Study Guide

Functional Movement Screening (test elements, scoring, cut score for high risk, intended population)

- System of assessment for basic functional movement patterns common to many activities and sports - Composed of 7 items with scoring 0-3 per item = 21 points - Lower than 14 will be at high risk - First 3 items assess functional movements, then 2 flexibility assessments, 1 core strength, 1 core stability (dynamic balance) - Score of 0 means pain and cannot perform movements - Primary Goals: Assess for pain, asymmetry, risk of injury or re-injury, and progress back to functional movement

Active Straight Leg Raise

- This pattern not only identifies the active mobility of the flexed hip, but also includes the initial and continuous core stability within the pattern as well as the available hip extension of the alternate hip - it is an appraisal of the ability to separate the lower extremities in an unloaded position. This movement is often lost when flexibility of multi-articular muscles is compromised. - The gluteus maximus/iliotibial band complex and the hamstrings are the structures most likely to result in flexion limitations. - Extension limitations are often seen in the iliopsoas and other muscles of the anterior pelvis - challenges the ability to dissociate the lower extremities while maintaining stability in the pelvis and core - challenges active hamstring and gastroc-soleus flexibility while maintaining a stable pelvis and active extension of the opposite leg.

Hurdle Step

- is an integral part of locomotion and acceleration - challenges the body's step and stride mechanics while testing stability and control in a single stance. - requires proper coordination and stability between the hips, moving asymmetrically with one bearing the load of the body while the other moves freely. The pelvis and core must begin with and maintain stability and alignment throughout the movement pattern. - The arms are still as they hold a dowel across the shoulders, giving the observer further representation of the static responsibility of the upper body and trunk in the stepping movement. - Excessive upper body movement in basic stepping is viewed as compensation; it is not seen when proper mobility, stability, posture and balance are available and functioning. - challenges bilateral mobility and stability of the hips, knees and ankles. The test also challenges stability and control of the pelvis and core as it offers an opportunity to observe functional symmetry.

State reasons to measure cardiorespiratory fitness

-Establishing baseline fitness data relative to published norms -Establish baseline to prescribe fitness to improve their goals -Compare ages, sex, and measurements of client and general population -Individualization of exercise prescription -Strengths and weaknesses of client -Tracking progress -Setting reasonable goals that motivate the client -Clinical assessment with patients with chronic diseases -Relation to function in everyday activities -Low CRF is an independent risk factor for cardiovascular and all-cause mortality

Calculate/add and interpret a basic FMS score

0 = pain regardless of quality of movement 1 = unable to perform 2 = Perform imperfectly/with compensation 3 = Perform as directed Best score of three tries is used Lowest score in R/L tests is used

Skill Related Components

1. Agility- the ability to change the position of the body with speed and accuracy 2. Balance- the maintenance of equilibrium while stationary or moving 3. Coordination- the ability to use the senses, such as sight, hearing, together with body parts in performing tasks smoothly and accurately 4. Power- the ability or rate at which one can perform work 5. Reaction Time- the time elapsed between stimulation and the beginning of the reaction to it 6. Speed- the ability to perform a movement within a short period of time

Health-Related Components

1. Cardiorespiratory endurance- the ability of the circulatory and respiratory systems to supply oxygen during sustained physical activity 2. Body composition- the relative amounts of muscle, fat, bone, and other vital parts of the body 3. Muscular strength- the ability of muscle to exert a force 4. Muscular endurance- the ability of a muscle to continue to perform without fatigue 5. Flexibility- the range of motion available at a joint

Know the test termination criteria

1. Onset of angina or angina-like symptoms 2. Drop in SBP > or equal to 10 mmHg with an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing 3. Excessive rise in BP: SBP >250 mmHg and/or DBP >115 mmHg 4. Shortness of breath, wheezing, leg cramps, or claudication 5. Signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin 6. Failure of HR to increase with increased exercise intensity 7. Noticeable changes in heart rhythm by palpitation or auscultation 8. Individual requests to stop 9. Physical or verbal manifestations of severe fatigue 10. Failure of the testing equipment

Moderate Intensity Exercise

40-59% HRR, 3.0-5.9 METs, RPE 12-13, an intensity that causes noticeable increase in HR and breathing

Ankle Mobility Screening

Assess for ankle dorsiflexion mobility before in-line lunge test: Will help you to assess whether ROM limitations in dorsiflexion may be limiting performance in squat, stepping or lunging tests.

ACSM Screening Algorithm

Determines current physical activity levels Identifies signs and symptoms for cardiovascular disease, metabolic disease, and renal disease Identifies individuals diagnosed with CV, metabolic, and renal diseases Cardiac, peripheral, vascular, renal, or cerebrovascular diseases, Type 1 and 2 diabetes mellitus, Uses signs and symptoms, disease history, current exercise participation, and desired exercise intensity to guide recommendations for preparticipation medical clearance *Questions to ask: Sedentary or exercises regularly Has CV, Metabolic, or Renal Diseases Has symptoms of these diseases (CVD Risk Factors)

Differentiate between muscle strength, muscle endurance and muscle power

Muscle strength: the muscle's ability to exert a maximal force on one occasion Muscle endurance: the muscle's ability to continue to perform successive exertions or repetitions against a maximum load Muscle power: the muscle's ability to exert force per unit of time

Differentiate between physical activity, exercise, and physical fitness

Physical activity: Any bodily movement from skeletal muscle contraction that results in a substantial increase over resting energy expenditure Exercise: A type of physical activity consisting of planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness Physical fitness: a set of attributes or characteristics that people have or achieve that relates to the ability to perform physical activity

