APK4125 Prescription Exam 1

Define cardiorespiratory fitness

(CRF) the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. Ability to perform large muscle, dynamic moderate-high intensity exercise for prolonged periods. Unless you have COPD or asthma, then circulatory system is limiting factor. Resting and exercising measurements should be completed.

Which leads look where??

(idk)

What is TPR effected by

(total vascular resistance) 1. radius of blood vessel -changes based on vasoconstriction/dilation (short term) -RAS system (liver and kidney) -endocrine system effects pituitary gland 2. length of blood vessel 3. blood viscosity (thickness)

Steps to approaching a case study: MR PLEASE standard operating procedure

*courtesy of the fitness professional's handbook* 1. M: MEDICAL HISTORY REVIEW in PAR-Q and health screen questionnaire. -Obtain the client's medical history (subjective-age, weight, family history, social history, surgeries etc.). 2. R: RISK FACTOR ASSESSMENT 3. P: PRESCRIBED MEDICATIONS (and supplements) should be in medical history. 4. L: LEVEL OF PHYSICAL ACTIVITY (current and past) should be in medical history. 5. E: ESTABLISHING THE NEED FOR PHYSICIAN CONSENT - w/new ACSM guidelines mostly for people wanting to do high intensity. 6. A: ADMINISTRATION OF FITNESS TESTS and evaluation of results. -What tests should we do to assess baseline? (understand where your client is in the world of fitness) 7. S: SETUP OF EXERCISE PRESCRIPTION. -Obtain their goals/make goals for training/exercise. No matter what, the two underlying general goals of a client are... 1. avoiding disease 2. improving fitness/athletic performance 3. need to make sure goals are SPECIFIC AND ATTAINABLE! -Calculate a program!!! 1. this is a "prescription", which is like "directions" to get to their fitness goals. each person has their own individual goal/plan/path to get to their goal! 2. the most important part of a prescription is the individual!! 3. what kind of exercises (resistance, endurance, CV, mix). 4. know how many ~sets ~reps ~load (% compared to 1RM) ~tempo ~rest time 8. E: EVALUATION OF PROGRESS WITH FOLLOW UP TESTS *like the SOP of an airplane before it flies, you MUST do all of these steps as standard procedure to keep consistency. *if you miss something you can get sued. *meds and supplements are so important bc someone with HTN meds should not be taking pre workout.

OLD format of ACSM risk stratification *know* this is the old pre participation health screening This is the Atherosclerotic Cardiovascular Disease (CVD) Risk Factors and defining criteria

*this helps determine someone's risk for CV disease* *if have a CMR disease already at high risk and shld see a doctor 1. Age: men ≥ 45 y/o and women ≥55 y/o. 2. Family history: myocardial infarction, coronary revascularization or sudden death before 55 yr in father (or other first degree male relative) or 65 yr in mother (or other female first degree relative). 3. cigarette smoking: current smoker or quit within the past 6 months. or has frequent exposure to environmental smoke. 4. physical inactivity: not participating in at least 30 mins of mod intensity physical activity (40-59% VO2 reserve) on at least 3 days a week for at least 3 months. 5. obesity: BMI ≥ 30 kg m^2 or waist girth > 102 cm (40 inches) for men and >88 cm (35 in) for women. If person has both, counts as one risk factor still (obesity) not two risk factors. 6. HTN: systolic BP ≥ 140 mm Hg and/or diastolic BP ≥90 mm Hg. Confirmed by measurements on at least two separate occasions. OR on antihypertensive medication such as beta blockers, ace inhibitors, Ca2+ channel blockers, diuretics (which decrease overall body fluid and decrease pressure). 7. Dyslipidemia: LDL cholesterol ≥ 130 mg dL (3.37 mmolL) or HDL < 40 mg dL (1.04 mmolL). Or on a lipid lowering medication (ex: statins to lower LDL). If *total serum cholesterol* is all that is available, use ≥200 mg dL (5.18 mmolL). Even if pt has ALL OF THESE, still counts as 1 risk factor (dyslipidemia). 8. Diabetes: fasting plasma glucose ≥ 126 mg dL (7.0 mmolL) or 2 hour plasma glucose values in oral glucose tolerance test ≥ 200 mg dL (11.1 mmolL) or hba1c ≥ 6.5%. Negative risk ractors 1. HDL-C: ≥60 mg dL (1.55 mmolL). If pt has this level of HDL-C it negates one of these risk factors. So lets say pt has 5 risk factors but has HDL-C=66, do 5-1=4 risk factors.

