ACSM's Guidelines for Exercise Testing and Prescription Chapters 1-12

Skinfold Sites

- Abdominal - Triceps - Biceps- not in seven fold - Chest/Pectoral - Medial calf- not in seven fold - Midaxillary - Subscapular - Suprailliac - Thigh

Globally, ___% of adults are physically inactive

31.1%

Severe

35-49%

An average of the two measures is used provided they do not differ by more than ___ mm

5 mm

Moderately severe

50-59%

In the United States, ___% of adults meet aerobic guidelines, ___% meet muscle strengthening guidelines, ___% meet both

51.6% 29.3% 20.6%

Moderate

60-69%

A comprehensive preexercise evaluation in the clinical setting generally includes

a medical history and risk factor assessment, physical examination, and laboratory tests, the results of which should be documented in the client's or patient's file.

The principle behind the skinfold technique is that the amount of

subcutaneous fat is proportional to the total amount of body fat

Basic body composition can be expressed as the

relative percentage of body mass that is fat and fat-free tissue using a two-compartment model

High intensity statin therapy is generally recommended for those with 10-yr risk estimated to be ___% (high risk)

≥7.5%

Siri Equation

%Fat = [(495/body density) - 450] x 100

The information obtained from health-related physical fitness testing, in combination with the individual's medical and exercise history, is used for the following:

- *Collecting baseline data and educating participants about their present health/ fitness status* relative to health-related standards and age- and sex-matched norms. - *Providing data that are helpful in development of individualized exercise prescriptions* (Ex Rx) to address all health/ fitness components. - *Collecting follow-up data that allow evaluation of progress* following an Ex Rx and long-term monitoring as participants age. - *Motivating participants* by establishing reasonable and attainable health/ fitness goals

The following steps should be taken to ensure client safety and comfort before administering a health-related physical fitness test:

- *Perform the informed consent process* and allow time for the individual undergoing assessment to have all questions adequately addressed (see Figure 3.1). - *Perform exercise preparticipation health screening* (see Chapter 2). - *Complete a preexercise evaluation including a medical history and a cardiovascular disease (CVD) risk factor assessment *(see Chapter 3). A minimal recommendation is that individuals complete a self-guided questionnaire such as the Physical Activity Readiness Questionnaire + (PAR-Q +) (see Figure 2.1). Other more detailed medical history forms may also be used. - *Follow the list of preliminary testing instructions* for all clients located in Chapter 3 under "Participant Instructions" section. These instructions may be modified to meet specific needs and circumstances.

YMCA cycle ergometer

- 2-4 3 min stages - HR at end of stage determines amount of resistance for next stage, plot and determine VO2max

YMCA Step test

- 3 min - 12 in bench - 24 steps per minute - After 3 min, sit client down, take HR first 5 s, take 15 s HR

Circumference Sites

- Abdomen - Arm - Buttocks/hips - Calf - Forearm - Hips/ thigh - Mid-thigh - Waist

The ACSM-AHA Primary Physical Activity Recommendations

- All healthy adults aged 18-65 yr should participate in moderate intensity aerobic PA for a minimum of 30 min on 5d/wk OR vigorous intensity intensity aerobic activity for a minimum of 20 min on 3d/wk - Combinations of mod and vig intensity exercise can be performed to meet this recommendation - Moderate intensity aerobic exercise can be accumulated to total the 30 min minimum by performing bouts each lasting >10 min - Every adult should perform activities that maintain or increase muscular strength and endurance for a min of 2d/wk - Because of the dose-response relationship between PA & health, individuals who wish to further improve their fitness + other benefits may exceed the minimum rec. of PA for more benefits

Pulmonary function testing with a spirometry is recommended for

- All smokers > 45 yr old - In any individual presenting with dyspnea (i.e., shortness of breath), - Chronic cough - Wheezing - Excessive mucus production

