D) Atherosclerosis D) Hypertension 37.5 mph with a 10% response for a patient who has experienced a grade? cardiac arrest but now is breathing and has a A) 18.17 L ⴢ min⫺1 clearly outweigh any associated risks. Which of the following procedures provides the A) Explain the risks associated with exercise and LEAST sensitivity and specificity in the diagnosis of exercise testing. Which of the following is a NONMODIFIABLE provoked by physical work or stress.96 mL ⴢ kg⫺1 ⴢ min⫺1 A) Continue the exercise test to determine why C) 29. HR is 150 bpm. Which of the following is disease? NOT an important component of a clinical exercise A) To effectively breathe through a progressively rehabilitation program certification? smaller airway A) A policies and procedures manual B) Coordinate breathing with activities of daily B) Program health outcomes and quality measures living C) Staff certification and/or licensure C) Increase respiratory muscle endurance and D) Adherence to insurance codes for billing strength D) Increase ventilatory threshold 36. factors B) Women ⬍50 yr of age with fewer than two risk 39. coronary artery disease? B) Implement preventive measures. A) Men ⬎50 yr of age with fewer than two risk D) Start phase I cardiac rehabilitation. D) To evaluate aerobic capacity. What is his estimated absolute energy expenditure? 34.17 mL ⴢ kg⫺1 ⴢ min⫺1 palpable pulse? B) 27. What is the relative oxygen consumption rate for 38. or squeezing sensation of the chest. 222 CERTIFICATION REVIEW • www. shoulders. 41. Although certification of clinical exercise reha- bilitation programs is a relatively new concept. A) Coronary angiography C) Perform emergency medical procedures. 42. A burning. B) Echocardiography D) Take care of an injury or medical emergency. To ensure C) 4. his C) Men ⬍40 yr of age with two risk factors blood pressure is 150/90 mm Hg.0 mph with a 5% grade.org 32. or arms.28 L ⴢ min⫺1 a safe environment during exercise testing and D) 8.acsm. heavy. For persons free of absolute contraindications to A) 1. A patient weighing 200 lb sets the treadmill at factors 4. a physician’s evaluation before initiating a vigorous C) Place the patient in a comfortable seated exercise program? position. constricting. the clinical exercise specialist must be prepared to do all the following EXCEPT 40. Health screening before participation in a graded 43.28 mL ⴢ kg⫺1 ⴢ min⫺1 B) Place the patient in the recovery position with the head to the side to prevent airway 33.76 mL ⴢ kg⫺1 ⴢ min⫺1 the patient had this response. Which of the following is NOT an example of a CES exercise test is indicated for all of the following capital expense? reasons EXCEPT A) Renovations A) To determine the presence of disease. Which of the following individuals DO NOT need obstruction.0. Dwyer_Part3_Sec9. B) Staff salaries B) To evaluate contraindications for exercise C) Exercise equipment purchases testing or training. D) Women ⬍50 yr of age with known disease and respiratory quotient is 1. D) 31. At peak exercise. D) Furniture and fixtures C) To determine the need for referral to a medically supervised exercise program.07 L ⴢ min⫺1 exercise. the health and medical benefits of exercise B) 2. What does flow-resistive training (a type of breath- it involves many already established components ing retraining) teach patients with pulmonary of the exercise program. neck.indd 222 11/07/12 11:57 PM . What is the total energy expenditure for a 70-kg A) Emphysema man doing an exercise session composed of 5 min B) Bronchitis of warm-up at 2. and in the D) V4 presence of continued vasoconstriction results in pulmonary hypertension? 46. people involved. C) Second degree. a list B) 20%–40% of one repetition maximum of each staff member’s responsibilities is not C) 40%–60% of one repetition maximum needed. 20 min of D) Asthma leg cycling at 8 MET. 47. Mobitz type I their responsibilities. Which ECG electrode is positioned at the fourth inflammation and edema of the trachea and intercostal space just to the left of the sternal border? bronchial tubes. C) Pulmonary hypertension 20 min of treadmill running at 9 MET. How should the exercise prescription be initially C) Decrease the intensity of the warm-up and altered for a patient exercising in the heat or in a increase the intensity of the cool-down.256 kcal B) Increase the intensity of the warm-up and decrease the intensity of the cool-down. Which type of AV block occurs with a PR interval with dates. P wave fails to conduct? D) There is no need to practice emergencies as CES A) First degree long as the staff members fully understand B) Second degree. muscular endurance? B) As long as everyone knows his or her individ. SECTION 9 CES Examination 223 44.0 metabolic equivalent (MET). hypertrophy of the mucous glands A) V1 that narrows the airway. and that progressively lengthens beyond 0. A) 10%–40% of one repetition maximum ual responsibilities during an emergency.20 s until a outcomes. times.5 MET? 51. and 5 min of cool-down at 2. Which exercise intensity is used for training down as long as everyone understands it. Which of the following is characterized by an 45. Which of the following is NOT considered to be an of the artery wall that is composed predominantly orthopedic condition that can lead to limitation of of smooth muscle cells and is responsible for regular exercise (physical conditioning)? vasoconstriction and vasodilation? A) Osteoarthritis A) Endothelium B) Rheumatoid arthritis B) Intima C) Osteoporosis C) Media D) Multiple sclerosis D) Adventitia 50. actions.indd 223 11/07/12 11:57 PM . humid environment? D) Prolong both the warm-up and the cool-down. Which of the following is NOT a characteristic of B) Decreasing the intensity and increasing the ventricular tachycardia? duration A) Wide QRS complex (ⱖ120 ms) C) Decreasing the intensity and decreasing the B) AV dissociation (P waves and QRS complexes duration have no relationship) D) Increasing the intensity and decreasing the C) Flutter waves at a rate of 250–350 atrial duration depolarizations per minute D) Three or more consecutive ventricular beats at 48. A) Increasing the intensity and increasing the duration 52. Which of the following would be prudent for any A) 162 kcal high-risk patient who wishes to exercise? B) 868 kcal A) Skip both the warm-up and the cool-down C) 444 kcal entirely. D) 60%–80% of one repetition maximum C) All emergency situations must be documented 54. D) 1. arterial hypoxemia that B) V2 leads to vasoconstriction of smooth muscle in C) V3 the pulmonary arterioles and venules. Which of the following is the thickest. Which of the following statements regarding an 100 beats ⴢ min⫺1 emergency plan is TRUE? A) The emergency plan does not need to be written 53. middle layer 49. Mobitz type II D) Third degree Dwyer_Part3_Sec9. 5 mph B) 1 in 2.4 in 10. which of the following statements is TRUE? 65. A) Bruce C) Patients should expect no significant B) Modified Åstrand improvement in exercise capacity.acsm. What is the incidence of cardiac arrest during 68.org 55. one weighing 50 kg and the other clinical exercise testing? weighing 80 kg. Which variable will be C) 1.000 approximately the same for each of the two subjects? D) Minimal to nonexistent A) MET B) Kilocalorie per minute C) Oxygen pulse (V̇O2/HR) D) V̇O2 (L ⴢ min⫺1) Dwyer_Part3_Sec9. Which of the following ECG interpretations graded exercise test when no medications were involves a QRS complex duration that exceeds taken. For patients with congestive heart failure. 66. Medications may directly alter the ECG response 59.000 52 mL ⴢ kg ⴢ min⫺1. Compared with data obtained during a previous 60. Two persons. during exercise and result in false-positive tests. Which of the following populations would ben. Which type of infarction is indicated if Q waves are 62. Which of the following graded exercise test proto- cols is NOT appropriate for previously sedentary 64. be appropriate for an individual with intermittent B) Warm-up and cool-down periods should be claudication? limited to 5 min.500 and 12% grade on a treadmill. A) Postmenopausal women B) Propranolol (Inderal).11 s and a P wave precedes the QRS complex if would have the following response to the same it is present? submaximal exercise intensity during a second test A) AV conduction delay A) A higher rate-pressure product (RPP) B) Normal cardiac function B) A larger QRS duration C) Supraventricular aberrant conduction C) A lower HR D) Acute myocardial infarction D) Greater ST-segment depression 61. Which of the following medications does NOT individuals? affect exercise HR response? A) Cooper 12-min test A) Angiotensin-converting enzyme (ACE) B) Step test inhibitors and angiotensin II blockers C) Treadmill test B) Calcium channel blockers D) Cycle ergometer test C) Thyroid medications D) ␤-Blockers 58.” which stage is detected by an ECG in leads V1 and V2 along with it recommended to use multiple resources to stress abnormal R waves? the importance of a desired change? A) Anterolateral A) Precontemplation B) Localized anterior B) Contemplation C) Posterior C) Preparation D) High lateral D) Instruction 56. C) Stroke survivors D) Reserpine (Serpasil). B) Athletes ⬍14 yr of age C) Digitalis (Lanoxin). Which should be lowered as an effective strategy in a very high risk for coronary artery disease? limiting the progression and promoting regression A) ⬍120 mg ⴢ dL⫺1 of atherosclerosis? B) ⬎100 mg ⴢ dL⫺1 A) LDL cholesterol C) ⬍70 mg ⴢ dL⫺1 B) High-density lipoprotein (HDL) cholesterol D) 100–120 mg ⴢ dL⫺1 C) TGs D) Blood platelets 57.indd 224 11/07/12 11:57 PM . They both exercise at 2. have maximal oxygen uptakes of CES A) 1 in 10. efit MOST from regular muscular strength and The drug MOST likely to have this effect is endurance training? A) Lidocaine (Xylocaine). 224 CERTIFICATION REVIEW • www. C) Naughton D) Peripheral adaptations are largely responsible D) Balke and Ware for an increase in exercise tolerance. What is an appropriate LDL goal for a patient with 63. In the “Readiness to Change Model. D) Hypertensive adults 67. a patient now taking Inderal (propranolol) 0. Which of the following treadmill protocols would A) Patients may not exceed a workload of 5 MET. C) An acute myocardial infarction. When measured C) HDL cholesterol level ⱖ40 mg ⴢ dL⫺1. 73.g. concerning stroke volume in healthy adults? D) Turbulent blood flow. B) Increase HR. 72. stroke volume increases to C) Ventricular tachycardia 50%–60% of maximal capacity. consumption of a patient with coronary artery C) Cardiac output. 79. ST-segment elevation may occur in all of the D) Lack of metabolic determination (i. A) The closing of the mitral valve. Studies show the least physically active populations of an exercise test. A) Increased V̇O2 D) During the initial phase (1–3 d after the event) B) Increased peripheral resistance of inpatient programs. NOT related to false-negative results? B) Elderly. B) Increased cardiac output during submaximal exercise. cleared to participate in outpatient exercise D) Increase cardiac output. B) The closing of the aortic valve and pulmonary D) Subendocardial ischemia. Long-term conditioning results in adaptations B) Total cholesterol level ⬍200 mg ⴢ dL⫺1. A) Decreased myocardial oxygen demand.. disease is reduced following endurance training as D) Arteriovenous oxygen difference. valves. sclerosis. Greater oxygen delivery is provided to the myocar- B) Patients with peripheral arterial disease should dium in all of the following situations EXCEPT exercise to leg pain level 3 (on 4-point scale). myocardial oxygen B) HR. B) Single vessel coronary artery disease D) Upper middle class. 71. CES programs (i. When prescribing exercise for patients with athero- C) Increase maximum coronary blood flow.. False-negative test results limit the diagnostic value 75. SECTION 9 CES Examination 225 69. An increase in maximal attainable RPP following B) Rating of perceived exertion (RPE). D) Increased mean arterial pressure Dwyer_Part3_Sec9.. B) A systolic blood pressure greater than 200 mm Hg C) During exercise. 74. Sounds heard during measurement of blood A) Coronary artery spasm. Which of the following statements are FALSE C) The contraction of the ventricle. C) Monitoring an insufficient number of ECG leads 76. successful CABG surgery for severe angina suggests C) HR. B) Increased arterial blood pressure and greater essarily indicate termination of an exercise stress test? ventricular outflow resistance will reduce A) ST-segment depression greater than 3. The incidence of false negatives to include all of the following EXCEPT is related to all but one of the following. A) Insufficient level of stress C) Less educated. 77.V̇O2max) following EXCEPT 70. Young Men’s Christian 81. with intermittent rest periods. adaptations result in a decrease in A) Stroke volume. 80. At a set workload (e. 78. healthy adults as all of the following EXCEPT A) LDL cholesterol level ⬍100 mg ⴢ dL⫺1. which of the following is TRUE? D) Increased extraction of oxygen by the A) Training HR among patients who are status myocardium.e.e. D) Whole-body oxygen consumption. Which of the following conditions would NOT nec. Which is A) Obese. A) A greater preload will increase stroke volume. pressure are produced by B) A ventricular aneurysm. Which of the following would you not expect to Association [YMCA]) can exercise safely with occur with increased workload? moderate angina levels (2⫹). after which D) Syncope increases in cardiac output are largely caused by further increases in HR. these D) TG level ⱕ200 mg ⴢ dL⫺1. C) Most patients with stable angina who are C) Increase coronary blood flow. A) Severe coronary artery disease.indd 225 11/07/12 11:57 PM . 4 MET). at the same submaximal exercise intensity. activities should be C) Increased cardiac output restricted to moderate intensity (3–5 MET). evidenced by a decrease in A) Systolic ejection period. of the cardiovascular system. post myocardial infarction are altered by ␣-blocking agents.0 min stroke volume. The 2001 National Committee Education Program D) Stroke volume is equal to the ratio of (NCEP) guidelines state desirable lipid values for end-diastolic volume to end-systolic volume. Long-term participation by healthy persons in 93. 226 CERTIFICATION REVIEW • www. physically inactive men compared to C) Blood pressure elevations during resistance physically active men of the same weight and age exercise are independent of the muscle mass typically have a involved. 91. During an exercise test. The primary effects of chronic exercise training on of ischemic threshold? blood lipids include A) HR A) Decreased TG and increased HDL. 83. for PTCA. Which of the following would be the BEST marker 92. C) Quadriceps femoris D) A slight decrease or no effect on blood pressure D) Gastrocnemius compared with a test without the medication. C) Increased HR. A) Contractility. you would expect C) Intramyocardial tension. C) Oxygen uptake C) Decreased HDL and increased LDL. and swimming surgical treatment of coronary artery disease is result in the following adaptations during maximum TRUE? exercise except one. Which of the following statements regarding 84. B) Mean arterial pressure and HR C) Exercise training slows down the progression C) Systolic pressure and HR of osteoarthritis. Which of the following muscle groups is a prime B) An increase in the anginal threshold compared mover for extension of the knee? with a test without the medication. A) Systolic blood pressure and stroke volume B) Osteoarthritis is common in older adults. During aerobic exercise. 94. A) Biceps femoris C) No change in HR or blood pressure compared B) Biceps brachii with a test without the medication. observed during maximal aerobic exercise. B) Blood pressure B) Decreased total cholesterol and LDL. A) Higher blood pressure. 85. CES 89. Which of the following statements concerning the activities such as running. C) Venous grafts are significantly superior to D) Increased blood flow through active muscles. While at rest.org 82. D) Typically. 86. The EXCEPTION is A) A coronary artery stent carries a lower rate of A) Increased oxidative capacity of a given mass of revascularization than does PTCA. D) Pulse pressure and HR D) Exercise training does not exacerbate pain. D) RPP D) Decreased total cholesterol and increased HDL. maximal resistance exercise are less than those C) Higher cardiac output. Which of the following is NOT associated with 90. muscle. depress the ST segment on the resting ECG. A) An ST-segment depression because ␤-blockers D) All of the above. The major determinant(s) of myocardial oxygen D) Long-term outcome of laser angioplasty is consumption is (are) unknown and thus rarely used.acsm. D) Lower stroke volume. D) Decreased RPP B) Blood pressure elevations are highest during isometric muscular actions. B) HR. Which variables are used to determine RPP? A) Exercise training improves function.indd 226 11/07/12 11:57 PM . B) Atherectomy is a prerequisite requirement B) Increased venous return. which of the following responses would NOT be considered normal? A) Increased systolic blood pressure B) Increased pulse pressure C) Increased mean arterial pressure D) Increased diastolic blood pressure Dwyer_Part3_Sec9. blood pressure elevations seen during B) Higher metabolic rate. cycling. Myocardial oxygen consumption is highly correlated osteoarthritis in older adults is FALSE? with RPP. 88. Which of the following statements regarding blood exercise-induced myocardial ischemia? pressure and resistance exercise (weightlifting) is A) Angina pectoris correct? B) ST-segment depression A) People with even mild cardiovascular disease C) Impaired left ventricular function should never perform resistance exercise. A cardiac patient is taking a ␤-blocker medication. 87. arterial grafts in terms of patency. a 12-lead ECG is C) Progress all activities performed from supine A) Monitored immediately. Which of the following is NOT an appropriate “Stages of Motivational Readiness. 98. and after treatments to after the test.indd 227 11/07/12 11:57 PM . test. and overhead press using 5-lb weights while sitting on the side of 96. D) Multiple-gated acquisition (MUGA) (blood D) Sensitive information (e. assess activity tolerance. and skin color and perform electrocardio- B) Monitored immediately. CES Dwyer_Part3_Sec9. activities. Which of the following is NOT part of an emergency plan? A) The plan should list the schedule of each staff member so that they can all be accounted for during an emergency. Which of the following statements about symptoms arise during recovery. (ROM) for extremities. for 5 min of recovery or until exercise-induced D) Measure vital signs. fatigue. D) Monitored and recorded only if any signs or 100. and low-resistance C) Intends to start exercising in the next 6 mo. B) The plan must be written. SECTION 9 CES Examination 227 95. changes are at baseline. C) The plan should outline each specific action. If an individual is in the action stage of the 99. then every 1–2 min to sitting to standing. Following termination of a graded exercise (stress) the bed. confidentiality is NOT correct? A) All records must be kept by the program 97. A) Limit activities as tolerated to the develop- B) Participates in some exercise but does so ment of self-care activities. B) Thallium stress test C) Data should be kept on file for at least 1 yr C) Single photo emission computed tomography test before being discarded. RPE.” he or she treatment activity for inpatient rehabilitation of a A) Has been physically active on a regular basis patient on the second day after CABG surgery? for ⬍6 mo. participant’s name) pool imagery) study needs to be protected. C) Monitored immediately only.g. then at 2 and 5 min graphy before. horizontal arm adduction. D) Has been physically active on a regular basis B) Limit upper body activities to bicep curls. D) The staff should be prepared and trained in the plan. What is the best test to help determine ejection director/manager under lock and key. symptoms. range of motion irregularly. during. fraction at rest and during exercise? B) Data must be available to all individuals who A) Angiogram need to see it. for ⬎6 mo.. 0 wk include pulmonary arterial hypertension and 3—C. resistance training can be used in moderation. radionuclide imaging. f. b. Exercising only when temperature and The steps are as follows: humidity are moderate a.0 6—C. footwear. Lidocaine is an antiarrhythmic 4—C. Atropine prescription. avoiding inject- 80 kg ing insulin into exercising muscles. To get L ⴢ min⫺1. Multiply 18. Other important diagnostic brain by increasing aortic diastolic pressure and studies for coronary artery disease include preferentially shunting blood to the internal coronary angiography. Convert relative V̇O2 to absolute Recommended precautions for the exercising V̇O2 by multiplying relative V̇O2 patient with diabetes include wearing proper (mL ⴢ kg⫺1 ⴢ min⫺1) by his body weight. (⬃30 min ⫻ 5 times per week ⫽ 150 total Chronic bronchitis. maintaining adequate hydration.7714 ⫽ 12. and can last several days or weeks. 