If an older client over 60 y/o says they want to be healthier, what should you assess?

1. current CV health and endurance & maybe flexibility (part of the 5 components of fitness). 2. current diet. *however, we are not licensed as an exercise physiologist or trainer to prescribe diets. must refer client to a nutritionist/licensed dietitian. we should monitor diet though and we can give general suggestions. 3. body composition (do they need to put on more muscle?).

Purposes for exercise testing:

1. identifying physiological strengths and weaknesses 2. ranking people for selection purposes 3. predicting future performances 4. evaluating the effectiveness of a training program or trial 5. tracking performance over time 6. assigning or manipulating training dosage

Example of 1. light physical activity 2. moderate 3. vigorous & how many mets

1. light (less than 3 mets. note that sedentary is less than or equal to 1.5 mets) -walking slowly -playing an instrument -washing dishes 2. moderate (3-5.9 mets) -walking at a brisk pace -mowing lawn -shooting hoops -light swimming 3. vigorous (greater than or equal to 6 mets) -walking very fast or at steep grade -jogging 5-6 mph -running 7+ mph -heavy farming -carrying bricks -shoveling snow -competitive sports -fast cycling -singles tennis -mod-hard swimming

What are signs and symptoms of CVD?

1. pain or discomfort in the chest, neck, jaw, arms or any other areas that may be due to ischemia (lack of blood flow from O2 to tissues). 2. dyspnea (SOB) at rest or at mild exertion may be an indication of underlying cardiac and/or pulmonary disease (if you have ischemia you most likely have SOB also). 3. syncope (passing out or losing consciousness) and dizziness during exercise. 4. orthopnea, and paroxysmal nocturnal dyspnea (waking up in the middle of the night with SOB). 5. ankle edema or swelling (not injury related). Due to poor blood flow or PAD (peripheral artery disease). This is fluid buildup due to high venous return. 6. palpitations and tachycardia. if resting HR > 100 bpm you are tachycardic. 7. intermittent claudication (muscle feels like its cramping but its not actually cramping-usually in calfs its like pain when you walk it feels like a cramp but not a cramp). 8. heart murmurs (genetic or developed over time). 9. Known disease.

What three items should be addressed when determining the type of assessment used?

1. physiological demands of the goal. 2. biomechanic and movement demands of the goal. 3. injury risk analysis for client and goal.

Diagnostic exercise testing is recommended for the following clients:

1. previously diagnosed CVD without recent test (within a year) 2. new or changing symptoms suggestive of CVD 3. DM and at least one of the following... -Age > 35 y/o -DMII>10 years duration -DMI>15 years duration -any additional atherosclerotic CVD risk factor -microvascular disease evidenced by vision impairment and BP response -autonomic dysfunction (inappropriate HR and BP response) 4. End stage renal disease. 5. Pt with pulmonary disease.

What are the two levels of screening for ACSM?

1. self guided (through surveys or papers they do on your own or you can GUIDE them through). 2. professional.

General training principles: all exercise programs must follow these following principles.

1. specificity: specific muscle group or movement type or patterns. 2. overload: training stress or intensity should increase greater than what client is used to. and increase progressively. 3. variation: volume, intensity, exercise selection, frequency of training, rest, speed. usually change every 2-6 weeks. 4. progression: altering training as client progresses. (SOVP)

If a client wants to be able to dunk a basketball, what should you assess?

1. vertical jump displacement (how high they can jump as of now) - assessment first!!! 2. lower body strength (hips, knee extension, plantar flexion and extension).

