ACSM 2022 CPT EXAM Questions and Answers

ACSM 2022 CPT EXAM Questions and Answers Use new client intake form to qualify client -Assess compatibility, goals, scope, style, schedule -Exchange contact info and schedule preferences -Discuss medical considerations and limitations; assess risk and need for medical release form -Schedule initial client consultation -Provide service intro package - ANSWER Components of Initial Contact/Interview Prep -Process, preparation- what to wear, eat and expect -Day, time, length of next meeting -Remind them about returning completed forms -Allow them to contact you or ask questions - ANSWER What should be communicated to the client about the initial consultation? -AHA/ACSM Health/Fitness facility pre-participation screening questionnare, PAR-Q, informed consent, medical clearance form, waiver, trainer-client contract, HIPAA, organizational procedures and policies - ANSWER What must be completed by client prior to initial client interview? All health history, especially any heart problems or signs and symptoms of CVD -Other diseases such as diabetes, asthma, muscle issues -Recent hospitalizations, illness, diagnoses, or surgical procedures -Work history, espe physical demands -Lab findings such as plasma glucose, serum lipids and lipoproteins, or other significant abnormalities -Previous physical exam findings such as murmurs, clicks, gallops, and other unusual cardiac and vascular findings; as well as abnormal pulmonary findings, high BP and edema -If they are on prescriptions -Risk factors for CVD - ANSWER What does a health/medical history include? PAR-Q or AHA/ACSM Health/Fitness facility pre-participation screening questionnare -CVD risk factor assessment and classification by qualified health/fitness, clinical exercise, or health care professionals -Medical evaluation including a physical exam and stress test by a qualified health care provider - ANSWER What does pre-participation health screening include? -Discomfort (angina, ischemia) in chest, neck, jaw or arms that may result from ischemia -Shortness of breath and rest or with mild exertion -Dizziness or loss of consciousness (syncope) -Bilateral ankle edema -Palpitations or tachycardia -Intermittent claudication (pain in a muscle with inadequate blood supply, usually a result of atherosclerosis)-stressed by exercise -Known heart murmer -Unusual fatigue or shortness of breath with usual activities - ANSWER Signs and symptoms of cardiovascular, metabolic or pulmonary disease -Recent change in ECG suggesting significant ischemia, recent myocardial infarction within two days, or other acute cardiac event -Unstable angina -Uncontrolled cardiac dysrhythmias -Symptomatic, severe aortic stenosis -Uncontrolled, symptomatic heart failure -Acute pulmonary embolos or pulmonary infarction - ANSWER Absolute contraindications to exercise testing -Acute myocarditis or pericarditis -Suspected or known dissecting aneurysm -Acute systemic infection, accompanied by fever, body aches or swollen lymph glands - ANSWER More absolute contraindications to exercise testing -Left main coronary stenosis -Moderate stenotic valvular heart disease -Electrolyte abnormalities -Severe arterial hypotension with SBP> 200, DBP>110 at rest -Tachy/bradydysrhythmias -Hypertrophic cardiomyopthy, or other forms of outflow track obstruction - ANSWER Relative contraindications to exercise testing -Neuromotor, musculoskeletal or rheumatoid disorders that are exascerbated by exercise -High degree AV block -Ventricular aneurysm -Uncontrolled metabolic disease such as diabetes, thyrotoxicosis -Chronic infectious disease such as HIV -Mental or physical impairment leading to inability to exercise adequately - ANSWER Relative contraindications to exercise testing, continued Increase in muscle size from remodeling of proteins- increase of muscle cell size - ANSWER Hypertrophy Muscle wasting. Can occur after prolonged immobility or can be from a disease - ANSWER Atrophy Increase in number of muscle cells or fibers - ANSWER Hyperplasia Medical clearance is recommended when: -An individual has known CV, metabolic or renal disease and is asymptomatic OR -An individual has any signs or symptoms of CV, metabolic or renal disease, regardless of disease status - ANSWER For an inactive person who does not participate in regular exercise, when is medical clearance recommended? Following medical clearance, light to moderate intensity exercise is recommended. May gradually progress as tolerated following ACSM guidelines. - ANSWER After a medical clearance for an inactive