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ACSM EP-C Exam

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3 Tools that provide accurate information for health and fitness assessments

1. physical activity Readiness - Questionnaire (PAR-Q)

2. CVD Risk Factor assessment and classification by qualified health/fitness, clinical exercise, or health care professionals

3. medical evaluation including a physical examination and stress test by a qualified health care provider

What is the minimum requirement when getting accurate information for health and fitness assessments

PAR-Q

Key Components of Medical History (10 things)

1. medical diagnosis of a prior illness
2. previous physical exam findings
3. history of symptoms
4. recent illnesses/procedures, etc.
5. orthopedic problems
6. medication use
7. habits
8. exercise history
9. work history
10. family history

7 components of informed consent

1. purpose & explanation of test
2. attendant risks & discomforts
3. responsibilities of participant
4. benefits to be expected
5. inquires (Questions)
6. use of medal records
7. freedom of consent

limitation of a PAR-Q?

it can only be identify those who are at high risk - can't tell between low or moderate risk

limitation of informed consent/health history forms?

most forms don't make recommendations based on intensity of the proposed exercise program

how many POSITIVE risk factors are there?

what are the 8?

1. age
2. family history
3. smoking
4. sedentary life
5. obesity
6. hypertension
7. dyslipidemia
8. pre-diabetes

positive risk factor for AGE: men & women

MEN: greater than or = 45
WOMEN: greater than or = 55

positive risk factor for FAMILY HISTORY

heart attack, coronary revascularization or sudden death in family BEFORE age 55 (in dad or 1st degree relative)

OR

heart attack, coronary revascularization or sudden death BEFORE age 65 (in mom or 1st degree relative)

positive risk factor for SMOKING

current smoker OR quit in the past 6 months

positive risk factor for SEDENTARY

not doing 30 min of moderate intensity PA (40%-<60% VO2R) on at least 3 days of the week for at least 3 months

Positive Risk Factor for OBESITY

BMI: greater than or = 30 kg/m2

Waist Girth for MEN: greater than 40 in/102cm

Waist Girth for WOMEN: greater than 35in/88cm

Positive Risk Factor for HYPERTENSION

SBP: greater than or = 140mmHg

DBP: greater than or = 90mmHg

OR on medication

Positive Risk Factor for DYSLIPIDEMIA

LDL: greater than or = 130mg/dL

HDL: greater than or = 40mg/dL

OR on lipid-lowering meds

Positive Risk Factor for PRE DIABETES

Impaired Fasting Glucose (IFG): greater than or = 100mg/dL & less than or = 125mg/dL

Impaired Glucose Tolerance (IGT): greater than or = 140 & less than or = 199

Negative Risk Factor

HDL: greater than or = 60

If pre-diabetes criteria is missing or unknown...

pre-diabetes should only be counted for those greater than or = 45yr

if less than 45 yr, pre-diabetes should only be counted if BMI is...

greater than or = 25

if there is no CVD risk factor mentioned...

it should be counted unless they have pre-diabetes

9 major signs/symptoms that suggest cardiovascular, pulmonary and metabolic disease

1. pain in chest, neck, jaw or arms
2. shortness of breath at rest or mild exertion
3. dizziness or syncope
4. orthopnea
5. ankle edema
6. palpitations/tachycardia
7. intermittent claudication
8. known heart murmer
9. unusual fatigue/shortness of breath with usual activities

Low Risk for before exercise test/program

-Asymptomatic with less than 2 risk factors
-No medical exam required
-No exercise stress test required before mod or vig activity
-No MD supervision

Moderate Risk for before exercise test/program

-Asymptomatic with greater than or = 2 risk factors
-Med exam required for vig exercise but not mod
-No exercise stress test required
-No MD supervision

High Risk for before exercise test/program

-Symptomatic
-Any known cardiovascular, pulmonary, renal or metabolic disease
-Yes to everything else

6 modifiable risk factors

1. smoking
2. obesity
3. sedentary lifestyle
4. pre-diabetes
5. hyperlipidemia
6. dyslipidemia