What is the projected time period for the following: 1. weight loss 2. muscle gain 3. increase in HDL cholesterol 4. increase in power production due to neural improvements 5. increase in flexibility due to stretch tolerance improvement 6. increase in muscular strength due to neural improvements

1. weight loss: depends on how much loss, but immediate as soon as caloric deficit begins. 2. muscle gain: depends on how much gain. 4-6 weeks to start seeing appreciable gains in protein synthesis. 3. increase in HDL cholesterol: 8-12 weeks of predominantly aerobic training. 4. increase in power production due to neural improvements: 2-4 weeks. 5. increase in flexibility due to stretch tolerance improvement: 2-4 weeks. 6. increase in muscular strength due to neural improvements: 1-4 weeks.

how long until delayed onset muscle shortness begins?

12-48 hours after exercise.

what is a normal RHR?

60-100 bpm

What is a healthy resting HR range?

60-100 bpm.

is CO or a-VO2 difference most variable among populations?

?

How does blood pressure change as blood moves through arteries, arterioles, capillaries, venuoles and veins.

Arteries (in systemic circuit) have the highest BP. It decreases as we get to veins. aorta has highest viscous flow pressure!

ACSM vs National Phys measurement of intensity

ACSM: not based of METS Nat Phys: measure intensity based off METS

What is the ideal test for CV endurance?

Bruce Protocol

What are the 5 components of health related fitness? Explain which are global and which are joint specific.

1. cardiovascular endurance (global) 2. body composition (global)-amount of lean mass vs fat mass 3. muscular strength (joint specific-usually want to get from lower body) 4. muscular endurance (joint specific-usually want to get from lower body) 5. muscular flexibility (joint specific-usually want to get from lower body) *these 5 are what the ACSM recommends assessing by the ACSM Guidelines for Exercise Testing and Prescription.

Explain the FITT principle

Frequency (How often? how many sessions per week?) Intensity (How hard? amt of effort measured by RPE and max HR) Time (How long? time duration of exercise session) Type (what? mode of exercise. time and intensity will depend on mode). *FITT principle must be on every prescription

History of PA pre-participation screening:

In 1996, Surgeon General Report stated that previously inactive men over the age of 40, women over the age of 50 and people at risk of CVD should consult a physician before starting an exercise program. But if you could've identified something on an individual and don't, they could get injured and you could get sued because it is only recommended to consult before. Now, we have screening programs by the ACSM (American college of sports medicine) and AHA (American heart association). ACSM was risk stratification screening tool, now relies more on physical activity history of participant, and presence of CV, metabolic or renal disease. AHA guidelines are still risk stratification.

How long is HR measured?

Ideally, 60 s. but it depends because it is reported in beats per minute. so you can 15s and multiply the beats by 4. if less than 15s its not accurate enough.

What age do males reach CV risk? Females?

Males - 45 y/o Females - 55 y/o

What are normal values, trained values and metabolic disorder values of relative O2:

Normal: 30-50 mL/kg/min (ideal, 60% of people generally). Trained: 60-80 mL/kg/min Metabolic disorder: 15-25 mL/kg/min

SMART goals (acronym)

S: specific to a component of fitness (who, what, where, when, why how) M: measurable. can you track the progress and measure the outcome. so you can see if client improved. A: attainable. is it physiologically possible? is it possible with clients time commitment? R: relevant. client will determine if goal is important to them and if they will prioritize it. is goal worthwhile and will it meet your needs. why do they want this goal in their lives. T: timely. When/how long will this take to see change/improve.

SBP vs DBP

SBP: pressure exerted against arterial walls when heart is contracting (systole). turbulent flow through arteries. There should be a LINEAR increase in SBP during exercise! DBP: pressure exerted against arterial walls when heart is relaxing (diastole). laminar flow through arteries. reflects TPR but not equal to it. Stays the same or slightly decreases during exercise. last sound heard when measuring BP with stethoscope.