person who either has known CV/metabolic/renal disease and is asymptomatic, or an individual who has any signs or symptoms of CV/metabolic/renal disease, regardless of disease status, how should that individual be progressed in an exercise program? NO - ANSWER Does an individual need medical clearance who is not diagnosed with CV, metabolic or renal disease, and shows no symptoms of the above? No medical clearance is needed before beginning an exercise program. It is recommended to start with light to moderate exercise and gradually progress to vigorous intensity exercise, following ACSM guidelines. - ANSWER How would a trainer progress an individual with no diagnosis or signs or symptoms of CV, metabolic or renal disease? The client should discontinue exercise immediately and obtain medical clearance before continuing exercise at any intensity - ANSWER If a patient is already exercising regularly, but has signs or symptoms of CV, metabolic or renal disease, regardless of diagnosis or not, should the client continue exercising? They may continue moderate intensity exercise without medical clearance, but if they want to progress to vigorous intensity exercise it is recommended to get medical clearance first. - ANSWER If a patient has a known history of CV, metabolic or renal disease, but no current signs or symptoms (ie they are stable), should this patient continue exercising? True - ANSWER T/F a client would be classified as low risk who has absence of ventricular dysrhymias during exercise testing and recovery, absence of angina or other significant symptoms such as shortness of breath, light-headedness, or dizziness during exercise testing and recovery, and has presence of normal hemodynamics such as appropriate increases and decreases in HR and SBP during exercise testing and recovery -Absence of: complicated ventricular dysrhythmias or revascularization procedures, absence of congestive heart failure, absence of signs or symptoms of post event or post procedure myocardial ischemia, absence of clinical depression -Resting ejection fraction is less than or equal to 50% -Uncomplicated myocardial infarction or revascularization procedure - ANSWER Non- exercise Testing Findings for Low Risk Clients -Presence of angina or other significant symptoms such as shortness of breath, light headedness or dizziness, but only at high levels of exertion , 7 or more METs - Mild to moderate level of silent ischemia during exercise testing or recovery -Functional capacity less than 5 METs -Resting ejection fraction 40-49% - ANSWER What would classify a client as moderate risk for cardiovascular and pulmonary rehabilitation risk stratification? High risk for exercise participation - ANSWER Presence of complex ventricular dysrhythmias during exercise testing or recovery HIGH RISK - ANSWER Presence of angina or other significant symptoms such as shortness of breath, light headnesses or dizziness at low levels of exertion (less than 5 METs or during recovery) HIGH RISK - ANSWER High level of silent ischemia during exercise testing or recovery HIGH RISk - ANSWER Abnormal hemodynmaics with exercise testing (flat or decreasing SBP with increasing workloads, chronotropic incompetence, or severe post exercise hypotension - Resting ejection fractin is less than 40% -History of cardiac arrest or sudden death -Complex dysrhymtias at rest -Complicated myocardial infarction or revascularization procedure -Congestive heart failiure -Signs or symptoms of post event or post procedure myocardial ischemia -Clinical depression - ANSWER Non exercise testing findings for High Risk stratification -Explains purpose of the test and the test itself -Risks and discomforts ass. with the thest - Responsibilities of the participant -Benefits to be expected -Inquiries (they can ask whatever) -Use of medical records -Freedom of consent (giving their consent) - ANSWER Informed consent form Men 45 or older, women 55 or older - ANSWER CVD Risk factors: Age Myocardial infarction, coronary revascularization, or sudden death before age 55 in father or first degree male relative and age 65 in mother or first degree female relative - ANSWER CVD risk factors:family history Current smoker or those who quit within the past 6 months or have exposure to environmental tobacco smoke - ANSWER CVD risk factors: smoking Not participating in at least 30 minutes of moderate intensity activity on at least 3d/wk for at least 3 months - ANSWER CVD risk factors: Physical inactivity Body mass index 30 or more or waist girth greater than 102 cm or 40 in for men and 88 cm or 