228 CERTIFICATION REVIEW • www. A junctional arrhythmia is a supraventricular and echocardiography are commonly used ectopic rhythm that results from a focus of by themselves or with other tests. Absolute V̇O2 ⫽ relative V̇O2 ⫻ body weight always wearing a medical identification bracelet ⫽ 45 mL ⴢ kg⫺1 ⴢ min⫺1 ⫻ or other form of identification. large muscle agent that can decrease automaticity in the groups.0 kcal ⴢ min⫺1 ⫻ 150 min ⫽ for 3 mo or more per year for at least 2 yr. Therefore. and moderate duration ventricular myocardium as well as raise the Patients who have had heart transplant fibrillation threshold. Divide by 3. Divide 10 lb by 0.600 mL ⴢ min⫺1 exercising with a partner. divide mL ⴢ min⫺1 by 1. ejection Epinephrine is an endogenous catecholamine fraction. a type of chronic obstruc- minutes) to get the total caloric expenditure tive pulmonary disease. Asthma to get kcal ⴢ min⫺1 Bronchitis is inflammation of the main air pas- sages to the lungs. d. Examples CES approximately 13.acsm. However.500 to get pounds of fat progressive disease of the lungs that causes shortness of breath.96 wk or the blood circulation in the lungs.7714 to get how many these air sacs unable to hold their functional weeks it will take him to lose 10 lb of fat shape upon exhalation.600 mL ⴢ min⫺1/1.000 ⫽ 3.org CES EXAMINATION ANSWERS AND EXPLANATIONS 1—D. always ⫽ 3.0 ⫽ 18. The young man weights 80 kg. abnormalities.0 kcal ⴢ min⫺1 by the total a cough. Echocardiography pulmonary edema. 2. and avoiding exercise during peak insulin activity. Junctional arrhythmia electrocardiography. monitoring blood glucose level regularly. and that optimizes blood flow to the heart and cardiac output. treat bradyarrhythmias. Duration should include a pro- is a parasympathetic blocking agent used to longed warm-up and cool-down. 6 d ⴢ wk⫺1.7714 lb of fat ⴢ wk⫺1 tion of lung tissue around the alveoli makes g. Bronchitis can be acute or 3. Supplemental oxygen should exercise at an RPE of between 11 ensures adequate arterial oxygen content and and 16 (moderate) and not use a target HR greatly enhances tissue oxygenation. with or without the production of number of minutes that he exercises sputum. echocardiography uses sound waves to assess Dwyer_Part3_Sec9.000 why a patient with diabetes cannot exercise at 3. 2—C. There is no reason c.500 kcal ⴢ lb⫺1 of fat ⫽ obstructive lung disease because the destruc- 0.0 kcal ⴢ min⫺1 chronic. systolic and diastolic function. Emphysema is called an 2. carotid artery. 13 wk 5—C.700 kcal ⴢ wk⫺1 Emphysema usually refers to a long-term. In addition. Epinephrine heart wall motion. Moderate intensity. Pulmonary vascular disease is a category of disorders that affect 10 lb of fat/0. Multiply 3. In the diagnosis of coronary artery disease. Acute bronchitis is characterized by e.indd 228 11/07/12 11:57 PM .700 kcal ⴢ wk⫺1/3.60L ⴢ min⫺1 any time if proper precautions are followed. automaticity located in the bundle of His. is characterized by the presence of a productive cough that lasts 18. 7—B.60L ⴢ min⫺1 ⫻ 5.60 L ⴢ min⫺1 by the constant 5. 150–200 kcal ⴢ d⫺1 (e. All of the above statements are true. at times. ing the HR and knowing the rate at which the 8—D. ventricles depolarizes first and then spreads to multiple vessel disease. reduced platelet ag- rates in patients after myocardial infarction by gregation. increased mitochondria and capillary A minimal caloric threshold of 150–200 kcal density).. Rapid weight loss is considered to be 3 lb ⴢ wk⫺1 17—B.g. and. left main coronary artery stenosis. The rate for All of these statements are true regarding activation is preset and varies for each patient. the U wave. Atrial repolarization usually is not lactate concentration above resting levels is seen on the ECG because it is obscured by the seen at 3 mph. of physical activity per day is associated with a significant 20%–30% reduction in risk of 16—D. which is often triggered by the simultaneous 14—A. which tial goal for previously sedentary individuals. Nitrates all-cause mortality and this should be the ini. more below the activation rate for a shock. In untrained individuals.2 ⫽ 50 kg 13—C. CABG surgery 50 rpm ⫻ 6 m ⫽ 300 m ⴢ min⫺1 CABG surgery usually is reserved for patients 2. P wave The anaerobic threshold is normally expressed The cardiac impulse originating in the sino. it occurs much sooner at 50%–60% V̇O2max. Long-term maintenance a. as a percentage of an individual’s V̇O2max.5 kg who have a poor prognosis for survival or are 60 min of cycling unresponsive to pharmacologic treatment. attenuate myocardial oxygen demand. 510 cal for women and 3–5 lb ⴢ wk⫺1 for men after the The steps are as follows: first 2 wk of the diet. These agents lower blood oxygen demand both at rest and at submaximal pressure. however. b.5 kp ⫽ 2. control ventricular arrhythmias. Write down your knowns and convert the CES Modifications in diet and exercise generally are values to the appropriate units. atrial node that spreads to both atria causing For example. study reported total recidivism within 3–5 yr. A prema- a patient with an AICD. An AV block result when supraventricular There are many benefits of chronic exercise for impulses are delayed in the AV node. then the anaerobic threshold ventricular electrical potentials. SECTION 9 CES Examination 229 A ventricular arrhythmia could be a premature stents. Such patients include those ventricular complex (PVC) in which one of the with angina. Ventricular is said to be 50% V̇O2max. Niacin lowers low-density lipids by vasomotor tone. decrease preload. 110 lb/2. Decreased endothelial-mediated vasomotor tone reduce the risk of postmyocardial infarction The mechanisms responsible for a reduction in mortality. one Medicine’s (ACSM’s) leg cycling formula. and alleviate ischemia. reduced myocardial oxygen demand. Ventricular repolarization is at 70%–80% V̇O2max. the T wave. keeping the HR 10 beats or within multiple locations of the ventricles. and left ventricular the other ventricle or ventricular fibrillation. Several precautions ture ventricular contraction occurs when the need to be taken. if V̇O2max occurs at 6 mph on atrial depolarization is indicated on the ECG a treadmill test and a sharp rise in blood as a P wave.indd 229 11/07/12 11:57 PM . contraindications to exercise testing. Choose the American College of Sports usually is a problem with rapid weight loss. including monitor- ventricles are prematurely depolarized. AICD is set to shock the patient. 55% 9—A. 15—B. Nitrates relax peripheral venous vessels. Rapid weight loss liver. This is because the adaptations from regular aerobic exercise have not occurred 10—C. Dwyer_Part3_Sec9. associated with more permanent weight loss. and improved endothelial-mediated 20%–35%. dysfunction. or PTCA. ␤-Adrenergic blockers reduce deaths from coronary artery disease include its myocardial ischemia by lowering myocardial effect on other risk factors. Nitrates do not 11—D. Persons with AICD must be monitored closely conduction of ischemic ventricular cells during exercise. Aspirin is a platelet inhibitor. inhibiting secretion of lipoproteins from the 12—C. represented on the ECG by the ST segment. In well-trained depolarization is represented on the ECG by athletes. anaerobic threshold typically occurs the QRS complex. workloads (resulting in an increased ischemic and significantly reduce first-year mortality and anginal threshold). and dyspnea. TGs with greater force during exercise because of a TGs are the only substance listed that has greater end-diastolic volume and enhanced me- been proved to be directly affected by exercise. and dry- Work rate ⫽ kg ⴢ m ⴢ min⫺1 ness or burning of the mouth and throat. can induce asthma. dissolving agent administered during acute lute V̇O2 (in L ⴢ min⫺1) by the constant 5. Next. ⫽ 1. 19—A. 24—A.5 with rest.5 kcal ⴢ min⫺1 is an irreversible necrosis of the heart muscle re- j. myocardial infarction to restore blood flow and to limit myocardial necrosis.5 kcal ⴢ min⫺1 ⫻ 60 min ⫽ 510 total cal certain arrhythmias. Bronchitis. Stroke volume 25—D. can provoke angina at rest (variant or Prinzmetal angina). Bronchitis ⫽ 750 kg ⴢ m ⴢ min⫺1 Bilateral ankle edema is a characteristic sign e. fifth intercostal space characterize the effects of digitalis on the ECG.5 ⫹ 3.5 ⫹ 3. midaxillary line. expends in 1 min by the number of minutes 23—D.000. Digitalis that she cycles.5 (mL ⴢ kg⫺1 ⴢ min⫺1) threshold in patients with angina.0. fifth intercostal space. general dehydration.7 L ⴢ min⫺1 ⫻ 5. f. Thrombolysis i. lowers the anginal 3.org c. is characterized by inflammation and edema Absolute V̇O2 ⫽ relative V̇O2 ⫻ body weight of the trachea and bronchial tubes. male gender. Classic ⫽ 34 mL ⴢ kg⫺1 ⴢ min⫺1 ⫻ 50 kg symptoms of bronchitis include chronic cough. we must see how many calories she (thrombolytic therapy) uses a specific clot- expends in 1 min by multiplying her abso.5 ⫹ 3. thereafter.8 ⫻ work rate/body weight) ⫹ blood pressure response). Lipoprotein (a) has not been shown to change Dwyer_Part3_Sec9. of a limb often results from venous throm- bosis or lymphatic blockage.700 mL ⴢ min⫺1 sputum production. Orthopnea is characterized by the Gross leg cycling V̇O2 ⫽ 34 mL ⴢ kg⫺1 ⴢ min⫺1 inability to breathe easily unless sitting up g. and family history of coro- CES curvilinearly with work rate until it reaches near nary artery disease are risk factors that cannot maximum at a level equivalent to approximately be controlled. crampy. and sometimes burning pain in the legs that typically occurs with exercise and disappears mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ 27 ⫹ 3. Tobacco smoking can be modi- 50% of aerobic capacity. not for 2–4 mo. Myocardial infarction 1.5 kg ⴢ 300 m ⴢ min⫺1 21—D. Intermittent mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ (1. The proper anatomic location of V4 is the midclavicular line.000 ⫽ 1. is an aching. right and left sternal Avoiding tension on the upper body typically borders. To find out how many calories she expends.700 mL ⴢ min⫺1/1. a pulmonary disorder. The patient should avoid upper body resistance Precordial leads V1 and V2 are located at the training because of sternal leg wounds for 4–6 mo. stroke volume increases Aging. a condition caused by an inad- 3. ⫽ 2. heart failure. All of the other precautions are appropriate. h. Shortening of the QT interval and a “scooping” of the ST–T complex 18—D. Write down the ACSM leg cycling formula.5 equate blood supply. There is no precordial lead site at the is recommended for 8–12 wk. Solve for the unknown. fourth intercostal space. straight or standing erect and is a symptom of we must first convert her oxygen consump. Finally. 230 CERTIFICATION REVIEW • www. Extreme cold Leg cycling (mL ⴢ kg ⴢ min ) ⫽ ⫺1 ⫺1 Exposure to cold causes vasoconstriction (higher (1.8 ⫻ 750/50) ⫹ claudication. Infarction by 1.0 ⫽ 8. Digitalis is used to treat heart failure and 8. increasing only slightly fied or eliminated. Midclavicular line.indd 230 11/07/12 11:57 PM . tion to absolute terms.acsm. 20—A. Substitute the known values for the of heart failure. whereas unilateral edema variable name. chanical ability of muscle fibers to produce force. A thrombosis is a specific clot that may cause a myocardial infarction. multiply the number of calories she sulting from prolonged coronary artery blockage.7 L ⴢ min⫺1 blood flow to the heart muscle. fifth intercostal space. Calculate the work rate. and d. Convert mL ⴢ min⫺1 to L ⴢ min⫺1 by dividing 22—C. Tobacco smoking During exercise. Ischemia is insufficient 1. The left ventricle is able to contract 26—B. High-risk individuals are those with one or more signs and symptoms or c. A Q wave is a negative deflection of a QRS contraindications for exercise testing or complex preceding an R wave.5 mph ⫻ 26.8 ⫻ of the impulse through the AV junction 93. with a multitude of the risks associated with exercise and exercise available techniques.8 ⫻ speed ⫻ fractional grade) ⫹ 28—B.8 ⫻ 0. The purpose of health screening before 29—C.8 m ⴢ min⫺1 or those who meet the threshold for two or 10% grade ⫽ 0. ischemia. QRS complex is dropped following a P wave. Substitute the known values for the variable two types: Mobitz type I and Mobitz type II. ST-segment total cholesterol are affected by diet and may be elevation with an absence of R waves that lowered indirectly from weight loss associated are replaced by Q waves is a sign of acute with exercise.76 mL ⴢ kg⫺1 ⴢ min⫺1 ventricles. Waist circumference ⬎35 in Emergency plans must be created. Adherence to insurance codes for billing women.1 ⫻ speed) ⫹ disease. myocardial infarction. Write down your knowns and convert the one risk factor. 34—C.5 (mL ⴢ kg⫺1 ⴢ min⫺1) Second-degree AV block is subdivided into d. Write down the ACSM’s walking formula. and gram such as a clearly articulated mission Dwyer_Part3_Sec9. This pause allows the AV node to 33—B. vigorous exercise. known cardiovascular. Mobitz type I also is known as the Wenckebach phenomenon.95. been established as part of the exercise pro- chamber enlargements. Women ⬍50 yr of age with fewer than two risk recover.76 mL ⴢ kg⫺1 ⴢ min⫺1 Low-risk individuals are those men younger The steps are as follows: than 45 yr and women younger than 55 yr a.1 ⫻ 93. High risk 32—C. BMI ⱖ30 kg ⴢ m⫺2.1) ⫹ 3. until a e. The identification and classification of obesity and implemented in the event of a medical and coronary artery disease risk has been emergency. LDL cholesterol and infarction. testing. Mobitz type I 3. who are asymptomatic and meet no more than b. name. Choose the ACSM’s walking formula. Moderate-risk individuals are values to the appropriate units. Solve for the unknown. be able to implement preventive mea- to-hip ratio ⬎0. 29. In this condition. The PR interval is the women younger than 50 yr with fewer than time that it takes from the initiation of an two coronary artery disease risk factors do not electrical impulse in the sinoatrial node to the require a physician’s evaluation before initiating initiation of electrical activity in the ventricles. resulting 9. or referral to a medically supervised Q wave is an indication of an old transmural exercise program. Men younger than 40 yr and myocardial infarction. The T wave indicates ventricular repolarization. although a new concept.38 ⫹ 16. pulmonary.884 ⫹ 3. In an ECG recording. An ECG is an excellent tool for detecting involves many components that have already cardiac rhythm and conduction abnormalities. or metabolic walking (kg⫺1 ⴢ min⫺1) ⫽ (0.5 conduct the impulse from the atria to the gross walking V̇O2 ⫽ 29. (1.8) ⫹ (1. those men ⱖ45 yr and women ⱖ55 yr of age 3.884 ⫹ 3. Clinical personnel must understand somewhat discretionary. of an injury or medical emergency. ST segment engaging in vigorous exercise is to identify ST segments are considered to be sensitive clients who require additional medical indicators of myocardial ischemia or injury. the conduction mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ (0.10 more risk factors. SECTION 9 CES Examination 231 favorably with exercise. This indicates that the AV junction failed to mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ 9. Acute myocardial infarction bilitation programs. testing to determine the presence of disease.indd 231 11/07/12 11:57 PM .38 ⫹ 16. A “pathologic” training. and body fat levels ⬎25% sures. waist. 27—D.5 mL ⴢ kg⫺1 ⴢ min⫺1 ⫽ becomes increasingly more difficult. CES Waist circumference levels ⬎35 in is specific to 35—D. and have knowledge regarding the care are all objective measures of obesity for males. Perform emergency medical procedures 30—D.8 ⫽ 93.5 in a progressively longer PR interval. practiced. and the following P wave is conducted factors with a normal or slightly shorter PR interval. Program certification of clinical exercise reha- 31—A. Angina can be either smaller airway classic (typical) or vasospastic (Prinzmetal).5 (mL ⴢ kg⫺1 ⴢ min⫺1) consists of connective tissue. The adventitia (1.83 ⫻ 90. participation in a graded exercise testing or an Respiratory muscle training increases exercise program is to obtain essential informa- respiratory muscle endurance and strength. which maintain arterial tone. is for large-scale purchases such as renovations. tion that will ensure the safety of the participant. Choose the ACSM’s walking formula.8 ⫻ speed ⫻ fractional grade) ⫹ is the outermost layer of the arterial wall and 3. a defined organizational chart with e. and family history of premature the head to the side to prevent airway obstruction. The intima is c. To effectively breathe through a progressively removing the stressor. enables one to consider possi- a balance between lactate production and ble contraindications to exercise testing and train- removal. health screening helps to determine the ventilation during exercise and likely reflects presence of disease. lium comprises a single layer of cells that form a tight barrier between blood and the arterial 5% grade ⫽ 0. It can be brought on by physical or psycho- logical stress and is relieved after resting or by 41—A. coronary heart disease. Capital expense vital signs. Solve methods to measure client health outcomes. billing practices Electrocardiography is the least sensitive and and use of insurance codes). 39—B. The pain often is felt cardiography have about the same sensitivity in the chest. V̇O2 ⫽ 2.17 L ⭈ min⫺1 The steps are as follows: 44—C.000 policy and procedures manual. and so forth.5 Dwyer_Part3_Sec9.. Electrocardiography the financial operations (e.05) ⫹ 3. Flow-resistive training involves breathing through a progressively smaller airway or 37—D. ing. 4. or arms. Radionuclide imaging and echo- myocardial ischemia. diabetes mellitus. 42—C. with the head to the side to 43—B. Directly visualizing the coronary arteries using coronary angi- 36—A. expansions. cheeks. 2. Staff salaries avoid an airway obstruction.acsm. male 38—B. and specificity. Family history Nonmodifiable risk factors include age. The endothe- values to the appropriate units.91 kg and proliferation into the intima.1 ⫻ 107. Write down your knowns and convert the cells. The media contains most of the smooth muscle b. and fixtures.8 ⫻ 107. Ventilatory threshold is the breakpoint in Thus. tobacco experienced a cardiac arrest yet is breathing and use. and helps to determine whether referral to a medically supervised exercise program is needed.2 m ⴢ min⫺1 and inhibit smooth muscle cells from migration 200 lb ⫽ 90. Modifiable risk factors The proper response to a patient who has include hypertension. dyslipidemia. has a pulse is to call to the emergency medical and physical inactivity. and a d. Adventitia is highly vascularized and provides the media and intima V̇O2 ⫽ (0. promote vasodilation.2 ⫻ with oxygen and other nutrients. shoulder. neck. system immediately.g. overweight or obesity.05 wall to resist thrombosis. Media a. 0. specific of all these tests. Write down the ACSM’s walking formula: the very thin.0 mph ⫽ 107. To evaluate aerobic capacity opening.17 L ⴢ min⫺1 The certification of a rehabilitation program is about the quality of the program as opposed to 40—C. innermost layer of the artery wall and is composed mainly of connective tissue CES walking (kg⫺1 ⴢ min⫺1) ⫽ (0. and well-used V̇O2 ⫽ 23.87 mL ⴢ kg⫺1 ⴢ min⫺1 a developed. V̇O2 ⫽ 23. furniture. fibroblasts. implemented.indd 232 11/07/12 11:57 PM . 