What is blood pressure? What is its unit?

force exerted by circulating blood on the walls of blood vessels an integral part of pre-exercise evaluation mmHg (millimeters of mercury) use this because it is the pressure exerted by that column of mercury. made up of two numbers: systolic and diastolic

Paracelsus idea

idea that everything is "poisonous" at a certain dose. in all exercise, there must be a balance w overloading and overtraining (volume of exercise).

Where is the HR typically measured? WHY?

in the radial artery radial pulse is felt on the wrist just under the clients thumb. radial artery is easy access and recognizable for rest and exercise.

hyperplasia

increase in the total number of muscle fibers in a given muscle.

Renin-angotensin-aldosterone system (RAAS)

increases BP and sympathetic activity

ACSM values for normal, pre-hypertensive and hypertensive BP:

normal: SBP<120 *and* DBP<80 (must be both) pre-hypertensive: SBP=120-139 OR DBP=80-89 hypertensive: SBP≥140 OR DBP≥90 -HTN (stage 1): SBP=140-159 or DBP=90-99 -HTN (stage 2): SBP=160 or higher or DBP=100 or higher -HTN CRISES (emergency care needed): SBP is higher than 180 or DBP higher than 110.

what nervous system controls RHR?

parasympathetic tone. of SNS on at rest and causing high RHR=raises concern.

Which of the Korotkoff sounds would you record as the diastolic pressure?

pressure at last korotkoff sound (a beating sound with each heart beat)

blood resistance (R) equation

proportional to (η x L)/(r)^4 η=viscosity L=length of blood vessel r=radius of blood vessel

Which of the Korotkoff sounds would you record as the systolic pressure?

the FIRST korotkoff sound (a beating sound with each Heart beat)

What is heart rate reserve?

the difference between maximal heart rate and resting heart rate

12 lead EKG placement (?)

white- right arm black- left arm red- left leg green- right leg V1 V2 V3 V4 V5 V6(?) there are 4 limb electrodes: -R & L leg -R & L arm

What is the ideal test for muscular strength?

YMCA bench press test

back squat vs front squat vs smith machine squat

back squat -quads and glut strength -hip mobility -stable core to stabilize weight on back -ankle dorsiflexion mobility front squat -more anterior core stability smith machine squat -do not need any core stability -focus more on muscular contraction -easier to fatigue without hurting form

Why are the 5 components of health related fitness important to assess?

because they are highly related to longevity and healthy life outcomes!!!

Bradycardia

abnormally slow heartbeat RHR<60 bpm it is up to a physician to diagnose bradycardia or tachycardia!

What is the equation for BMI?

kg/m^2 (body MASS INDEX) only measures height and weight, not accurate for body composition.

What is the drug Monopril for?

medication for HTN to lower blood pressure. works as an ACE inhibitor (renin/angiotensin system). side effect=dry cough.

Compare effect of 15 reps of bench press at low weight VS 3 reps of bench press at high weight.

-15 reps of bench press at low weight: anaerobic glycolytic adaptation. high buff capacity of lactate. muscular endurance. -3 reps of bench press at high weight: muscular strength and power

If a client wants to lose 10-15 lbs, what should you assess?

1. body composition (measured by a body fat %, skinfold assessment or DEXA) - assessment first!!! Need to know their body composition first. Because their goal for losing weight is most likely to lean out and get more lean muscle mass than fat mass.

examples of cardiometabolic renal diseases

-DMI -DMII -stroke (myocardial infarction) -heart attack (low O2 in cardiac tissue and causes pain-angina) -heart surgery, cardiac catheterization or coronary angioplasty -pacemaker/implantable cardiac defibrillator/rhythm disturbance -heart valve disease -heart failure -heart transplant -congenital heart disease -renal disease (renal failure)

Laminar vs. Turbulent Flow

-Laminar Flow- occurs when a fluid flows in parallel layers. the flow is slowest near the vessel wall (where there is more friction) and fastest in the center of the blood vessel (where there is less friction). -Turbulent Flow- a flow regime characterized by chaotic property changes. Turbulent flow describes a situation in which blood flows in all directions!