35 inches for women - ANSWER CVD risk factors: Obesity SYS BP 140 or more, DBP 90 or more on at least two separate occasions, or on anti- hypertensive medication - ANSWER CVD Risk factors: hypertension Low density lipoprotein cholesterol 130 mg/dl or more. HDL less than 40 mg/dl or on lipid lowering meds. If total serum cholesterol is all that is available, needs to be 200 mg/dl or more is a risk factor - ANSWER CVD risk factors: dyslipidemia Fasting plasma glucose 126 mg/dl or more or 2 h plasma glucose values in oral glucose tolerance test - ANSWER CVD risk factors: diabetes HDL 60 mg/dl or more - ANSWER CVD risk factor: negative risk factor 10-15% - ANSWER What percent of the time should a personal trainer be speaking during an initial consultation? True, if the results are available immediately. Clients like to known how they did. - ANSWER T/F Assessment results can be a part of the initial client consultation Pre-contemplatoin, contemplation, preparation, action, maintenance - ANSWER What are the stages of the Trans-Theoretical Behavioral Model? -Individual is unaware of need to change -Resistant to change -Raising awareness and education - ANSWER What is the pre-contemplation stage of the Trans-Theoretical Behavioral Model? -Awareness of need to change -Open to discussion about change -Still undecided -Motivation and encouragement may be needed - ANSWER What is the contemplation stage of the TTBM? Preparation stage of TTBM - ANSWER -Decided that it is worth making the change -Preparing to make changes -May need help planning Action stage of TTBM - ANSWER -Actively creating changes -May need assistance problem-solving -Reinforce positive behaviors -Continue behaviors -Create plans to avoid relapse -Continue to help reinforce and problem solve - ANSWER Maintenance stage of TTBM A client's belief in his or her ability to succeed - ANSWER Self-efficacy FALSE - ANSWER T/F clients with low self efficacy have a greater level of confidence and belief in change and are more likely to engage in successful behaviors Suggests that the main predictors of behavior change are the perceived seriousness of a potential health problem related to the behavior (ex inactivity), one's susceptibility to potential health consequences, and the belief that making the suggested behavior changes will result in decreased risk of consequences - ANSWER Health Belief Model True - ANSWER T/F According to the Health Belief Model, the client must believe any perceived barriers are outweighed by benefits True - ANSWER According to the Health belief model, the cost of changing the behavior must be relevant for the client and worth the risk reduction it offers Health Belief Model - ANSWER Which theory of behavior change asserts that a theoretical client, Joan, will be more likely to engage in long-term physical activity if she recognies and understands her risk of illness associated with a sedentary lifestyle, accepts that this risk is serious, and believes that engaging in physical activity and nutrition intervention will reduce this risk Suggests that intention to engage in a behavior will ultimately result in that behavior, and that a client's level of intent is shaped by his or her attitudes ( how helpful and enjoyable the behavior is perceived to be), subjective norms (social pressure), and perceived control (self-efficacy and controllability). - ANSWER Theory of Planned Behavior Theory of Planned Behavior - ANSWER Which theory of behavior change states that a potential client, Yolanda, is likely to engage in a successful behavior change because she enjoys physical activity (she was an athlete), she still has friends who pursue activity, and she believes she can reverse her elevated BP through activity? Bandura's Social Cognitive Theory - ANSWER What is perhaps the most commonly used theory in behavior change today ? States that outcome expectations, IE what you think will happen as a result of your new behavior, and self efficacy, IE situation specific self confidence-- are the most important factors in behavior change. (These factors are further divided into environment, skills and abilities, opportunities to watch and learn, self control, reinforcement and incentives, coping skills, and past experiences that may shape expectations. - ANSWER Social Cognitive Theory SCT stands apart in that in puts great emphasis on a clients thoughts and feelings. Proponents of SCT believe that clients actively shape their lives by thinking, feeling, reflecting and observing themselves. - ANSWER How does social cognitive theory stand apart from