232 CERTIFICATION REVIEW • www.01 kg/1.2) ⫹ (1. Angina ography provides the highest sensitivity and Angina pectoris is the pain associated with specificity. place the patient in the recovery position. and then stay with Staff salaries are not capital expenses but are the patient and continue to monitor his or her grouped under variable costs.1 ⫻ speed) ⫹ with some smooth muscle cells. Paced breathing helps to coordinate The overall goal of health screening before breathing with activities of daily living. Substitute knowns few smooth muscle cells. Place the patient in the recovery position with gender.org statement. cluding heat cramps. a wide QRS complex times.268. Common clinical symptoms of Multiply 362. The emergency plan must be written down and and facilitates dissipation of body heat. sputum production notable in the morn- 1. flutter is characterized by flutter waves at a rate 49—D. decreasing transient global left ven- environment. Treadmill is 9. The 52—C. available in all testing and exercise areas. heat syncope.5 (because 1 MET emphysema are shortness of breath or cough- ⫽ 3. (70 kg). of one repetition maximum) and lower Dwyer_Part3_Sec9. Flutter waves at a rate of 250–350 atrial plan should list the specific responsibilities of depolarizations per minute each staff member. Cool-down provides a gradual recovery 48—C. 40%–60% of one repetition maximum that generally is localized first on an articular Rapid strength gains will be achieved at cartilage.75 mL ⴢ kg⫺1. venous return. increased perfusion Cool-down is 2. and 46—C. 10 ⫹ 180 ⫹ 160 ⫹ 12. and blood pressure close to resting levels. mucous production.75 mL ⴢ kg⫺1 by body weight of the lung parenchyma and smaller airways. required equipment. and eventual cor pulmonale. Bronchitis straight line between V2 and V4.268. and decreasing ventricular dysrhyth- duration of exercise to allow for acclimatation. determine the MET level for each activity. Rheumatoid arthritis is an inflamma- higher resistance or weight (80%–100% tory disease affecting joints as well as organs. hypoxemia. V2 Osteoporosis involves the loss of bone density. V3 is at the midpoint of a 50—B. hypertension is a mean pulmonary artery 47—C. Pulmonary which is equal to 444 kcal.5 ⫽ 362. The (ⱖ120 ms). mias. and results. Emphysema primarily involves abnormalities Multiply 1. All emergency situations must be documented from exercising. and pulmonary arterial activities.000 mL ⫽ is characterized by increased airway reactiv- 1 L). people involved.50 MET ⫻ 5 min ⫽ 12. is equal to 88. per minute or faster. Atrial should be trained in the emergency plan. All staff and a QRS complex that does not have the members. CES morphology of bundle-branch block. the exercise prescription should be tricular dysfunction following sudden strenuous altered by initially lowering the intensity and the exertion.5 MET resulting in ventilation–perfusion mismatch.5 MET. ing. and pre- Ventricular tachycardia is characterized by determined contacts for an emergency response.0 MET ⫻ 5 min ⫽ 10 MET effects includes further airway narrowing. AV dissociation (the P waves plan should be practiced with both announced and QRS complexes have no relationship) and unannounced drills periodically. High ambient temperature or relative humidity 51—D. SECTION 9 CES Examination 233 45—B. prevents postexercise hypotension. chronic cough. three or more consecutive ventricular beats All emergencies must be documented with dates. including nonclinical staff members. actions. It allows the return of HR and with dates.812. actions.5 mL. Prolong both the warm-up and the cool-down.indd 233 11/07/12 11:57 PM . and heat stroke. dehydration.000 (because 1. of the sternal border. Divide Asthma is an episodic reversible condition that that number by 1. Then. decreasing the occurrence of ischemic ST-segment heat exhaustion. 444 kcal mucous gland enlargement that involves the First. determine the total number of MET for all arterial hypoxemia. V4 is at the mid- Signs and symptoms of bronchitis include clavicular line onto the fifth intercostal space. maintains outcomes. Multiple sclerosis of 250–350 atrial depolarizations per minute. The body attempts to heal by depositing collagen in the airway walls. which is equal to ing.0 MET ⫻ 20 min ⫽ 180 MET an increase in airway resistance decreasing Cycle is 8. times. The Warm-up is 2.0 MET ⫻ 20 min ⫽ 160 MET ventilation to the lung.81 L. Multiply 88. people involved. increases the risk of heat-related disorders in- Warm-up may have preventative value.5 MET by 3. large airways.81 L by ity to various stimuli resulting in widespread 5 (because 5 kcal ⫽ 1 L of oxygen consumed). reversible narrowing of the airways. which is equal to 88. Decreasing the intensity and decreasing pressure at rest ⬎25 mm Hg or ⬎30 mm Hg the duration with exercise. V1 is disorder with demyelination occurring in the at the fourth intercostal space just to the right central nervous system. In this type of depression. Osteoarthritis is a degenerative joint disease 53—C. V2 electrode is located at the fourth intercostal Multiple sclerosis is a chronic inflammatory space just to the left of the sternal border. hypertension.5 mL ⴢ kg⫺1 ⴢ min⫺1). and the increase or maintenance of lean CES body mass may also occur. and diabetes are throughout the test. physician and family persuasion. ACE inhibitors and angiotensin II blockers for an increase in exercise tolerance. enhanced strength of connective according to peripheral arterial disease severity. 57—A. In addition.500 PR Interval lengthens until a P wave fails to With the physical demands of exercise.500). Digitalis can modify the ST–T contour and aged and older adults. and. educa- those in a category of “very high risk. P present or absent but with relationship to QRS. Precontemplation 56—C. and increases every 2 min. and it can be impossible to tell where one ends and the other begins. Digitalis may produce menopausal women who may experience a characteristic scooping of the ST–T complex. tissue.000 true posterior myocardial. The advantages of field tests are that they all 63—A. 62—A. ACE inhibitor and angiotensin II receptor Physical conditioning in patients with heart blockers: ⇔ HR (R and E) failure and moderate-to-severe left ventricular Calcium channel blockers: ⇑ or ⇑ or ⇔ HR dysfunction results in improved functional (R and E) capacity and quality of life and reduced ␤-Blockers: ⇓ HR (R and E) symptoms. Postmenopausal women than other common protocols (e. diseased populations. For muscular 60—C. widened QRS usually with number of reps—usually ⱖ15. Small increments in the benefits of increased muscular strength. In primary prevention trials. Mobitz type I Second degree: Mobitz type I (Wenckebach). The incidence of a cardiac V1. In particular. 58—D. These all-out run tests may thelium. Naughton are responsible for the increase in exercise The Naughton protocol is appropriate for tolerance. post. This can of ⬍70 mg ⴢ dL⫺1 appears to be appropriate for be achieved through written materials. The goal is to reduce pacing ability also can have a profound impact the availability of lipids to the injured endo- on test results. low protocol).indd 234 11/07/12 11:57 PM . 1 in 2. lowering be inappropriate for sedentary individuals or total cholesterol and LDL cholesterol has been individuals at increased risk for cardiovascular shown to reduce the incidence and mortality of and musculoskeletal complications. This may occur Dwyer_Part3_Sec9. Supraventricular aberrant conduction endurance. which is reflected by (1/2. grade allow claudication times to be stratified bone density. Peripheral adaptations are largely responsible 64—A. emergency situations can occur. ⬍70 mg ⴢ dL⫺1 Patients express lack of interest in making Since publication of Adult Treatment Panel change. The speed remains constant (2 mph) back pain. An individual’s level of motivation and reversing atherosclerosis. more rapid loss of bone mineral density. 61—B. a lower weight is used (40%–60% Supraventricular aberrant conduction — QRS of one repetition maximum) with higher complex is ⱖ0.. It is more gradual with increases in intensity and it uses a lower speed 59—A. Bruce A reduction in the risk of osteoporosis.g. Peripheral adaptation (increased Thyroid medications: ⇑ HR (R and E) skeletal muscle oxidative enzymes and improved mitochondrial size and density) 65—C. 54—B.” tional classes. Posterior are exercising. conduct. including middle. major clinical trials question the treatment involves the use of multiple resources to stress thresholds for LDL. LDL cholesterol potentially could be maximal tests and by their Lowering total cholesterol and LDL cholesterol nature are unmonitored for blood pressure and has proved to be effective in reducing and even HR. 234 CERTIFICATION REVIEW • www. These adaptations 66—C. Digitalis are beneficial for all ages. in particular. coronary artery disease. Moving patients through this stage III. especially in a clinical setting where patients with disease 55—C. an LDL goal the importance of the desired change.11 s. Second degree. abnormal R waves. slow AV conduction. Cooper 12-min test and other means. V2 based on abnormal Q waves except for arrest during exercise testing is 4 in 10. unchanged initial vector. hypertension. The ST segment and T wave are fused together.acsm. The grade starts at 0% associated with resistance training.org repetitions (reps) (6–8). ST-segment tensity of activities in a way comparable among depression indicates insufficient blood flow people of different body weight. This results in turbulence that produces exercise intensity. (i. An increase in maximal RPP indicates (not ⬎200 mm Hg) is a relative indication for that there is improved/increased blood flow to exercise stress test termination. 67—C. The other three choices do not di- decrease in diastolic blood pressure. An increase rectly affect myocardial oxygen demand. diastolic volume. not determining 78—B. ischemia) to the heart muscle. in V̇O2. the audible sounds (Korotkoff sounds). There can be For healthy adults. cardiac output. Turbulent blood flow the exercised muscles. and the arterial blood pressure that it is pump- Rest periods should then be allowed until the ing against (HR ⫻ systolic blood pressure). reach an ischemic threshold. This volume load results in a rise in MET) would reduce myocardial oxygen con- systolic blood pressure and no change or a slight sumption. These adapta- above the pressure in the cuff and then drops tions (i. normal TG as ⬍150 mg ⴢ dL⫺1. digitalis can cause virtually Obese and elderly persons are often less any arrhythmia and all degrees of AV. frailty). SECTION 9 CES Examination 235 when digitalis is in the therapeutic range. Subendocardial ischemia MET is a physiological measure indicating the The most common ECG change with subendo- energy cost of a given physical activity. Stroke volume is equal to the ratio of Sufficient physiological stress is needed to end-diastolic volume to end-systolic volume. However.e. 80—A. 79—C. stroke volume is calculated compensation by collateral circulation with by subtracting end-systolic volume from end- single vessel disease. Patients with peripheral arterial disease should sure is typically seen with an increased workload. there is a vol- Myocardial oxygen consumption is increased ume load on the heart and cardiovascular system.g. Increased peripheral resistance 73—C. The 2001 NCEP guidelines list oxygenated blood flow to the myocardium.e. 12-lead) are required to monitor a complete view of the heart. Lack of metabolic determination (i. A systolic blood pressure greater than 200 mm Hg RPP is an indicator of myocardial oxygen A systolic blood pressure of ⬎250 mm Hg demand. increased aerobic fitness) result in a back down beyond the cuffed region of the decreased HR at the same level of submaximal arm. 82—D. Sufficient ECG leads (e.. Adaptations to long-term aerobic activity include an increased oxidative capacity of 70—D. and increased venous in spurts as the pressure in the artery rises blood flow return to the heart. The other three the coronary arteries. physically active because of various physical or medical limitations (e.. With 75—D. RPP is a measure of the stress put on the cardiac The guidelines recommend patients with periph- muscle (myocardial oxygen demand) based on eral arterial disease achieve 3 (intense pain) on the number of times it needs to beat per minute the 4-point claudication scale during exercise. Decreased RPP with intermittent rest periods. A pain fully resolves before continuing exercise. blood flows through active muscles. HR During increasing aerobic activity. 68—A. Upper middle class digitalis toxicity. A lower HR The less educated are often not aware of the Inderal is a ␤-blocker that diminishes the effect of important health and fitness benefits of being norepinepherine and epinephrine and lowers HR. by a number of variables. physically active on a regular basis. Increase maximum coronary blood flow 71—B. A decreased HR at a given intensity (4 resistance. including increased which causes a decrease in peripheral vascular HR. HR V̇O2max is not a cause for a false negative. osteoarthritis. MET cardial ischemia is ST-segment depression. which will reduce or limit the TG level. V̇O2max) 77—D. Dwyer_Part3_Sec9. values are used as a means of indicating the in- NOT ST-segment elevation.. 69—D. 81—B.g. TG level ⱕ200 mg ⴢ dL⫺1 less oxygen delivery to the myocardium be- All of the guidelines listed are correct except cause of blockage(s).e. CES exercise to leg pain level 3 (on 4-point scale)..indd 235 11/07/12 11:57 PM . increased blood flow When measuring blood pressure. MET 76—D. and mean arterial pres- 74—B. Severe coronary artery disease Severe coronary artery disease will result in 72—D. conditions are reasons for exercise stress test termination.. the knee to extend. Atherectomy The muscle has four heads (quad). A coronary artery stent carries a lower rate of Likewise.200. HR during maximal exercise is related to age. nosis rate in the low single digits. during demand. ⬍50% at 10 yr). 80 ⫻ 140 ⫽ 11. 236 CERTIFICATION REVIEW • www. but atherectomy is not a prerequisite shaft of the femur. restenosis within 6 mo of laser angioplasty. 86—C. isometric contractions 84—C. HR or blood pressure alone. Blood nervous system. Systolic pressure and HR should be avoided. which may reduce falls in not a direct measure of ischemia. 90—B. Exercise training slows down the progression of osteoarthritis. systolic pressure is 140. respectively.indd 236 11/07/12 11:57 PM . they do so poste- with a test without the medication. Although the biceps femoris and gastrocnemius CES 94—B. as dic. constant — stroke volume at rest. diastolic pressure remains pressure is also reduced at rest and during Dwyer_Part3_Sec9. 85—D. 91—C. the skeletal muscle fibers. Restenosis occurs within 6 mo in approxi- 88—C. This constant force The lower HR prolongs diastole (ventricular exerts pressure on the blood vessels. So physically inactive men will typically resistance and the heart’s efforts to overcome have a lower stroke volume compared to physi. benefit on lowering TG and increasing HDL. indicator of the ischemic threshold compared to Further. whereas a stent has about a 25% failure muscle responsible for knee extension. or even slightly decreased. example. contractions. decreasing any or all three choices revascularization than does PTCA. exercise improves strength. Increase HR 92—A. RPP Little scientific evidence suggests that regular (HR ⫻ systolic blood pressure) is a measure or exercise slows down the progression of osteo- indicator of the stress put on the cardiac muscle arthritis. Oxygen uptake is and postural stability. Contraction of the muscle causes of superior patency (90% vs. Because of the associated car- diovascular challenges. Lower stroke volume isometric muscular actions. reducing myocardial oxygen demand at rest 89—D. Increased aerobic fitness rather than rhythmic — force is generated by usually results in a lower resting HR (HRrest). Blood pressure elevations are highest during 83—D. Quadriceps femoris mately 30%–50% of patients who have had a The quadriceps femoris muscle is the major PTCA. All of the above are influenced more by dietary habits and body An increase in any or all of the three choices weight than by exercise training. will increase myocardial oxygen consumption. rate and the drug-eluting stent having a reste- tated by its proximal and distal attachments. An increased RPP can be associated exercise. Owing to this vascular beat. increasing end-diastolic volume and sults in occlusion (or blocking) of blood flow enables more blood to be ejected with each through the vessels. This occurs through a Because of the vasodilation associated with ex. 93—A. it. will decrease myocardial oxygen consumption. Regular aerobic activity typically increases During isometric contractions.org decreased RPP indicates less myocardial oxygen unchanged. particularly among those HR ⫻ systolic blood pressure ⫽ RPP. this at-risk population. making it a better benefits observed in the general population. reduction in chronotropic (HR) and inotropic ercise-induced stimulation of the sympathetic (strength of contraction) responses. An increase in the anginal threshold compared muscles cross the knee joint. Decreased TG and increased HDL HR during maximal exercise will not increase Chronic exercise training has its greatest with adaptations from long-term physical activity. The biceps brachii is found About 25%–50% of patients will experience a in the upper body and is an elbow flexor. three of can be used along with PTCA and is useful which originate from the anterior portion of when the PTCA catheter cannot pass through the ilium and one of which originates on the the artery. For with known cardiovascular disease. HR is 80 bpm. blood pressure is highest during isometric cally active men of the same age and weight. Changes in total cholesterol or LDL cholesterol 87—D. which re- filling). riorly and are primarily active in knee flexion ␤-Blockers increase the anginal threshold by and ankle plantarflexion. Internal mammary artery grafts are and insert on the tibia via a common tendon preferred over saphenous venous grafts because (patellar). Physical activity can lead to the same (myocardial oxygen demand).acsm. Increased diastolic blood pressure and during exercise. All four heads converge for PTCA. balance. with exercise-induced myocardial ischemia. 28. 96—A. 18. 65. 2. 6. Accounting for staff in an emergency is not Stages of motivational readiness describe five essential. 35. 44. 21. technetium-99m is cretion must be used when sharing data. 43. and 6 mo or more. 71. 99 85. 92. 56. 66. Areas where the blood pools. technetium emissions. 11. 84. 38. low-resistance activities. 64. 62. 27. 46. 5 min or until exercise-induced ECG changes 100—C. Monitored immediately. resting and exercise cardiac function related Clearly. 26. (reduced chronotropic and inotropic response) such as the ventricles. 29. 74. 69. As applied to physical activity or training as well as have a document to refer exercise. 82. Has been physically active on a regular basis during an emergency. Such exer- The 12-lead ECG should be recorded imme. 4. 52. 23. 1. cises should be avoided until the sternum and diately after exercise. 37. 45. It is important to note that some questions can be classified as testing multiple domains by the knowledge. actions by each staff member in an emer- action (stage 4). 34. 13. 68. 50. 94. 59. 77. to during an emergency. 76. 8. and dis- wall motion. 39. 16. 32. Limit activities as tolerated to the development activity but has not maintained this program for of self-care activities. 97 Dwyer_Part3_Sec9. are visualized by the and a reduction in total peripheral resistance. 20. before being discarded. 48. 79. 97—D. 25. 54. 47. current ACSM’s recommendations for physical 99—A. Data should be kept on file for at least 1 yr are at baseline. then every 1–2 min for chest incisions have healed. 9. 57. 15. 61. 86. 80. preparation (stage 3). then every 1–2 min Strenuous and resistive upper body exercises for 5 min of recovery or until exercise-induced and activity can cause injury to the sternum changes are at baseline. 7. skills. injected into the bloodstream. 72 90. 91. 98. 100 33. they are precontemplation (stage 1). and maintenance (stage 5). ␤-Blockers do not produce ST-segment changes 98—A. 41.indd 237 11/07/12 11:57 PM . ejection fraction. 60. 70. however. The plan should list the schedule of each staff on the resting ECG. where it attaches CES EXAMINATION QUESTIONS BY DOMAIN Use the following table as a guide to assist you in your studying process. Delineating specific contemplation (stage 2). 24. gency situation and training the staff in these The action stage is when the person is engaged actions obviously are integral parts of any in physical activity or exercise that meets the emergency plan. 55. ROM for extremities. 