Sphygmomanometry

-a common procedure that measures arterial blood pressure -using a Sphygmomanometer (inflatable cuff with blood pressure gauge) and a stethoscope

ECG or EKG

-electrocardiogram -process of recording the electrical activity of the heart using electrodes placed on the patient's body -it is a graphic record of the direction and magnitude of the electrical activity generated by the depolarization and repolarization of the atria and ventricles -usually a 12 lead ECG is measured, but there can also be 2 lead, 3 lead and 6 lead.

AHA/ACSM Health/Fitness Facility Pre-Participation Screening Questionnaire

-more comprehensive than PAR-Q -surveys recognized signs and symptoms suggestive of CVD and other risk factor thresholds -no research has been performed on AHA/ACSM questionnaire. -diff questionnaires depending on where your working.

Test organization:

-organize tests so they can follow in sequence without stressing the same muscle group repetitively -does not matter order as long as we get person back to resting HR and BP in between each one -but if we put certain ones back to back, fatigue will play a role and can be unreliable -order also depends on what they are training for (but in general, tests typically get longer as you go down)

Explain the 80/20 rule

-proposed by Gray Cook -80% of positive results from an exercise prescription are derived from 20% of total workout -with the given info: after 6 weeks of a 15 exercise workout routine increased 1-RM bench press 40 lbs. so... 15x .20= 3 exercises. 40 x .80=32 lbs. so ~30 lbs of this increase in bench press came from 3 exercises in that workout!!

exercise effects on BP

-temporarily increases BP in response to an increased metabolic demand for O2 -The benefit in exercise is over time it decreases resting HR and BP -isometric (contraction of muscles does not change muscle length) exercise (ex: wall sit or plank) INCREASES BP most dramatically because highest pressure response. (both SBP and DBP) -also increases MAP, CO and HR. -dynamic CV exercise (running or cycling) tends to only increase SBP because of higher venous return and less pressure response. -dynamic resistance exercise can increase the blood pressure significantly in localized areas.

Health History Questionnaire

-used to establish medical/health risks for both activity assessment and activity participation. -however, each client is different about sharing habits -at minimum, should address... 1. *family* history (immediate family: mom dad siblings) of CMR (cardiometabolic renal disease) 2. *YOUR history* of various diseases and illnesses including CVD 3. surgical history 4. past and present health behaviors and habits (including sleep habits) 5. current use of drugs and medications and supplements 6. specific history of various signs and symptoms suggested of CVD and other chronic or metabolic diseases. *present symptoms*

What other factors influence HR (other than type of exercise)?

1. any environmental stress (fight/flight response) 2. overtraining (can cause a chronic increased HR) 3. medications -stimulants can increase HR (ex: caffeine, synephrine, DMAA, adderall, ritalin, vyvanse, didrex, cocaine, epinephrine) -some meds can decrease HR (beta blockers like metropolol, carvedilol and atenolol) 4. hydration status (if dehydrated, volume decreases so pump more blood out to increase HR) 5. fitness level 6. age (as an individual ages they get a lower mx HR)

What are the components of skill related fitness? (think, this is especially with athletes because closely related to sport).

1. Agility 2. Balance 3. Coordination 4. Speed 5. Power 6. Reaction time *these components of fitness explain why good athletes can play multiple sports professionally! have these skill related components of fitness that overlap in many sports. ex: Bo Jackson w baseball and football. ex: Michael Jordan w basketball and minor league baseball. *lots of people can have health related components of fitness but not everyone has SKILL related!! *thats why you need to see if a client needs improvement in health related components of fitness, skill related components of fitness or BOTH.

What tests analyze body composition?

1. BIA 2. SKIN folds 3. BOD POD.

When prescribing a time line for the prescription, what should be considered?

1. Dose of exercise: how many sessions a week, how much a day, how many exercises, reps, volume. (want least amount of time working out as possible while still meeting goals!!!) 2. Potency of exercise: for a given exercise, what is the amount of change? want to maximize. 3. Maximal effect of exercise: how good can we get from the same dose/routine (tolerance of exercise). 4. Efficacy of exercise: how effective is the routine at reaching the intended goal? determined by FITT principle. -bc you could be potent at something that isnt the intended goal.

