ACSM Personal Trainer Certification Exam Review 2022/2023

ACSM Personal Trainer Certification Exam Review 2022/2023 pretest considerations for healh appraisal - ANSWER-systematic approach in screening clients for: signs and symptoms, family history, risk factors for disease informed consent - ANSWER-an agreement to do or allow something to occur, made with an awareness of relevant facts, including: procedures, risks, benefits, limitations, and discomforts -legal and ethical document -often paired with release of liability form Par-Q - ANSWER-used for screening Physical Activity Readiness Questionnaire minimal standard for moderate intensity exercise 7 questions; if answered "yes" to any question, then require to get medical release form from healthcare provider physician referral - ANSWER-safeguard for high risk clients who may compromise health with exercise without medically trained staff -physician's name, stating diagnosis, and exercise perscription risk stratification - ANSWER-assigns individuals to low, medium, or high risk based on presence of conditions ACSM risk stratification matrix - ANSWER-makes recommendations based upon low, moderate, or high risk clients positive risk factors - ANSWER-family history of disease cigarette smoking hypertension hyercholesterolemia/dyslipidemia impaired fasting glucose obesity sedentary lifestyle family history of disease - ANSWER-myocardial infarction, coronary revascularization, or sudden death before age 55 in males and 65 females (1st degree relatives) cigarette smoking - ANSWER-currently smoking or quit withing 6 months, or exposed to 2nd hand smoke over 6 months hypertension - ANSWER-clients currently taking antihypertensive medication and/or confirmed (2 separate occasions) 140/90 BP or higher hypercholesterolemia/dyslipdemia - ANSWER-clients currently taking lipid lowering medication and/or those with total serum cholesterol >200 mg/dL, or high density lipoprotein cholesterols of 0.35 mg/dL impaired fasting glucose - ANSWER-fasting blood glucose > or equal to 110 mg/dL (2 separate measurements) obesity - ANSWER-BMI > or equal mg/m^2 or waist girth exceeding approximately 39.4 inches sedentary lifestyle - ANSWER-those not meeting recommended amount of physical activity (at least 30 minutes of physical activity at a moderate intensity 40-60%, at least 3 days a week for at least 3 months) negative risk factors - ANSWER-high serum HDL cholesterol: >60 mg/dL emerging risk factors - ANSWER-inflammatory markers: reactive C protein (CRP) and fibrinogen low risk - ANSWER-men <45, women <55, asymptomatic, with 1 or less risk factors A) current medical examination and exercise testing prior participation- not necessary for moderate or vigorous exercise B) physician supervision of exercise tests- not necessary for submax or maximal tests moderate risk - ANSWER-men >45, women >55, or those who meet the threshold for 2 or more risk factors A) current medical examination and exercise testing prior participation- not necessary for moderate but recommended for vigorous exercise B) physician supervision of exercise tests- not necessary for submax but recommended for maximal tests high risk - ANSWER-1 or more signs and symptoms listed or a known cardiovascular, pulmonary, or metabolic disease A) current medical examination and exercise testing prior participation- recommended for moderate or vigorous exercise B) physician supervision of exercise tests- recommended for submax or maximal tests exercise testing steps - ANSWER-M.R.I.P.L. medical history risk factor assessment interpreting the data (cardio endurance, muscle strength/endurance, flexibility, body comp) prescribing exercise program lifestyle counseling stress test - ANSWER-usually only recommended by physician if the client has symptoms of coronary artery disease, or significant risk factors for CAD do NOT do vigorous exercise with: - ANSWER-clients with diagnosed or present cardio diseases, congenital abnormalities, and/or hereditary abnormalities: hypertrophic cardiomyopathy coronary arter abnormalities aortic stenossi signs/symptoms of cardiovascular and pulmonary disease - ANSWER--pain, discomfort, distress in areas that may be due to ischemia (chest, neck, jaw, arms, etc.) -shortness of breath at rest or mild exertion -dizziness or syncope -edema, especially ankle -tachycardia, or other arrhythmic occurrences (known heart murmur) -orthopnea or paroxysmal dyspnea -intermittent claudication -unusual fatigue or shortness of breath with ADLs ischemia - ANSWER-an inadequate blood supply to an organ or part of the body, especially the heart muscles. -can result in heart attack, can by silent intermediate condition of CAD edema - ANSWER-puffy swelling of tissue from the accumulation of fluid -common in arms, hands, legs, ankles, and feet, face, abdomen *symptoms:* swelling of tissue directly under skin, stretched or shiny skin, skin that pits after being pressed, increased abdominal size -remove salt from clients diet may help with swelling -can be sign of underlying disease (heart failure, kidney disease, cirrhosis of liver etc.) orthopnea - ANSWER-ability to breathe only in an upright position -difficulty breathing in supine position -usually indicative of left ventricular dysfunction paroxysmal dyspnea - ANSWER-sudden, recurring episode of difficult breathing -asthma angina - ANSWER-heart pain -insufficient supply off blood *symptoms:* chest pain/discomfort, pain in neck shoulder back arms or jaw, nausea, fatigue, sweating, shortness of breath, anxiety, dizziness stable angina - ANSWER-most common type occurring with exertion and going away with rest can be triggered by mental or emotional stress could feel like indigestion and spread to arms, back, or other areas unstable angina - ANSWER-*medical emergency* occurs even at rest and usually more severe and longer lasting (as long as 30 minutes) -may signal heart attack!!! arrhythmias - ANSWER-abnormal heart rhythm: -tachycardia -bradycardia -atrial fibrillation -ventricular ectopic beats (VEB tachycardia - ANSWER-very fast heart rate sinus: >100 bpm atrial: >100 bpm with narrow QRS complex, w/ P waves originating not from sinus node ventricular: potentially life threateing, >100 bpm, with at least 3 irregular heartbeats in a row (ventricular fibrillation, asystole, or death) bradycardia - ANSWER-unusually slow heart rate (less than 60 bpm) atrial fibrillation (A-fib) - ANSWER-irregular heart rhythm -continuous rapid firing of atrial foci -no P waves -does not completely depolariaze -series or erratic tiny spikes ventricular ectopic beats (VEB) - ANSWER-heartbeat arising from an abnormal focus. Called premature beats (before next schedule heart beat) or escape beats (later than next scheduled heart beat) dyspnea - ANSWER-shortness of breath (SOB). difficult or uncomfortable breathing experienced subjectively. can occur at rest or be cause by exertion exertion cause dyspnea - ANSWER-suggests presence of cariopulmonary disorders (especially left ventrifular dysfunction or chronic obstructive pulmonary disease) -tachypnea -hyperventilation -hyperpnea tachypnea - ANSWER-increase in respiratory rate above normal hyperventilation - ANSWER-increase minute ventilation relative to metabolic need hyperpnea - ANSWER-disproportionate rise in minute ventilation relative to an increase in metabolic level unilateral edema - ANSWER-a limb completely swollen, often cause by venous thrombosis or lymphatic blockage in limb ankle edema - ANSWER-most common, sign of heart failure or bilateral chronic venous insufficiency heart murmur - ANSWER-usually harmless cause by blood flowing through a damage or overworked heart valve can indicate valvular abnormalities intermittent claudication - ANSWER-muscle with inadequate blood supply being stressed by exercise, causing pain -doesn't occur when standing/sitting, more severe when walking upstairs/hill *symptoms:* often described as a cramp, disappears couples minutes after stopping exercise paroxysmal nocturnal dyspnea (PND) - ANSWER-dyspnea that occurs after 1-2 hours of sleep *symptoms:* wheezing/coughing that