31. 40. 30. 17. 87. MUGA (blood pool imagery) study There is no accepted minimal or maximal MUGA study may be performed to assess amount of time that data should be stored. 83. Numbers 19. immediately after CABG surgery. 73. Writing down the plan is essential categories of readiness to change or maintain so that the staff can read it as part of their behavior. In this test. 93. SECTION 9 CES Examination 237 exercise by a reduction in cardiac output to red blood cells. member so that they can all be accounted for 95—A. 12. 58. and abilities (KSAs). 53. data must be stored in a to cardiac output. 63. for ⬍6 mo. 10. 81. 5. 89. and confidential (lock-and-key) manner. 95 51. 42. 22. 67. 96. Domain Number I II III IV V Domain Name Patient/Client Exercise Program Leadership and Legal and Assessment Prescription Implementation and Counseling Professional Ongoing Support Considerations Percentage of 30% 30% 20% 15% 5% Questions from Domain CES Question 3. 75. 36. 14. 49. 78. 88. Dwyer_Part3_Sec9.indd 238 11/07/12 11:57 PM . However. Tables. Thus.indd 239 11/07/12 11:10 PM . it is strongly recom. material. more than 45 figures. APPENDIX A Supplementary Figures. and tables when studying the concept mended that you consult the original source of this presented. and Boxes from Other ACSM Certification Texts For your convenience. tables. figures. for your full is presented in is also understood. boxes. tables. and boxes. a figure may display a concept and boxes from other ACSM certification texts are that is only fully understood when the context that it reproduced in this appendix. you should understanding of the concepts presented in these consider consulting the original sources of these various figures. 239 Dwyer_Appendix_A. For instance. Available from: http://purl. Adapted from The President’s Council on Physical Fitness and Sports. American Heart Association. Centers for Disease Control and Prevention. senior editor. Available from: http://www. • Body composition: The relative amounts of muscle. ACSM. such as sight and hearing. • Muscular endurance: The ability of muscle to continue to perform without fatigue. • Combinations of moderate and vigorous intensity exercise can be performed to meet this recommendation. National Center for Chronic Disease Prevention and Health Promotion. American College of Sports Medicine. individuals who wish to further improve their fitness. fat. Definitions—Health. and other vital parts of the body. AHA.htm BOX 1. Med Sci Sports Exerc. et al.S. 9th ed. reduce their risk for chronic diseases and disabilities. Department of Health and Human Services.39(8):1423–34.gov/GPO/LPS21074 and U. Source: Haskell WL. • Coordination: The ability to use the senses. • Reaction time: The time elapsed between stimulation and the beginning of the reaction to it. GETP9 CHAPTER 1. Washington (DC): President’s Council on Physical Fitness and Sports. 278 p. together with body parts in performing tasks smoothly and accurately. • Moderate intensity. ACSM’s Guidelines for Exercise Testing and Prescription. 1996 [cited 2012 Jan 7]. SKILL-RELATED PHYSICAL FITNESS COMPONENTS • Agility: The ability to change the position of the body in space with speed and accuracy. 2007.fitness. and boxes come from the indicated chapters of the following source: Pescatello LS.acsm. BENEFITS AND RISKS ASSOCIATED WITH PHYSICAL ACTIVITY GETP9 Chapter 1 Boxes BOX 1. • Because of the dose-response relationship between physical activity and health. aerobic activity for a minimum of 20 min on 3 d ⭈ wk1. • Power: The ability or rate at which one can perform work.indd 240 11/07/12 11:10 PM . aerobic physical activity for a minimum of 30 min on 5 d ⭈ wk1 or vigorous intensity.gpo. and Physical Activity [Internet].org ACSM’S GUIDELINES FOR EXERCISE TESTING AND PRESCRIPTION. aerobic activity can be accumulated to total the 30 min minimum by performing bouts each lasting 10 min.S. 2014. bone. tables. Fitness. Lee IM. Physical Activity and Health: A Report of the Surgeon General. • Balance: The maintenance of equilibrium while stationary or moving. 11 p. Pate RR. Department of Health and Human Services. and/or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity.gov/ digest_mar2000.access.2 The ACSM-AHA Primary Physical Activity Recommendations • All healthy adults aged 18–65 yr should participate in moderate intensity. 2000 [cited 2012 Jan 7]. Baltimore (MD): Lippincott Williams and Wilkins. • Muscular strength: The ability of muscle to exert force. • Speed: The ability to perform a movement within a short period of time. • Flexibility: The range of motion available at a joint. 240 CERTIFICATION REVIEW • www. 9TH EDITION (GETP9 ) The following figures.1 Health-Related and Skill-Related Components of Physical Fitness HEALTH-RELATED PHYSICAL FITNESS COMPONENTS • Cardiorespiratory endurance: The ability of the circulatory and respiratory system to supply oxygen during sus- tained physical activity. Atlanta (GA): U. • Every adult should perform activities that maintain or increase muscular strength and endurance for a minimum of 2 d ⭈ wk1. Dwyer_Appendix_A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Public Health Service. Dwyer_Appendix_A.3. neck. discomfort in the chest.3) Metabolic: Diabetes mellitus (Types 1 and 2) or renal disease Pain. interstitial lung disease. peripheral vascular. Metabolic Pulmonary: COPD. Yes No jaw. Signs/Symptoms. Tables. asthma.indd 241 11/07/12 11:10 PM . arms. Pulmonary. Disease? or cystic fibrosis (see Table 2. APPENDIX A Supplementary Figures. or other areas that may result from ischemia Shortness of breath at rest or with mild exertion Major Signs or Dizziness or syncope Orthopnea or paroxysmal nocturnal Symptoms Suggestive dyspnea of CV. or Known CV. and Boxes from Other ACSM Certification Texts 241 GETP9 CHAPTER 2. CVD Risk Factors Cardiovascular: Cardiac. cerebrovascular disease Pulmonary. PREPARTICIPATION HEALTH SCREENING GETP9 Chapter 2 Figures Review Health/ Medical History for: Known Disease. Ankle edema Metabolic Disease? Palpitations or tachycardia Intermittent claudication Known heart murmur Unusual fatigue or shortness of breath Yes No with usual activities Age Family History Current Cigarette Number of CVD Risk Smoking Sedentary Lifestyle Factors Obesity Hypertension Dyslipidemia Prediabetes Moderate Low High Risk Risk Risk FIGURE 2. Logic model for classification of risk. Yes Exercise Test Rec Exercise Test Rec Exercise Test Rec Before Exercise? Before Exercise? Before Exercise? Mod Ex .No Max .No Vig Ex .Yes Vig Ex . ≥6 METs “An intensity that causes substantial increases in HR and breathing. they may be considered when there are concerns about risk.Yes MD Supervision of MD Supervision of MD Supervision of Exercise Test Exercise Test Exercise Test if Done? if Done? if Done? Submax . however.No Mod Ex .No Vig Ex . exercise test.3) Medical Exam Rec Medical Exam Rec Medical Exam Rec Before Exercise? Before Exercise? Before Exercise? Mod Ex . and physician supervision of exercise testing are not recommended in the preparticipation screening. Dwyer_Appendix_A. exercise test. Medical examination.No Mod Ex .” Not Rec: Reflects the notion a medical examination.Yes Vig Ex .Yes Vig Ex . more information is needed for the Ex Rx.indd 242 11/07/12 11:10 PM . and physician supervision are recommended in the preparticipation health screening process.No Vig Ex .No Submax .No Max .No Mod Ex . 40%–<60% VO2R.4. and/or are requested by the patient or client. 3–<6 METs “An intensity that causes noticeable increases in HR and breathing. or Asymptomatic Asymptomatic known cardiovascular.acsm. ≥60% VO2R.org Risk Classification High Risk Low Risk Moderate Risk Symptomatic.No Submax . exercise testing.” • Vig Ex: Vigorous intensity exercise. and supervision of exercise testing preparticipation recommendations based on classification of risk. FIGURE 2.Yes • Mod Ex: Moderate intensity exercise.Yes Max .No Mod Ex . 242 CERTIFICATION REVIEW • www. Rec: Reflects the notion a medical examination. renal. or metabolic disease (see Table 2. <2 Risk Factors ≥2 Risk Factors pulmonary. prediabetes should be counted as a risk factor for those 45 yr. oxygen uptake reserve. For individuals having high HDL 60 mg ⭈ dL1 (1.18 mmol ⭈ L1) (21) Prediabetesa Impaired fasting glucose (IFG) fasting plasma glucose 100 mg ⭈ dL1 (5. physical activity (40%–60% V̇O2R) on at least 3 d of the week for at least 3 mo (22.04 mmol ⭈ L1) or on lipid-lowering medication. V̇O2R. or on antihypertensive medication (9) Dyslipidemia Low-density lipoprotein (LDL) cholesterol 130 mg ⭈ dL1 (3. If the prediabetes criteria are missing or unknown.2. Heart Disease and Stroke Statistics—2012 Update: a report from the American Heart Association. especially for those with a body mass index (BMI) 25 kg ⭈ m2. et al.04 mmol ⭈ L1) confirmed by measurements on at least two separate occasions (5) NEGATIVE RISK FACTOR DEFINING CRITERIA High-density lipoprotein 60 mg ⭈ dL1 (1.77 mmol ⭈ L1) and 199 mg ⭈ dL1 (11. that CVD risk factor should be counted as a risk factor except for prediabetes. b High HDL is considered a negative risk factor. 2012. and Boxes from Other ACSM Certification Texts 243 GETP9 Chapter 2 Tables TABLE 2. for these individuals one positive risk factor is subtracted from the sum of positive risk factors. Dwyer_Appendix_A. 2004. Tables. APPENDIX A Supplementary Figures.55 mmol ⭈ L1) (HDL) cholesterol a If the presence or absence of a CVD risk factor is not disclosed or is not available.94 mmol ⭈ L1) or impaired glucose tolerance (IGT) 2 h values in oral glucose tolerance test (OGTT) 140 mg ⭈ dL1 (7. confirmed by measurements on at least two separate occasions. Ann Intern Med. and those 45 yr with a BMI 25 kg ⭈ m2 and additional CVD risk factors for prediabetes. use 200 mg ⭈ dL1 (5. coronary revascularization. If total serum cholesterol is all that is available. 31. Go AS.55 mmol ⭈ L1) and 125 mg ⭈ dL1 (6. Preventive Services Task Force.140(7):569–72. Atherosclerotic Cardiovascular Disease (CVD) Risk Factors and Defining Criteria Risk Factors Defining Criteria Age Men 45 yr.125(1):e2–220.55 mmol ⭈ L1). Circulation.30) Obesity Body mass index 30 kg ⭈ m2 or waist girth 102 cm (40 in) for men and 88 cm (35 in) for women (10) Hypertension Systolic blood pressure 140 mm Hg and/or diastolic 90 mm Hg. or sudden death before 55 yr in father or other male first-degree relative or before 65 yr in mother or other female first-degree relative Cigarette smoking Current cigarette smoker or those who quit within the previous 6 mo or exposure to environmental tobacco smoke Sedentary lifestyle Not participating in at least 30 min of moderate intensity.S. Source: Roger VL. Lloyd-Jones DM.37 mmol ⭈ L1) or high-density lipoproteinb (HDL) cholesterol 40 mg ⭈ dL1 (1. U.indd 243 11/07/12 11:10 PM . Screening for coronary heart disease: recommendation statement. The number of positive risk factors is then summed. women 55 yr (12) Family history Myocardial infarction. 2) Diabetes mellitus and at least one of the following: Age 35 yr OR Type 2 diabetes mellitus 10-yr duration OR Type 1 diabetes mellitus 15-yr duration OR Hypercholesterolemia (total cholesterol 240 mg ⭈ L1) (6. CAD. American College of Sports Medicine. or cystic fibrosis.org TABLE 2.indd 244 11/07/12 11:10 PM . ACSM.acsm. New ACSM Recommendations for Exercise Testing Prior to Exercise-Diagnosed Cardiovascular Disease Unstable or new or possible symptoms of cardiovascular disease (see Table 2.3. Dwyer_Appendix_A.62 mmol ⭈ L1) OR Hypertension (systolic blood pressure 140 or diastolic 90 mm Hg) OR Smoking OR Family history of CAD in first-degree relative 60 yr OR Presence of microvascular disease OR Peripheral artery disease OR Autonomic neuropathy End-stage renal disease Patients with symptomatic or diagnosed pulmonary disease including chronic obstructive pulmonary disease (COPD). coronary artery disease. 244 CERTIFICATION REVIEW • www. interstitial lung disease. asthma. electrocardiogram. Sample of informed consent form for a symptom-limited exercise test. Benefits To Be Expected The results obtained from the exercise test may assist in the diagnosis of your illness. Dwyer_Appendix_A. Purpose and Explanation of the Test You will perform an exercise test on a cycle ergometer or a motor-driven treadmill. or slow heart rhythm. heaviness in the chest. We may stop the test at any time because of signs of fatigue or changes in your heart rate. It is not to be released or revealed to any individual except your referring physi- cian without your written consent.1. APPENDIX A Supplementary Figures. and having had an opportunity to ask questions that have been answered to my satisfaction. You are also expected to report all medications (including nonpre- scription) taken recently and. It is important for you to realize that you may stop when you wish because of feelings of fatigue or any other discomfort. back. or symptoms you may experience. those taken today to the testing staff. However. jaw. You are responsible for fully disclosing your medical history as well as symptoms that may occur during the test. The exercise intensity will begin at a low level and will be advanced in stages depending on your fitness level. 6. Use of Medical Records The information that is obtained during exercise testing will be treated as privileged and confidential as described in the Health Insurance Portability and Accountability Act of 1996. PREEXERCISE EVALUATION GETP9 Chapter 3 Figure Informed Consent for an Exercise Test 1. the information obtained may be used for statistical analysis or scientific purposes with your right to privacy retained. 2. Date Signature of Patient Date Signature of Witness Date Signature of Physician or Authorized Delegate FIGURE 3. Your prompt reporting of these and any other unusual feelings with effort during the exercise test itself is very important. in rare instances. or in evaluating what type of physical activi- ties you might do with low risk. shortness of breath with low-level activity. 4. in evaluating the effect of your medications. Freedom of Consent I hereby consent to voluntarily engage in an exercise test to determine my exercise capacity and state of cardiovascular health. tightness. in particular. 3. heart attack. Tables. please ask us for further explanations. 5. These include abnormal blood pressure. and I understand the test procedures that I will perform and the attendant risks and discomforts. Attendant Risks and Discomforts There exists the possibility of certain changes occurring during the test. irregular. Inquiries Any questions about the procedures used in the exercise test or the results of your test are encouraged. Responsibilities of the Participant Information you possess about your health status or previous experiences of heart- related symptoms (e. Emergency equipment and trained personnel are available to deal with unusual situations that may arise. Knowing these risks and discomforts. Every effort will be made to minimize these risks by evaluation of preliminary information relating to your health and fitness and by careful observations during testing. or death. I have read this form. and/or arms) with physical effort may affect the safety of your exercise test. fainting. stroke. and. I understand that I am free to stop the test at any point if I so desire. pain. If you have any concerns or questions.indd 245 11/07/12 11:10 PM . My permission to perform this exercise test is given voluntarily. neck. I consent to participate in this test. 7. or blood pressure.g. fast. pressure. and Boxes from Other ACSM Certification Texts 245 GETP9 CHAPTER 3.. gov/pubmed/12356646 Dwyer_Appendix_A. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). body aches.5 Contraindications to Exercise Testing ABSOLUTE • A recent significant change in the resting electrocardiogram (ECG) suggesting significant ischemia. Bricker JT. Modified from Gibbons RJ.. 246 CERTIFICATION REVIEW • www.ncbi.e.. HIV) • Mental or physical impairment leading to inability to exercise adequately a Relative contraindications can be superseded if benefits outweigh the risks of exercise.acsm. or swollen lymph glands RELATIVEa • Left main coronary stenosis • Moderate stenotic valvular heart disease • Electrolyte abnormalities (e. especially if they are asymptomatic at rest.g. accompanied by fever.nih. these individuals can be exercised with caution and/or using low-level endpoints. hypokalemia or hypomagnesemia) • Severe arterial hypertension (i. or myxedema) • Chronic infectious disease (e.g. musculoskeletal. thyrotoxicosis.org GETP9 Chapter 3 Box BOX 3. 2002.40(8):1531–40. diabetes.. J Am Coll Cardiol. Available from: http://www.. [cited 2007 Jun 15]. ACC/AHA 2002 guideline update for exercise testing: summary article. or other acute cardiac event • Unstable angina • Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise • Symptomatic severe aortic stenosis • Uncontrolled symptomatic heart failure • Acute pulmonary embolus or pulmonary infarction • Acute myocarditis or pericarditis • Suspected or known dissecting aneurysm • Acute systemic infection.indd 246 11/07/12 11:10 PM .g. Balady GJ. et al. recent myo- cardial infarction (within 2 d). In some instances. systolic blood pressure [SBP] of 200 mm Hg and/or a diastolic BP [DBP] of 110 mm Hg) at rest • Tachydysrhythmia or bradydysrhythmia • Hypertrophic cardiomyopathy and other forms of outflow tract obstruction • Neuromotor. or rheumatoid disorders that are exacerbated by exercise • High-degree atrioventricular block • Ventricular aneurysm • Uncontrolled metabolic disease (e.nlm. 52 1. heart/lung transplants. Champaign (IL): Human Kinetics.indd 247 11/07/12 11:10 PM . Wagner DR. multiple sclerosis.22 1.108 18–48 Men (4.97 / Db) 4.81 / Db) 4.32 1. body density. NA. Malay) Women (4.086 13–17 Men (5.69 / Db) 5.4.95 / Db) 4.100 18–22 Men (5.078 Childs C (5. no data available for this population subgroup.57 1. APPENDIX A Supplementary Figures.48 / Db) 5. p.96 / Db) 4.85 1.33 / Db) 4. 9.089 Resistance trained 35 6 Women (4. fat-free body density based on average values reported in selected research articles.48 1.100 Men (4.34 1.19 / Db) 4.86 / Db) 4.78 1. HIV/AIDS.95 / Db) 4.12 / Db) 4.91 1.106 18–62 Men (4. Population-Specific Formulas for Conversion of Body Density to Percent Body Fat Population Age Gender %BF FFBda (g ⭈ cm⫺3) 9–17 Women (5.67 / Db) 4.08 1. Dwyer_Appendix_A.27 / Db) 4.101 60–90 Men (4.090 Caucasian 18–59 Men (4.099 Women (4.093 All sports 18–22 Women (4. kidney failure (dialysis). 2004.52 1.51 1. HEALTH-RELATED PHYSICAL FITNESS TESTING AND INTERPRETATION GETP9 Chapter 4 Table TABLE 4.41 1.97 / Db) 4. 2nd ed.099 Women (5.86 / Db) 4.51 1.24 / Db) 4.27 / Db) 4.099 Anorexia nervosa 15–44 Women (4.106 24–79 Women (4. and Boxes from Other ACSM Certification Texts 247 GETP9 CHAPTER 4.097 Endurance trained 21 4 Women (4.116 Spinal cord injury (paraplegic/quadriplegic) 18–73 Women (4.85 1.50 1.101 CLINICAL POPULATIONSb Cirrhosis Childs A (5. b There are insufficient multicomponent model data to estimate the average FFBd of the following clinical populations: coronary artery disease.28 1.092 Women (5.12 / Db) 4.39 1.97 / Db) 4.098 Men NA NA Hispanic 20–40 Women (4.084 Childs B (5. cystic fibrosis.84 / Db) 4.82 1.94 / Db) 4.21 / Db) 4.76 / Db) 4.87 / Db) 4.41 1. diabetes mellitus. chronic obstruc- tive pulmonary disease.68 1.97 / Db) 4. cancer.105 (4. %BF. Indian. percentage of body fat.52 1.099 American Indian 18–60 Women (4.50 ETHNICITY Women 1.76 1.086 Women (5.95 / Db) 4.52 1. Adapted with permission from Heyward VH. Db.59 1.95 / Db) 4.102 Singaporean (Chinese.105 24 4 Men (5.96 / Db) 4.18 1.50 1.070 Obesity 17–62 Women (4.088 African American 19–45 Men (4. thyroid disease.50 1.52 1.02 / Db) 4.100 18–73 Men (4.100 Women (4.107 8–12 Men (5.114 a FFBd.97 / Db) 4.87 / Db) 4. Tables.111 Asian Japanese Native 61–78 Men (4.69 1.70 / Db) 4. Applied Body Composition Assessment.03 / Db) 4.37 1.099 ATHLETES 21 2 Men (5. and muscular dystrophy.39 1. 