other theories of behavior change? NO - ANSWER According to social cognitive theory, will a client have positive outcome expectations if they think they are unable to improve their weight status or that they are a failure? If a client believes he or she can meet goals, overcome challenges, and improve health, then he or she will be able to succeed in behavior change. Therefore, a trainer can teach clients skills and self-maintenance techniques such as self-monitoring and planning, highlighting successes, and offering coping and problem solving skills to increase the client's self-efficacy. - ANSWER How can social cognitive theory be applied to helping a client implement behavior change? Lots of stuff in it from different models. -goals direct attention and energy towards desired behaviors -goals lead to greater effort -Goals extend the time and energy devoted to a desired behavior -Goals increase the use of goal-relevant skills - ANSWER What is the goal setting theory? -Level of commitment to change -Importance of the goal -Self-efficacy -Feedback on goal progress -Attainment of the appropriate skill level to achieve the goal - ANSWER What is the success of goal setting moderated or affected by? Behavior change is achieved through setting realistic, maintainable goals that are small, relative to baseline activity, and cumulative. Combines components such as goal setting, feedback, and self-monitoring to yield achievement of initial goals and increases in self-efficacy to further behavior change. Goals are small, self selective. Linked to lifestyle and maintainable across time - ANSWER Small Changes Model Behavior change is a result of not only the individual factors but also social structure, environment, community, policy and law - ANSWER Socioecological theory Socioecological - ANSWER Which theory recognizes that clients are affected by their greater environment? Tracking one's own behavior for the dual purpose of increasing awareness and monitoring progress - ANSWER What is self-monitoring? Specific, measurable, achievable,, realistic, time oriented. - ANSWER SMART goals One of the most fundamental components of a successful intervention. Experts say rapport with a client is the first step to behavior change and adherence. - ANSWER Rapport - Communicate and display your credentials -Confirm your professionalism by dressing and acting appropriately -Highlight commonalities and relate to them -Affirm their strengths and empathize with their struggles and feelings -Self dislcose and share relavent struggles you have had -Show genuine interest in your client -Non verbal cues- eye contact, open posture, appropriate facial expression -Remain non judgemental and open minded -Listen -Offer explanations for components of the intervention - ANSWER How can a trainer build rapport with a client? Prone - ANSWER Lying face down Supine - ANSWER Lying face up Valgus - ANSWER Distal segment of a joint deviates laterally Varus - ANSWER Distal segment of a joint deviates medially Anterior - ANSWER Ventral, front of body Posterior - ANSWER Dorsal, back of body Center of gravity - ANSWER Where weight force of said object is considered to act Horizontal abduction - ANSWER movement away from the midline of the body in the transverse plane, usually used to describe horz humerus movement when the shoulder is flexed 90 degrees Horizontal adduction - ANSWER movement towards the midline of the body in the frontal plane, usually used to describe horz humerus movement when shoulder is flexed 90 degrees How many bones are in the human body? How many engage in voluntary movement? - ANSWER -206 total -177 can move Diaphysis - ANSWER Main portion of a long bone or shaft Epiphysis - ANSWER Ends of long bone; covered with articular cartilage Cartilage - ANSWER Resilient, semi-rigid form of connective tissue that reduces the friction and absorbs some of the shock in synovial joints 2 types of bones - ANSWER Compact (dense Cancellous (spongy) Compact bone - ANSWER Forms external layer of all bones and a large portion of the diaphysis of long bones. Provides support for weight bearing and has very few spaces in it Spongy (cancellous) bone - ANSWER Latticework, provide strength against stresses Ligaments - ANSWER Fibrous, tough CT connecting bone to bone Synovial joint - ANSWER Most common type of joint in human body 5 features of a synovial joint - ANSWER Enclosed by a fibrous joint capsule, joint capsule encloses the joint cavity, joint cavity is lined with synovial membrane, synovial fluid occupies the joint cavity, articulating