wakes client up; usually relieve once awake to sit up or productively cough syncope - ANSWER-fainting or sudden loss of consciousness caused by lack of blood supply to the cerebrum -fall in BP -when accompanied with dizziness may result from cardiac disorders preventing normal cardiac output: severe coronary artery disease, hypertrophic cardiomyopathy, aortic stenosis, and malignant ventricular dysrhythmias palpitations - ANSWER-fluttering, rapid, or punding sensations in the chest related to cardiac arrhythmias, such as premature ventricular contractions (PVCs) -usually harmless -triggered by stress, exercise, or medication *if accompanied with chest pain/discomfort, fainting, shortness of breath, and/or severe dizziness seek emergency medical attention* indication - ANSWER-valid reason to use certain tests, medications, procedures, etc. contradictions - ANSWER-conditions or facts requiring the withholding of certain medical treatments or tests absolute contradictions - ANSWER-do not perform exercise test! -acute myocardial infarction, unstable angina, uncontrolled cardiac arrhythmias, symptomatic severe aortic stenosis, symptomatic heart failure, acute pulmonary embolus, pulmonary infarction, acute myocarditis or pericarditis, acute dissection, dissection aneruysm, or acute system infection with fever body aches or swollen lymph glands relative contradictions - ANSWER-test may still be performed, sometimes with modifications -left main coronary stenosis, moderate stenotic valvular heart disease, electrolyte abnormalities, severe arterial hypertension, tachyarrhythmias or bradyarrhythmias, hypertropic cardiomyopathy, outflow tract obstruction, neuromuscular, musculoskeletal or rheumatoid disordors, ventricular aneurysm, uncontrolled metabolic disease, chronic infectious disease, mental or physical impairment, high degree atrioventricular block absolute indications - ANSWER-immediately stop if any seen: sings of heart attack onset of chest pain drop in systolic BP below resting pressure or with increasing workload signs of poor circulation extreme shortness of breath ataxia, vertigo, visual or gait problems, or confusion abnormal heart rhythms technical inability to monitor the ECG client's request to stop relative indications - ANSWER-do not call for immediate stop: increasing chest pain shortness of breath severe fatigue wheezing leg cramps/ intermittent claudication hypertensive response (260/115 mm Hg or higher) pronounced ECG changes from baseline bundle branch block supraventricular tachycardia or other less serious arrhythmias 5 components of fitness assessment - ANSWER-cardio endurance muscular strength muscular endurance flexibility body comp isotonic contraction - ANSWER-contraction wherein the muscle remains unchanged, and the distance between the origin and insertion shortens isometric - ANSWER-muscle contraction without shortening or changing distance between the origin and insertion isokinetic - ANSWER-concentric muscle or eccentric muscle in which the speed and tension are constant throughout the range of lengthening or contractin 1 RM testing - ANSWER-1. cover movement, then do light warm up 5-10 reps of light- moderate exertion 2. rest for 1 min, light stretching, then 3-5 reps of moderate-heavy exertion 3. add 5-10 pounds if successful lifting previous weight, rest 5-10 minutes before adding weight again 4. divide 1 RM by their body weight to get relative results BMI equation - ANSWER-703 * lbs/in^2 BMI categories - ANSWER-underweight: < 18 normal weight: 18.5-24.9 overweight: 25-29.9 obese > 30 normal BP - ANSWER-< 120/80 pre-hypertensive BP - ANSWER-120-139 / 80-89 stage 1 hypertension BP (HTN) - ANSWER-140-159 / 90-99 stage 2 hypertnsention BP - ANSWER-> 160/10 periodization - ANSWER-the process of varying a training program at regular time intervals to bring about optimal gains in physical performance -improves muscular endurance, strength, power, motor performance, and/or muscle hypertrophy variable resistant - ANSWER-a resistance that changes over ROM when an isotonic contraction is used to move a load plyometric exercise - ANSWER-"jump training" dynamic resistance exercises that rapidly stretch a muscle and then rapidly shorten it EX) jumping/hopping exercise recommendations for adults - ANSWER-150 min/week of moderate activity or 75 min/week of vigorous activity (use if want to improve fitness level) 5-7 days/week stretching 3-5 days/week cardio 2-3 days/week of resistance training for 45-60 min/day resistance training guidelines - ANSWER-at least 2 days/week for 45-60 min consist of 3 set of 12-15 reps 30 sec rest period 7-0 moderate exercises intensity measurements - ANSWER-heart rate METs VO2 max aerobic activity for healthy population - ANSWER-3-5 days/week on consecutive days, alternate with another mode 20-60 min of continuous activity volume of workload - ANSWER-duration and frequency of the activity performed within the time frame allotted for the training process cardio benefits - ANSWER-decrease obesity, hypertension, type II diabetes, depression increase immunity, blood lipids, glucose tolerance, and a sense of well being average VO2 - ANSWER-*sedentary:* 35 ml/kg/min *athlete:* 70 ml/kg/min can improve by increasing training volume and intensity MHR formula (Maximum Heart Rate) - ANSWER-206.9 - (0.67 * age) EX) 206.9 - (0.67 X 21) = 192.83 Karvonen formula - ANSWER-(MHR - RHR) * intensity = + RHR = desired intensity EX) 25 year old with RHR being 65 bpm 206.9 - (0.67 X 25) = 190 MHR 190 - 65 = 125 125 X .65 = 75 + 65 = 140 125 X .85 = 106 + 65 = 171 target heart rate zone = 140-171 bpm METs calculation - ANSWER-*women:* 14.7 - (0.13 X age) = target *men:* 14.7 - (0.11 X age) = taret BMI - ANSWER-obesity related problem when >25 mild obesity = 25-30 moderate obesity = 30-35 severe obesity = 35+ linear periodization - ANSWER-continual progression of increasing intensity. The amount of weight is increase as the reps are decreased -good for beginners/intermediate levels alternation periodization - ANSWER-altering between volume and intensity -god for more advanced clients EX) more weight with less reps, then less weight with more reps initial stage of condition - ANSWER-10-15 min warm up 15-30 min moderate activity (40-60% of heart rate reserve) 3-4 days/week improvement stage of conditioning - ANSWER-10-15 warm up 30 min of 50-85% intensity to start then increase duration by 10-20% every week increase intensity 5-10% every 2 weeks once goal met, maintain with other activities benefits of flexiblity - ANSWER-decrease occurrences of muscle imbalances, joint dysfunctions, and overuse injuries/ injury prevention -static, ballistic, and PNF static stretching - ANSWER-corrective measure passively stretch and hold 10-30 sec -muscles relax due to autogenetic inhibition and elongation of muscle ballistic stretching - ANSWER-uncontrolled bouncing, jerking, bobbing, or pulsing to achieve greater range of motion NOT preferred stretch -possible risk of injury and soreness -causes muscles to contract, leading to muscle fibers tearing PNF stretching (proprioceptive neuromuscluar facilitation) - ANSWER-rehabilitation of clients stretching based on a contract-and-relax technique requiring the help of another person -facilitate muscle relaxation and fuller range of motion benefits of strength training - ANSWER-reduce body fat, create lean muscle mass, burn more overall calories throughout day decreases symptoms of many chronic diseases, help develop stronger bones, reduce risk of injury, help control weight, and assist in overall strength in daily activities superset - ANSWER-performing 2 exercises using same muscle groups back to back circuit training - ANSWER-series of exercises back to back with little rest horizontal loading - ANSWER-completing all sets of an exercise before moving on to the next exercise vertical loading - ANSWER-completing one set of all exercises before beginning the second set proper breathing - ANSWER-breath diaphragmatically during aerobic activity (through stomach) -if clients cannot switch to proper breathing pattern, refer them