248 CERTIFICATION REVIEW • www.acsm.org GETP9 Chapter 4 Box BOX 4.3 Generalized Skinfold Equations MEN • Seven-Site Formula (chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh) Body density 1.112 0.00043499 (sum of seven skinfolds) 0.00000055 (sum of seven skinfolds)2 0.00028826 (age) [SEE 0.008 or ⬃3.5% fat] • Three-Site Formula (chest, abdomen, thigh) Body density 1.10938 0.0008267 (sum of three skinfolds) 0.0000016 (sum of three skinfolds)2 0.0002574 (age) [SEE 0.008 or ⬃3.4% fat] • Three-Site Formula (chest, triceps, subscapular) Body density 1.1125025 0.0013125 (sum of three skinfolds) 0.0000055 (sum of three skinfolds)2 0.000244 (age) [SEE 0.008 or ⬃3.6% fat] WOMEN • Seven-Site Formula (chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh) Body density 1.097 0.00046971 (sum of seven skinfolds) 0.00000056 (sum of seven skinfolds)2 0.00012828 (age) [SEE 0.008 or ⬃3.8% fat] • Three-Site Formula (triceps, suprailiac, thigh) Body density 1.099421 0.0009929 (sum of three skinfolds) 0.0000023 (sum of three skinfolds)2 0.0001392 (age) [SEE 0.009 or ⬃3.9% fat] • Three-Site Formula (triceps, suprailiac, abdominal) Body density 1.089733 0.0009245 (sum of three skinfolds) 0.0000025 (sum of three skinfolds)2 0.0000979 (age) [SEE 0.009 or ⬃3.9% fat] SEE, standard error of estimate. Adapted from Jackson AW, Pollock ML. Practical assessment of body composition. Phys Sportsmed. 1985;13(5):76–80, 82–90 and Pollack ML, Schmidt DH, Jackson AS. Measurement of cardiorespiratory fitness and body composition in the clinical setting. Compr Ther. 1980;6(9):12–27. Dwyer_Appendix_A.indd 248 11/07/12 11:10 PM APPENDIX A Supplementary Figures, Tables, and Boxes from Other ACSM Certification Texts 249 GETP9 CHAPTER 7, GENERAL PRINCIPLES OF EXERCISE PRESCRIPTION GETP9 Chapter 7 Figure Heart Rate Reserve (HRR) Method Available test data: HRrest: 70 beats ⭈ min1 HRmax: 180 beats ⭈ min1 Desired exercise intensity range: 50%–60% Formula: Target Heart Rate (THR) [(HRmax HRrest) % intensity] HRrest 1) Calculation of HRR: HRR (HRmax HRrest) HRR (180 beats ⭈ min1 70 beats ⭈ min1) 110 beats ⭈ min1 2) Determination of exercise intensity as %HRR: Convert desired %HRR into a decimal by dividing by 100 %HRR desired intensity HRR %HRR 0.5 110 beats ⭈ min1 55 beats ⭈ min1 %HRR 0.6 110 beats ⭈ min1 66 beats ⭈ min1 3) Determine THR range: THR (%HRR) HRrest To determine lower limit of THR range: THR 55 beats ⭈ min1 70 beats ⭈ min1 125 beats ⭈ min1 To determine upper limit of THR range: THR 66 beats ⭈ min1 70 beats ⭈ min1 136 beats ⭈ min1 THR range: 125 beats ⭈ min1 to 136 beats ⭈ min1 V̇O2 Reserve ( V̇O2R) Method Available test data: V̇O2max: 30 mL ⭈ kg1 ⭈ min1 V̇O2rest: 3.5 mL ⭈ kg1 ⭈ min1 Desired exercise intensity range: 50%–60% Formula: Target V̇O2 [(V̇O2max V̇O2rest ) % intensity] V̇O2rest 1) Calculation of V̇O2R: V̇O2R V̇O2max V̇O2rest V̇O2R 30 mL ⭈ kg1 ⭈ min1 3.5 mL ⭈ kg1 ⭈ min1 V̇O2R 26.5 mL ⭈ kg1 ⭈ min1 2) Determination of exercise intensity as %V̇O2R: Convert desired intensity (%V̇O2R) into a decimal by dividing by 100 %V̇O2R desired intensity %V̇O2R Calculate %V̇O2R: %V̇O2R 0.5 26.5 mL ⭈ kg1 ⭈ min1 13.3 mL ⭈ kg1 ⭈ min1 %V̇O2R 0.6 26.5 mL ⭈ kg1 ⭈ min1 15.9 mL ⭈ kg1 ⭈ min1 3) Determine target V̇O2R range: (%V̇O2R) V̇O2rest To determine the lower target V̇O2 range: Target V̇O2 13.3 mL ⭈ kg1 ⭈ min1 3.5 mL ⭈ kg1 ⭈ min1 16.8 mL ⭈ kg1 ⭈ min1 To determine upper target V̇O2 range: Target V̇O2 15.9 mL ⭈ kg1 ⭈ min1 3.5 mL ⭈ kg1 ⭈ min1 19.4 mL ⭈ kg1 ⭈ min1 Target V̇O2 range: 16.8 mL ⭈ kg1 ⭈ min1 to 19.4 mL ⭈ kg1 ⭈ min1 4) Determine MET target range (optional): 1 MET 3.5 mL ⭈ kg1 ⭈ min1 Calculate lower MET target: 1 MET/3.5 mL ⭈ kg1 ⭈ min1 MET/16.8 mL ⭈ kg1 ⭈ min1 MET 16.8 mL ⭈ kg1 ⭈ min1/3.5 mL ⭈ kg1 ⭈ min1 4.8 METs Calculate upper MET target: 1 MET/3.5 mL ⭈ kg1 ⭈ min1 MET/19.4 mL ⭈ kg1 ⭈ min1 MET 19.4 mL ⭈ kg1 ⭈ min1/3.5 mL ⭈ kg1 ⭈ min1 5.5 METs 5) Identify physical activities requiring EE within the target range from compendium of physical activities (1,2) or by using metabolic calcula- tions shown in Table 7.3 or reference (22). Also see the following exam- ples of use of metabolic equations. FIGURE 7.1. Examples of the application of various methods for prescribing exercise intensity. HRmax, maximal heart rate; HRrest, resting heart rate; MET, metabolic equivalent; V̇O2, volume of oxygen consumed per unit of time; V̇O2max, maximal volume of oxygen consumed per unit of time. Dwyer_Appendix_A.indd 249 11/07/12 11:10 PM 250 CERTIFICATION REVIEW • www.acsm.org %HRmax (Measured Or Estimated) Method: Available data: A man 45 yr of age Desired exercise intensity: 70%–80% Formula: THR HRmax desired % Calculate estimated HRmax (if measured HRmax not available): HRmax 220 age HRmax 220 45 175 beats ⭈ min1 1) Determine THR range: THR Desired % HRmax Convert desired % HRmax into a decimal by dividing by 100 Determine lower limit of THR range: THR 175 beats ⭈ min1 0.70 123 beats ⭈ min1 Determine upper limit of THR range: THR 175 beats ⭈ min1 0.80 140 beats ⭈ min1 THR range: 123 beats ⭈ min1 to 140 beats ⭈ min1 %V̇O2 (Measured or Estimated) Method Available data: A woman 45 yr of age Estimated V̇O2max: 30 mL ⭈ kg1 ⭈ min1 Desired V̇O2 range: 50%–60% Formula: V̇O2max desired % Determine target V̇O2 range: Target V̇O2 Desired % V̇O2max Convert desired intensity (%V̇O2) into a decimal by dividing by 100 Determine lower limit of target V̇O2 range: Target V̇O2 0.50 30 mL ⭈ kg1 ⭈ min1 15 mL ⭈ kg1 ⭈ min1 Determine upper limit of target V̇O2max range: Target V̇O2 0.60 30 mL ⭈ kg1 ⭈ min1 18 mL ⭈ kg1 ⭈ min1 Target V̇O2 range: 15 mL ⭈ kg1 ⭈ min1 to 18 mL ⭈ kg1 ⭈ min1 1) Determine MET target range (optional): 1 MET 3.5 mL ⭈ kg1 ⭈ min1 Calculate lower MET target: 1 MET/3.5 mL ⭈ kg1 ⭈ min1 MET/15.0 mL ⭈ kg1 ⭈ min1 MET 15.0 mL ⭈ kg1 ⭈ min1/3.5 mL ⭈ kg1 ⭈ min1 4.3 METs Calculate upper MET target: 1 MET/3.5 mL ⭈ kg1 ⭈ min1 MET/18.0 mL ⭈ kg1 ⭈ min1 MET 18.0 mL ⭈ kg1 ⭈ min1/3.5 mL ⭈ kg1 ⭈ min1 5.1 METs 2) Identify physical activities requiring EE within the target range from compendium of physical activities (1,2) or by using metabolic calcula- tions shown in Table 7.3 and reference (22). See the following examples of use of metabolic equations. Using metabolic calculations (22) or (Table 7.3) to determine running speed on a treadmill Available data: A man 32 yr of age Weight: 130 lb (59 kg) Height: 70 in (177.8 cm) V̇O2max: 54 mL ⭈ kg1 ⭈ min1 Desired treadmill grade: 2.5% Desired exercise intensity: 80% Formula: V̇O2 3.5 (0.2 speed) (0.9 speed % grade) 1. Determine target V̇O2: Target V̇O2 desired % V̇O2max Target V̇O2 0.80 54 mL ⭈ kg1 ⭈ min1 43.2 mL ⭈ kg1 ⭈ min1 2. Determine treadmill speed: V̇O2 3.5 (0.2 speed) (0.9 speed % grade) 43.2 mL ⭈ kg1 ⭈ min1 3.5 (0.2 speed) (0.9 speed 0.025) 39.7 (0.2 speed) (0.9 speed 0.025) 39.7 (0.2 speed) (0.0225 speed) 39.7 0.2225 speed 178.4 m ⭈ min1 speed Speed on treadmill: 10.7 km ⭈ h1 (6.7 mi ⭈ h1) FIGURE 7.1. (Continued) Dwyer_Appendix_A.indd 250 11/07/12 11:10 PM APPENDIX A Supplementary Figures, Tables, and Boxes from Other ACSM Certification Texts 251 Using metabolic calculations (22) (Table 7.2) to determine % grade during walking on a treadmill Available data: A man 54 yr of age who is moderately physically active Weight: 190 lb (86.4 kg) Height: 70 in (177.8 cm) Desired walking speed: 2.5 mi ⭈ h1 (4 km ⭈ h1; 67 m ⭈ min1) Desired MET: 5 METs Formula: V̇O2 3.5 (0.1 speed) (1.8 speed % grade) 1. Determine target V̇O2: Target V̇O2 MET 3.5 mL ⭈ kg1 ⭈ min1 Target V̇O2 5 3.5 mL ⭈ kg1 ⭈ min1 17.5 mL ⭈ kg1 ⭈ min1 2. Determine treadmill grade: V̇O2 3.5 (0.1 speed) (1.8 speed % grade) 17.5 mL ⭈ kg1 ⭈ min1 3.5 (0.1 67 m ⭈ s1) (1.8 67 m ⭈ s1 % grade) 14 (0.1 67 m ⭈ s1) (1.8 67 m ⭈ s1 % grade) 14 6.7 (120.6 % grade) 7.3 120.6 % grade 0.06 % grade % grade 6% Using metabolic calculations (22) (Table 7.3) to determine target work rate (kg ⭈ m ⭈ min1) on a Monarch leg cycle ergometer Available data: A woman 42 yr of age Weight: 190 lb (86.4 kg) Height: 70 in (177.8 cm) Desired V̇O2: 18 kg ⭈ m ⭈ min1 Formula: V̇O2 7.0 (1.8 work rate)/body mass 1. Calculate work rate on cycle ergometer: V̇O2 7.0 (1.8 work rate)/body mass) 18 mL ⭈ kg1 ⭈ min1 7.0 (1.8 work rate)/86.4 kg 11 (1.8 work rate)/86.4 950.4 1.8 work rate 528 work rate Work rate 528 kg ⭈ m ⭈ min1 86.6 W FIGURE 7.1. (Continued) Dwyer_Appendix_A.indd 251 11/07/12 11:10 PM 252 Dwyer_Appendix_A.indd 252 TABLE 7.1. Methods of Estimating Intensity of Cardiorespiratory and Resistance Exercise Resistance Cardiorespiratory Endurance Exercise Exercise GETP9 Chapter 7 Tables . Intensity (%VO2max) Absolute Absolute Intensity Relative Relative Intensity Relative to Maximal Exercise Intensity (MET) by Age Intensity Capacity in MET Perceived Middle % One CERTIFICATION REVIEW • www.acsm.org %HRR or . Exertion 5 METs Young Older . 20.METs 10 .METs Intensity %HRmax %VO2max . MET Age Repetition %VO2R (Rating on %VO2max %VO2max %VO2max (20–39 yr) (ⱖ65 yr) (40–64 yr) Maximum 6–20 RPE Scale) Very light 30 57 37 Very light 34 37 44 2 2.4 2.0 1.6 30 (RPE 9) Light 30–40 57–64 37–45 Very light to 34–43 37–46 44–52 2.0–3 4.8 4.0 3.2 30–50 fairly light (RPE 9–11) Moderate 40–60 64–76 46–64 Fairly light to 43–62 46–64 52–68 3.0–6 4.8–7.2 4.0–6.0 3.2–4.8 50–70 somewhat hard (RPE 12–13) Vigorous 60–90 76–96 64–91 Somewhat hard 62–91 64–91 68–92 6.0–8.8 7.2–10.2 6.0–8.5 4.8–6.8 70–85 to very hard (RPE 14–17) Near 90 96 91 Very hard 91 91 92 8.8 10.2 8.5 6.8 85 maximal to (RPE 18) maximal HRmax, maximal heart rate; HRR, heart rate reserve; MET, metabolic equivalent; RPE, rating of perceived exertion; V̇O2max, maximum oxygen consumption; V̇O2R, oxygen uptake reserve. Adapted from Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. The quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–559. 11/07/12 11:10 PM APPENDIX A Supplementary Figures, Tables, and Boxes from Other ACSM Certification Texts 253 TABLE 7.3. Metabolic Calculations for the Estimation of Energy Expenditure (V̇O2max [mL ⭈ kg⫺1 ⭈ min⫺1]) During Common Physical Activities Sum of Resting ⫹ Horizontal ⫹ Vertical/Resistance Components Resting Horizontal Vertical Component/ Activity Limitations Component Component Resistance Component Walking 3.5 0.1 ⫻ speeda 1.8 ⫻ speeda ⫻ gradeb Most accurate for speeds of 1.9–3.7 mi ⭈ h⫺1 (50–100 m ⭈ min⫺1) Running 3.5 0.2 ⫻ speeda 0.9 ⫻ speeda ⫻ gradeb Most accurate for speeds ⬎5 mi ⭈ h⫺1 (134 m ⭈ min⫺1) Stepping 3.5 0.2 ⫻ steps ⭈ min⫺1 1.33 ⫻ (1.8 ⫻ step Most accurate for stepping rates of heightc ⫻ steps ⭈ min⫺1) 12–30 steps ⭈ min⫺1 Leg cycling 3.5 3.5 (1.8 ⫻ work rated)/ Most accurate for work rates of body masse 300–1,200 kg ⭈ m ⭈ min⫺1 (50–200 W) Arm cycling 3.5 (3 ⫻ work rated)/ Most accurate for work rates between body masse 150–750 kg ⭈ m ⭈ min⫺1 (25–125 W) a Speed in m ⭈ min⫺1. b Grade is percent grade expressed in decimal format (e.g., 10% ⫽ 0.10). c Step height in m. Multiply by the following conversion factors: lb to kg: 0.454; in to cm: 2.54; ft to m: 0.3048; mi to km: 1.609; mi ⭈ h⫺1 to m ⭈ min⫺1: 26.8; kg ⭈ m ⭈ min⫺1 to W: 0.164; W to kg ⭈ m ⭈ min⫺1: 6.12; V̇O2max L ⭈ min⫺1 to kcal ⭈ min⫺1: 4.9; V̇O2 MET to mL ⭈ kg⫺1 ⭈ min⫺1: 3.5. d Work rate in kilogram meters per minute (kg ⭈ m ⭈ min⫺1) is calculated as resistance (kg) ⫻ distance per revolution of flywheel ⫻ pedal frequency per minute. Note: Distance per revolution is 6 m for Monark leg ergometer, 3 m for the Tunturi and BodyGuard ergometers, and 2.4 m for Monark arm ergometer. e Body mass in kg V̇O2max, maximal volume of oxygen consumed per unit of time. Adapted from Armstrong LE, Brubaker PH, Whaley MH, Otto RM, American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 7th ed. Baltimore (MD): Lippincott Williams & Wilkins; 2005. 366 p. Dwyer_Appendix_A.indd 253 11/27/12 12:49 AM and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. • 20 min of exercise per day can be beneficial. or a combination of moderate and vigorous exercise on 3–5 d ⭈ wk1 is recommended. Adapted from Garber CE. • Light-to-moderate intensity exercise may be beneficial in deconditioned persons.000 steps ⭈ d1 to reach a daily step count 7.000 MET-min ⭈ wk1 is recommended.org TABLE 7. 2011. Deschenes MR.5. purposeful exercise that involves major muscle groups and is continuous and rhythmic in nature is recommended. American College of Sports Medicine position stand. • Exercise bouts of 10 min may yield favorable adaptations in very deconditioned individuals. The quantity and quality of exercise for developing and maintaining cardiorespiratory.acsm. • This approach may enhance adherence and reduce risks of musculoskeletal injury and adverse cardiac events. Aerobic (Cardiovascular Endurance) Exercise Evidence-Based Recommendations FITT-VP Evidence-Based Recommendation Frequency • 5 d ⭈ wk1 of moderate exercise. musculoskeletal.indd 254 11/07/12 11:10 PM .43(7):1334–559. • Exercising below these volumes may still be beneficial for persons unable or unwilling to reach this amount of exercise. especially in previously sedentary persons. Dwyer_Appendix_A. Type • Regular. Progression • A gradual progression of exercise volume by adjusting exercise duration. frequency. Intensity • Moderate and/or vigorous intensity is recommended for most adults. et al. or 20–60 min ⭈ d1 of vigorous exercise. or a combination of moderate and vigorous exercise per day is recommended for most adults. Pattern • Exercise may be performed in one (continuous) session per day or in multiple sessions of 10 min to accumulate the desired duration and volume of exercise per day. Med Sci Sports Exerc. Time • 30–60 min ⭈ d1 of purposeful moderate exercise. Volume • A target volume of 500–1. or 3 d ⭈ wk1 of vigorous exercise. 254 CERTIFICATION REVIEW • www. • Increasing pedometer step counts by 2. Blissmer B.000 steps ⭈ d1 steps is beneficial. and/or intensity is reasonable until the desired exercise goal (maintenance) is attained. 1-RM. • 15–20 repetitions are recommended to improve muscular endurance. • Single joint exercises targeting major muscle groups may also be included in a resistance training program. American College of Sports Medicine position stand. • 10–15 repetitions is effective in improving strength in middle-aged and older individuals starting exercise. Repetitions • 8–12 repetitions is recommended to improve strength and power in most adults. • A single set of resistance exercise can be effective especially among older and novice exercisers.43(7):1334–559. 2011. Blissmer B. one repetition maximum. Pattern • Rest intervals of 2–3 min between each set of repetitions are effective. Dwyer_Appendix_A. • 2 sets are effective in improving muscular endurance.indd 255 11/07/12 11:10 PM . Med Sci Sports Exerc. Deschenes MR. et al. and Boxes from Other ACSM Certification Texts 255 TABLE 7. • A rest of 48 h between sessions for any single muscle group is recommended.6. The quantity and quality of exercise for developing and maintaining cardiorespiratory. and/or increasing frequency is recommended. musculoskeletal. APPENDIX A Supplementary Figures. • Multijoint exercises affecting more than one muscle group and targeting agonist and antagonist muscle groups are recommended for all adults. and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. and/or more repetitions per set. • A variety of exercise equipment and/or body weight can be used to perform these exercises. Tables. typically after performing multijoint exercise(s) for that particular muscle group. Resistance Exercise Evidence-Based Recommendations FITT-VP Evidence-Based Recommendation Frequency • Each major muscle group should be trained on 2–3 d ⭈ wk1. Sets • 2–4 sets are recommended for most adults to improve strength and power. Intensity • 60%–70% 1-RM (moderate-to-vigorous intensity) for novice to intermediate exercisers to improve strength • 80% 1-RM (vigorous-to-very vigorous intensity) for experienced strength trainers to improve strength • 40%–50% RM (very light-to-light intensity) for older individuals beginning exercise to improve strength • 40%–50% 1-RM (very light-to-light intensity) may be beneficial for improving strength in sedentary individuals beginning a resistance training program • 50% 1-RM (light-to-moderate intensity) to improve muscular endurance • 20%–50% 1-RM in older adults to improve power Time • No specific duration of training has been identified for effectiveness. Adapted from Garber CE. Progression • A gradual progression of greater resistance. Type • Resistance exercises involving each major muscle group are recommended. PNF. • Static flexibility (i. c Activities at the target V̇O2 and MET can be determined using a compendium of physical activity (1. Pattern • Repetition of each flexibility exercise 2–4 times is recommended.2). heart rate reserve.3).acsm. b V̇O2max/peak is the highest value obtained during maximal/peak exercise or it can be estimated from a submaximal exercise test. Dwyer_Appendix_A. • For proprioceptive neuromuscular facilitation (PNF) stretching. a 3–6 s light-to-moderate contrac- tion (e. and Metabolic Equivalents (METs) • HRR method: Target HR (THR) [(HRmax/peaka HRrest) % intensity desired] HRrest • V̇O2R method: Target V̇O2Rc [(V̇O2max/peakb V̇O2rest) % intensity desired] V̇O2rest • HR method: Target HR HRmax/peaka % intensity desired • V̇O2 method: Target V̇O2c V̇O2max/peakb % intensity desired • MET method: Target METc [(V̇O2max/peakb)/3.7.e. 20%–75% of maximum voluntary contraction) followed by a 10–30 s assisted stretch is desirable. Progression • Methods for optimal progression are unknown. and PNF are each effective. maximal or peak heart rate. BOX 7.. proprioceptive neuromuscular facilitation. HRmax/peak.indd 256 11/07/12 11:10 PM . Volume • A reasonable target is to perform 60 s of total stretching time for each flexibility exercise. Flexibility Exercise Evidence-Based Recommendations FITT-VP Evidence-Based Recommendation Frequency • 2–3 d ⭈ wk1 with daily being most effective Intensity • Stretch to the point of feeling tightness or slight discomfort Time • Holding a static stretch for 10–30 s is recommended for most adults. • In older individuals. resting heart rate. oxygen uptake reserve.2 Oxygen Uptake (V̇O2). V̇O2R. holding a stretch for 30–60 s may confer greater benefit.. 2) or metabolic calculations (22) (Table 7.5 mL ⭈ kg1 ⭈ min1] % intensity desired a HRmax/peak is the highest value obtained during maximal/peak exercise or it can be estimated by 220 age or some other prediction equation (see Table 7. HRrest. GETP9 Chapter 7 Box Summary of Methods for Prescribing Exercise Intensity Using Heart Rate (HR). active or passive).g. ballistic flexibility. Please see The Concept of Maximal Oxygen Uptake in Chapter 4 for the distinction between V̇O2max and V̇O2peak.org TABLE 7. Type • A series of flexibility exercises for each of the major muscle-tendon units is recommended. HRR. • Flexibility exercise is most effective when the muscle is warmed through light-to-moderate aerobic activity or passively through external methods such as moist heat packs or hot baths. 256 CERTIFICATION REVIEW • www. dynamic flexibility. 2014. APPENDIX A Supplementary Figures. FUNCTIONAL ANATOMY RM7 Chapter 1 Figures Superior Frontal Sagittal plane plane Transverse Posterior plane Medial Lateral Anterior Inferior FIGURE 1. and Boxes from Other ACSM Certification Texts 257 ACSM’S RESOURCE MANUAL FOR GUIDELINES FOR EXERCISE TESTING AND PRESCRIPTION. and boxes come from the indicated chapters of the following source: Swain P. 7TH EDITION (RM7 ) The following figures. senior editor.2.indd 257 11/07/12 11:10 PM . Dwyer_Appendix_A. RM7 CHAPTER 1. tables. ACSM’s Resource Manual Guidelines for Exercise Testing and Prescription. Baltimore (MD): Lippincott Williams and Wilkins. Anatomical planes of the body. Tables. 7th ed. 23. 258 CERTIFICATION REVIEW • www. Divisions of the skeletal system.acsm.indd 258 11/07/12 11:10 PM . Dwyer_Appendix_A.org Cranium SKULL Facial SHOULDER Clavicle HYOID Scapula THORAX Sternum Ribs UPPER EXTREMITY VERTEBRAL VERTEBRAL Humerus COLUMN COLUMN Ulna Radius Carpals PELVIC PELVIC GIRDLE GIRDLE Phalanges Metacarpals LOWER EXTREMITY Femur Patella Tibia Fibula Tarsals Metatarsals Phalanges Anterior Posterior FIGURE 1. Posterior view of superficial muscles. and Boxes from Other ACSM Certification Texts 259 Sternocleidomastoid Trapezius Infraspinatus Deltoid Teres minor Teres major Triceps brachii Latissimus dorsi Brachioradialis Anconeus Extensor carpi radialis brevis External Extensor digitorum oblique Extensor carpi ulnaris Gluteus medius Flexor carpi ulnaris Abductor pollicis longus Extensor pollicis Tensor fasciae brevis latae Extensor pollicis Gluteus longus maximus Adductor magnus Vastus lateralis Biceps femoris Plantaris Semitendinosus Gastrocnemius Gracilis Popliteal fossa Semimembranosus Soleus Sartorius Soleus Peroneus longus Flexor digitorum Flexor hallucis longus longus Peroneus brevis Calcaneal (Achilles) tendon FIGURE 1. Tables.29. APPENDIX A Supplementary Figures.indd 259 11/07/12 11:10 PM . Dwyer_Appendix_A. org Orbicularis oculi Depressor anguli oris Orbicularis oris Sternocleidomastoid Thyrohyoid Platysma Omohyoid Trapezius Scalenes Sternohyoid Deltoid Latissimus dorsi Pectoralis major Serratus anterior Biceps brachii Brachialis Rectus abdominus Triceps brachii Brachioradialis Extensor carpi radialis External oblique longus and brevis Extensor carpi Brachioradialis radialis longus Flexor carpi radialis Palmaris longus Illiacus Flexor carpi ulnaris Psoas major Flexor digitorum Tensor fasciae superficialis latae Flexor pollicis longus Pectineus Thenar muscles Adductor longus Hypothenar muscles Adductor magnus Sartorius Iliotibial tract of Gracilis tensor fasciae latae (iliotibial band) Vastus lateralis Rectus femoris Vastus medialis Tendon of quadriceps femoris Peroneus longus Patella Tibia Tibialis anterior Soleus Extensor digitorum longus Extensor hallucis brevis FIGURE 1. 