Normal BP level

SBP: less than 120
DBP: less than 80

Pre-hyperensive BP level

SBP: 120-139
DBP: 80-89

Hypertensive BP level

SBP: greater than or = 140
DBP: greater than or = 90

optimal LDL Cholesterol

less then 100

Near optimal/above optimal LDL Cholesterol

100-129

borderline high LDL Cholesterol

130-159

high LDL Cholesterol

160-189

very high LDL Cholesterol

greater than or = 190

how many ABSOLUTE conditions for Exercise testing

what are they

1. recent significant change in the resting EKG suggesting ischemia or heart attack
2. unstable angina
3. uncontrolled rhythms
4. symptomatic severe aortic stenosis
5. uncontrolled symptomatic heart failure
6. acute pulmonary infarction
7. acute myocarditis
8. suspected dissecting aneurysmm
9. acute systemic infection w/ fever, body aches, or swollen lymph glands

patients with absolute contraindications...should not or should... perform exercise tests until such conditions are stabilized/treated

should NOT

how many RELATIVE conditions for Exercise testing

what are they?

• Left main coronary stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities
• Severe arterial hypertension at rest (SBP of > 200 mmHg and/or a DBP of > 110 mmHg)
• Tachydysrhythmia or bradydysrhythmia
• Hypertrophic cardiomyopathy
• Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
• High-degree AV block
• Ventricular aneurysm
• Uncontrolled metabolic disease (e.g., diabetes, thyrotoxicosis, or myxedema)'
• Chronic infectious disease (e.g., HIV)
• Mental or physical impairment leading to inability to exercise adequatel

proper order or assessments for heath related physical fitness testing (7 things)

1. pre-screening/risk classification
2. take resting HR, BP, height, weight BMI and ECG (if appropriate)
3. body comp (waist and skin)
4. cardiorespiratory fitness (max or sub max test on bike or treadmill)
5. muscular strength 1 or more RM upper and lower body (bench press & leg press)
6.muscular endurance (curl up, push up, or bench press)
7. flexibility (sit and reach)

take another circumference measurement if...

measurements are not within 5 mm

Risk Criteria for waist circumference WOMEN: very low

less than 70cm (28.5in)

Risk Criteria for waist circumference WOMEN: low

70-89 cm (28.5-35in)

Risk Criteria for waist circumference WOMEN: high

90-110 (35.5-43)

Risk Criteria for waist circumference WOMEN: very high

greater than 110 (43.5in)

Risk Criteria for waist circumference MEN: very low

less than 80 cm (31.5 in)

Risk Criteria for waist circumference MEN: low

80-99 cm (31.5-39 in)

Risk Criteria for waist circumference MEN: high

100-120 cm (39.5-47 in)

Risk Criteria for waist circumference MEN: very high

greater than 120cm (47in)

health risk is very high for men when WHR is

greater than 0.95

health risk is very high for women when WHR is

greater than 0.86

men 60-69 should not have WHR of...

greater than 1.03

women 60-69 should not have WHR of...

greater than 0.90

difference between a theory and a model

THEORY: systematic view of behavior by specifying relationships between variables and predicting specific behaviors/situations

MODEL: defined as a hypothetical depiction of behavior (don't attempt to understand, just represent)

Transtheoretical Model of Change (TTM) (5 things)

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

Pre-contimplation

not intending to take actioning within the next 6 months - could be bc they are uninformed or not motivated/have had failed attempts

contemplation

intending to alter behavior within next 6 months and are aware

preparation

intention of increasing PA in immediate future - may have specific plan - are doing some PA

action

specific measurable changes have been made in past 6 months

maintenance

mainting PA and working to prevent relapse for at least 6 months

Social Cognitive Theory (SCT)

emphasizes reciprocal determinism (interaction b/w individuals & their environments)

what 3 main factors influence behavior?

1. the environment (how close to a gym)
2. individual personality/experience
3. behavioral factors

one key concept to SCT is...

self efficacy: confidence in ones ability to successfully engage and perform a specific behavior

self efficacy is a product of (4 things)

1. inactive mastery experience
2. vicarios experience (living vicariously)
3. verbal persuasion
4. physiological state

Social Ecological Model

approach integrating multiple variables/layers that influence behavior

the layers include (5 things):

1. intra and interpersonal
2. community and organizational
3. institutional factors
4. environmental factors
5. public policies

health belief model

framework that outlines a persons health behavior that is based on health beliefs

according to health belief model, an individual examines the _____ aspects of a particular health action and does what?

negative; weighs negative with the positive

theory of planned behavior (TPB)

intention-based model use to explain PA behavior across many populations

what is the primary influence in determining behavior according to TPB?

intention

____directly reflects the individuals level of ______ to perform the desired behavior

intention;motivation

self determination theory

people have 3 basic physiological needs that must be met in order to engage in behavior

what are the 3?