Calculate a strength ratio for the leg press or bench press test and analyze data using a norms table

Strength ratio = weight pushed in lbs / body weight in lbs

Pre Participation Health Screening Process

The need for medical clearance before initiating a moderate to vigorous exercise program using the ACSM screening algorithm with the help of a qualified exercise or health care professional. In the absence of assistance, interested individuals may use the PARQ+ questionnaire If indicated during screening, the individual may have to get medical clearance from a physician or other qualified healthcare provider

List the FITT-VP Aerobic Exercise Recommendations for Fitness

Volume: a target volume of > or = to 500- 1000 MET/min/week Increasing pedometer step counts by > or = to 2000 steps/day to reach a daily step count of > or = to 7000 steps/day is beneficial Exercising below these volumes may still be beneficial for persons unable or unwilling to reach this amount of exercise

Standard Error of Estimate

a measure of the scatter of points around a regression line, All VO2 max estimates should be interpreted within a range

Differentiate between the fulcrum, the stabilization arm and the movement arm of a goniometer.

- Fulcrum centered to identified anatomic landmark - Stabilization arm remains fixed (establishes the start position) - Movement arm moves in relation to client's movement (establishes the ending position)

Berg Balance Test (test elements, scoring, cut score for high risk, intended population)

- 14 items with scoring from 0-4 per item = 56 points - To measure balance among older people with impairment in balance function by assessing the performance of functional tasks -A change of 8 points is required to reveal a genuine change in function between 2 assessments - Contains static (with and without visual cues) and dynamic balance (sit to stand, chair transfer, turn 360 degrees, reaching, looking over shoulder) challenges - Progressively more points are deducted if: • the time or distance requirements are not met • the subject's performance warrants supervision • the subject touches an external support or receives assistance from the examiner Fall Risk: High = 0-20 pts, Medium = 21-40 pts, Low ≥ 40pts.

Know the minimum resistance training guidelines: frequency, reps

- Frequency: 2-3 days/week - Reps: 8-12, 10-15 in older adults, 15-20 for muscle endurance - Total body: 1-3 sets of 6-10 exercises per session hits all major muscle groups (2-3 upper body; 2-3 lower body; 2-3 core) Often used when someone does RT 2-3 times/week Often focused on compound exercise for upper and lower body to include most or all major muscle groups each session - Split Routines: can be split by push/pull, upper/lower body, or muscle groups (chest back abs, legs, arms) Each area of the body is trained 2 nonconsecutive days per week and a different area is trained on consecutive days RT 4 times/week often uses a push/pull or upper/lower body split RT 5+ times/week often uses muscle group split of 3 consecutive days of training each group, then rest day, then repeat 3 consecutive days. Allows the lifter to perform a greater total volume of training without becoming overly fatigued in any one muscle group - DOMS- Delayed Onset Muscle Soreness: inflammation, microtears in the muscle

Know the minimum resistance training guidelines: sets, rest between sets and between workouts

- Order of exercises Perform large before small muscle group exercises Perform multijoint exercises before single-joint exercises - Sets: 2-4 - Rest between sets Strength Focus: minimum of 2-3 minutes rest between sets of same exercise or muscle group allows for recovery of phosphocreatine Endurance Focus: can be less than 1-2 minutes to enable performance under conditions of fatigue - Strategies to enable rest and be time efficient: rotate upper and lower body exercises Circuit of 1 set of each exercise, then repeat rather than consecutive sets of the same exercise - Rest for 48 hours in between workouts

Clearance Tests

- Shoulder clearance test: assess for pain before or after reaching test - Spinal extension clearance test: assess for pain before or after push up test - Spinal flexion clearance test: assess for pain before or after rotary stability test

Deep Squat

- demonstrates fully coordinated extremity mobility and core stability, with the hips and shoulders functioning in symmetrical positions. - Extremity mobility, postural control, pelvic and core stability are well represented in the deep squat movement pattern. - challenges total body mechanics and neuromuscular control when performed properly. We use it to test bilateral, symmetrical, functional mobility and stability of the hips, knees and ankles. - The dowel held overhead calls on bilateral, symmetrical mobility and stability of the shoulders, scapular region and the thoracic spine. - The pelvis and core must establish stability and control throughout the entire movement to achieve the full pattern.

Shoulder Mobility

- demonstrates the natural complementary rhythm of the scapular-thoracic region, thoracic spine and rib cage during reciprocal upper extremity shoulder movements - it uses each segment to its range of active control, leaving little room for compensation. Removing compensation provides a clear view of movement ability. - The cervical spine and surrounding musculature should remain relaxed and neutral. - The thoracic region should have a natural extension. - There should be internal rotation and adduction in one extremity and flexion, external rotation and abduction of the other.