Preparticipation Screening algorithm

- Apparently healthy participants who do not currently exercise and have no history or signs or symptoms of CV, metabolic, or renal disease can immediately, and without medical clearance, initiate an exercise program at light-to-moderate intensity. If desired, progression beyond moderate intensity should follow the principles of Ex Rx covered in Chapter 6. - Participants who do not currently exercise and have (a) known CV, metabolic, or renal disease and (b) are asymptomatic should obtain medical clearance before initiating a structured exercise program of any intensity. Following medical clearance, the individual may embark on light-to-moderate intensity exercise and progress as tolerated following ACSM Guidelines. - Symptomatic participants who do not currently exercise should seek medical clearance regardless of disease status. If signs or symptoms are present with activities of daily living, medical clearance may be urgent. Following medical clearance, the individual may embark on light-to-moderate intensity exercise and progress as tolerated following ACSM Guidelines (see Chapter 6). - Participants who already exercise regularly and have no history or signs or symptoms of CV, metabolic, or renal disease may continue with their current exercise volume/ intensity or progress as appropriate without medical clearance. - Participants who already exercise regularly; have a known history of CV, metabolic, or renal disease; but have no current signs or symptoms (i.e., are clinically "stable") may continue with moderate intensity exercise without medical clearance. However, if these individuals desire to progress to vigorous intensity aerobic exercise, medical clearance is recommended. - Participants who already exercise regularly but experience signs or symptoms suggestive of CV, metabolic, or renal disease (regardless of disease status) should discontinue exercise and obtain medical clearance before continuing exercise at any intensity.

Muscular strength and endurance are health-related fitness components that may improve or maintain the following important health-related fitness characteristics

- Bone mass, which is related to osteoporosis - Muscle mass, which is related to sarcopenia - Glucose tolerance, which is pertinent in both the prediabetic and diabetic state - Musculotendinous integrity, which is related to a lower risk of injury including low back pain - The ability to carry out the activities of daily living, which is related to perceived quality of life and self-efficacy among other indicators of mental health - FFM and resting metabolic rate, which are related to weight management

Seven-Site Formula Sites

- Chest - Midaxillary - Triceps - Subscapular - Abdomen - Suprailiac - Thigh

Exercise preparticipation health screening algorthim with respect to?

- Determining current PA levels - Identifying signs and symptoms of underlying CV, metabolic, and renal disease - Identifying individuals with diagnosed CV and metabolic disease - Using signs and symptoms, disease history, current exercise participation, and desired exercise intensity to guide recommendations for preparticipation medical clearance

The following should be accomplished before the client/ patient arrives at the test site:

- Ensure consent and screening forms, data recording sheets, and any related testing documents are available in the client's file and available for the test's administration. - *Calibrate all equipment* (e.g., cycle ergometer, treadmill, sphygmomanometer) *at least monthly*, or more frequently based on use; certain equipment such as ventilatory expired gas analysis systems should be calibrated prior to each test according to manufacturers' specifications; and document equipment calibration. Skinfold calipers should be regularly checked for accuracy and sent to the manufacturer for calibration when needed. - *Ensure a room temperature between 68 ° F and 72 ° F* (20 ° C and 22 ° C) and humidity of less than 60% with adequate airflow

Factors that can alter submax HR response

- Environmental - Dietary - Behavioral

Two important conclusions from the Physical Activity Guidelines Advisory Committee Report

- Important health benefits can be obtained by performing a moderate amount of PA on most, if not all days of the week - Additional health benefits result from greater amounts of PA. Individuals who maintain a regular program of PA that is longer in duration, of greater intensity, or both are likely to derive greater benefit than those who engage in lesser amounts.

A comprehensive health/ fitness assessment includes the following:

- Informed consent and exercise preparticipation health screening - Preexercise evaluation - Resting measurements - Circumference measurements and body composition analysis - Measurement of CRF - Measurement of muscular fitness - Measurement of flexibility.

General Indications for stopping an Exercise Test

- Onset of angina or angina-like symptoms - Drop in SBP of >10 mm Hg w an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing - Excessive rise in BP: systolic pressure >250 diastoliv > 115 - Shortness of breath, wheezing, leg cramps, or claudication - Signs of poor perfusion: light-headedness, confusion ataxia, pallor, cyanosis, nausea, or cold and clammy skin - Failure of HR to increase with increased exercise intensity - Noticeable changes in heart rhythm by palpation or auscultation - Subject requests to stop - Physical or verbal manifestations of severe fatigue - Failure of the testing equipment

Lifestyle modification cornerstone of antihypertensive therapy

- PA - Weight reduction - Dietary Approaches to Stop Hypertension (DASH) eating plan (i.e., a diet rich in fruits, vegetables, low-fat dairy products with a reduced content of saturated and total fat), - Dietary sodium reduction (no more than 2 g sodium per day), - Moderation of alcohol consumption

Major Signs or Symptoms Suggestive of Cardiovascular, Metabolic, and Renal Disease

- Pain; discomfort (or other anginal equivalent) in the chest, neck, jaws, or other areas that may result from myocardial ischemia - Shortness of breath at rest or with mild exertion - Dizziness or Syncope - Orthopnea or paroxysmal nocturnal dyspnea - Ankle edema - Palpitations or tachycardia - Intermittent claudication - Known heart murmur - Unusual fatigue or shortness of breath with usual activities