surfaces of bones are covered with hyaline cartilage, which helps absorb shock and reduce friction Synarththrodial joints - ANSWER Ex. sutures of skull-no movement Amphiarthrodial joints - ANSWER Move slightly. Held together by ligaments or fibrocartilage- ex pubic symphisis T/F Joint movement is a combo of rolling, sliding and spinning of the joint surface - ANSWER True ROM - ANSWER Degree of movement within a joint Muscles: uniarticular, biarticular or multiarticular - ANSWER Uni- causes movement at one joint. Bi or multi- causes movement at two or more joints Agonist - ANSWER Prime muscles moving for a movement. Ex biceps curl- biceps brachii, brachialis, brachioradialis Antagonist - ANSWER Opposing muscles for a movement. Ex biceps curl- ************* are triceps brachii Synergist - ANSWER Stabilizing muscles, prevent unwanted movement to help prime movers perform more efficiently Sagittal Plane - ANSWER Divides body into left and right sides. Movements in the sagittal plane are visible from the side. Frontal Plane - ANSWER (Coronal plane)-divides body into anterior and posterior portions. Movements in front plane are visible from the front. Horizontal Plane - ANSWER Transverse, cross sectional, or axial plane- divides body into superior and inferior. Movements in this plane are visible from above Lordosis - ANSWER Exessive inward curvature of the lumbar spine, swayback Scoliosis - ANSWER S shape spine Kyphosis - ANSWER Excessive outward curvature of the spine, humpback Joint types: plane - ANSWER Gliding and sliding movements; AC joint Hinge joint - ANSWER This type of joint produces uniaxial movements- elbow flexion and extension Ellipsoidal joint - ANSWER Biaxial movements- wrist flexion, radiocarpal extension Saddle joint - ANSWER Allows movements in all planes. Thumb Ball and socket joint - ANSWER Mulitaxial, allow movements in all directions. Hip and shoulder joints Pivot joint - ANSWER UniAXIAL joints that permit rotation. Ex radioulnar. Allow movement around one axis with limited rotation (knee flex and extend with limited int/ext rotation) Trapezius primary action - ANSWER Upward rotation Rhomboids, pex minor, levator scapulae primary action - ANSWER Downward rotation What muscles elevate the scapulothoracic joint? What is an example of an exercise that does this? - ANSWER Rhomboids, levator scapulae, traps Shoulder shrug What muscles depress the scapulothoracic joint? - ANSWER Pec minor, traps What muscles protract the scapulothoracic joint? - ANSWER Serratus anterior, pec minor. Supine db serratus press, push up What do the rhomboids and traps do at the scapulothoracic joint? - ANSWER Retraction. Exercise= seated row What action are the anterior delts, pec major, and biceps brachii doing in a db front press or incline bench press at the GH joint? - ANSWER Flexion, 90-100 degrees What muscles are performing extension at the gh joint during a db pullover or chinup? - ANSWER Lats, teres major, pec major, posterior delt and triceps long head What muscles abduct the GH joint? - ANSWER Middle delt, supraspinatus. 90-95 degrees. Ex db lateral raise, db press What muscles adduct the GH joint? - ANSWER Lats, teres major, pec major. ex lat pulldown, seated row, cable crossover, flat bench db fly What action is occuring at the GH joint during a prone reverse db fly or a reverse cable fly?? - ANSWER Horz abduction, using posterior delt, teres major, lats What action is occuring at the GH joint during a flat bench chest fly? What muscles are acting on the GH joint as agonists? - ANSWER horz adduction, 135 d, pec major, anterior delt What action is occuring at the GH joint duirng a lat pulldown, bent over row, db row, db press, or front raise? - ANSWER Internal rotation using lats, teres major, subscap, pec major, and anterior delt What action is occuring at the GH joint duirng a db side lying exercise? - ANSWER External rotation using infraspinatus, teres minor, posterior delt What action is occuring at the elbow during a dumbbell curl or hammer curl? What muscles are the agonisits? - ANSWER Flexion, biceps brachii, brachialis, brachioradialis What muscles cause extension at the elbow? - ANSWER Triceps brachii and anconeous What muscles cause supination at the radioulnar joint? - ANSWER Biceps brachii, supinator. DB curl w/supination What muscles cause pronation at the radioulnar joint? - ANSWER Pronator quadratus, pronator teres. DB pronation What action is occuring at the wrist with a db wrist curl? - ANSWER Flexion. Muscles are flexor carpi radialis and ulnaris, palmaris longus, flexor digitorum