Discuss Risks of physical activity in active vs sedentary subjects

-The risk of AMI are very low in healthy individuals who perform moderate intensity physical activity -There is an increased risk of AMI for individuals who perform vigorous physical activity and in sedentary subjects compared to rest -Sedentary subjects are higher because they are inactive and perform unaccustomed or infrequent exercise -The risk of AMI during or immediately after vigorous exercise was 50 times higher for the inactive compared to individuals who vigorously exercised for 1 hour sessions for less than or equal to 5 days/week -Relative risks are higher during vigorous exercise, while absolute risks are very low -*The figure shows that the baseline relative risk of AMI of an active subject is half the relative risk of a sedentary subject - *The figure shows that a sedentary subject 100 times the relative risk of AMI during vigorous activity compared to baseline risk for sedentary subjects

State factors that can affect the accuracy of goniometry measurement

Anatomic landmarks are accurately identified Joint axis point has been clearly defined Body is stabilized in proper alignment Client is instructed to move slowly through the proper ROM and the goniometer is properly aligned Test administrator is familiar with normal ROM for each joint

Understand the difference between direct measurement and indirect estimation of CR fitness

Direct: graded exercise test measuring gas exchange Indirect: no measurement of gas exchange, graded exercise test, pacer test, cooper's test

F=Frequency: know the minimum guidelines for frequency of resistance training

Each major muscle group should be trained on 2-3 days/week, with at least 48 hours separating the training of the same muscle group

Assess or create a resistance training program in terms of exercise order, exercise selection given goals and good practice (making sure agonist-antagonist muscles are represented)

Ex. 1. push-ups & dumbbell rows (chest and upper body) 2. leg extensions & leg curls (quads and hamstrings) 3. planks & bird dogs (abdominals & spinal erectors)

30-3-3 Rule

Exercise participation, performing planned, structured physical activity if not participating in regular activity or hasn't participated for at least 30 min at moderate intensity at least 3 days/week for at least the last 3 months.

List benefits of physical activity in each category: cardiovascular and respiratory function

Increased maximal oxygen uptake resulting from both central and perIpheral adaptations Decreased minute ventilation at a given absolute sub maximal intensity Decreased myocardial oxygen cost for a given absolute submaximal intensity Decreased HR and BP at a given submaximal intensity Increased capillary density in skeletal muscle Increased exercise threshold for the accumulation of lactate in the blood Increased exercise threshold for the onset of disease signs and symptoms (eg. angina pectoris, ischemic ST-segment depression, claudication)

Know the seven movements of the FMS and what each movement tests for.

Mobility: leg raise and shoulder mobility Stability (core control): rotary stability and pushup Functional pattern: squat, inline lunge, hurdle step 1. Deep Squat 2. Hurdle Step 3. Inline Lunge 4. Shoulder Mobility 5. Active Straight-Leg Raise 6. Trunk Stability Push-Up 7. Rotary Stability

List the FITT-VP Aerobic Exercise Recommendations for Fitness

Pattern: Exercise may be performed one (continuous) session per day or multiple sessions of > than or = to 10 min to accumulate the desired duration and volume of exercise/day exercise bouts of < than 10 min may yield favorable adaptations in very deconditioned individuals Interval training can be effective in adults

Know the moderate and vigorous intensity ranges for RPE and 1-RM

RPE method: adjust resistance and/or reps so that last rep of each set reaches a given RPE range (see chart below) %1RM method: prescribe resistance based on RM chart Moderate: 12-13 RPE, 50-<70% of 1-RM Vigorous: 14-17 RPE, 70-<85% of 1-RM

Identify which are relative vs absolute measures

Relative measures: %HRR, %HR max, %VO2 max, RPE, %1RM Absolute measures: METs

Define range of motion and list factors influencing ROM

The amount of available motion, or arc of motion, that occurs at a specific joint Many (not all) assessed from body at anatomic position: Can be assessed actively or passively Factors: Age (reduced collagen solubility with age in adults) Gender (women > men) Previous joint injury Specific diseases (e.g., arthritis) Physical activity Individual variation

Explain the guidelines for and purpose of a warmup and cooldown. Assess adequate warmup and cool-down from a case study.

Warm Up: To prepare the body before doing intense exercise Increases HR Warms up synovial fluid at joints Gradually stimulates the heart, prevents heart attack Gradually delivers more blood flow to muscles (redistribution) Cool Down: Allows body to return resting levels Is done to clear lactic acid Allows the heart to slow down Prevents venous pooling Muscle pump is used to provide venous return and push blood back to the heart

Explain why it is important to avoid the Valsalva maneuver and recommend a breathing pattern for resistance training

Valsalva maneuver is a breathing method that may slow your heart when it's beating too fast. To do it, you breathe out strongly through your mouth while holding your nose tightly closed. This creates a forceful strain that can trigger your heart to react and go back into normal rhythm. - Is prolonged isometric contraction, and motionless standing, which may result in decreased venous return and hypotension

List the risk factors for CHD

Positive: -Age: Men > or = to 45 years; women > or = to 55 years -Family history: Myocardial Infarction (heart attack), coronary revascularization, or sudden cardiac death before 55 years in father or other male first-degree relative or before 65 years in mother or other female first-degree relative -Cigarette smoking: current cigarette smoker or who quit within the previous 6 months or exposure to environmental tobacco smoke -Physical inactivity: not meeting the minimum threshold of 500-1000 METs/min of moderate to vigorous activity or 75-150 min/week of moderate to vigorous intensity physical activity -Body mass index/waist circumference: BMI of > or = to 30 kg*m^-2; waist circumference of > 102 cm (40 in) for men, and > 88 cm (38 in) for women -Blood pressure: Systolic BP > or = to 130 mmHg and/or diastolic BP of > or = to 80 mm Hg, based on an average of > or = to 2 readings obtained on > or = to 2 occasions, or on antihypertensive medication -Lipids: low-density lipoprotein cholesterol (LDL-C) of > or = to 130 mg*dL or high-density lipoprotein cholesterol < 40 mg*dL in men; < 50 mg*dL in women or non HDL-C < 130 mg*dL or on a lipid lowering medication. If total serum cholesterol is available, use > or = to 200 mg*dL -Blood glucose: Fasting plasma glucose > or = to 100 mg*dL or 2 h plasma glucose values in oral glucose tolerance test (OGTT) > or = to 140 mg*dL; or HbA1C of > or = to 5.7% Negative: HDL-C: > or = to 60 mg*dL