What are general indications for STOPPING an Exercise Test?

1. Onset of angina or angina like symptoms (chest pain) 2. Drop of SBP of greater than or equal to 10 bpm Hg with an increase in WR or if SBP decreases below the value obtained in the same position prior to testing (this is bc SBP should linearly inc with exercise bc the heart is contracting harder). 3. Excessive rise in BP: systolic BP greater than 150 mm Hg and or diastolic pressure greater than 115 mm Hg 4. SOB, wheezing, leg cramps or claudication 5. Signs of poor perfusion: light-headedness, confusion, ataxia (lack of coord, balance or speech), pallor (pale), cyanosis (face=blue), nausea or cold and clammy skin 6. Failure of HR to increase with increased exercise intensity 7. Noticeable change in heart rhythm by palpation or auscultation (monitored by EKG) 8. Subject REQUESTS TO STOP 9. Physical or verbal manifestations of severe fatigue 10. Failure of testing equipment

Steps of taking someones blood pressure with a Sphygmomanometer and sthetoscope.

1. Put inflatable cuff on left arm (bicep) 2. place stethoscope at brachial artery 3. Increase external pressure of cuff to be above 120 mmHg (so it is higher than pressure pushing out of vessel). This occludes the vessel and stops arterial blood flow so you cannot hear any sounds. 4. slowly release pressure. when pressure of cuff=same pressure as blood pressure, blood can go through vessel turbulently. this makes the first korotkoff sound (systolic BP) 5. keep listening, when you hear the sound fade away, that is when the blood returns to laminar flow and that last korotkoff sound is diastole (diastolic BP).

If a client wants to be a D1 football cornerback, what should you assess?

1. agility (with drills). 2. power (with team sports, power is important).

1 MET=

3.5 ml/kg/min O2 consumed amount of energy needed to keep body alive at rest.

Who was the first person to do research on VO2 max and work on lactate threshold?

AV Hill

Tachycardia

Abnormally rapid heartbeat RHR>100 bpm more concerned with tachycardia than bradycardia

Absolute vs relative VO2

Absolute: L/min. Directly related to body size. Does not really tell us about CR function. Shaq has a higher abs VO2 than Kevin Hart because he has more body mass/tissue that needs O2. -Can use indirect calorimetry to determine how many cals a person burns just by the amount of O2 they consume. -1L O2=5 kcals burned. Relative: mL/kg/min. *USED TO ASSESS CARDIORESPIRATORY FITNESS*. Kevin hart probably has a higher relative O2 because he does marathons and stuff. Since divides by body weight, basically for every Kg of body weight, how many L of O2 consumed. Used to express energy expenditure in weigh bearing exercises.

BP equation

BP = CO x TPR CO is also known as Q (quantity of blood flow/cardiac output)

Why do we not use the carotid artery to measure RHR?

Bc there are many baroreceptors around the carotid vessel that detect pressure changes and these pressure changes can activate SNS (affects SA and AV nodes). It is also uncomfy for pt to have you gripping their neck. However, there is also a type of carotid massage that can increase PNS stimulation.

what type of exercise will chronically reduce HR?

CARDIOVASCULAR EXERCISE! HIIT resistance exercise has not been shown to reduce HR unless there are also body composition changes accompanied with it.

relationship between HR, BP, SV, TPR (total peripheral resistance)

CO=HR x SV Elevated heart rate is associated with elevated blood pressure Three factors determine the force: the length of the blood vessels in the body, the diameter of the vessels, and the viscosity of the blood within them. Total peripheral resistance is an important concept to understand because it plays a vital role in the establishment and manipulation of blood pressure. This relationship is expressed mathematically as MAP = CO x TPR, where CO stands for cardiac output, and MAP stands for mean arterial pressure. more resistance=less SV.

Which Health Related Component of fitness is most highly related to all-cause mortality?

CR fitness. inverse relationship

What is the most accurate method to measuring body composition?