260 CERTIFICATION REVIEW • www.30. Anterior view of superficial muscles. Dwyer_Appendix_A.indd 260 11/07/12 11:10 PM .acsm. 2. ↔ no change. Tables. and Boxes from Other ACSM Certification Texts 261 RM7 CHAPTER 3.2. EXERCISE PHYSIOLOGY RM7 Chapter 3 Table TABLE 3. increase. System Changes Neonatal Infancy Childhood Adolescence Adulthood Senescence Cardiovascular System Cardiac output ↑ ↑ ↔ ↔ Stroke volume ↑ ↑ ↔ ↓ HRmax ↑ ↔ ↓ ↓ V̇O2max ↑ ↑ ↓ ↓ Pulmonary System Vital capacity ↑ ↑ ↑ ↓ ↓ Musculoskeletal System Bone mineral density ↑ ↑ ↑ ↔ ↓ Fat-free body mass ↑ ↑ ↑ ↑ ↓ Anaerobic capacity ↑ ↑ ↑ ↓ Flexibility ↑ ↑ ↓ ↓ % Body fat ↑ ↑ ↑ ↑ Nervous System Motor control ↑ ↑ ↑ ↔ ↓ Immune System Immune system ↑ ↑ ↔ ↓ function ↑ increases. Dwyer_Appendix_A. Comparison of the Relative Hemodynamic Responses to Dynamic and Static Exertion Dynamic (Isotonic) Static (Isometric) Cardiac output Heart rate Stroke volume 0 Peripheral resistance Systolic blood pressure Diastolic blood pressure 0 Mean arterial pressure 0 Left ventricular work Volume load Pressure load .indd 261 11/07/12 11:10 PM . APPENDIX A Supplementary Figures. RM7 CHAPTER 5. . ↓ decreases. unchanged. LIFESPAN EFFECTS OF AGING AND DECONDITIONING RM7 Chapter 5 Table TABLE 5. 0. decrease. personal certification or public licensure) and authorized parties.1 Tips for Exercise Professionals Some tips for exercise professionals regarding legal they manage their own participation safely and matters include the following: effectively. clients. and follow up to verify that quent and regular basis. Develop emergency response plans. observe their related participation. Use appropriate informed consent for all services in emergencies. and institute auto- fied attorney and risk manager). capabilities. professional liability insurance coverage. and organization or environment. Know and apply in practice the most rigorous and 5. mated external defibrillation programs as applicable. 9. LEGAL CONSIDERATIONS FOR EXERCISE PROGRAMMING RM7 Chapter 10 Box BOX 10.acsm. Document fulfillment of your service in a manner current peer-developed guidelines applicable to your consistent with standard of care and your written services.g. program policies and procedures. Maintain credentials relevant to your service 6. Communicate critical information in a timely way to (e. 262 CERTIFICATION REVIEW • www. based on rehearsal experiences. 7. rehearse for 3.indd 262 11/07/12 11:10 PM .. 2. Instruct clients in techniques of participation and 8.org RM7 CHAPTER 10. Maintain equipment and inspect facilities on a fre- correct problems. 4. Dwyer_Appendix_A. 1. Report incidents and follow up to continuously im- limitations relevant to their health and physical prove emergency readiness and performance. document and upgrade procedures which such consent is relevant (consult with quali. vomiting. note time symptoms started. blurred or double (4 oz or ½ cup regular soda or orange juice or vision. coughing. nausea. continue pulse. sudden 15 min if continued hypoglycemia. begin Temporary loss of consciousness emergency breathing or compressions as needed. arrest by lack of oxygen to the heart.2. loss of coordination Try pursed-lip breathing. Maintain open airway. and Boxes from Other ACSM Certification Texts 263 RM7 CHAPTER 19. hunger. muscle weakness. administration of bronchodilator if prescribed (18). turn head to side if vomiting. activate EMS. CPR if needed. Maintain open airway. activate EMS. denial of medical (whichever is most comfortable). skin color — pale. sweet well or tests positive for urinary ketones (4). Stop activity. administer oral fluids if conscious. Stop activity. Tables. May cause Activate EMS. Stroke or TIA Lack of oxygen to the brain. assist with Hyperventilation. give oxygen if hypoxic. lethargy. Start symptoms such as drowsiness. and check blood sugar if patient does not respond immediately. Hypoglycemia Low blood sugar. or loss of vision and voluntary movement. weak elevated. check blood sugar. airway. give nitroglycerin and oxygen per ACLS protocol if known history of CAD. when AED/manual defibrillator is be unresponsive without breathing or available. vitals and signs/symptoms. Postpone exercise if an individual is not feeling polyuria. jaw. activate EMS and transport. check pulse. APPENDIX A Supplementary Figures. three glucose tablets) if conscious. Nausea. Tachypnea Abnormally rapid respiration rate. Continue to monitor blood glucose. CAB (chest compressions. Sudden cardiac An abnormal heart rhythm usually caused Activate EMS. Angina Pain/pressure in the chest. Consume meal moodiness or snack to prevent recurrence. Activate EMS. if signs/symptoms persist. sweating. irregular pulse. unconsciousness. Hyperglycemia Abnormally high blood sugar. if not. Repeat in seizure. which is relieved with rest and/or medication). or facial droop (continued) Dwyer_Appendix_A. headache. Monitor severe headache with no known cause. If unconscious. neck. confusion. CPR as indicated. Acute Responses for Cardiopulmonary and Metabolic Conditions/Emergencies Condition Definition/Signs and Symptoms Acute Care Dizziness/fainting Disoriented. treat cause if Hyperventilation known. confusion. loss of coordination. if no relief.indd 263 11/07/12 11:10 PM . slurred speech. EXERCISE PROGRAM SAFETY AND EMERGENCY PROCEDURES RM7 Chapter 19 Tables TABLE 19. Check blood sugar. Dyspnea Labored breathing. Get 12-lead EKG. tremors. place supine with legs Syncope rapid. and administer large amounts of noncaloric or low-calorie fluids orally if conscious. Profuse sweating. problem. check glucose if possible. defibrillate shockable rhythms. nausea. Trained professionals may give insulin to lower blood sugar. arm Stop activity. wheezing. confused. dizziness. Stop fruity breath. hyperventilation activity if symptoms persist. blurred vision. administer 5–20 g (6) of CHO tachycardia. Activate EMS or physician evaluation (unless patient is diagnosed with chronic stable angina. activate EMS. place in seated or supine position and/or back. move into a more relaxed position. Determine responsiveness. victim may rescue breathing). use glucagon emergency kit if trained. shortness of breath blood pressure. and rhythm if possible. rhabdomyolysis dark urine cool. Chameides L. loss of coordination. Maintain airway. warm stiffness. test or SBP 200 and/or DBP 105 during exercise bout Hypotension Low BP that causes symptoms such as Stop activity. and identify the rhythm. Monitor vital signs. arms. SBP 250 or DBP 115 without If BP does not drop quickly. et al. Treat the cause. tachycardia. dyspnea. dizziness. Activate EMS and immediately move to cool area.org TABLE 19. loss of consciousness. dry skin but can be sweating. Acute Responses for Cardiopulmonary and Metabolic Conditions/Emergencies (Continued ) Condition Definition/Signs and Symptoms Acute Care Hypertension High blood pressure — if resting SBP Do not exercise. secure airway. muscle any wet clothing and replace with dry. encourage cool dizziness. blood pressure. cool with cool spray. 2010. remove headache. nausea.acsm. fatigue the victim. it Stop activity.122(18 Suppl 3):S934–46. confusion. is not unusual for patients on -blockers give oxygen. systolic blood pressure. Hyperthermia Heat injury Heat cramps Painful. exercise. emergency room. hypotension. Hypothermia Body temperature falls below 35° C or 95° Activate EMS and move to a warm place.). Activate EMS if symptoms do not resolve and BP does not improve. give oxygen. Activate etc. and administer oral fluids if conscious. Other signs and symptoms such as EMS or obtain physician evaluation. Exertional Muscle pain. clothes. ER. Heat exhaustion Heavy sweating. shivering. Check for signs or athletic individuals to have slow resting of poor perfusion. give hot liquids. carbohydrate fluids. monitor vitals and hydration status. assess vital signs. BP.2. Circulation. Stop activity and move to cool area. Dwyer_Appendix_A. 264 CERTIFICATION REVIEW • www. CAD. application of ice and massage abdominal. dizziness. monitor vitals and signs/symptoms. and identify rhythm. guidelines for tachycardia. bpm. Heat stroke Hot. tachycardia. DBP. diastolic blood pressure. refer for physician evaluation. Alert provider or take to ER. Administer chilled oral electrolyte- most commonly affecting calves. involuntary. EKG. 200 or DBP 110. Administer fluids if conscious. and fatigue. elevate syncope.indd 264 11/07/12 11:10 PM . Remove F. and give oral fluids if conscious. CHO. Tachycardia Resting HR 100 bpm or abnormally high Stop activity. beats per minute. Bradycardia Resting HR 60 bpm with symptoms. often unconscious with core body water bath to chin preferred). activate EMS. HR given the condition (anxiety. Monitor core temperature. or activate EMS if no rapid improvement. coronary artery disease. Adapted from Markenson D. Ferguson JD. Assess vital signs. alert physician or take symptoms of stroke or TIA during exercise to ER. electrolyte-carbohydrate drinks but avoid chilling headache. check vital signs. legs. carbohydrate. pale. Activate EMS and transport to hospital immediately. isolated muscle spasms Stop activity. HR. dowse with cool water (ice seizure. muscle spasms. SBP. Part 17: first aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. monitor core temperature and vitals. TIA. and treat contributing factors. HRs without symptoms. and back muscles followed by gentle stretching. decrease in mental clothing and cover with blankets or warm water function. follow ACLS dyspnea or angina may be present. remove clothing. heart rate. Stop activity. swelling and weakness. and lethargy. electrocardiogram. or wrap in cool wet temperature 40° C (104° F) sheets. disorientation to rewarm gradually. Place in a supine position. syncope. transient ischemic attack. tight. swelling. Refer to physician for stitches/tetanus. swelling. RICE..e. bruising. II. and some loss of function Grade III Complete tear Severe pain. Palpable defect. possible localized protocol) spasms Grade II More extensive Loss of function. grade II includes those of grades I and II. physician evaluation. Immobilization. Immobilize joint with padded splint in position acute bone pain found if warranted. APPENDIX A Supplementary Figures. and III). X-rays fracture a Signs and symptoms for each grade include those for the grade below the one listed (i. RICE (see Table 19-4 for definitions and fibers ness. complete Immobilization. and/or fascia Grade I Affects only a few Mild discomfort. and bruising Spraina A stretch or tear to the ligaments and stabilizing connec- tive tissues of a joint Grade I Slight tear or Minimal pain. refer for physician evaluation damage to more bruising. Wash your hands immediately after providing care.indd 265 11/07/12 11:10 PM . redness. unable to bear evaluation weight on the joint Stress Microscopic damage Insidious onset of pain that Physician evaluation. moderate pain. physician evaluation swelling. non–weight-bearing fracture to the bone due to persists when attempting activities repetitive stress activity. Lacerations/ Open skin wounds Pain. grade III includes signs and symptoms listed under grades I. Apply sterile corns dressing. mild fever fer of blood-borne pathogens. Acute Responses for Common Musculoskeletal Injuries/Emergencies Injury Description Signs/Symptoms Acute Care Blisters/ Closed skin wounds Pain. bleeding. antibiotic ointment. swelling. difficulty with weight bearing. Tables. swelling. Follow universal precautions to prevent the trans- abrasions swelling. disability. Apply direct pres- sure to stop bleeding. tendon. infection Clean with antiseptic soap. point-specific tenderness Simple Sudden break of a Swelling. rest. tion as surgery may be required.3. little RICE stretch without joint or no loss of function. RICE. Straina A stretch or tear in a muscle. and Boxes from Other ACSM Certification Texts 265 TABLE 19. pain. swelling. RICE. severe pain. slight instability or no bruising Grade II Partial tear Bruising. Dwyer_Appendix_A. prompt physician evalua- plete rupture loss of function. Irrigate with large volumes of water to remove debris. apply antibiotic ointment and sterile dressing for abrasions and superficial injuries. and localized fibers tenderness Grade III Severe tear or com. RICE. Clean with soap or sterile saline. prompt physician bruising. place a thin towel between skin and ice bag Compression Reduction of swelling Elastic wrap/compression sleeve Elevation Reduction of swelling Elevate extremity above heart level Adapted from Markenson D. swelling. and Prentice WE. 2010. two to three times inflammation. 14th ed. RICE Protocol for Acute Injuries Treatment Purpose Application Rest Pain control.indd 266 11/07/12 11:10 PM . and bleeding per day. use plastic bag.122(18 Suppl 3):S934–46. Immediately post injury. 266 CERTIFICATION REVIEW • www. Arnheim DD.4. immobilization. Chameides L. depending on severity of injury Ice Reduction of pain. New York (NY): McGraw-Hill Higher Education. duration. Ferguson JD. spasms. Circulation. or reduction in training intensity. 940 p.acsm. 2011.org TABLE 19. prevention of reinjury Complete rest. et al. 10–20 min. ice and water mixture. Arnheim’s Principles of Athletic Training: A Competency-Based Approach. or use of non–weight- bearing activities. Part 17: first aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. Dwyer_Appendix_A. frequency. Tables. including hours of operation to oversee a medical emergency? cognitive problems such as dementia or Alzheimer • Who will activate EMS? Are telephone numbers for disease. fire extinguishers. and do they receive gymnasium)? routine maintenance? • What care will be provided? • Is the facility conducting and documenting • Who will render care? cardiovascular risk screening of all new members. ACSM’s Health/Fitness Facility Standards and Guidelines. 2011. latex or similar gloves. pool. illness) numbers if primary contacts are unavailable? Current status of involved or injured individuals Patients/members should be encouraged to update Type of assistance being given this information on a regular basis.. if exercise to the emergency scene? equipment malfunction were a potential concern)? • Have the facility administrators invited • Was the accident/injury report submitted to the representatives from EMS to become familiar facility’s insurance administrator and legal counsel with the floor plan and activities of the facility? in a timely manner (within 24 h of the accident) • Are emergency response training sessions and marked as “privileged and confidential” when conducted regularly (at least once every 3 mo) appropriate? and documented? • Are employees given appropriate protocols for • Does emergency training consists of both handling inquiries made by media and other announced and unannounced mock drills? representatives regarding the incident? • Are emergency drills and training documented and evaluated with recommendations for necessary Adapted from Peterson JA. emergency procedure plan? physician permission to participate. emergency infor- blood-borne pathogen guidelines and procedures? mation. team leader. and alternative telephone Type of emergency (injury. telephone numbers this information posted next to the phone? with special instructions. weight room. medical liaison)? • Have staff members been appropriately informed • Is there a manager/team leader available during all of orthopedic or other health problems. and • Are different emergency procedures developed and other emergency equipment? posted for various areas within the facility (testing • Are emergency equipment and supplies clearly areas. stretchers.g. informed consent. and • Who will direct ambulance. and patients? CPR. • Are all staff and supervisors certified in first aid. and is members. APPENDIX A Supplementary Figures. Exact location of the facility and the afflicted • Are properly documented injury and accident reports individual within the facility including statements by the injured and witnesses Specific point of entry into the facility and their contact information completed and stored Telephone number being used in an appropriate secure location for review and • Who will supervise the other activity areas if super.. displayed and accessible at a central staff location? AED. and Boxes from Other ACSM Certification Texts 267 RM7 Chapter 19 Box BOX 19. follow-up by administration? visors must leave to assist at an accident scene? • Is there a plan for collecting facts and data after • Who will help with crowd control? the accident including interviewing witnesses. 4th ed. Champaign (IL): changes? Human Kinetics. splints. and/or ACLS as appropriate? • Are persons at high risk directed to seek facilities pro- • Is there a plan for public access defibrillation (PAD)? viding appropriate levels of care and staff supervision? • Is staff training documented in personnel files or the • Are appropriate documents (health appraisal. • Who has access to keys for locked areas or doors? retention of any broken equipment parts. assumption of • Have all staff received training for OSHA’s risk or waiver. American College of Sports Medicine. that might affect participation? emergency procedures clearly posted? • Are emergency notification cards on file for each • Are all staff members familiar with the information participant that include telephone numbers of family to be provided to EMS over the telephone. AED. captain. and advanced directives) completed and • Are the responsibilities of individual staff members accessible to staff in the event of an emergency? identified (e. and labeled and routinely checked. or the code team taking photographs if appropriate (e.1 Strategies for Developing an Emergency Care Plan • Who is the staff member in charge of the facility’s • Is EMS involved in the training and conduction emergency plan and programming and is there of drills? physician oversight (medical director)? • Do all staff members know the location and have • Is an outline of the entire emergency care plan easy access to first-aid kits.g. guests. 211 p. Dwyer_Appendix_A. EMS. physician names. outdoor areas.indd 267 11/07/12 11:10 PM . Tharrett SJ. Y N 4. Motivating People to be Physically Active. Y N ITEM Stage 1 2 3 4 Precontemplation No No — — Contemplation No Yes — — Preparation Yes — No — Action Yes — Yes No Maintenance Yes — Yes Yes Modified with permission from Marcus B. Y N 2. Y N For activity to be regular. I have been regularly physically active for the past 6 mo. 2nd ed. Forsyth L. please circle Yes (Y) or No (N).org RM7 CHAPTER 46. I currently engage in regular physical activity. COUNSELING PHYSICAL ACTIVITY BEHAVIOR CHANGE RM7 Chapter 46 Box BOX 46. Dwyer_Appendix_A. it must add up to a total of 30 or more minutes per day and be done at least 5 d ? wk21.acsm. 2009. Champaign (IL): Human Kinetics.indd 268 11/07/12 11:10 PM . I intend to become more physically active in the next 6 mo. 200 p. I am currently physically active. Yes No 3. 