State the preparation for and order of test administration

Preparation: Have all forms ready Calibrate equipment Environmental temperature ideally between 68-72 degrees with less than 60% humidity Area for sitting and client comfort *Anxiety before test can cause elevated HR and BP Administration: Informed consent - carefully explain test and answer questions The individual agreeing to perform the test, understands the risks, and knows answers to questions they may have PARQ+ and pre-participation screening Plan Order of Tests: Resting measures, body composition, then physical testing Client may fatigue quickly so order of tests is important*

Know the components of a comprehensive fitness assessment

Prescreening/risk stratification Resting HR, BP, height, weight, body mass index, ECG (if appropriate) Body composition Cardiorespiratory fitness (not VO2 max if testing all the same day) Muscular strength Muscular endurance Flexibility - functional capacity of the joints to move through a full range of motion (ROM) Balance (Functional Movement Screen)

List benefits of physical activity in each category: reduction in morbidity and mortality

Primary prevention (interventions to prevent the initial occurrence) Higher activity and/or fitness levels are associated with lower death rates from CAD Higher activity and/or fitness levels are associated with lower incidence rates for CVD; CAD; stroke; Type 2 Diabetes mellitus; metabolic syndrome, osteoporotic fractures; cancer of the bladder, breast, colon, endometrium, and lung; and gallbladder disease Secondary prevention (interventions after a cardiac event to prevent another) Using a meta-analysis, cardiovascular and all-cause mortality are reduced in patients with post-myocardial infarction who participate in cardiac rehab exercise training, especially as a component of multifactorial risk factor reduction

ACSM 2011 Position Stand

Professional organizations often come out with positions. Very formal process The organization will assemble a large group of experts around a certain topic and the experts will spend a year or two years, maybe even a little more reviewing all of the evidence related to the topic Experts will then rate the evidence based on how strong it is and use evidence categories (A,B,C,D) Evidence category A: There are meta analysis and large multicenter randomized control trials that present strong evidence to back up whatever statement is being made Evidence category B: There might be randomized control trials but are smaller and a lot of good epidemiological evidence to show a high correlation to support the statement Evidence category C: There are small trials, maybe not randomized, or maybe its more epidemiological data, or maybe the data isn't strong Evidence category D: Expert Opinion, Maybe there hasn't been a lot of research in an area, but the experts believe that the statement is important enough to make the position stand, calling for more research in that area

List the FITT-VP Aerobic Exercise Recommendations for Fitness

Progression: A gradual progression of exercise volume by adjusting exercise duration, frequency, and/or intensity is reasonable until the desired exercise goal is (maintenance) is attained This approach may enhance adherence and reduce risks of musculoskeletal injury and adverse CHD events

List benefits of physical activity in each category: reduction in Coronary Artery Disease (CAD) risk factors

Reduced resting systolic/diastolic pressure Increased serum-high density lipoprotein cholesterol and decreased serum triglycerides Reduced total body fat and intra abdominal fat Reduced insulin needs; improved glucose tolerance Reduced blood platelet adhesiveness and aggregation Reduced inflammation

Berg Balance Test Elements

Sitting to standing Standing unsupported Sitting unsupported Standing to sitting Transfers Standing with eyes closed Standing with feet together Reaching forward with outstretched arm Retrieving object from floor Turning to look behind Turning 360 degrees Placing alternate foot on stool Standing with one foot in front Standing on one foot

Use the extrapolation method to estimate and interpret VO2max from the YMCA Bike test Use norms charts to interpret results

Step 1: Graph watts of kg/min on x-axis and HR on y-axis. Only graph data where HR is larger than 110 bpm. Step 2: Make a best fit line through the data and extend the line so that it intersects the predicted HRmax Step 3: Drop a line from the HRmax to the x-axis to find the watts of kg/min predicted at maximum exercise Step 4: Calculation based formula: VO2 = 7 + ((1.8*kg/min)/(kgBW) or 7 + (10.8W/kgBW)

Understand the YMCA Cycle Protocol, including how steady rate HR is determined and assessed

Submaximal cycle ergonometer test that uses two to four 3-minute stages of continuous exercise with a constant pedal rate of 50 rpm If HR IS <80 BPM, change resistance to 125 Watts If HR is 80-89 BPM, change resistance to 100 Watts If HR is 90-100 BPM, change resistance to 75 Watts If HR is >100 BPM, change resistance to 50 Watts Use stages 3 and 4 as needed to elicit two consecutive steady state HRs between 110 BPM and 70% of HRR 1st stage: 25 Watts 2nd stage: 125 Watts, 100 Watts, 75 Watts, 50 Watts 3rd stage: 150 Watts, 125 Watts, 100 Watts, 75 Watts 4th stage: 175 Watts, 150 Watts, 125 Watts, 100 Watts Reasons to Stop YMCA Test: Should be below 85% of HR max based on age

List the FITT-VP Aerobic Exercise Recommendations for Fitness

Time: 30-60 min/day (150 min/week) of purposeful moderate exercise, 20-60 min/day (75 min/week) of vigorous exercise, or a combination of moderate and vigorous exercise is recommended for most adults > than 20 min/day (>150 min/week) of exercise that can be beneficial, especially in sedentary persons