to a health care professional inhale concentric exhale eccentrically valsalva maneuver physiological response - ANSWER-initial pressure rise first 5-10 sec reduced venous return and 15-20 sec compensation 20-23 sec pressure relief 24 sec + return of cardiac output eccentric contraction - ANSWER-strongest of 3 muscle actions target heart rate zones - ANSWER-*zone 1:* recovery zone 40-60% *zone 2:* aerobic zone 65-85% *zone 3:* peak zone 85%+ exercise perscription components - ANSWER-mode intensity duration frequency progression target heart range for moderate activity - ANSWER-50-70% of max HR specificity principle - ANSWER-exercising a certain body part that develops primarily that part must perform exercise/skill to improve on exercise/skill overload principle - ANSWER-body easily adapts to increase or decreased physical demand, enabling people to develop muscle coordination and sports-specific skills adaption principle - ANSWER-greater stress than normal is required for adaption to occur to improve fitness/strength/endurance, then workload must increase accordingly progression principle - ANSWER-optimal overload level and optimal time frame for overload to occur if overload is too slow, then less improvements if overload too fast could cause injury or muscle damange adequate rest and recover cardiovascular disease (CVD) - ANSWER-any disease that affects the heart or blood vessel increase risk of heart attack, heart failure, sudden death, high blood pressure, stroke, and cardiac rhythm problems *preventable/treatable:* high blood pressure, high cholesterol, excess weight, diabetes, physical inactivity, metabolic syndrome, smoking, excessive alcohol consumption, illegal drug use, and stress *nonpreventable/treatable:* previous heart attack, family history of heart disease, increasing age, gender, and race athersclerosis - ANSWER-plaque formation lipid deposits i medium-large sized arteries sedentary lifestyle, diet with high intake of saturated fat, high blood pressure, smoking, and any other toxic agent to the body -endothelial cells of artery can be damaged -increased risk of heart attack obese statistics - ANSWER-1/3 adults 1/5 young people ages 6-19 type II diabetes cons - ANSWER-can increase risk of: affected blood vessels and nerves including: vision impairment, kidney disease, peripheral vascular disease, atherosclerosis, and hpertension chronic diseases - ANSWER-NEED PHYSICIAN APPROVAL BEFORE EXERCISE PROGRAM -or ever exercise recommendations aerobic exercise benefits - ANSWER-conditions heart and lungs by increasing amount of oxygen the heart uses more efficiently -decrease risk of heart disease and stroke -positive effect in decreasing blood cholesterol levels and blood pressure resting metabolic rate - ANSWER-accounts for up to 75% of daily calories. increase in muscles requires more calories to maintain, which mean the higher your high blood pressure and resistance training - ANSWER-use lighter weights with more reps consider consulting physician for strength training routine borg scale - ANSWER-walking or cycling = level 13 strength activities = levels 15-17 challenging activities become easier over time acute adaptions - ANSWER-stroke volume and cardiac output stroke volume - ANSWER-how much blood is expelled with each heartbeat at rest ~72 bpm cardiac output - ANSWER-stroke volume and heart rate blood per min = HR * SV at rest ~5 L/min chronic adaptions to heart - ANSWER-decrease CVD, stroke, high blood pressure, and obesity with prolonged exercise: -increase red blood cell's oxygen carrying capacity -increase size of heart (more blood produced) -lower blood pressure -reduced blood lipids pulmonary diffusion - ANSWER-ability of blood to extract oxygen from alveoli metabolic rate - ANSWER-accounts for up to 75% of calories burned by body each day to maintain normal body functions -heart, lungs, brain function heat exhaustion symptoms - ANSWER-heavy sweating cool/clammy skin fatigue nausea fainting heat stroke symptoms - ANSWER-MEDICAL EMERGENCY apply cool water to skin and seek medical help high fever, hot/dry skin w/o sweating, pounding pulse, dizziness, nausea/vomiting, confusion, unconsciousness -higher risk with heart disease or CVD (may cause damage to organs) patients with diuretics or beta blockers - ANSWER-ask doctor about safe levels of water in hot temps vs mild temps cold temps and heart disease - ANSWER-exercising in cold temps makes heart work harder to maintain core temp -ask doctor safe levels of exposure to cold and which activities to avoid -always bundle up heart attack symptoms - ANSWER-MEDICAL EMERGENCY, CALL 911 chest discomfort pain/discomfort in one or both arms, neck, back, jaw, or stomach shortness of breath with or without chest discomfort breaking out in a cold sweat feeling nauseous or lightheaded hypothermia symptoms - ANSWER-MEDICAL EMERGENCY, CALL 911 exhaustion or drowsiness shivering confusion memory loss fumbling hands slurred speech chronic obstructive pulmonary disease (COPD) - ANSWER-a group of lung diseases that block airflow upon exhalations; difficult to breathe or dyspnea -higher altitude = less oxygen to inhale *conditions:* emphysema, chronic asthmatic bronchitis, asthma, cystic fibrosis medications (bronchodialators, steroids, and antibiotics), supplement oxygen, pulmonary rehabilitation; with severe emphysema can do lung volume reduction surgery or lung transplant exercise programming cardio recommendations - ANSWER-moderate intensity 55-69% high intensity 70-89% -new to exercising clients begin at 55% 20-60 min 3-5 days/week strength training recommendations - ANSWER--involve 8-10 exercises for major muscles with at least one set per exercise -8-12 reps per set for 2-3 nonconsecutive training days/week -full range movements that are pain free -moderate speed body weight exercises - ANSWER-*pros:* can be performed anywhere without equipment *cons:* difficult to increase resistance easily and target specific muscle groups resistance machine exercises - ANSWER-*pros:* allow client to control resistance and isolate specific muscles *cons:* requires special equipment free weight exercises - ANSWER-*pros:* client controls resistance, isolate specific muscles, and improve muscle balance *cons:* not mechanically supported so risk of injury is higher bioenergetics - ANSWER-process of transferring energy from foods throughout the body, supplying the contracting muscles with usable energy: ATP phosphagen system - ANSWER-uses immediate stored energy inside the muscle cell -ATP and phosphocreatine (PCR) EX) sprinting and weightlifting *no more than 30 sec* nonoxidative system (anaerobic) - ANSWER-AKA lactic acid or glycolytic system short term energy system ATP and phosphocretine to be re-synthesized at a rapid rate uses carbs (glucose and glycogen) for ATP production -byproduct: lactic acid produced when carbs breakdown w/o oxygen EX) running upstairs *30 sec - 3 min* high intensity effort oxidative system (aerobic) - ANSWER-long term energy system produces large amounts of ATP breaks downs carbs and fats -byproducts: water and carbon dioxide when broken down w/ oxygen EX) running marathon, hiking *>3 min* anaerobic/ lactate threshold - ANSWER-when working muscle demands more ATP than is being provided, the muscles will rely on the nonoxidative system for energy along with oxidative system erythrocytes - ANSWER-red blood cells -contains hemoglobin hematocrit - ANSWER-blood test to measure erythrocytes (RBC) within blood -slightly higher in men due to testosterone leukocytes - ANSWER-white blood cells -body's defense system hyperemia - ANSWER-increased amount of blood flow to working muscle of the body ^exercise = ^oxygen and nutrient delivery to muscles -increases waste removal (lactate and carbon dioxide) cardiovascular drift - ANSWER-prolonged endurance exercise increases body temp plasma moved from blood to tissue to promote sweating -can cause increased HR, and decreased stroke volume and volume of blood hemoconcentration - ANSWER-movement of plasma out of blood decrease of fluids within blood upper respiratory track - ANSWER-nose pharynx (throat) larynx (voice box) lower respiratory track - ANSWER-trachea (wind pipe) lungs bronchi bronchioles (passageway into alveoli) alveoli (air sacs) tricuspid valve - ANSWER-located between right atrium and right ventricle bicuspid valve (mitral valve) - ANSWER-located between the left atrium and left ventricle pulmonic valve (pulmonary semi-lunar valve) - ANSWER-located between the right ventricle and pulmonary artery aortic valve - ANSWER-located between the left ventricle and aorta pulmonary circulation - ANSWER-right atrium to heart w/o oxygen blood. Heart pumps blood into lungs to gain oxygen then to left atrium w/ oxygenate blood -works with lungs systemic ciculation - ANSWER-transports oxygenated blood away from heart and oxygen depleted blood back towards heart -circulated blood to all parts of body, except lungs blood flow of heart - ANSWER-right atrium tricuspid valve right ventricle pulmonic valve pulmonary artery lungs pulmonary veins left atrium mitral/bicuspid valve left ventricle aortic valve aorta (rest of body) anatomy of heart - ANSWER- ejection fraction - ANSWER-% of blood in ventricle when heart is in a relaxation (diastolic) state but this blood actually gets pumped out during the contraction (systolic) phase frank-starling law - ANSWER-amount of blood left in each ventricle after end diastolic volume will significantly affect the stroke volume -every contraction creates a greater stretch on heart muscles; contractile force wil eventually increase normal EDV ~125 ml normal ESV ~55ml minute ventilation - ANSWER-volume of air breathed in 1 min at rest ~6 L/min -per breath is *tidal volume* (0.5L - 4 L) shunting - ANSWER-when blood is shunted away from all vital organs of body to exercising muscles axial skeleton - ANSWER-skull vertebral column ribs sternum (supports and protects vital organs) appendicular skeleton - ANSWER-arms legs pelvis pelvic girdle (provides movement and support) spine - ANSWER-33 vertebrae: -7 cervical -12 thoracic -5 lumbar -5 sacral -4 coccygeal scoliosis - ANSWER-abnormal curve of spine in frontal plane kyphosis - ANSWER-outward curve on spine causing hunch thoracic and sacral region -develops as fetus lordosis - ANSWER-inward curve on spine cervical and lumbar regions -develops after birth te*nd*ons - ANSWER-*m*uscle to *b*one ligaments - ANSWER-bone to bone sliding filament theory - ANSWER-theory of muscle contraction; sarcomeres shorten when thick filaments pull on thin filaments length tension relationship - ANSWER-The resting length of a muscle and the tension the muscle can produce at this resting length. -produce greatest tension at resting length (how much contracted/lengthened dependent on force) type I muscle fibers - ANSWER-slow twitch most resistant to fatigue produce large amounts of ATP w/oxygen developed through training and genetics -marathon runners type IIA muscle fibers - ANSWER-fast twitch produce bursts of power fatigue quickly ATP produced w/o oxygen ATP broken down rapidly -sprinters type IIB muscle fibers - ANSWER-combo of Type I and Type II fibers ATP produced w/ and w/o oxygen produce g muscle contractions more prone to fatigue that type I -resistance training sagittal plane - ANSWER-divides body into left and right sides -flexion and extension -rotates around mediolateral axis (perpendicular) EX) walking or squatting transverse plane - ANSWER-divides body into superior and inferior portion -internal/external rotation, horizontal flexion/extension, and supination/pronation -rotates around longitudinal axis (perpendicular) EX) throwing baseball or golf swing frontal (coronal) plan - ANSWER-divides body into anterior and posterior portions -abduction/adduction, side flexion, and inversion/eversion -rotates around anteroposterior axis (perpendicular) EX) side bending, and lateral arm lifts synarthrosis - ANSWER-fixed fibrous joints no movement held together with connective tissue -sutures in skull amphiarthrossi - ANSWER-slightly movable cartilaginous joints -spine and ribcage connected with cartilage darthrossi - ANSWER-freely movable synovial joints most common -head, knee, elbow, shoulder ball and socket joint - ANSWER-circumduction, rotation, and angular movements in all planes -shoulder and hip hinge joint - ANSWER-flexion/extension in one plane -knee and elbow pivot joint - ANSWER-rotation around central axis -range of motion of head and stability of neck saddle joint - ANSWER-flexion/extension, abduction/adduction, and circumduction/opposition -thumb gliding joint - ANSWER-inversion and eversion -ankle condyloid joint - ANSWER-circumduction, abduction/adduction, and flexion/extension -wrist inversion - ANSWER-turning sole of foot toward midline of body eversion - ANSWER-turning sole of foot away from midline of body body comp readings - ANSWER-skinfold bioelectrical impedance analysis (BIA) waist-hip ratio *all have 3-4% rate of error* skinfold measurements - ANSWER-taken prior exercise client should not wear lotion/oil use right side of body mark sites measure for 4 seconds measure to nearest 1/2 - 1 mm 2 measurements of each site in rotational order and averaged (difference more than 1 mm = measure again) women skinfold sites - ANSWER-triceps suprailium thigh mens skinfold sites - ANSWER-chest ab thigh bioelectrical impedance analysis (BIA) - ANSWER-fluid is capable of electrical conduction, safe, low level current flows through body fluids to determine body comp -clients lies flat on table no limbs touching w/ electrodes on hands and feet -more lengthy and expensive than skinfold implications of BIA - ANSWER-*min reccomended level of total body fat:* men: 5% women: 15% *optimal health:* men: 10-25% women: 18-30% lower ranges for athletes ideal wait-hip ratios - ANSWER-women 18-59: <0.87 women 60+: <0.91 men 18-59: <0.96 men 60+: <1.04 positive health affects for women maintaining ideal WHR - ANSWER-optimal levels of estrogen lowered susceptibility to diabetes, cardio disorders, and ovarian cancer positive health affects for men maintaining ideal WHR - ANSWER-higher fertility lower susceptibility to prostate and testicular cancers 4 criteria for anorexia nervosa diagnosis - ANSWER-1. refuse to maintain body weight or body weight during growth period 15% lower than anticipated 2. being underweight and strong fear of gaining weight/fat 3. denial and think their appearance is heavily influenced by body weight 4. amenorrhea (3 consecutive cycles+) potential complications with anorexia - ANSWER-anemia, kidney problems, and/or death heart issues bone density loss amenorrhea, decreased testosterone gastrointestinal issues electrolyte abnormalities mental health issues and disorders bulimia nervosa criteria - ANSWER-binging at least twice weekly for at least 3 months behaviors different than anorexia self evaluation focused on body shape/weight (vomiting, laxatives, diuretics, enemas, fasting, exercising excessively) complications of bulimia - ANSWER-dehydration (kidney failure) heart issues tooth decay, gum disease amenorrhea digestive problems (dependence on laxatives) anxiety/depression drug/alcohol abuse binge eating disorder (BED) criteria - ANSWER-recurrent bingeing episodes twice weekly for at least 6 months with at least 3 of the following: -eating until uncomfortable -eating when not physically hungry -eating rapidly -eating alone for fear of being embarrassed by how much food is being consumed -feeling disgusted, depressed or guilty after the episode of overeating complications with binge eating disorder - ANSWER-depression suicidal thoughts insomnia obesity high BP type II diabetes high cholesterol heart disease gallbladder disease and other digestive issues joint pain muscle pain headache menstrual problems some types of cancer 1 pound = - ANSWER-3500 calories of fat bad fats - ANSWER-saturated and trans fat complex fats good fats - ANSWER-mono-unsaturated and poly-unsaturated fats lower cholesterol and reduce risk of certain diseases calories per gram - ANSWER-carbs - 4 fats - 9 proteins - 4 alcohol - 7 water soluble vitamins - ANSWER-B complex and C assist in ezyme activity