268 CERTIFICATION REVIEW • www. For example. Yes No 1. you could take one 30-min walk or three 10-min walks each day. Please be sure to follow the instructions carefully.5 Assessing Physical Activity Stages of Change PHYSICAL ACTIVITY STAGES OF CHANGE INSTRUCTIONS: For each question below. telephone calls. intensity. IMPLEMENTING.indd 269 11/07/12 11:10 PM . List specific goals in ARRANGE: behavioral terms ADVISE: Specify plan for follow-up 2. The five A’s model applied to physical activity promotion in clinical settings. Share plan with practice team ASSIST: ASK: Identify personal barriers and Collaboratively set physical activity problem-solving techniques goals based on patient’s interest Indentify potential community and confidence to perform the opportunities for physcial activity behavior and social support FIGURE 48. and type 3. List barriers and Personal health risks visits. strategies to address Benefits of change mailed reminders barriers Amount. APPENDIX A Supplementary Figures. Specify follow-up of physical activity plan 4. and Boxes from Other ACSM Certification Texts 269 RM7 CHAPTER 48.1. Dwyer_Appendix_A. Tables. PLANNING. AND EVALUATING PHYSICAL ACTIVITY PROGRAMS RM7 Chapter 48 Figure ASSESS: Physical Activity Level Physcial Abilities Beliefs & Knowledge Personal Action Plan 1. senior editor.acsm. tables. and boxes come from the indicated chapters of the following source: Bushman BA.org ACSM’S RESOURCES FOR THE PERSONAL TRAINER. 270 CERTIFICATION REVIEW • www. 4th ed. 2014. ACSM’s Resources for the Personal Trainer. 4TH EDITION (RPT4 ) The following figures.indd 270 11/07/12 11:10 PM . Dwyer_Appendix_A. Baltimore (MD): Lippincott Williams and Wilkins. Pronator quadratus m. Supinator m. Biceps brachii m. Extensor digitorum brevis m. Pronator teres m. mm. 7 Rectus abdominis m. Palmar Tensor fasciae aponeurosis latae m. Gluteus minimus m. Tendon 1 Sternocleidomastoid m. Key Iliotibial tract Vastus lateralis m. Iliopsoas m. 11 Rectus sheath Extensor hallucis longus m. 6 Rectus sheath Peroneus longus m. Platysma m. Extensor digitorum longus m. Mentalis m. Peroneus tertius t. Medial head Triceps brachii Long head 5 Lateral head muscle Lateral head 4 7 4 Biceps brachii m. Flexor pollicis longus m. Pronator teres m. Orbital part Levator labii superioris alaeque nasi m. oblique m. Pectineus m. 4 Long head Deltoid m. Orbicularis oris m. Tibialis anterior t. 10 Transversus Extensor hallucis longus m. 7 Abductor pollicis longus m. Rectus femoris m. Peroneus brevis m. Gastrocnemius m. Scalenus medius m. Flexor digitorum profundus m. Iliotibial tract 1 Subclavius m. 8 6 8 Bicipital aponeurosis Brachialis m. Flexor carpi radialis 10 15 Extensor carpi radialis Supinator m. Gluteus 13 Flexor retinaculum medius m. Sartorius m. (posterior layer) Peroneus brevis m. Gluteus medius m. (anterior layer) Soleus m. Superior Nasalis m. Palpebral part Auricularis muscles Procerus m. Omohyoid muscle Superior belly m. (Asset provided by Anatomical Chart Co. 12 Arcuate line 13 Cremaster m. 11 Flexor carpi ulnaris m. Key Depressor anguli oris m. Medial patellar retinaculum 4 Serratus anterior m. Peroneus longus m. 8 External abdominal Interosseous membrane Tibialis anterior m. tt. Levator anguli oris m. Zygomaticus minor m. Sartorius m. Ligament Thyrohyoid m. Masseter m. Rectus femoris m. 9 14 Bicipital aponeurosis Brachioradialis m. 9 Internal abdominal Extensor digitorum longus m. Patellar l. Levator labii superioris m. Brachioradialis m. Superior extensor retinaculum 14 Linea alba Peroneus tertius m. Depressor septi m. Biceps brachii muscle Long head 2 Coracobrachialis m. Muscle scapulae m. Soleus m. 15 Aponeurosis of external Inferior extensor retinaculum Extensor digitorum longus tt. 3 Pectoralis minor m. Biceps brachii t. abdominal oblique m. Brachialis m. 2 Deltoid m. Triceps brachii muscle Latissimus dorsi m. Tables. Lateral patellar retinaculum 2 External intercostal mm. Tibialis anterior m. Muscles Trapezius m. Pectineus m. Frontalis m. Adductor muscles Vastus intermedius m. Orbicularis oculi muscle Corrugator supercilii m. Tensor fasciae latae m. abdominis m. Flexor digitorum superficialis m. Risorius m. Flexor carpi radialis t. and Boxes from Other ACSM Certification Texts 271 RPT4 CHAPTER 3. longus m. Peroneus longus t. Flexor digitorum superficialis m. Magnus Rectus femoris m. Biceps femoris m. Superficial muscles — anterior view. 12 Palmaris longus m.8. Anterior Zygomaticus major m. Longus Vastus medialis m. l. APPENDIX A Supplementary Figures. Medial head 6 Brachialis m. 5 Pectoralis major m. ANATOMY AND KINESIOLOGY RPT4 Chapter 3 Figures Skin Galea aponeurotica Anterior view Temporalis m. 3 Short head 5 Latissimus dorsi m. t. Flexor carpi radialis m.) Dwyer_Appendix_A.indd 271 11/07/12 11:10 PM . FIGURE 3. Tendons Subscapular m. Brevis Gracilis m. Extensor carpi radialis longus m. Buccinator m. Depressor labii inferioris m. Teres major m. Flexor carpi ulnaris m. oblique m. Flexor retinaculum Flexor pollicis longus m. Ligaments Levator Sternohyoid m. ll. Sartorius 17 Serratus posterior inferior m. Short head Vastus lateralis m. 23 Supinator m. m. interosseous m. Extensor carpi radialis longus m. Soleus Flexor digitorum longus mm. 31 Inferior gemellus m. Medial head Plantaris m. Inferior peroneal retinaculum Brevis 33 Quadratus femoris m. 19 Flexor digitorum Brachioradialis m. 3 Deltoid m. Occipitalis m. 3 14 Lateral head Triceps brachii muscle 15 16 4 Lateral head Brachialis m. Lateral head 12 Erector spinae mm. 26 Extensor pollicis longus m. 12 Extensor digitorum m. 2 Spine of C7 Iliotibial tract Biceps femoris muscle 3 Rhomboid major m. Calcaneal t. 7 8 6 Anconeus m. Gastrocnemius m. Occipitalis minor m. Gracilis m. 23 Adductor muscles Key Minimus Adductor magnus m. 4 Latissimus dorsi m. 1 2 9 Omohyoid muscle. 6 Thoracolumbar fascia 7 External abdominal oblique m. 31 32 Extensor retinaculum ulnaris 24 29 30 33 Dorsal m. Tendons Teres major m. Vastus lateralis m. Long head 5 Spine of T12 Biceps femoris m. Brevis 27 Piriformis m. Lateral head Popliteus m. 26 Gluteus minimus m. Extensor carpi radialis brevis m. 24 Greater trochanter Peroneus muscles Aponeurosis of soleus m. Key 11 Infraspinatus m. Magnus 1 Trapezius m. Posterior auricular m. carpi 29 Extensor indicis m. 23 Gluteus maximus m.indd 272 11/07/12 11:10 PM . Anconeus m. mm. 9 Splenius cervicis m. Flexor digitorum longus mm. 19 12th rib 20 Thoracolumbar fascia (removed) 21 Gluteus medius m. 25 Iliac crest Longus Tibialis posterior m. Muscle 1 Teres major m. 21 brevis m. 28 Superior gemellus m. Sternocleidomastoid m. 30 Sacrotuberal l. Tendon (covered by fascia) 13 Long head tt. Semispinalis capitis m. 272 CERTIFICATION REVIEW • www.org Skin Posterior view Galea aponeurotica Superior auricular m. Levator scapulae m. Inferior belly 10 Supraspinatus m. 15 Iliocostalis lumborum m. 9 Triceps brachii muscle t. profundus m.acsm. Ligaments Deltoid m. Peroneus longus m. 20 Flexor carpi ulnaris m. m. Plantaris m. Trapezius m. 13 Spinalis thoracis m. Flexor 22 23 28 Extensor pollicis brevis m. Splenius capitis m. Semimembranosus m. 16 Serratus anterior m. Vastus lateralis m. 8 Internal abdominal oblique m. Muscles Infraspinatus m. Soleus m. Flexor hallucis longus m. ll. Long head 4 17 18 Extensor carpi radialis 5 longus m. 22 Tensor fasciae latae m. 18 External intercostal m. 21 25 Extensor carpi radialis Extensor carpi ulnaris m. Abductor pollicis longus m. Flexor hallucis longus m. 22 Extensor pollicis brevis m. 29 Obturator internus m. Superficial muscles — posterior view. Peroneus brevis m. Semitendinosus m. Flexor retinaculum Longus FIGURE 3. Peroneus tendons Superior peroneal retinaculum 32 Obturator externus m. Gastrocnemius muscle 11 Rhomboid minor m. Gastrocnemius muscle Medial head 14 Longissimus thoracis m.) Dwyer_Appendix_A. Tibialis posterior t. 27 Abductor pollicis longus m. 10 Serratus posterior superior m. l. Ligament Teres minor m.9. mm. (Asset provided by Anatomical Chart Co. A. Kinesiology: The Mechanics and Pathomechanics of Human Movement.48.) Dwyer_Appendix_A.indd 273 11/07/12 11:10 PM . and Boxes from Other ACSM Certification Texts 273 Posterior Anterior Cervical curve (formed by cervical vertebrae) 1 2 3 4 5 6 7 Thoracic curve 8 (formed by thoracic 9 vertebrae) 10 11 12 1 Intervertebral disk 2 3 Lumbar curve (formed by 4 lumbar vertebrae) 5 Sacrum Sacral curve (formed by sacrum) Coccyx FIGURE 3. Westpoint. Hardy. D. (Courtesy of Neil O. C. Hyperkyphosis. (From Oatis CA.49. APPENDIX A Supplementary Figures. B. CT. Vertebral column — lateral view showing the four normal curves and regions. Tables. Baltimore [MD]: Lippincott Williams & Wilkins.) A B C D FIGURE 3. Normal and abnormal curves of the vertebral column. Hyperlordosis. Normal. 2003. Scoliosis. acsm. Major Joint Motions and Planes of Motion Major Joints Type of Joints Joint Movements Planes Scapulothoracic Not a true joint (“physiological” Elevation–depression Frontal or “functional” joint) Upward–downward rotation Frontal Protraction–retraction Frontal Medial–Lateral rotation Transitional Anterior–Posterior Tilting Sagittal Glenohumeral Synovial: ball-and-socket Flexion–extension Sagittal Abduction–adduction Frontal Internal–external rotation Transverse Horizontal abduction–adduction Transverse Circumduction Multiple Elbow Synovial: hinge Flexion–extension Sagittal Proximal radioulnar Synovial: pivot Pronation–supination Transverse Wrist Synovial: ellipsoidal Flexion–extension Sagittal Abduction–adduction Frontal Metacarpophalangeal Synovial: ellipsoidal Flexion–extension Sagittal Abduction–adduction Frontal Proximal and distal Synovial: hinge Flexion–extension Sagittal interphalangeal Intervertebral Cartilaginous Flexion–extension Sagittal Lateral flexion Frontal Rotation Transverse Hip Synovial: ball-and-socket Flexion–extension Sagittal Abduction–adduction Frontal Internal–external rotation Transverse Circumduction Multiple Knee Synovial: bicondylar Flexion–extension Sagittal Internal/external rotation Transverse Ankle: talocrural Synovial: hinge Dorsiflexion–plantarflexion Sagittal Ankle: subtalar Synovial: gliding Inversion–eversion Frontal Dwyer_Appendix_A.indd 274 11/07/12 11:10 PM . 274 CERTIFICATION REVIEW • www.org RPT4 Chapter 3 Table TABLE 3.3. Comparison of activity with the energy pathways used ATP.) Dwyer_Appendix_A. 2004. Anatomy and Physiology.4. 26. Human Walking. Baltimore [MD]: Lippincott Williams & Wilkins. p. electron transport-oxidative phosphorylation.16. football line play. ATP PCr lactic acid. adenosine triphosphate. (Reprinted with permission from Premkumar K. Baltimore [MD]: Lippincott Williams & Wilkins. and Boxes from Other ACSM Certification Texts 275 RPT4 CHAPTER 4. (Adapted from Rose J.indd 275 11/07/12 11:10 PM . Normal walking gait. EXERCISE PHYSIOLOGY RPT4 Chapter 5 Figure Exercise duration 0s 4s 10 s 1. fast breaks. creatine phosphate. 100m swim) Electron Transport- Oxidative Phosphorylation Aerobic endurance (beyond 800m run) Immediate/short-term Aerobic-oxidative system non-oxidative systems Predominant energy pathways FIGURE 5. APPENDIX A Supplementary Figures. javelin throw. BIOMECHANICAL PRINCIPLES OF TRAINING RPT4 Chapter 4 Figure Phases Stance Phase Swing Phase Periods Initial double support Single limb stance Second double support Initial swing Mid swing Terminal swing Events Foot strike Opposite Reversal of Opposite Toe off Foot Tibia Foot strike toe off fore-aft shear foot strike clearance vertical % of Cycle 0% 12% 50% 62% 100% FIGURE 4. aerobic oxidation. 1994.5 min 3 min + ATP Strength-power (power lift.) RPT4 CHAPTER 5. tennis serve) ATP+PCr Types of performance Sustained power (sprints. high jump. editor. 2nd ed. golf swing. PCr. 2nd ed. The Massage Connection. Gamble JG. Tables. anaerobic glycolysis. gymnastics routine) ATP+PCr+Lactic Acid Anaerobic power- endurance (200-400m dash. perhaps breast and prostate) • Increased mitochondrial density • Hypertension • Increased lactate threshold • Noninsulin-dependent diabetes mellitus • Lower HR and BP at a fixed submaximal work rate • Osteoporosis • Lower myocardial oxygen demand at a fixed submaximal • Anxiety work rate • Depression • Lower minute ventilation at a fixed submaximal work rate Improved immune function: Improved blood lipid profile: Improved glucose tolerance and insulin sensitivity • Decreased triglycerides • Increased high-density lipoprotein cholesterol • Decreased postprandial lipemia Improved work. recreational. of Health and Human Services.S.org RPT4 Chapter 5 Table TABLE 5. and sports performance Improved body composition Decreased fatigue in daily activities Enhanced sense of well-being a Many of the health benefits accrue from physical activity may have relatively little effect on increasing cardiorespiratory fitness (U. 276 CERTIFICATION REVIEW • www.indd 276 11/07/12 11:10 PM . Benefits of Increasing Cardiorespiratory Activities and/or Improving Cardiorespiratory Fitnessa Improved cardiorespiratory function: Decreased risk of the following: • Increased maximal oxygen uptake • Mortality from all causes • Increased maximal Q and SV • Coronary artery disease • Increased capillary density in skeletal muscle • Cancer (colon.2. Dept.acsm. Physical Activity Guidelines Advisory Committee Report 2008 ). Dwyer_Appendix_A. THE INITIAL CLIENT CONSULTATION RPT4 Chapter 10 Figures New Client Intake Form Contact Information Date: _____ _____Phone _____ In-Person Name: ______________________________________________________________________________ Address: ______________________________________________________________________________ Preferred method of contact: _____ Phone (home): ____________________ _____ Phone (cell): ____________________ _____ Email: ___________________________ Training Schedule Interest (circle all that apply): Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday am am am am am am am am midday midday midday midday midday midday midday midday pm pm pm pm pm pm pm pm Health and Fitness Information General Health and Fitness Goals (check all that apply): _____ strength _____ disease management _____ endurance _____ stress management _____ sport performance _____ weight management _____ physical appearance _____ energy/vitality Health or other Fitness Professional(s) treating client: ______________________________________________________________________________ ______________________________________________________________________________ Medical Considerations/Limitations: ______________________________________________________________________________ ______________________________________________________________________________ MD Release Form Needed: _____ Yes _____ No MD Name/Phone Contact (if necessary): ___________________________________________________ Action Items Referral to Health of Fitness Professional: _____ Yes _____ No Referral: ______________________________________________________________________ If compatible: MD Release Form (if necessary) Date Sent: _______________ Rec’d: _______________ Initial Client Consultation Date: ____________________ Service Introduction Packet Delivered: _____ In-Person _____ Email _____ Mail Comments: ______________________________________________________________________________ ______________________________________________________________________________ FIGURE 10. Dwyer_Appendix_A. and Boxes from Other ACSM Certification Texts 277 RPT4 CHAPTER 10. Example of a new client intake form. APPENDIX A Supplementary Figures.indd 277 11/07/12 11:10 PM . Tables.3. I understand that the facility staff is not authorized to give out my Personal Trainer’s personal contact information. • Cancellation Policy: I understand that appointments must be cancelled by contacting my Personal Trainer directly.acsm.. Client Signature: Date: Personal Trainer (Print): Date: FIGURE 10. dressed and ready to train. • I may not bring an outside Personal Trainer into the facility to train with me. • I have exchanged contact information with my Personal Traininer and have indicated my preference for being contacted. If I arrive late for my appointment. he/she will schedule an additional session at no cost to me. 278 CERTIFICATION REVIEW • www. __________________________________________. (Adapted with permission from Plus One Health Management. • I understand that I may communicate any customer service issue and/or acknowledge excellent performance to the Facility Manager. or does not show up. • In the event that my Personal Trainer fails to contact me within 24 hours of our scheduled session. Example of personal training client agreement. • I understand that I am expected to arrive for my appointments on time.indd 278 11/07/12 11:10 PM . in order to avoid being charged for the full session. • Private personal training sessions are one hour. have read and agree to the following: (Client’s Name-Please Print) • Appointments will be scheduled directly through my assigned Personal Trainer and can be scheduled on days and times that are mutually agreed upon. I understand that my training session will end at the previously scheduled time. • No Show Policy: I understand that if I do not show up for my scheduled training session. New York.org Personal Training Client Agreement I. New York. Inc.4. within 24 hours of my scheduled time. 2008.) Dwyer_Appendix_A. I will be charged for the full session. Tables.indd 279 11/07/12 11:10 PM . if high risk Screening Process Dwyer_Appendix_A.1 Figure 11.6 provider.5 High risk Medical clearance or Necessary Risk classification/exercise testing Refer to physician or healthcare referral phase or not? Figure 11. and Boxes from Other ACSM Certification Texts 279 RPT4 CHAPTER 11. APPENDIX A Supplementary Figures. SCREENING AND RISK CLASSIFICATION RPT4 Chapter 11 Figure Low risk Determine number of risk factors Risk model Moderate risk Table 11. and • Raise both arms to the • Hold an item.) • Walk with head turns • Obstacles Walk side to side • Sidestep on heels • Sidestep while carrying • Sidestep on toes an item • Turn in a circle • Sidestep with head turns • Crossover walk: cross one foot over the other foot Adapted with permission from Bushman B. ed.indd 280 11/07/12 11:10 PM . Sample Progressive Balance Program Level 1 Level 2 Level 3 Challenge Seated Seated chair lean Add arm movements: Combine arm and leg • Sit on a pillow balance • Raise one arm at a movements • Sit on a stability ball activities time to the front and • Close one eye then to the sides • Close both eyes • Raise both arms to • Turn head to the the front and then to right and then to the sides the left Add leg movements: • Raise one knee at a time • Raise one leg (straightened) at a time Standing Upright stance In all four variations. narrow • Lateral sway to the front and then to right and then to stance. sway: • Close both eyes activities including wide ward sway • Raise one arm at a time • Turn head to the stance.acsm. sand. 2011. Champaign (IL): Human Kinetics. COMPREHENSIVE PROGRAM DESIGN RPT4 Chapter 13 Table TABLE 13. Dwyer_Appendix_A. etc. 396 p. add: Add arm movements to • Close one eye balance (variations • Forward and back. semi. ACSM’s Complete Guide to Fitness & Health. such tandem) front and then to the as a book sides Movement Walk forward and • Wide stance walk • Tandem walk forward • Barefoot balance backward • Narrow stance walk and backward • One eye closed activities • Walk on heels • Walk while carrying an • Surface change • Walk on toes item (mat. (side to side) the sides the left tandem. 280 CERTIFICATION REVIEW • www.5.org RPT4 CHAPTER 13. APPENDIX A Supplementary Figures. Tables.1 Likert-Type Chart to Determine Muscle Soreness 0 1 Minor soreness 2 3 Moderate soreness 4 5 Extreme soreness 6 Dwyer_Appendix_A.indd 281 11/07/12 11:10 PM . RESISTANCE TRAINING PROGRAMS RPT4 Chapter 14 Box BOX 14. and Boxes from Other ACSM Certification Texts 281 RPT4 CHAPTER 14. 1996.. Dwyer_Appendix_A.g. Increased exercise threshold for the onset of disease Randomized controlled trials of cardiac rehabilitation signs or symptoms (e. claudication) dial infarction do not support a reduction in the rate of nonfatal reinfarction. stroke. Department of Health and Human Services. 