Know alternate patterns for resistance training: total body workout, upper-lower body split, push-pull split and body part split

Total body workout: hits all major muscle groups Upper-Lower body split: Upper body muscle groups then lower body muscle groups Push-pull split: Exercises that are pushing and then pulling, front vs. back Body part split: Leg muscle groups, arm muscle groups Target muscles - Agonist-antagonist - Push-pull Target joints - Multi-joint (compound) - Upper Extremity: pushups, dips - Lower extremity: Squat, Leg press - Single joint - Upper extremity: Bicep curls, tricep extensions -Lower extremity: leg curls, knee extension Dynamic (Concentric, Eccentric) vs Static Machines vs Free Weights vs Bands/Kettlebells/Balls

Describe the advantages and disadvantages of treadmill vs bike vs step tests

Treadmill tests: Advantages: walking is a familiar activity for many, can accommodate many fitness levels, pacing is not an issue, can adjust workload precisely Disadvantages: access to equipment, hard to get clear Bp or ECG signal, can be hard to balance, weightbearing and impact, holding handrails can be confounding. Cycle ergometry tests: Advantages: non-weightbearing and non-impact, easy to measure ECG, Bp, HR, take less space and less expensive, balance not an issue, can adjust workload, no electricity needed Disadvantages: pacing can be an issue, muscle fatigue can be limiting, VO2max measures are 10-15% lower with cycle ergometer compared with treadmill

List the FITT-VP Aerobic Exercise Recommendations for Fitness

Type: Regular purposeful exercise that involves major muscle groups and is continuous and rhythmic in nature

Know the minimum resistance training guidelines: rep. speed and load

Velocity 4-6 seconds/rep for beginners to focus on form Range of rep speeds is optimal Can emphasize concentric or eccentric phase with timing Be aware of Training Volume and Load Training volume = Number of reps X sets Ex: 100lb Bench press x 2 sets x 10 reps = 20 reps Training load = reps x sets x weight Ex: 100lb Bench press x 2 sets x 10 reps = 2000 units

List the light, moderate, vigorous measures for exercise intensity: %HRR, RPE (Borg 6-20 scale), METs, and %1RM

% HRR: very light- <30, light- 30-39, moderate 40- 59, vigorous 60-89, near maximal to maximal- > or = to 90 RPE: < very light- < than 9, very light to fairly light- 9-11, fairly light to somewhat hard- 12-13, somewhat hard to very hard- 14-17, > or = to very hard- > or = 18 METs: very light- > than 2, light- 2.0-2.9, moderate- 3.0-5.9, vigorous- 6.0-8.7, near maximal to maximal- > than or = to 8.8 %1RM: very light- < than 30, light-30-49, moderate- 50-69, vigorous- 70-84, near maximal to maximal- > than or = to 85

In-Line Lunge

- is a component of the deceleration movements and direction changes produced in exercise, activity and sport - provides a quick appraisal of left and right functions in the basic pattern. It is intended to place the body in a position to focus on the stresses as simulated during rotation, deceleration and lateral movements. - The narrow base requires appropriate starting stability and continued dynamic control of the pelvis and core within an asymmetrical hip position equally sharing the load. - places the lower extremities in a split-stance position while the upper extremities are in an opposite or reciprocal pattern. This replicates the natural counterbalance the upper and lower extremities use to complement each other, as it uniquely demands spine stabilization - challenges hip, knee, ankle and foot mobility and stability, at the same time simultaneously challenging the flexibility of multi-articular muscles such as the latissimus dorsi and the rectus femoris. - True lunging requires a step and descent. The inline lunge test only provides observation of the descent and return; the step would present too many variables and inconsistencies for a simple movement screen. - The split-stance narrow base and opposite shoulder position provide enough opportunities to discover the mobility and stability problems of the lunging pattern.

Trunk Stability Push-up

- is a unique, single-repetition version of the common floor-based pushing exercise - used as a basic observation of the reflex core stabilization and is not a test or measure of upper-body strength - to initiate movement with the upper extremities in a push-up position without allowing movement of the spine or hips - Extension and rotation are the two most common compensatory movements. These compensations indicate the prime movers within the push-up pattern incorrectly engage before the stabilizers. - tests the ability to stabilize the spine in the sagittal plane during the closed kinetic chain, upper-body symmetrical pushing movement.

Rotary Stability

- observes multi-plane pelvis, core and shoulder girdle stability during a combined upper and lower extremity movement - requiring proper neuromuscular coordination and energy transfer through the torso. It has its roots in the creeping pattern that follows basic crawling in our developmental sequence - has two important implications: It demonstrates reflex stabilization and weight shifting in the transverse plane, and it represents the coordination efforts of mobility and stability observed in fundamental climbing patterns.

Understand the purpose, content, and administration of informed consent.

-Is collected before the collection of any personal and confidential information, any form of fitness testing, or exercise participation -Enough information must be present so the individual understands the purposes and risks associated with screening, assessment, and the exercise program -Should be verbally explained to the participant -Should include a statement that the individual has the opportunity to ask questions about the exercise screening, exercise testing or fitness assessment, or the exercise program, and has been given answers and sufficient information in order to consent -Document any questions that were asked, along with the responses -It must indicate that the person is free to withdraw at any time -Efforts must be made to keep privacy and comply with HIPPA

Explain the FMS performance pyramid and how skill is dependent upon performance and optimal movement fundamentals.