1. competence
2. relatedness
3. autonomy

S.T.E.P.S

Screening
Testing
Education
Programing
Supervision

primary sources of law (4 things)

1. constitutional law
2. statutory law
3. case law
4. administrative law

constitutional law

The federal government and all states have constitutions that not only provide the authority for government but also define how it will function and what its responsibilities are.

statutory law

Or legislative laws are enacted by mandates from federal, state, and municipal governments, and this codification of law imposes duties or restrictions upon individuals.

does the good samaritan law apply to EP-C while on the job?

good samaritan law

Immunity is granted to those persons who in good faith try to protect, serve, and tend to other who are injured or ill

case law

or "common law" based on decisions of courts and administrative tribunals

administrative law

Is found within specialized bodies or agencies that have been granted law-making power to regulate specific activities.

Ex of admin law

(OHSA) which is the Occupational Safety and Health Administration

criminal law

governs the conduct of both individuals and groups toward society as a whole

civil law

pertains to personal responsibilities that an individual or group must observe when dealing with other individuals/groups

how can EP-C violate criminal law?

The EP-C can be charged with the unauthorized practice of medicine, physical therapy, or dietetics.

For example; diagnosing a client as hypertensive after a resting blood pressure reading.

civil lawsuits are most common within which industry?

fitness

when individuals or groups violate civil laws...

they can be sent to noncriminal court

civil lawsuits handle disputes between who?

individuals, orgs, businesses and governmental agencies where 2 parties: the injured and the EP-C present their case

tort law

breach of legal duty amounting to civil wrong or injury for which a court will provide compensation/damage

a tort by definition is...

a wrongful act (whether on purpose or not) that cause insult, injury or death

does tort law include all negligence cases?

yes

3 categories of torts

1. intentional misconduct
2. negligent conduct
3. "no fault"

most cases filed against fitness facilities are accusing of...

negligence

negligence is concerned with the ___ and ___ in dealing with clients

prudence and caution

3 major causes of injury/death associated with PA

1. inherent (accident)
2. negligence: due to fault of defendant (EP-C)
3. extreme forms of negligence: reckless conduct of defendant

what insurance coverage should an EP-C have?

general & professional

OSHA is what?

Occupational Safety and health administration - principle federal agency charged with the enforcement of safety and health legislation in workplace

OSHA concerns for the EP-C (3 things)

1. blood borne pathogens
2. cleaning agents
3. swimming pool chemicals

HIPAA is what?

health insurance portability and accountability act - protect privacy of clients health info & identifiable health info for client and EP-C

contract law

governs agreements that are enforceable in court

contracts are...

agreements pertaining to legal rights and obligations between individuals & collective bodies

4 examples of contracts within health fitness field

1. employment contract
2. informed consent
3. waivers
4. membership contracts

civil rights act of 1964

prohibits discrimination of race, color, gender, religion or national origin

Americans with disabilities act of 1990 (ADA)

prohibits employment discrimination to basis of disabilities or perceived disabilities

background checks include what? (3 things)

1. criminal records
2. commercial records
3. financial records

equal pay act of 1963

prohibits different pay on basis of gender

the #1 priority of any facility should be...

the health and safety of its members

management = ___ risk

mitigating/reduce

leadership = ___ risk

taking risks

check leadership and management chart

...

what are the 4 leadership models?

1. classical
2. transactional
3. visionary
4. organic

classical model of leadership:

leaders power/influence is considered innate (born with it)

no necessary vision

leaders influence is based off fear/respect

does the classical model before more or less popular with increase worker skills

less popular

transactional model:

no real vision - influence based on contracts/negotiations b/w leader and workers

managers are rewarded

visionary model (aka charismatic or transformational):

leader using emotion to inspire/create followers

influence based on relationship of the team and endorsements of a leader

organic model:

collective vision of the group/team

influence based on the relationship and endorsements of a leader

2 key behaviors critical to leadership:

1. initiating structure
2. consideration

trait theory aka "great man":

promotes idea that being a "superior leader" is all about genetics

idea that someone is born to lead

situational leadership theory:

purpose is to open up communication and increase quality & frequency of conversations about performance/development

situational leadership theory says that development is based on the relationship between what two factors?