like enrgy production fat soluble vitamins - ANSWER-A, D, E, K stored in liver usually no supplements- needed excess can be toxic female athlete triad - ANSWER-low bone mass disordered eating amenorrhea *sublcinical eating disorder* in to cm - ANSWER-*2.54 cm to in - ANSWER-*0.39 kg to lbs - ANSWER-*2.2 lbs to kg - ANSWER-*0.45 par-Q - ANSWER-Physical Activity Readiness identifies people who should not be tested in a field setting. Proceed with caution if a client answers yes to one or more questions. May require physician clearance program planning - ANSWER-needs of the target population, the existing or needed expertise of the care deliverers, and market demand for particular services. -keep up with the health and fitness industry changes and modify programs accordingly! legal and ethical considerations - ANSWER-never try to diagnose a client -look for underlying health issues provide them with a written statement of the facilities standards of care, and provide confidentiality written statement of standard of care health risk assessment - ANSWER-before exercising with any client! -identify health risk factors -control health care costs -predict employee absenteeism -encourage clients to be proactive Health Insurance Portability and Accountability Act (HIPPA) - ANSWER-set of federal regulations adopted to protect the confidentiality of patient information and the ability to retain health insurance coverage tort laws - ANSWER-State legislation that applies to civil cases dealing with wrongful conduct or injuries, negligence tort action factors - ANSWER-1. the defendant owed the claimant a duty of care 2. the defendant bread that duty of care 3. reasonably foreseeable damage was caused by the breach of duty 4 basic duties - ANSWER-inform instruct monitor supervise waivers - ANSWER-suggested for every client to lower risk of liability in cases of negligence program development - ANSWER-systematic process that involves ongoing and structured planning to successfully achieve goals overuse injuries - ANSWER-muscle pulls sprains strains over-extension - ANSWER-similar to overuse injuries, but overexertion may result in exhaustion, shortness of breath, dizziness, and other dangerous conditions type I diabetes - ANSWER-insulin dependent typically under age 40 and chronic condition type II diabetes - ANSWER-insulin resistant -resistant to effects or fails to produce enough insulin -more common ideal blood glucose level for diabetics - ANSWER-100-200 mg/dL when 1-2 hours after eating diabetic considerations - ANSWER-time workouts in relation to meals and insulin dosage -check blood glucose before and after workouts -consult physicians for possibility of reducing insulin by 10-50% when beginning exercise -proper warm up and cool down -appropriate footwear -remain hydrated -avoid exercising in extreme conditions hyperglycemia - ANSWER-blood glucose exceeding 200 mg/dL hyp*er*glycemic client - ANSWER-*symptoms:* frequent urination, increased thirst, blurred vision, fatigue, headache, cardiac arrhythmia, deep and rapid breathing 1. give water 2. test blood sugar levels if possible 3. have them take their prescribed dosage of insulin, if not there, seek medical attention immediately hypoglycemia - ANSWER-blood glucose below 70 mg/dL hy*po*glycemic client - ANSWER-*symptoms:* shakiness, dizziness, sweating, hunger, irritability/moodiness, anxiety/nervous, headache, confusion, pallid skin 1. have client sit or lie down 2. have client check blood sugar 3. raise blood sugar levels immediately 4. rest until signs improve 5. check blood glucose when feeling better 100 mg/dL enough to resume activity *no signs of improvement: seek medical attention!* bradycardia symptoms - ANSWER-fainting, dizziness, light-headness, fatigue, shortness of breath, angina, confusion, tiring quickly during exercise if symptoms shown: perform CPR if needed, seek medical attention immediately! tachycardia symptoms - ANSWER-dizziness, light-headedness, palpitations, angina, shortness of breath if symptoms shown: perform CPR if needed, seek medical attention immediately! responding to seizure - ANSWER-1. call 911 2. lower person to ground and on side 3. protect head from injury 4. turn person's head to side 5. cover with blanket if possible 6. once done, place into recovery position 7. check breathing and pulse 8. aderess any injuries 9. comfort person responding to shock - ANSWER-1. monitor breathing/pulse 2. keep warm 3. address external bleeding 4. elevate legs to maintain circulation (unless nausea, potential broken bones, or breathless) 5. avoid giving them anything to drink responding to diabetic emergency - ANSWER-1. address life threatening issues 2. if conscious give sugar 3. if conscious and not better 5 min after sugar, call 911 4. if unconscious, call 911 RICE - ANSWER-rest ice compression elevation (stabilization) american disabilities act (ADA) - ANSWER-required to improve accessibility to those with disabilities short term effects of exercise - ANSWER--increased energy and improved insulin action -increased cardiac output -endorphin release -increased metabolism -stress and anxiety reduction -better sleep long term effects of exercise - ANSWER--weight loss -mobility -disease prevention learning theories of human behavior - ANSWER-behaviorism cognitivism constructionsim humanism behaviorism - ANSWER-views learners as observers who develop or learn their behavior based on the type of outside feedback they receive operant conditioning - ANSWER-the learner is viewed as passive, until acted upon by environmental stimuli cognitivism - ANSWER-a person's learning process is affected by their own unique thinking, memory, and problem-solving abilities -mind being a computer (info comes in, processed, then outcomes) constructionism - ANSWER-people have unique sequences of learning experiences, and holds these past experiences affect the way people process new info -learner is active, constructive process -link info to prior knowledge humanism - ANSWER-most complex theory learners must be evaluated entirely in order to understand, interpret, and predict their reactions to new info -each unique and personal to own self learning phases - ANSWER-cognitive associative automatic cognitive phase - ANSWER-learning basics of exercise/skill -mostly thinking before executing -attention on instruction and guidance associative phase - ANSWER-muscle memory begins -more comfortable with exercise/skill -corrections on form or technique -give constructive criticism automatic phase - ANSWER-perform exercise efficiently without much thought to proper form or technique -muscle memory automatically makes corrections -positive feedback and further instruction necessary health belief model - ANSWER-psychological reasons for a person's inactivity by evaluating their current attitudes and beliefs as a set of variables, dependent on individual perceptions, modifying factors, and the likelihood of action health belief model diagram - ANSWER- trans-theoretical model of change in behavior (TMC) - ANSWER-6 stages of change that people go through when developing new patterns of behavior: precontemplation, contemplation, preparation, action, maintenance, (relapse/termination) processes of behavioral change - ANSWER-within trans-theoretical model 10 processes of behavioral change -5 cognitive (best when in initial stages of chage) -5 behavioral (during action and maintenance stages) 5 cognitive processes - ANSWER-1. conscious raising 2. dramatic relief 3. environmental reevaluation 4. self-reevaluation 5. social liberation 5 behavioral processes - ANSWER-1. counter-conditioning 2. helping relationships 3. reinforcement management 4. self-liberation 5. stimulus control decisional balance - ANSWER-part of trans-theoretical model of change how people view pros and cons of healthy lifestyle as going through stages of change -beginning cons outweigh pros, the in time they reverse self-efficacy - ANSWER-self-confidence social cognitive theory (SCT) - ANSWER-interaction of behavioral, personal, and environmental influences interaction creates unique behavior