1. Bottom tier is movement fundamentals (mobility, balance, coordination) 2. Performance (strength, endurance & power) 3. Skill (run, shoot, swim) Creation of movement patterns: Motor learning - patterns stored in motor memory (cerebral cortex and basal nuclei) Sensory feedback - proprioceptors (GTO, spindles, pacinian corpuscles), visual feedback, vestibular centers (inner ear, cerebellum) Afferent and Efferent pathways and reflexes Movement fundamentals: Sources of reduction in mobility and stability: Dysfunction in any of the pathways described Any asymmetry between left and right sides Injury/pain and compensation Daily activity and postures Training or activity imbalances New neurological motor and recruitment pathways are created, even after pain or injury is resolved Functional movement is impaired.

Compare classic vs non-linear periodization and state the purpose of periodization.

1. Classic periodization - Use a progressive increase in the intensity with only small variations in each 2- to 4- week microcycle. - The group of four microcycles is termed a mesocycle. - A long-term training program consisting of several mesocycles is termed a macrocycle (e.g., a 1-year training plan) 2. Nonlinear or Undulating periodization - Variation in the intensity and volume within each microcycle (typically 7-10 days) over the course of the training program (e.g., a 16-week mesocycle) 3. Block Periodization - Each block has a different focus, rather than a build in intensity over time (like muscle endurance, power, and strength)

Describe, define, and assess the major signs or symptoms suggestive of cardiovascular, metabolic, and renal disease

1. Pain; discomfort (or other anginal equivalent) in chest, neck, arms, jaw, or other areas that may result from myocardial ischemia; or recent onset pain of unknown origin 2. Shortness at breath at rest or with mild exertion, Dyspnea (abnormally uncomfortable awareness of breathing) 3. Dizziness or syncope (loss of consciousness) 4. Orthopnea (dyspnea at rest in the recumbent position that is relieved by sitting upright or standing) or paroxysmal nocturnal dyspnea (dyspnea beginning 2-5 hours after the onset of sleep, which may be relieved by sitting on the side of the bed or getting out of bed) 5. Ankle edema (bilateral ankle edema that is out evident at night or unilateral ankle edema of a limb often results from venous thrombosis or lymphatic blockage in the limb) 6. Palpitations (unpleasant awareness of the forceful or rapid beating of the heart) or tachycardia 7. Intermittent claudication (the pain that occurs in lower extremities with an inadequate blood supply that is brought on by exercise 8. Known heart murmur 9. Unusual fatigue or shortness of breath with usual activities

Physical Activity Readiness Questionnaire (PARQ+):

A self-screening tool with the absence of a qualified exercise or health care professional that is completed by an individual that wishes to initiate an exercise program Was developed in part to reduce barriers for exercise and false positive screenings Questions to better tailor pre exercise recommendations based on relevant medical history and symptomatology May also be used as a mental health tool for professionals that may want additional screening resources beyond the Pre Participation Health Screening algorithm The questionnaire includes 7 questions and the + means additional follow-up questions to guide participation recommendations 1. Has your doctor said that you had a heart condition or high BP? 2. Do you feel pain in your chest at rest, during your ADL's, or when you do physical activity? 3. Do you lose balance because of dizziness or have you lost consciousness in the last 12 months? 4. Have you ever been diagnosed with another chronic medical condition? 5. Are you currently taking prescribed medications for a chronic condition? 6. Do you currently have or have had within the past 12 months a bone, joint, or soft tissue problem that could be made worse by becoming more physically active? 7. Has your doctor ever said that you should only do medically supervised physical activity?

State the conditions that must exist for submaximal tests to be truly predictive of VO2max

Administration - Endpoint : % of age-predicted MHR or HR range - 3-4 minute stages to ensure steady-state HR - VO2max estimated from intensity that would have been achieved if the person had worked to maximum. - Accurate predictive ability based on - Steady state HR is obtained for each exercise work rate. - Linear relationship between HR and work rate. - Minimal difference between actual and predicted HRmax. - Mechanical efficiency is the same for everyone. - No situation to alter the HR response to exercise

Advantages of free weights & machines

Advantages: - Free weights incorporate the stabilizing muscles that enable you to perform the movements you choose to make and may be more effective in producing overall muscular strength and power gains. - Free-weight exercises tend to more closely match the movement patterns you're likely to need for specific sports. - Free weights are more versatile; you can do a wide variety of exercises with a simple set of dumbbells. - Free weights tend to be inexpensive, are portable and take up little space. - Machines are generally safer and easier to use, an advantage for beginners learning a specific movement. - Some machines are more efficient than free weights at isolating a specific muscle or muscle group. This is important when you're strengthening a specific body part or rehabilitating an injury. - Machines ensure correct movements for a lift, which helps prevent cheating when muscle fatigue sets in. - Machine workouts can take less time because you can move easily from machine to machine. Changing the resistance is easy; you just insert a pin or enter a code.

Pre-Participation Health Screening:

At the same time, to encourage the vast majority of the population to exercise and to reduce the barriers and costs of medical clearance in the general population. To identify individuals who should receive medical clearance before initiating a moderate to vigorous intensity exercise program or increasing their current exercise program To identify individuals that are with clinically significant diseases who may benefit from participating in medically supervised exercise program To identify individuals with medical conditions that may require exclusion from exercise programs until those conditions have been abated or controlled

Understand the limitations of using normative data, especially if it is not the same and age and gender as your subject, or does not use the same protocol, machine, or position that you used

Change in muscular fitness over time can be based on the absolute value of the external load or resistance, but when comparisons are made between individuals, the values should be expressed as relative values, In both cases, caution must be used in the interpretation of the scores because the norms may not include a representative sample of being measured, a standardized protocol may be absent, or the exact test being used may differ. In addition, the biomechanics for a given resistance exercise may differ significantly when using equipment from different manufacturers, further impacting generalizability.