superficialis What muscles extend the wrist? - ANSWER Extensor carpi radialis, brevis and ulnaris, extensor digitorum. DB reverse wrist curl What do the flexor and extensor carpi ulnaris do? - ANSWER Adduct the wrist What do the extensor carpi radialis longus and brevis and the flexor carpi radialis do at the wrist? - ANSWER Abduction Isotonic - ANSWER Muscular contraction in which the muscle exerts a constant tension. Can be concentric or eccentric. Dynamic movement. Isometric - ANSWER Muscular action in which no change in the in the muscle length takes place. Ex wall sit, static hold. Isokinetic - ANSWER Allows one to maintain a maximum resistance throughout the whole ROM by controlling the speed of the movement Acute responses to CV exercise - ANSWER ^HR, SV, CO, aVO2 difference. BF is redirected to working muscles (85-90% goes to muscles!!)SBP ^ with ^ exercise intensity. VO2^. Chronic adaptations to strength training - ANSWER Improved muscular strength and endurance. 60-80% of max force is required for strength gains; however, 75-90% is recommended for optimal strength GAINZ. Muscle must be overloaded by a load greater than what one is accustomed to. Strength training also improves aerobic enzyme systems. increases capillarization and number of mitochondria THE POWERHOUSE OF THE CELLLLLL Chronic adaptations to cardiovascular training - ANSWER INCREASES: max O2 uptake, cardiac output (Q), stroke volume (SV), more capillaries, more mitochondria, increased lactate threshold, lower HR and BP at a fixed submax workload during exercise, lower O2 demand at a fixed sub max workload,lower ventilation. Improved glucose tolerance and insulin sensititity. Decrased risk of mortality, CAD, cancer, hypertension, diabetes type 2, osteoperosis, anxiety, depression. IMproved blood lipids. INCREASES HDL, decreases triglycerides. Improved body comp, decreased fatigue. Anaerobic glycolysis - ANSWER Rapid breakdown of carb molecules (glycogen or glucose), without O2 being present. This produces ATP quickly. Creatine Phosphate System - ANSWER Transfers high energy phosphate from CP to rephosphorylate ATP from AP, using the enzyme creatine phosphate. This is a rapid system but limited, because CP exists in limited quantities in the cell. CP system is anaerobic because oxygen is NOT involved in the rephosphorylation process( see above) Aerobic Oxidation - ANSWER Krebs Cycle or electron transport train. Can use carbs, protein or fat as substrates for ATP. Aerobic system requires oxygen delivery and use but sustains HIGH rates of ATP production for muscular energy for long periods of time. Steady State - ANSWER Balance between energy required by a muscle to do work and the production of ATP via aerobic metabolism Discomfort (angina) in chest, neck jaw or arms that may result from ischemia - ANSWER Sign/ symptom of CV, metabolic or pulm disease shortness of breath at rest or with mild exertion - ANSWER sign. or symptom of CVD, metabolic or pulm disease Dizziness, syncope, bilateral ankle edema - ANSWER Sign or symptom of CVD/met/puml disease palpitations or tachycardia, intermittent claudication - ANSWER sign or symptom of CVD, pulm or met disease known heart murmer, unusual shortness of breathe or fatigue with usual activities - ANSWER sign or symptom of CVD, pulm or met disease Recent change in ECG suggesting ischemia, recent myocardial infarction within 2 days or other acute cardiac event - ANSWER Absolute contraindication Unstable angina, uncontrolled cardiac dysrhytmias, uncontrolled, symptomatic heart failiure - ANSWER Absolute contraindication Symptomatic, severe aortic stenosis, acute pulmonary embolos or pulmonary infarction - ANSWER Absolute contraindication Acute systemic infection, acute myo or pericarditis - ANSWER Absolute Contraindication Suspected or known dissecting aneurysm - ANSWER Absolute Contraindication Relative Contraindication to exercise - ANSWER Electrolyte abnormalities, l main coronary stenosis Moderate stenotic valvular disease, severe arterial hypotensions (SBP 200 or more DBP 110 or more at rest) - ANSWER Relative contraindication Hypertrophic cardiomyopathy, tachy or bradydysrhythmias - ANSWER Relative contraindication neuromotor, musculoskeletal or rheumatoid disorders that are exaserbated by exercise - ANSWER relative contraindication Ventricular aneurysm or hi degree AV block - ANSWER Relative contraindication Uncontrolled metabolic disease - ANSWER Rel. Contranidication Chronic infectious disease or a mental impairment leading to inabilitiy to exercise adequately - ANSWER Rel. Contraindication