1. competence
2. commitment

path-goal leadership theory:

modification of situational leadership = involves leader setting a path to specific goal

transformational leadership

inspires and motivates others

what are the 5 practices associated with transformational leadership?

1. challenging the process
2. inspiring a shared vision
3. enabling others to act
4. modeling the way
5. encouraging the heart

transactional leaders:

view leadership as the process of exchanging one thing for another

Lewin's Leadership Styles (3 things)

1. autocratic
2. democratic
3. laissez-fair

autocratic style:

leader makes decisions on their own

democratic stye:

leader includes peers in decision making

laissez-faire style:

followers make their own decisions

servant leadership theory

establishes that organizational performance is 2nd to the relationship b/w leader and followers

leader member exchange theory (LMX)

centers on "interactions" b/w leader and follower

intended to help est. a more mature leadership relationship

based on vertical dyad research with est. in-groups & out-groups

emotional intelligence

a set of skills that include awareness of self/others, ability to handle emotions & relationships

contextual intelligence

ability to adapt/respond appropriately to any number of different contexts where context is determined by environmental factors

management Grid

intended to measure the relationship b/w one's concern for people and production

what are the 5 major styles of management grid by blake and mouton?

1. improvised management
2. country-club management
3. authoritarian management
4. middle-of-the-road management
5. team or democratic management

improvised management has a low concern for...

people and production

country-club management has a high concern for ___ and a low concern for ___

employees;production

authoritarian management has a high concern for ___ and a low concern for ____

efficiency;employees

middle of the road management has a moderate concern for ...

production and employee satisfaction

team/democratic management has a high concern for both...

production and morale

scientific management is

the organization and supervision of jobs and duties based on the manager's direct observation of the job

bureaucratic model of management

formalized and centralized, have firm hierarchy and divide labor

Total Quality Management (TQM)

create consistency of purpose for improved product/service

remove barriers that rob people of pride and workmanship

management by objective (MBO)

idea that pre-established objective should be used in the appraisal of every aspect of org.

performing relies on defining/assessing objectives & requires collaboration, planning and goal setting

for MBO objectives to work they must be...

SMART

Specific
Measurable
Achievement oriented
Realistic
Time oriented

motivator-hygiene theory

there are factors that contribute separately to job satisfaction and dissatisfaction

motivators = increase or decrease job satisfaction?

increase

hygiene factors = increase or decrease job satisfaction?

increase

Theory X

assumption that most followers are inherently lazy and if given chance will avoid work

Theory Y

assumption that employees are self-motivated, want responsibility and exercise self-direction

what is the single greatest contributor to how management practice is understood today

behavioral approach

behavioral approach is what type of style of management

democratic

name all of the skin fold sites (9 things)

1. abs
2. triceps
3. biceps
4. chest
5.medial calf
6. midaxillary
7. sub scapular
8. suprailiac
9. thigh

which skin folds are vertical folds?

abs, triceps, biceps, medal calf, midaxillary, thigh

which skin folds are diagonal?

chest, sub scapular, suprailiac

% Fat equation

% Fat = 495/BD - 450

pros and cons for field tests

Pros: easy to admin large # of ppl, little equipment needed

Cons: some test can be max for some ppl = might be inappropriate

pros and cons for motor driven treadmills

pros: can accommodate least fit to most fit and can do walking and running

Cons: high $$$, not easy to transport, can make taking measurements hard

pros and cons for cycle ergometer

Pros: lower $$$, easy to transport, east to get measurements

cons: cycling is less familiar mode of exercise = muscle fatigue & underestimation of VO2

pros and cons of step test

pros: low $$$, little equipment, easy to transport, short test, test a lot of ppl

cons: ppl with balance problems might have trouble,

whats the first thing you do before a submit CRF test?

take resting BP and HR

how many min should be given for a warm up on the cycle?