List benefits of physical activity in each category: mental and cognitive health

Decreased anxiety and depression Improved cognitive function Enhanced physical function and independent living in older adults Enhanced feeling of well-being Enhanced quality of life Improved sleep quality and efficiency Enhanced performance of work, recreational, and sport activities Reduced risk of falls and injuries from falls in older adults Prevention of mitigation of functional limitations in older adults Effective therapy for many chronic diseases in older adults

Interpret cardiovascular fitness testing results and prescribe exercise based on results

Dependent on individual's health status, exercise tolerance, and exercise program goals Any component of FITT may be increased Frequency, intensity, and duration should not be increased together in any single week. Initially, gradual increases in frequency or duration every 1 to 2 weeks over the first 4 to 6 weeks is reasonable to get to the minimum requirements, given goals. After frequency and duration are established, intensity may be gradually adjusted until recommended quality and quantity of exercise are met. If you increase intensity, consider a decrease in duration so the total MET-min is equivalent. Then build up duration. Ex: A client is cycling for 30 min at 4 METS = 120MET-min. Increase the intensity to 5 METS, then decrease the duration to 25 min for the first week = 120 MET-min Following adjustments, monitor individuals for adverse effects (adjust downward if not well tolerated). No pace, no gain

Limitations of free weights & machines

Disadvantages: - You must learn to balance the weight while exerting force. This can be difficult—and potentially dangerous—if you are lifting weights overhead. - The isolation of specific muscles can be difficult. To target the muscle you want, you must use very precise technique. - Free weights can be swung for momentum rather than lifted slowly and steadily, which works the muscles more effectively and safely. - Training alone can lead to injury if you don't use proper technique. - Most machines involve moving a weight along a predetermined path, making it difficult to strengthen the stabilizer muscles. - Machines are much more limited, with most devices allowing only one exercise. - Most machines are geared to the average-sized person, so if you're shorter or taller than average, you may find it difficult to use some machines. However, some companies have developed equipment that is scaled down to suit many smaller men and women. - Using machines allows to adjust without putting undue stress on your muscles and joints. Using machines may also be easier and less discouraging if you're a novice, because free weights require some coordination to use.

Describe the advantages and disadvantages, names, and basic protocols of the field tests

Examples: 1.5-mile (2.4-km) test for time Rockport One-Mile Fitness Walking Test Cooper 12-minute test 6-minute Walk Test PACER test (kids) Advantages: easy to administer, some can be self-administered, can administer to groups of people simultaneously, little equipment needed, inexpensive, norms established for many field tests. Disadvantages: hard to get HR, RPE and Bp for some tests, hard to monitor for abnormal responses, some tests depend on maximal effort which may not be appropriate for some folks, pacing can be a challenge

Know the FITT-VP recommendations for cardiovascular health

Frequency: If only performing moderate intensity, at least 5 days per week If only performing vigorous intensity, at least 3 days per week If performing a combination of moderate and vigorous, 3 to 5 days per week Frequency is prescribed to match the intensity of exercise to be performed with fewer days required for minimal gains if higher intensities of exercise are performed. Intensity: Light, defined as 30-39% HRR or VO2R for deconditioned or sedentary persons. Moderate, defined as 40% to 59% of HRR or VO2R Vigorous, defined as 60% to 89% of HRR or VO2R Intensity should be designed to gradually increase up to the desired level. Interval training or short bouts can be used as training mechanisms. Time (duration): 30-60 min per session for moderate, 20 to 60 min per session for vigorous, 60-90 min per session for those aiming for weight loss or prevention of weight regain. Duration can be accumulated in >10 minute bouts. Type (mode): Continuous, rhythmic exercise using large muscle groups Must be a mode that taxes the cardiorespiratory system Consider client skill level and goals when selecting the exercise mode Volume: A minimum of >500-1,000 MET-min/wk-1; 1000 kcal/wk; 150 min/wk; >5400-7900 steps/day

List the FITT-VP Aerobic Exercise Recommendations for Fitness

Frequency: > or = to 5 days a week of moderate exercise, > or = to 3 days a week of vigorous exercise, or a combination of moderate and vigorous exercise from > or = to 3 to > or = 5 days a week Intensity: Moderate and/or vigorous activity is recommended for most adults Light- to moderate-intensity exercise may be beneficial in reconditioned adults

