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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?
8
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
9
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
12
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?
no
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
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?
no
mark is at ___ cm
26
for YMCA test yardstick perpendicular to ___ in mark
15
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
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