2-3 min

a specific protocol should consist of ___ - ___ min stages

2-3

HR should be monitored at least ___ times during each stage, near the ___ of the ___ and ___ minutes of each stage

2; end; second; third

if HR is > 110 ppm what should happen?

steady state HR (two HR within 5 bpm) should be reached before the workload is increased

BP should be monitored when?

the list min of each stage and repeated in the event of a hypertensive/hypotensive response

RPE and rating scales should be monitored near the ___ of the ___ minute of each stage

end; last

how often should the clients appearance and symptoms be monitored and recorded?

regularly

the test should be terminated when... (5 things)

1. reaches 70% HR reserve (85% of age predicted HRmax)
2. fails to conform to the protocol
3. experiences adverse signs/symptoms
4. asks to stop
5. emergency situation

appropriate cool down/recovery should be initiated consisting of either (2 things)

1. continued exercise at a work rate = to the first stage or lower

2. a passive cool down if the subject experiences signs of discomfort or an emergency

all physiologic observations should be continued for at least how many min?

5 min of recovery unless abnormal responses happen

what are the general indications for stopping an exercise test (10 things)

1. onset of angina
2. drop in SBP > or = 10 w/ increase in WR
3. excessive rise in BP (SBP>250 and/or DBP>115)
4. shortness of breath/leg cramps
5. signs of dizziness etc.
6. HR doesn't increase when exercise increases
7. noticeable changes in heart rhythm
8. request to stop
9. severe fatigue (physical or verbal)
10. test equipment fails

1RM or multiple RM test familiarization (5 steps)

1. subject should warm up with the exercise being tested
2. get 1-RM within 4 trials with 3-5 min rest in between
3. select initial weight (50%-70% of capacity)
4. resistance is increased by 2.5-20 until subject can't complete w/ good form
5. final weight lifted successfully is recorded as absolute 1-RM/mult. RM

for curl up test what distance should the tape be at for people less than 45?

12 cm

more than 45?

8 cm

LOOK OVER ABSOLUTE AND RELATIVE CONTRAINDICATIONS FOR RT

...

first thing you should do for RT in children and adolescents

- make sure its a safe environments and appropriate training instruction

after intro then you should...

dynamic warm up for 5/10 min

after dynamic warm up then how often should you initiate training program?

2/3 x week on nonconsecutive days w/ light RT

general training session guidelines for child:

1 to 3 sets of 6-15 reps with combo of upper and lower body

for kids incorporate exercises that specially focus on the....

trunk

do you wear shoes for sit and reach?

mark is at ___ cm

for YMCA test yardstick perpendicular to ___ in mark

YMCA = *heels

heels touching tape 10-12 in apart

both = hold position for...

2 seconds

components of exercise training session: warm up

at least 5-10 min of light to moderate intensity of cardio & muscular endurance

components of exercise training session: conditioning

at least 20=60 min of aerobic, resistance, neuromotor and/or sport specific activity

are exercise bouts of 10 min acceptable as long as they add up to 20-60 min?

yes

components of exercise training session: cool down

at least 5-10 min of light to moderate intensity cardio/muscular endurance

components of exercise training session: stretching

at least 10 min of stretching

EQ for HRmax

220-age

EQ for Astrand HRmax

216.6 - (0.84 x age)

EQ for Tanaka HRmax

208 - (0.7 x age)

EQ for Gellish HRmax

207 - (age x .7)

EQ for Gulati HRmax

206 - (age x .88)

EQ for HRR :

Target HR = [(HRmax - HRrest) x % intensity desired] + HRrest

EQ for VO2R:

Target VO2R = [(VO2max - VO2rest) x % intensity desired] + VO2rest

VO2 EQ

Target VO2 = VO2max x % intensity desired

MET EQ

Target MET = [(VO2max)/3.5] x % intensity desired

look at conversation flow chart!!!!

...

FITT for aerobic *name it

F: </= 5 d/w of mod. or >/= 3 d/w of vig.

I: mod/vig depending on subject

T: works major muscle groups

T: 30-60 min a day OR 2-60 vig

V: >/= 500-1000 MET ; ^ steps by 2,000 per day until 7,000

P: 1 session per day

P: gradual progression