Joint ROM Movements & Norms

Hip Extension (lying prone and lifting leg straight up off the table): A- greater trochanter, SA- midline of lateral pelvis, MA- lateral midline of femur, Norm- 10-30 degrees Hip Flexion testing leg fully extended (lying supine and lifting leg straight up off the table, foot is straight): A-greater trochanter, SA- midline of lateral pelvis, MA- lateral midline of femur, Norm- 90-135 degrees Hip Adduction (lying supine, moving leg out towards the side, is taken in midline thigh): A- ASIS, SA- imaginary horizontal line connecting both ASIS, MA- anterior midline of femur, Norm- 10-30 degrees Hip Abduction (lying supine, moving leg in towards the opposite side, is taken in midline of thigh): A- ASIS, SA- imaginary horizontal line connecting both ASIS, MA- anterior midline of femur, Norm- 30-50 degrees Shoulder Extension (lying down and putting arm back): A- greater tubercle, SA- perpendicular to floor, MA- midline of lateral humerus, Norm-20-60 degrees Shoulder Flexion (having arm reach the sky): A- greater tubercle, SA- perpendicular to floor, MA- midline of lateral humerus, Norm-90-120 degrees Shoulder Internal Rotation (lying down with arm perpendicular to the floor and extending arm backward): A- olecranon process of elbow, SA- perpendicular to the floor, MA- lateral midline of ulna, Norm- 70-90 degrees Shoulder External Rotation (lying down supine with arm at 90 degrees and extending arm backward): A-olecranon process of elbow, SA- perpendicular to the floor, MA- lateral midline of ulna, Norm- 70-90 degrees

Know the "2-for-2" rule of progression

If the client can perform 2 or more repetitions over the assigned repetition goal in the last set in 2 consecutive workouts, weight should be added to the next training session - Increase resistance by 5-10%

Understand what VO2 max is and the ways used to measure it

Maximal Exercise Tests (HRmax, VO2max and AnT): Graded exercise tests Incremental changes in workload until peak exertion/exhaustion are achieved Typically performed in a clinical setting Submaximal Exercise Tests: Graded exercise tests or single stage, steady rate VO2 predicted from HR response to submaximal exercise Prescribed intensity Typically performed in a laboratory or gym setting

Understand the difference between max and submax testing, and when and why you'd use each method (pros vs cons)

Maximal: provides the best assessment of safety of exercise and disease presence. provides best data (e.g., true peak HR) for exercise prescription purposes. Submaximal: takes less time to perform, is less expensive, and does not require physician supervision. may be safer for those with established disease. Consider purpose and goals of the client, capability of client, time, equipment, personnel, safety, cost, risk-benefit

Know the standardized conditions for muscle fitness assessment

Muscle function tests are very specific to the muscle group and joints tested, the type of muscle action, velocity of muscle movement, type of equipment, and joint ROM. Results of any one test are specific to the procedures used, and no single test exists for evaluating total muscular endurance or strength. Individuals should participate in familiarization/practice sessions with test equipment and adhere to a specific protocol including a predetermined repetition duration and ROM in order to obtain a reliable score that can be used to track true physiologic adaptations overtime. Moreover, a warm-up consisting of 5-10 minutes of light intensity aerobic exercises, dynamic stretching, and several light intensity repetitions of the specific testing exercise should precede muscular fitness testing. These warmup activities increase muscle temperature and localized blood flow and promote appropriate cardiovascular responses for exercise Standardized conditions: 1. Aerobic warm up 2. Equipment familiarization 3. Strict posture 4. Consistent repetition duration (movement speed) 5. Full ROM 6. Use of spotters when necessary

Understand the general protocols and differentiate between the different strength vs endurance tests: pushup test vs 1-RM benchpress

Muscular Endurance: Pushup test: the maximum number of pushups that can be done without rest and evaluates the endurance of the upper body muscles 1. Men starting in the standard "down" pushup position (fingers pointing forward and under the shoulders, back straight, head up, using toes as the pivotal point) and women in the "knee pushup" position (lower legs in contact with the mat, fingers pointing forward and under the shoulders, back straight, head up) 2. The individual must raise the body by straightening the elbows and return to the "down" position, until the chin touches the mat and the stomach should not touch the mat 3. For both men and women, the individual's back must be straight at all times and must push up to a straight arm position 4. The maximal number of push-ups performed consecutively without rest is counted as the score 5. The test is stopped when the individual strains forcibly or unable to maintain the appropriate technique within two repetitions

Understand the general protocols and differentiate between the different strength vs endurance tests: 1-RM vs 10-RM

Muscular Strength: 1-RM: the greatest resistance that can be moved through the full ROM in a controlled manner with good posture 10-RM: performed until failure 1. Testing should be completed only after the individual has participated in familiarization/practice sessions 2. The individual should warm up by completing a number of sub maximal repetitions of the specific exercise that will be used to determine the 1-RM 3. Determine the 1-RM within four trials with rest periods of 3-5 minutes between trials 4. Select an initial weight that is within the individuals perceived capability (about 50%-70% of capacity) 5. Resistance is progressively increased by 5%-10% for upper body or 10%-20% for lower body exercise fro the previous successful attempt until the individual cannot complete the selected repetition(s); all repetitions should be performed at the same speed of movement and ROM to instill consistency between trials 6. The final weight lifted successfully is recorded as the absolute 1-RM or multiple RM

Interpret and use the Astrand-Rhyming nomogram for the bike and step test

One Stage (6-min) Cycle Test: Unconditioned male = 50 or 100 watts Conditioned male = 100 or 150 watts Unconditioned female = 50 or 75 watts Conditioned female = 75 or 100 watts 6 minute stage @ 50 rpm where steady state HR reaches 125-170 bpm. HR measured at minute 5 and minute 6 If HRs are within 5 bpm of each other, use average. If HRs are >5 bpm, have subject ride for an additional minute until 2 consecutive HRs are within 5 bpm. Use ave of these two HRs. VO2max prediction using nomogram Use ruler to connect the workload (watts * 6.12 = kg/min) to the average heart rate Careful about men vs women sides of lines Use Age Correction Factor if appropriate *Draw 2 dots between pulse rate and workload and connect it to get VO2 max