DEXA (bone density and body comp).

Explain ECG electrode vs ECG lead.

ECG electrode: is simply the conductive pad that is attached to the skin to record any changes in electrical activity. Any pair of electrodes can measure the electrical potential difference between 2 corresponding locations of attachment. ECG lead: consists of 2 surface electrodes of opposite polarity (one positive and one negative-known as a bipolar lead). Or one positive surface electrode and a reference point (known as a unipolar lead). Each lead gives an opportunity to look at the heart from a different position. -for the common 12-lead, 10 electrodes are positioned on the body. *know where leads are placed for practical!!* in order to localize where we have good and poor conduction of the heart

Net vs Gross Rates of O2 Consumption

Gross VO2: caloric cost of both resting VO2 (1 MET) and exercise VO2. Net VO2: caloric cost of exercise VO2 alone.

Explain each of the PAR-Q self guided screening tools.

PAR-Q (Physical Activity Readiness Questionnaire) -1992 -contains 7 Yes/No questions -is widely used to assess physical readiness and identify those for whom STRENUOUS PA IS NOT RECOMMENDED -prepares client for moderate physical activity -has been shown to identify 89% of true positives (sensitivity) and only 42% of true negatives (specificity). This means it is bad at identifying people who truly could be at risk. -if you answer YES to one or more questions, must talk to doctor before can begin exercise program. PAR-Q+ -2010 -has not been used long enough to accumulate sensitivity and specificity data. -also 7 YES/NO questions -if answer yes to one or more of them, complete follow up page questions (pg 2-3). -if answer NO to all of f/u questions, you can sign participant declaration but it is recommended that you consult a licensed exercise professional or physician before exercise (especially vigorous). -if you answer yes to one of more of f/u questions, patient must complete ePARmed-X and see a physician. ePARmed-X + Physician Clearance Follow-Up Questionnaire -form to doctor saying...what you want to do with client, your concerns with the client's health, and you ask physician if they are ok with your prescription. -physician will generally give you things they should avoid during exercise.

ECG formation of a pulse:

QRS: depolarization of the heart towards the positive electrode produces a positive deflection. This shows contraction of ventricles? ___(?): depolarization if the heart away from the positive electrode produces a negative deflection. ST segment (?): repolariz of heart towards the positive electrode produces a negative deflection. T(?): repolariz of heart towards positive electrode produces a positive deflection. *need big R (depolariz at ventricle) because lots of myocardium there and need sufficient depolariz to pump blood.

Resting vs Exercise Measurements of CRF?

Resting measurements: -Resting HR and BP (lower RHR in a more fit individual because they have higher SV. Low HR and High SV = CO) -Resting ECG's Exercise Measurements: -most CV measurements are variations of estimating or measuring VO2 -Measure HR, BP and RPE in these max or submax tests

TPR equation

TPR = MAP/CO

What do you assess?

The 5 components of health related fitness (and any specific areas of fitness related to the client's goals).

New ACSM pre-participation health screening.

The old version (risk factor assessment) for risk classification is no longer part of the pre assessment. The new health screening process is only focused on 3 aspects 1. the individual's current level of physical activity (1st) 2. first do they have a CMR disease, then is there a presence of signs or symptoms of known CV, metabolic or renal disease (2) 3. the desired exercise intensity of the pt, is this level of intensity good for the pt (3) *will say stop for MC (medical clearance) at any time feels necessary in chart. *does not consider pulmonary diseases bc pulmonary includes asthma and COPD. is hard for these people to do high intensity, so usually get MC anyway.

As an exercise physiologist, what MUST you do before you give a client any exercise prescription?

There must be an assessment!!! then from assessment you will probably do a graded exercise test (GEX).

What is the general purpose of an assessment and pre-participation screening?

To determine health risk and status of a client in order to determine clients who are at risk (and minimize their risks associated w PA). Determine a client's limitations when making a program. Do they have any injuries or significant medical concerns? Identify who should receive a medical evaluation before beginning. Also who needs medical supervision DURING exercise? Also to determine fitness level of client (to help make decisions on their physical activity in the future). To determine the clients goals! Establish benchmark data to look back on and compare to!