patterns -people influence and are influenced by their environments social cognitive theory dynamic model - ANSWER-personal: feelings/thoughts behavioral: demeanor/personality environmental: external events/other people *key constructs: observational learning, reinforcement, self-efficacy rewards - ANSWER-extrinsic ok at beginning (rewards for attaining goals) clients must understand intrinsic rewards (benefits of better fitness) a reward that inspires permanent success electrocardiographs (ECG) - ANSWER-provide basic info about physiological condition of the myocardium -record electrical impulses -HR, rhythm, impulse conduction route, pathology, and/or disease of myocardium ECG paper - ANSWER- ECG - ANSWER-elevation or depression in ST segment indicates serious pathology Einthoven's triangle - ANSWER-pair of electrodes that creates a triangle around the heart formed by the bipolar leads -includes lead I, II, and III ECG interpretation - ANSWER-number of P waves determines atrial rate number of R waves determines ventricular rate 60-100 bpm: SA node 60-80 bpm: atria 40-60 bpm: AV node/junction 20-40 bpm: ventricles cardiac cycle - ANSWER-p wave <0.12 sec PR interval 0.12-0.2 sec QRS complex <0.12 sec T wave amplitude <10mm AT interval <0.40 sec determining arrhythmias - ANSWER-1. determine if regular measure R-R intervals for ventriculary regularity measure P-P intervals for atrial regularity if difference is >0.06 sec, signifies irregularity 2. determine exact HR 3. analyze complex formation P-P intervals equal? PR interval equal? between 0.12-2.0 sec? QRS complex look alike? R-R intervals <0.12 sec? types of arrhythmias - ANSWER-atrial fibrillation ventricular fibrillation (v-Fib) atrial flutter multifocal atrial tachycardia (MAT) paroxysmal junctional tachycardia premature atrial complexes (PACs) premature ventricular complexes (PVCs) ventricular tachycardia (V Tach) supraventricular tachycardia (SVT) asystole *ventricular rhythms are life threatening!!!* ventricular fibrillation (v-Fib) - ANSWER-type of cardiac arrest no pumping action immediate CPR and defibrillation!!! rapid discharges from ventricular foci no identifiable waves (if any sort of pattern repetition, then not this case) atrial flutter - ANSWER-rapid series of atrial depolarization resembles teeth of saw multifocal atrial tachycardia (MAT) - ANSWER-various P wave shapes -sometimes associated with digitalis toxicity in clients with heart disease paroxysmal junctional tachycardia - ANSWER-Caused by sudden rapid pacing (150- 250bpm) of irritable automaticity focus in AV Junction. Can cause left ventricle to depolarize before right causing widened QRS complex. premature atrial complexes (PACs) - ANSWER-not life threatening, occur often in exercise when atrial site other than sinus node depolarizes prematurely narrow QRS complex ventricular tachycardia (V Tach) - ANSWER-150-250 bpm pattern of huge, consecutive PVC-like complexes SA node continues to pace the atria only sporatic atrial depolarization *coronary ischemia or cardiac hypoxia* treat quickly! premature ventricular complexes (PVCs) - ANSWER-not life threatening, occur often in exercise site in ventricles fires before next wave p waves not present or hidden wide QRS complex chagnge from beat to beat supraventricular tachycardia (SVT) - ANSWER-atrial fibrillation and flutter narrow QRS tchycardia asystole - ANSWER-no electrical activity no waveforms defibrillation no longer initiated diagnostic stress testing indications - ANSWER-extension of clients medical history and physical examination provokes signs or symptoms of cardio or pulmonary disease evaluate exertional discomfort, chest discomfort, dyspnea, leg discomfort, palpitations, and neurological symptoms -diagnostic purposes, functional evaluation, and determines prognosis or risk diagnostic stress testing contraindications - ANSWER-risk of exercise outweighs benefits pre-exercise test evaluation and careful review of medical history absolute contradictions should not perform until stabilized or treated relative contradictions should be tested after evaluating risk/benefit ratio stress test procedures - ANSWER--informed consent document -cover with client risks and the purpose is to elicit signs and symptoms of cardio or pulmonary disease -review client's history, current medications, and indications for test, current/recent symptoms -record and examine resting ECG before testing (identify contradictions to compare) -appropriate personnel present (direct physician supervision for high risk medical conditions) stress test protocols - ANSWER-bruce protocol is most common -modified one for older, weaker clients -HR, BP, RPE before during and after testing 6-8 min recovery for cool down assess standard chest pain evaluations, dyspnea, and claudication at end of each stage (if present, asses more than once per stage) absolute indications to stop stress test - ANSWER-1. drop in systolic BP >10 mm Hg from baseline accompanied by other signs of ischemia 2. moderately severe angnia 3 out of 10 3. increasing nervous system symptoms (ataxia, dizziness, near syncope) 4. poor cardiac perfusion (cyanosis or pallor) fatigue or symptom/sign limitation interpreting stress test - ANSWER--usually quite safe -clinical responses, ECG responses, exercise capacity, hemodynamic responses, and what the exercise test score says about the client -ECG or hemodynamic abnormalities -ST segment depression is myocardial ischemia -ST segment changes early on or in recovery indicate CVD or multivessel disease -dysrhythmias hypertension: systolic >250 mmHg or increase of 140 mmHg (should drop quickly after exercise but if doesnt then ischemia and poor prognosis) -chronotropic incompetence (<80% predicted HRR) hemodynamic responses - ANSWER-identify high-risk situations in stress test drop in SBP: decreases cardiac output (absolute termination) radionuclide testing - ANSWER--thallium/technetium stress test -injecting dye to see anything abnormal finding dead tissue from heart attack echocardiographic imaging - ANSWER-ultrasound of heart done before and immediately after stress test pathologies - ANSWER-atrioventricular blocks bundle branch blocks (BBB) myocardial ischemia myocardial infarction (MI) chamber enlargement atrioventricular (AV) blocks - ANSWER-delay within AV node which delays impulse from atria (long pause before ventricular contraction) one 1st degree, 2 2nd degree, and one 3rd degree (complete) heart block types -heart disease, aging, and pericarditis can all cause 1st degree AV block - ANSWER-delay with a prolonged PR interval more than 0.2 sec on ECG cardiac cycle consistently normal, but PR interval is prolonged every cycle -partial block 2nd degree AV block (Wencheback block) - ANSWER-PR interval becomes progressively longer each cycle until AV node no longer conducts stimulus QRS complex eventually drops -irregular rhythm; more P waves than QRS complexes 2nd degree AV block (Mobitz) - ANSWER-punctual P wave is not followed by QRS response NO progressive lengthening of PR interval or premature P wave 3rd degree AV block - ANSWER-complete AV block none of the atrial depolarizations conduct to ventricles -automaticity focus below the blocks escapes overdrive suppression to pace the ventricles at its inherent rate -ventricular rate may be so low that insufficient blood flow to brain occurs bundle branch blocks (BBB) - ANSWER-block in conduction within the right or left bundle branch -wide QRS complex (>120 ms) --disease of bundle branches or ventricular abnormalities, drugs, electrolyte, or metabolic disorders may cause 2 classifications: left and right (RBBB & LBBB) RBBB - ANSWER-activation of the left ventricle occurs before the right ventricle -triphasic complex trigger screening for conditions affecting right side of heart or lungs (pulmonary emboli, COPD, and cardiomyopathy) LBBB - ANSWER-initial ARS deflection is altered due to initial impulse traveling across the septum from the right to left -initial negative deflection V1 and initial upright deflection in V6 (wide notched appearance) -followed by imaging