2014. et al. Nelson ME.acsm.S. CARDIORESPIRATORY TRAINING PROGRAMS RPT4 Chapter 15 Box BOX 15. Increased exercise threshold for the accumulation of especially as a component of multifactorial risk lactate in the blood factor reduction. submaximal intensity Secondary prevention (i. and U.indd 282 11/07/12 11:10 PM . recreational. REDUCTION IN CORONARY ARTERY DISEASE RISK FACTORS OTHER BENEFITS Reduced resting systolic/diastolic pressures Decreased anxiety and depression Increased serum high-density lipoprotein cholesterol Enhanced physical function and independent living in and decreased serum triglycerides older persons Reduced total body fat and reduced intraabdominal fat Enhanced feelings of well-being Reduced insulin needs and improved glucose tolerance Enhanced performance of work. Decreased heart rate and blood pressure at a given cardiovascular and all-cause mortality are reduced submaximal intensity in patients with postmyocardial infarction who Increased capillary density in skeletal muscle participate in cardiac rehabilitation exercise training.. Rejeski WJ. 2007. Physical activity and public health in older adults: recommendations from the American College of Sports Medicine and the American Heart Association. cancer of the colon Decreased minute ventilation at a given absolute and breast. ACSM’s Guidelines for Exercise Testing and Prescription. National Center for Chronic Disease Prevention and Health Promotion.39(8):1435–45. senior editor.org RPT4 CHAPTER 15.. Type 2 central and peripheral adaptations diabetes. interventions after a cardiac Decreased myocardial oxygen cost for a given absolute event [to prevent another]) submaximal intensity Based on meta-analyses (pooled data across studies). 9th ed. and gallbladder disease. and sport Reduced blood platelet adhesiveness and aggregation activities Reduced risk of falls and injuries from falls in older DECREASED MORBIDITY AND MORTALITY persons Primary prevention (i. Baltimore (MD): Lippincott Williams & Wilkins. Department of Health and Human Services. coronary artery disease. 282 CERTIFICATION REVIEW • www. ischemic exercise training involving patients with postmyocar- ST-segment depression. Public Health Service. interventions to prevent the Prevention or mitigation of functional limitations in initial occurrence) older adults Higher activity and/or fitness levels are associated with Effective therapy for many chronic diseases in older lower death rates from coronary artery disease. osteoporotic fractures. adults Source: Pescatello LS. Atlanta (GA): U. Physical Activity and Health: A Report of the Surgeon General.S.1 Benefits of Regular Physical Activity/Exercise IMPROVEMENT IN CARDIOVASCULAR AND Higher activity and/or fitness levels are associated with RESPIRATORY FUNCTION lower incidence rates for combined cardiovascular Increased maximal oxygen uptake resulting from both diseases. Blair SN.e. angina pectoris. 278 p.e. Centers for Disease Control. Med Sci Sports Exerc. or with the assistance of a the cool-down period. GUIDELINES FOR DESIGNING FLEXIBILITY PROGRAMS RPT4 Chapter 16 Table TABLE 16. relaxed for 2–3 s. Dynamic repeating each activity stretching is often incorporated in the “active” 5–12 times. each static stretches warm-up consists of for 10–30 s. it may have a justifiable role. total of 60 s for each flexibility exercise. maximum intensity is fied fitness profes- tracted for 6 s. its use in training and rehabilitation of athletes where explosive movements are critical. The client assumes a position and follow the static following a thorough then either holds it with some other part of stretching protocol. for athletes involved the muscle lengthening and could possibly lead in ballistic sport skills. warm-up or during (PNF) PNF. recommends stretches large muscle group be repeated two to four movements) or during times to accumulate a the cool-down period. Hold warm-up (a thorough holding that stretch. “contract-relax. traction at 20%–75% Appropriate for certi- sive stretch. warm-up or during the body (i. the cool-down period. partner or some other apparatus (i. the muscle is isometrically con. phase of the group exercise warm-up due to their similarity to the movements or patterns that will be used during the conditioning period.1. exercises are very rhythmic in nature. 30–60 s 5–10 min of light-to- for older adults.” Following the preliminary pas. properly educated on the technique. Static stretching consists of should be targeted at following a thorough slowly moving to minor discomfort and then least 2–3 d ⴢ wk1. stretching Appropriate for certified strap). Overview of Stretching Technique and Appropriate Use Technique Definition Exercise Design Appropriate Use Static This is the most common method used to All major muscle groups Appropriate for use stretching improve flexibility. cool-down.. APPENDIX A Supplementary Figures. This method is most effective with the A total of 60 s of educated on the use of a trainer to assist the client through the stretching time should technique. This bouncing motion may pro. These range of motion. and contraction of the targeted muscle group. should be targeted at following a thorough lar facilitation Although there are several ways to employ least 2–3 d ⴢ wk1. which is held for assisted stretching. May be suitable duce a powerful stretch reflex that counteracts on an individual basis. Dynamic Dynamic stretching involves moving parts of Begin gradually with a Appropriate for use stretching your body through a full range of motion while small range of motion during the warm-up or gradually increasing the reach and/or speed progressing to larger as part of the of movement in a controlled manner. Ballistic This approach involves a bouncing or jerky Exercise design would Not appropriate for stretching type movement to reach the muscle’s range of be determined by the general popula- motion limits. the most common technique is termed A 3–6 s of muscle con.e. activity-specific needs tion. to tissue injury. clients if properly 10–30 s. Dwyer_Appendix_A. Tables. Although ballistic stretch is not common practice for the general population. Proprioceptive PNF stretching involves both the stretching All major muscle groups Appropriate for use neuromuscu. ACSM moderate multijoint.e. arm). and Boxes from Other ACSM Certification Texts 283 RPT4 CHAPTER 16.indd 283 11/07/12 11:10 PM . be achieved per targeted muscle group. The goal is to slowly move the client into fitness professionals the stretch in order to prevent a forceful action to use with clients if and possible injury. stretch.. Passive The client is not actively involved in this type of Exercise design would Appropriate for use stretching stretching. then passively followed by 10–30 s of sionals to use with moved into the final stretch. Dwyer_Appendix_A. PERSONAL TRAINING SESSION COMPONENTS RPT4 Chapter 17 Figure Least skill Most skill Easiest. foundational Less safe.org RPT4 CHAPTER 17. Exercise session continuum.indd 284 11/07/12 11:10 PM .acsm.1. controversial FIGURE 17. 284 CERTIFICATION REVIEW • www. most stable Hardest. least stable Appropriate for almost everyone Appropriate only for the very fit Very safe. FACSM. Graduate School of Education Kansas City. Illinois Buffalo. EdD. Director of Cardiac Rehabilitation Health & Human Performance Research Medical Center Professor. New York ASSOCIATE EDITOR Walter R.indd 285 11/05/12 10:02 PM . FACSM Professor and Chair. PhD Jeffrey L. MS Performance Vice President of Certification Director. Missouri Canisius College Buffalo. Niederpruem. Sports Medicine. PhD Professor. Health and Human Performance Center American Health Information Management Association Canisius College Chicago. New York Khalid W. Thompson. APPENDIX B Editors for the Previous Two Editions EDITORS FOR THE 3RD EDITION EDITORS FOR THE 2ND EDITION SENIOR EDITORS SENIOR EDITORS Khalid W. Department of Sports Medicine. Health and Human Michael G. Roitman. Bibi. PhD. Bibi. Georgia 285 Dwyer_Appendix_B. FAACVPR Professor of Kinesiology and Health (College of Education) Professor of Nutrition (College of Health and Human Services) Georgia State University Atlanta. Dwyer_Appendix_B.indd 286 11/05/12 10:02 PM . North Carolina Michael Deschenes. Criswell. Florida Swedish Covenant Hospital Chicago. FAACVPR Presbyterian Hospital Chapter 2 Presbyterian Center for Preventive Cardiology Charlotte. Pleasant. PhD Brown University Department of Kinesiology Providence. Physical Therapy Golden. PhD Community Health and Psychiatry and Human Behavior Chad Harris. PT. PhD New York. Mazzeo. PhD. Verrill. MS. MA Boulder. PhD. Betts. New York Health Sciences Department Central Michigan University Chapter 5 Mt. FACSM Department of Kinesiology Chapter 7 University of Rhode Island Kingston. Daniels. Michigan Bess H. Rhode Island Boise State University Boise. FACSM Klein Buendel Inc. APPENDIX C Contributors to the Previous Two Editions CONTRIBUTORS TO THE 3RD EDITION Chapter 4 Carol Ewing Garber. Inc. Idaho David E. New Hampshire Department of Integrative Physiology University of Colorado Nancy J. New York Department of Applied Physiology and Kinesiology University of Florida Kathy Donofrio Gainesville. Colorado Physical Activity Department Plus One Holdings. ACSM CHAPTER AUTHORS Department of Biobehavioral Sciences Chapter 1 Teachers College Columbia University Jeffrey J. FACSM Department of Movement Science Chapter 3 Grand Valley State University Allendale. Illinois 287 Dwyer_Appendix_C. Marcus. PhD. Rhode Island Frederick S. Glass. PhD. FACSM Kinesiology Department Chapter 6 College of William & Mary Willamsburg. FACSM Elaine Filusch Betts. Michigan Andrea Dunn. Belli. Virginia Stephen C. PhD New York. David S. PhD. PhD. FFAHA. MBA CPTE Health Group Robert S. Colorado Central Michigan University Mt. PhD. FACSM Nashua. MS.indd 287 11/05/12 10:03 PM . Pleasant. Michigan Deborah Riebe. New York Jeffery J. and Community Sciences Khalid W. Pennsylvania Theodore J. PhD. PhD University of Central Florida Sports Medicine. PhD. Dwyer. Anatomy and Biomechanics Buffalo.indd 288 11/05/12 10:03 PM . FACSM Department of Exercise and Sports Science Chapter 9 University of Wisconsin-La Crosse La Crosse. Florida Dwyer_Appendix_C. Carlton Bessinger. Electrocardiography Buffalo. MA Center for Lifestyle Medicine Kathleen M. Michigan Department of Exercise Science East Stroudsburg University CONTRIBUTORS TO THE 2ND EDITION East Stroudsburg. PhD. PhD. Cahill.org Chapter 8 Joshua Lowndes. Wojcik. MPH. Rock Hill. Florida Canisius College Chapter 12. New Hampshire Department of Movement Science Grand Valley State University Gregory B. 288 CERTIFICATION REVIEW • www. PhD. DC Julie J. PhD. New York Department of Human Nutrition Winthrop University Kathy Donofrio S. Pire. Oregon Brian Undermann. RD New York. Bibi. Koch. Betts. Daniels. Downing. FACSM Dennis W. FACSM Chapter 11 Department of Child. Health and Human Performance Orlando. ATC University of Central Florida Sugar Land. PhD. PhD. Glass. Illinois Chapter 10 Chapter 11 Frederick S. FACSM Allendale. Michigan Canisius College Chapter 1. South Carolina Swedish Covenant Hospital Chicago. Angelopoulos. PhD Department of Health and Physical Education Chapter 10 Winthrop University Rock Hill. MS CPTE Health Group Stephen C.acsm. Texas Orlando. ATC. FACSM Nashua. MA Adelphi University CHAPTER CONTRIBUTORS Human Performance Laboratory Chapter 1 Garden City. FACSM Spine and Sport Foundation Central Oregon Community College San Diego. PhD Central Michigan University Human Performance Center Mount Pleasant. MPH Chapter 1. Anatomy and Biomechanics Center for Lifestyle Medicine University of Central Florida Orlando. California Health and Human Performance Bend. Wygand. New York Elaine Filusch Betts. Family. South Carolina Neal I. MA Plus One Fitness R. Wisconsin Janet R. PhD Central Michigan University Chapter 12 Mount Pleasant. Angelopoulos. Florida John W. Michigan Theodore J. MS. New York John Mayer. PHD. indd 289 11/05/12 10:03 PM . EdD The Health and Human Performance Center Department of Kinesiology and Physical Education Canisius College Valdosta State University Buffalo. Wygand. Metabolic Calculations Chapter 4. MD. Safety. PhD Department of Kinesiology Boise State University Boise. Physical Education. PhD Gainesville. PhD. Idaho Chapter 1. PhD. PhD Chapter 12. Human Behavior and Psychology CPTE Health Group Nashua. MS Chapter 5. Missouri David S. RCEP Diana LaHue. Deschenes. FACSM Research Medical Center Cooper Institute for Aerobics Research Kansas City. Michigan Garden City. Virginia Susan M. Wojcik. Pennsylvania Chapter 9. Injury Prevention. Colorado Chapter 12. Dwyer. Pathophysiology and Risk Factors Kathleen M. Human Behavior and Psychology Janet R. PhD Gregory B. and Human Department of Movement Science Performance Science Grand Valley State University Adelphi University Allendale. New York Valdosta. and Emergency Care Department of Integrative Physiology Chapter 10. Glass. APPENDIX C Contributors to the Previous Two Editions 289 Khalid W. New Hampshire Robert S. Colorado Brenda M. Bibi. New York Chapter 6. Human Development and Aging Brown University Providence. Electrocardiography Department of Exercise and Sport Sciences University of Florida Bess H. Exercise Programming Research Medical Center Kansas City. Program and Administration/Management John W. Program and Administration/Management University of Colorado Boulder. Electrocardiography Chapter 5. California The College of William and Mary Chapter 4. Exercise Physiology Robert Tung. FACSM California Polytechnic State University Department of Kinesiology San Luis Obispo. Rhode Island Frederick S. Virginia East Stroudsburg. Nutrition and Weight Management Chapter 10. PhD. Davy Chapter 3. FACSM Chapter 7. Marcus. PhD. Kasper. Texas Electrophysiology Clinic Chapter 8. Anatomy and Biomechanics Dwyer_Appendix_C. PhD Chapter 9. Georgia Chapter 11. Missouri Denver. Pathophysiology/Risk Factors Williamsburg. ATC. RN. PhD. FACC Electrophysiology Clinic Andrea L. Mazzeo. Cahill. Puhl. Virginia Chapter 2. FACSM Department of Psychology Department of Exercise Science Virginia Tech University East Stroudsburg University Blacksburg. Exercise Programming Chad Harris. Health Appraisal and Fitness Testing Chapter 8. MSN Sugar Land. Human Development and Aging Virginia Tech University Blacksburg. FACSM Department of Health. Nutrition and Weight Management Associate Professor of Kinesiology Department of Physical Education and Kinesiology Michael R. MS. Daniels. Florida Department of Psychiatry and Human Behavior Chapter 3. Dunn. Criswell. PhD Mark J. MA Stephen C. indd 290 11/05/12 10:03 PM .Dwyer_Appendix_C. medical records. 55–62 exercise prescription (Domain II) answers and explanations. 4–5 job task analysis information and resources. 171–178 Domain IV (legal. professional considerations) Domain I (initial client consultation. 219–227 case studies related to.indd 291 11/08/12 12:28 AM . 153–178 procedures. 165 case studies. risk factor reduction. education implementation) labels. 195–217 examination. 30–32 211–212 training program determination. 216 answers. patient/client assessment (Domain I) 195–199 baseline intake. 34 participant performance and progress education. 35–40 ECG case studies. 208–210 Domain IV (leadership. duration modification. questions by domain. 195 200–205 program implementation. 3–4 communicating hazards to employees. answers. 74 job task analysis. professional. 74 200–201 job task analysis. 237 examination questions by domain. effective use of exercise modalities. implementation (Domain II) 202–203 client feedback. program review with client. 25–27 disease management. updates. 153–154 participant safety procedures. physician referral. exercise response. 10–14 211–214 domains Domain V (legal. business. 217 job task analysis information and resources. 35 safe. 217 Domain I (patient/client assessment) healthy lifestyle practices. 198–199 job task analysis information and resources. intensity duration determination. 207–208 case study related to. program review with participant. Index Index ACSM Certified Clinical Exercise Specialist. 15–23 engineering controls. explanations. assessment) case studies related to. and answers. 205–206 205–211 program reassessment. 163–165 participant records. intensity. inspection case studies. job task analysis information and resources. exercise programming. 218 ACSM Certified Personal Trainer. 8–9 answers and explanations. See CPT emergency equipment. 196–198 Domain II (exercise prescription) participant’s risk evaluation. 228–237 job task analysis information and resources. 6–7 examination questions by domain. 63–74 clinically appropriate prescription development. satisfaction. 190–193 marketing) examination. 170 case study related to. 3–10 job task analysis information and resources. 166–171 case study related to. 169–170 case study related to. 204–205 client technique monitoring. 211 job task analysis information and resources. self-monitoring. explanations. ongoing support) participant feedback assessment. 214 exercise modalities selection. 218 case study related to. 179–190 Health Insurance Portability and Accountability Act domains (HIPAA). 27–29 referrals. 24–25 291 Dwyer_Index. 237 job task analysis information and resources. 213 frequency. program implementation. 15–52 prescription. enjoyment. collaboration with health care professionals. 33 leadership. professional considerations (Domain V) ACSM Certified Health Fitness Specialist. explanations. 169 job task analysis information and resources. clinical status. 24–35 215–217 Domain III (leadership. 216 CES exercise environment evaluation. 40–51 questions by domain. counseling (Domain IV) exercise frequency. ongoing support (Domain III) Domain III (program implementation. monitoring. 154–163 supervision. procedures. See HFS continuing education programs. progress. implementation) exposure incident defined. counseling) CPT case study related to. case studies related to. See CES legal. 169 Domain II (exercise programming. 86–93 anthropometric and body composition. and marketing (Domain (Domain II) IV) cardiorespiratory exercise prescriptions. client role model. 93–95 Domain II (exercise prescription and implementation) selection and preparation. 77–85 health and fitness assessment (Domain I) answers. 15 answers and explanations. 48 determination. 37–40 support within scope of practice. FITT health care professionals. exercise insurance. 292 CERTIFICATION REVIEW • www. job task analysis information and resources. initial documents. 50 muscular strength. explanations. professional. 110–112 case studies. 79–80 with controlled disease. 131–138 client instructions. 41–42 preactive screening. privacy. 127–128 122–125 human resources. knowledge base.acsm. 45–56 healthy special populations. education implementation (Domain III) communication techniques. professional Domain IV (legal/professional) relationships. 122–124 job task analysis information and resources. 150 assessment. 124–125 case study related to. 99–100 job task analysis information and resources. 96 job task analysis information and resources. 16 questions by domain. legal/professional (Domain IV) 101–116 injury prevention program. health appraisal. 126–127 job task analysis information and resources. flexibility. management (Domain V) 117–121 communication techniques. 49–50 program to achieve outcomes and goals marketing. 118–119 leadership. standards of practice. client base. 80–82 risk management guidelines. 51 environmental conditions. 116 continuing education program participation. 114–116 copyrights. health/fitness facilities management. cardiovascular. flexibility-based activities. 126 Dwyer_Index. 42–45 109 HFS weight management programs. 83–85 behavioral readiness evaluation. risk stratification. flexibility. 103–105 Code of Ethics. fitness-related educational resources. 129 case study related to. endurance. goal setting. endurance. 101–103 medical clearance.org CPT (Continued) Domain V (management) initial client consultation. 47–48 113–114 confidentiality. 82–83 fiscal resources. FITT American College of Sports Medicine’s (ACSM’s) principle. 120–121 information. 18–23 counseling and behavioral strategies (Domain III) reassessment plan/timeline development. 17 126–129 client data. business. preexercise screening. 121 positive exercise experience creation. risk management program. 49 history. 97–98 case study related to. 35–37 exercise prescription and implementation legal. program job task analysis. 101 lifestyle practices. 77–79 muscular strength. assessment (Domain I) case study related to. 100–101 domains assessment protocols. 139–149 client interview. 40–41 resistance. fitness assessments review. 93–129 development baseline. emergency policies and Domain III (counseling and behavioral strategies) procedures. 93 Domain I (health and fitness assessment) cardiovascular fitness assessments. exercise adherence.indd 292 11/08/12 12:28 AM . 46 clinical populations with physician clearance. 93–101 participant’s readiness. physical examination questions by domain. organizations principle. business plan development. healthy participants and case study related to. 150 fitness assessments. 23 behavioral and motivational strategies. action plan. 106–109 collaboration. 117 client education. 16–17 examination.