2018 Physical Activity Guidelines for Americans

Two most important 1. Aerobic Exercise: 150-300 minutes/week of moderate to vigorous intensity. 2. Muscle strengthening: 8-12 repetitions to fatigue, at least one set for the legs, hip, back, abdomen, chest, shoulders, and arms on 2-3 nonconsecutive days a week. Other important 1. For older adults: same aerobic exercise just light to moderate intensity 2. Yoga, Tai Chi, Qigong good for stress release 3. Stretching: no specific dose but great 4. Children: 60 minutes of moderate to vigorous intensity exercise a day 5. Balance training: 3 times a week for fall prevention *150 mins of moderate int. or 75 mins vig int. aerobic exercise or a combo *for more benefits 300 mins moderate int. or 150 mins vig int. aerobic exercise or combo *at least two days a week of resistance exercise at moderate or vig intensity

VO2 max vs VO2 peak

VO2 max: rate of O2 uptake during max aerobic exercise. VO2 peak: highest VO2 achieved when a true VO2 has not been attained or validated. Indiv. may not reach max because...they said they needed to stop, it takes a lot of effort that they may not want to put in.

Explain the Fick Equation:

VO2= [CO] x [a-VO2 difference] VO2=total amount of O2 body is consuming CO=cardiac output. capacity of heart, lungs, blood to transport oxygen to working muscles. a-VO2 diff=utilization of oxygen by muscles during work/exercise. During exercise, leg muscles will have higher a-VO2 than kidneys or digestive tract. **the difference in the oxygen content of the blood between the arterial blood and the venous blood. It is an indication of how much oxygen is removed from the blood in capillaries as the blood circulates in the body*.

What is the most common measure of CR fitness?

VO2 (volume of O2 uptake by body)

ADA 2015 a1c guidelines

a1c ≥ 6.5% is risk. must be below 6.5%

What are the benefits and negatives of self guided screening?

benefits: -free -on clients own time negatives: -sometimes client can underestimate or overestimate self -for general health questions, having a professional there would make them more honest or help them understand the questions better

what is blood doping?

blood doping gives you an artificial amount of RBC's, and thus an increase in O2 carrying capacity in blood which is effective for aerobic performance. However, inc RBC's increases blood viscosity which increases risk of Heart attack, stroke and aneurysm. ex: lance armstrong

a1c

blood test that measures glycated hemoglobin (HbA1c) to assess glucose control over long term (~3 months).

Exercise testing can be diagnostic or prognostic, explain the difference between the two.

diagnostic -usually done to diagnose (so done by a physician), but no matter what, always monitored by a physician because diagnostic tests usually done on high risk individuals!! -mostly done for CV testing -or for diagnosing CV diseases -or done for those about to start a vigorous exercise program -examples include EKG tests, echocardiogram, thallium scintigraphy, cardiac MRI -NEVER SELF DIAGNOSE. we as exercise physiologists can perform these tests alone technically but you must refer them to a physician. prognostic -compare risk of an individual to the general population they are a part of -assess people with risk to CVD -data regarding symptoms, functional capacity, and myocardial ischemia during exercise should be considered together -*performing assessments for Health Related components of fitness and comparing to normative data*

what is claudication? How can you tell difference between claudication of muscle and muscle cramp?

ischemic response in periphery (legs/calfs) due to lack of O2 in that area. if person gets off and muscle is loose=claudication if person gets off and muscle is still cramped=cramp

When resting heart rate decreases, what increases?

resting stroke volume. this allows for more efficient and healthy blood flow. CO=HR x SV CO maintained

why is it always important to check the participants resting HR (and between sets)

to make sure vagus (parasympathetic) NS is working.

Why should you NOT put your thumb on the patient when recording their heart rate?

your thumb is braced. you do not put your thumb on the pt because you have your individual PP (*princeps pollicis* artery) in thumb that can interfere with their HR!!! you run the risk of recording your HR and not theirs (bpm)