study: underlying cardiac pathology (dialated/hypertropic cardiomyopathy, hypertension, aortic valve disease, cardio disease) myocardial ischemia - ANSWER-partial or complete blockage of blood to the heart muscle moderate-high risk for disease need to identify -evidenced in ST segment as depression >1mm below baseline myocardial infarction (MI) - ANSWER-near-total or complete blockage to artery which blocks blood flow to an area of the heart *MI triad:* ichemia, injury, and necrosis (initial lack of oxygen, ischemia 20-40 min, then death of tissue) -time span of 2-12 hours abnormal Q waves, ST segment depression, ST segment elevation, T wave inversion (scan ALL leads) chamber enlargement - ANSWER-Involves the atria, the ventricles or both. It implies either dilation or hypertrophy of the chamber walls. right atrial enlargement - ANSWER-biphasic P wave, initial component is larger leads V1 and V2 tall, peaked P waves can accompany pathologies: COPD, congenital heart disease, coronary artery disease, pulmonary hypertension, pulmonary stenosis, tricuspid valve stenosis, tachycardia, or exercise left atrial enlargement - ANSWER-biphasic P wave broad notched P waves in lead I and II can accompany pathologies: mitral valve disease, hyertension, aortic stenosis or regurgitation, or hypertropic cardiomyopathy right ventricular hypertrophy - ANSWER-height increases in R waves in lead V1 and progressively smaller in leads V2-V6 left ventricular hypertrophy - ANSWER-increased amplitude of R wave in leads V3-V6 increased amplitude in S wave in leads V1-V2 QRS complex exaggerated treatments for cardiac pathologies - ANSWER-pacemakers angiography cardiac catherization coronary bypass surgery pharmacologic agents pacemaker - ANSWER-helps heart beat regularly at appropriate rate -assists or replaces normal electrical conduction system -most common is too slow HR -SA node dysfunction and AV block unnaturally sharp spikes single chamber, dual chamber, and implantable cardioverter defibrillator (ICD) single-chamber packemakers - ANSWER-use 1 lead right atrium or right ventricle (only receives and sends signal and pace where placed) on ECG look for spike followed by P wave for ventricular; spike followed by wide, bizarre QRS complex for atrial dual-chamber pacemakers - ANSWER-2 leads one on right atrium and right ventricle each provide AV synchrony -lower mortality rates and higher survival rates -on ECG: look for 2 spikes in each cardiac cycle implantable cardioverter defibrillator (ICD) - ANSWER-fast HR indicated for sudden cardiac death due to: ventricular tachycardia/fibrillation with no reversible cause; spontaneous and sustained ventricular tachycardia; syncope without known cause; and non-sustained ventricular tachycardia with coronary artery disease angiography - ANSWER-injecting radio-opaque contrasting agent into blood vessel allows the inside of blood vessels and heart chambers to be visualized identify any compromised artery opening as well as the presence of atherosclerosis cardiac cathererization - ANSWER-interventional treatment purposes minimally invasive identify cardiac pathologies (blockages, stenosis, thrombosis, etc) angioplasty: placement of stents (expandable stainless steel mesh tubes placed in vessels via balloon catheter to expand a blocked stenotic artery) -allows blood flow coronary bypass surgery - ANSWER-treats heart disease (revascularization surgery), due to extensive atherosclerosis or blockage restores blood flow by rerouting around blocked artery (healthy blood vessel removed else where is connected to artery) -done to single or multiple arteries -improves symptoms of angnia and shortness of breath pharmacologic agets for cardiac pathologies - ANSWER-*beta blockers:* decrease HR and cardiac output -hypertension, angina, arrhythmias, MI, and hear failure *ace inhibitors:* expand blood vessels and lower resistance by lowering angiotensin II levels -hypertension and chronic heart failure *nitrates:* relax blood vessels and increase blood and oxygen supply to heart -angina and chronic heart failure *anti-arrhythmics:* suppressing activity of tissue initiating electrical impulses too quickly in SA node OR slowing and regulating fast electrical impulses in heart -atrial fibrillation; normal sinus rhythm; ventricular arrhythmias; slow ventricular response in atrial fibrillation *anti-coagulants:* decrease the clotting ability of the blood -atrial fibrillation which of the waveforms on the ECG will yield info about atrial enlargement? what should you look for? - ANSWER-P waves yield info about atrial enlargement look for tall, peaked P waves in 3rd degree AV block, how many impulses from the SA node penetrate the AV nod to depolarize the ventricles? is the rhythm regular or irregular? - ANSWER-3rd degree is a total block, NO impulses from the SA node penetrating the AV node regular rhythm which leads do you look for RBBB in? LBBB? - ANSWER-RBB leads V1 and V2 LBBB leads V5 and V6 what are the characteristic ECG changes that yield info about ischemia? - ANSWER- ECG changes such as *inverted T waves and/or ST segment depression* yield info about ischemia what criteria need to be met for ST segment elevation to be considered abnormal on an ECG? ST segment depression? - ANSWER-abnormal is ST segrment > 1mm above or below baseline in 2 or more continuous leads which part of the ECG will yield info about the AV node? - ANSWER-the PR interval yield info about the AV node tells you the relationship between the atrial and ventricles true/false: sinus tachycardia is a regular rhythm - ANSWER-true what rhythm produces a straight line on the ECG, suggesting that there is no electrical activity left in the heart? - ANSWER-asystole: a rhythm which produces a straight line on the ECG, suggestion no electrical activity in the heart cardiac muscle cells are unique in that they are able to generate their own electrical impulse. what is the ability called? - ANSWER-automaticity: the ability in cardiac muscle cells to generate their own electrical imulse leads V3 and V4 view which area of the heart? - ANSWER-leads V3 and V4 view the *anterior left ventricle* of the heart on an ECG, what does the P wave represent? - ANSWER-the P wave represents atrial depolarization on an ECG age groups - ANSWER-*infant:* 3 weeks - 1 year *child:* 1-10 years *juvenile:* 10-16 years *adolescence:* 16 - early 20s *adulthood:* early 20s - 64 years *senescence:* 65-100+ years exercise for children - ANSWER-educate importance of staying active physiological considerations for children - ANSWER-1. higher VO2 (^ oxygen delivery). Coresponds with growth spurts = hypertrohpy of heart and stimulation of RBC and hemoglobin 2. higher resting/exercise HR 3. lower resting/exercising BP 4. hormonal changes 5. thermoregulatory differences (less sweat rate, ^ heat production and sensitivity to excessive heat/cold) 6. musculoskeletal and bone formation 7. body composition physical considerations for children - ANSWER-1. existing medical conditions (asthma, epilepsy, diabetes) 2. overuse injuries (inadequate warm up, bad shoes, poor technique, faulty equipment, or overtraining) 3. appropriateness of resistance training: -strict supervision required -sports/activity specific -focus on proper technique (start with body weight exercises, then progress to light weights with frequent repetitions) psychological considerations for children - ANSWER-1. healthy body image (emphasis on health opposed to appearance) 2. mental discipline (parents/coaches must look for: state or trait anxiety, and burn-out) 3 social skills 4. lifestyle attitudes state anxiety - ANSWER-stress reaction that occurs during sport/recreation preparation trait anxiety - ANSWER-intrinsic personality characteristic that may be compounded in situation stress -worry, self-criticism, anxiety burn-out - ANSWER-reaction to stress associated with training and competition symptoms: emotional exhaustion, withdrawal, and decreased physical performance daily PA for children - ANSWER-moderate level of activity 30-60 minutes on most days of the week ages 5-12 need minimum of 60 min of activity several days a week (bouts of 15 min or more each day) -moderate to vigorous activity exercise prescription for children - ANSWER-*aerobic activity:* 5-7 days/week moderate-vigorous activity intermittent in nature 60 min + per day (several sessions of 15-20 min) age appropriate exercises the utilize all muscle groups *resistance training:* 5-7 days/week 4-6 muscle groups 1-3 set of 8-15 reps 20-30 min sessions (add weight up to 6 reps, then add 1-2 reps ever session until 12-15 reps) submax and using full range of motion *flexibility:* 5-7 day/week light-moderate (12/13 RPE) hold 15-30 sec 2-4 static stretches for each muscle group exercise for older adults - ANSWER-pre-exercise evaluation in clinical setting recommended (medical history, physical exam, and lab tests) physiological considerations for older adults - ANSWER-1. lower VO2, reduced max HR and CO 2. higher resting/exercise BP 3. decreased immune function 4. decrease sensitivity in thermoregulation (reduced total body water and capacity for sweating) 5. increased risk factors such as: -hypertension, hyperlipedemia, diabetes, coronary artery disease physical considerations for older adults - ANSWER-1. decrease in bone and muscle mass 2. decreased balance and coordination 3. increase in obesity; higher % of fat mass 4. osteoarthritis 5. orthopedic injuries psychological considerations for older adults - ANSWER-1. self-efficacy (improve perception to perform task) 2. self-concept 3. cognitive functioning 4. life satisfaction exercise prescription for older adults - ANSWER-*aerobic activity: 5-7 days/week light-moderate (50-80% max HR) 30-60 min a day (can be 10-15 min intervals) walking, stationary bike, low orthopedic stress *resistance training:* 2 days/week 1 set of 8-10 reps for each muscle group (RPE 12-13) 20-30 min sessions (Gradually add weight as tolerated) weight training machines, tubing and bands (with assistance) *flexibility:* 5-7 days/week light-moderate (12-13 RPE) hold 15-30 sec 2-4 static stretches for each muscle group COPD and restrictive lung disease tests for diagnosis - ANSWER-chest x-ray computerized temography (CT) arterial gas analysis sputum examination pulmonary function test (PFT) restrictive lung disease - ANSWER-group of lung diseases characterized by restriction in the lungs causing the inability to fully inhale -stiffness in lungs, chest wall, weak muscles, or nerve damage interstitial lung disease/pulmonary fibrosis, sarcoidosis, obesity, scoliosis, muscular dystophy or amyotophic lateral sclerosis (ALS) immunosuppressant drugs, corticosteroids, anti-inflammatory drugs, anti-fibrotic drugs, oxygen therapy and pulmonary rehabilitation diabetes - ANSWER-set of metabolic diseases with high blood sugar primary risk factor: family history (especially if parent/sibling) risk factors for type II: obesity/overweight, ethnicity, insulin resistance, hypertension, family history, sedentary lifestyle, age signs/symptoms of cardiopulmonary and metabolic diseases: - ANSWER-1. pain or discomfort in chest, neck, jaw, or back 2. resting or mild exertional dyspnea 3. dizziness or syncope 4. paroxysmal nocturnal dyspnea 5. orthopnea (inability to breath laying down) 6. ankle edema 7. plapitations (rapid HR or skiped beat) 8. claudication 9. heart murmurs 10. unusual fatigue or dyspnea with ADLs metabolic syndrome - ANSWER-1. central obesity (men >40 in waist, women >35 in) 2. antherogenic dyslipidemia 3. insulin resistance/glucose intolerance 4. proinflammatory state 5. prothrombic state 6. hyertension (130/85) effects of exercise on pulmonary disorders - ANSWER-reversing muscle deconditioning and improving pace clients walk farther with less dypnea reduce risk of CAD improvement in overall weakness in peripheral and respiratory muscles, anxiety, depression, and nutrition abnormalities effects of exercise on asthma - ANSWER-can be triggered by exercise in cooler weather: scarf in front of mount/nose to trap warm moist air medications to block prior exercise (beta-agonist bronchodialator) effects of exercise on metabolic syndrome - ANSWER-acute and chronic activity have substantial impact on: 1. hypertension 2. dyslipidemia 3. glucose intolerance/insulin insensitivity 4. obesity effects of exercise on diabetes - ANSWER-type I: control blood sugar levels, similar to insulin; eventually can lower insulin injections needed type II: helps clean glucose from circulation 12-28 hours post exercise, decreases hyperglycemic episodes, eventually increased glucose storage capacity because muscles will require more glucose with exercise effects of exercise on coronary artery disease (CAD) - ANSWER-1. effects on risk factors: decrease resting/exercise BP, decrease in total cholesterol (LDL and triglyceride), increase in HDL, improved glucose tolerance and insulin sensitivity, decrease in body fat percentage and waist circumference 2. reduces cardiac oxyge demand at rest/submax (increased ischemic/angina thresholds) 3. reduces platelet aggregation 4. improved endothelial function and tone medications: ACE inhibitors, beta blockers, calcium channel antagonists, nitrates, digitalis, diuretics claudication - ANSWER-to limp; pain/tension in legs while walking that subsides after rest; caused by inadequate blood supply common symptom of peripheral artery disease (PAD) embolism - ANSWER-blockage in a blood vessel from a blood clot or other foreign matter that gets trapped when traveling through the bloodstream stenosis - ANSWER-abnormal narrowing or contraction of a valve or artery ECG changes in CAD - ANSWER-horizontal or downward sloping ST depression of 1 mm in 2 leads T-wave abnormalities ECG changes in pulmonary disease - ANSWER-low voltage QRS complex poor R wave progression ECG changes in hypertensive heart disease - ANSWER-left ventricular hypertrophy and left atrial enlargement are common LBBB and atrial fibrillation can occur ECG changes in myocardial ischemia and infarction (MI) - ANSWER-severe or prolonged ischemia ST elevation upright T waves or inverted ECG changes in atrial enlargement - ANSWER-P wave >0.12 sec (mitral valve disease) tall P wave >2.5 mm (pulmonary disease) P wave notched or biphasic ECG changes in ventricular hypertrophy - ANSWER-high voltage criteria in leads over hypertophied areas left ventricular hypertrophy (LVH): tall R waves, deep S waves, ST changes w/ T wave inversion -aortic stenosis and hypertensive heart disease right ventricular hypertrophy (RVH): R wave greater than S wave, ST changes with T wave inversion ECG changes in pericarditis - ANSWER-ST segment elevation T wave inversion ECG changes in electrolyte abnormalities - ANSWER-hypokalemia: ST depression, flattened T waves hyperkalemia: narrow peaked T wave, prolonged PR interval, small P wave, wide QRS complex and asystole hypocalcemia: prolonged QT intervals 0.48 sec hypercalcemia: shortened QT interval 0.26 sec health behavior adherence - ANSWER-1. assess clients education needs 2. identify clients self management goals 3. plan process of teaching-learning and behavioral change 4. help client achieve self management goals by implementing educational and behavioral intervention 5. evaluate the client has attained self management goals model of participation centered education/counseling - ANSWER-1. info gathering by health professional 2. develop a helping relationship by establishing support 3. earlier stages of change benefit most from cognitive strategies, but later stages depend more on behavioral techniques whole body plethysmography - ANSWER-used primarily for COPD and emphysema technique for measuring the volume of gas in the lungs, including air trapped in poorly communicating air spaces impedance plethysmography - ANSWER-venous impedance plethysmography a technique using cuff occlusion of the venous flow from a limb in which the change in limb volume is used to diagnose acute venous obstruction or vascular insufficiency of an extremity diagnostic tests for coronary artery disease - ANSWER-monitor: ECG, hemodynamic, and symptomatic responses frequently used for potential CVD clients -treadmill and b