Astrand-Rhyming Cycle Ergometer Test

- Single stage test lasting 6 min - Pedal rate 50 rpm - Goal to obtain HR between 125-175 - HR measured during 5th & 6th min - Average of the two HRs is used to estimate VO2max

Disease risk increases with total waist-to-hip measurement above

.0.95 for men 0.86 for women

Skill-Related Physical Fitness Components

1) Agility 2) Coordination 3) Balance 4) Power 5) Reaction time 6) Speed

Health-Related Physical Fitness Components

1) Cardiorespiratory Endurance 2) Body Composition 3) Muscular Strength 4) Muscular Endurance 5) Flexibility

general procedures for submaximal testing of cardiorespiratory fitness

1) HR & BP right before exercise 2) Familiarize patient w equipment (treadmill/cycle) (upright posture, 25 degree bend in knee, hands proper position 3) 2-3 min warm up 4) 2 or 3 min stages 5) HR taken at end of 2nd & 3rd min. If HR is >110 steady state (within 5 beats) should be reached before increasing workload 6. BP last min of each stage 7. RPE near end of min and end of each stage 8. Monitor clients symptoms 9. Stop test when reaches 70% HR from 85% predicted, fails protocol, symptoms, asks to stop, emergency 10. Physiologic observations monitored for at least 5 min. Continue low level exercise until HR & BP stabel

Preparticipation health screening before initiating PA or an exercise program for gen. pop is a two-stage process:

1. The need for medical clearance before initiating or progressing exercise programming is determined using the updated and revised ACSM screening algorithm (see Figure 2.2) and the help of a qualified exercise or health care professional. In the absence of professional assistance, interested individuals may use self-guided methods (discussed later). 2. If indicated during screening (see Figure 2.2), medical clearance should be sought from an appropriate health care provider (e.g., primary care or internal medicine physician, cardiologist). The manner of clearance should be determined by the clinical judgment and discretion of the health care provider.

Two consecutive HR measurements between ___ & ___ should be obtained to predict VO2max

110 BPM 70% HRR

For individuals aged 40- 70 yr, each increment of 20 mm Hg in systolic blood pressure (SBP) or 10 mm Hg in diastolic blood pressure (DBP) doubles the risk of CVD across the entire BP range of ________

115/75-185/115 mm Hg

Light intensity PA = ? METs

2.0-2.9 METs

Moderate intensity PA = ? METs

3.0-5.9 METs

Classification of LDL

<100 Optimal 100-129 near optimal/ above optimal 130-159 Borderline high 160-189 High ≥190 Very high

Recommended BP goal for most patients is

<140./90

Classification of Triglycerides

<150 Normal 150-199 Borderline high 200-499 High >500 Very high

Classification of Total Cholesterol

<200 Desirable 200-239 Borderline high ≥240 High

Very Severe

<35

Classification of HDL

<40 low ≥60 high

Vigorous intensity PA = ? METs

>=6.0 METs

JNC 7

A classification scheme for hypertension in adults

Physical Fittness

Ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to to enjoy leisure-time pursuits and meet unforeseen emergencies

Atherosclerotic Cardiovascular Disease (CVD) Risk Factors and defining criteria

Age: Men > 45 yr, Women > 55 yr Family History: MI, coronary revascularization, or sudden death before 55 yr in father or other male first-degree relative or before 65 yr in mother or other female first-degree relative Cigarette smoking: Current cigarette smoker or those who quit within the previous 6 mo or exposure to environmental tobacco smoke Sedentary lifestyle: Not participating in at least 30 min of moderate intensity, physical activity (40%-<59% VO2R) on at least 3 d of week for at least 3 mo Obesity: Body mass index >30 kg*m or waist girth >102 cm (40 in) for men and >88 cm (35 in) for women Hypertension: Systolic BP >140 mm Hg and/or diastolic >90 mm Hg, measurements for two separate occasions Dyslipidemia: LDL cholesterol >130 mg dL or HDL <40 mg dL or on lipid-lowering medication If total serum cholesterol all that is available, use >200 mg*dL Diabetes: Fasting plasma glucose =>126 mg*dL or 2 h plasma glucose values in oral glucose tolerance test (OGTT) =>200 mg*dL or HbA1C >6.5% Negative risk factors: HDL cholesterol >60 mg * dL, if present, one positive risk factor is removed

Waist to hip ratio

Circumference of the waist divided by the circumference of the hips

Physical Activity

Any bodily movement produced by the contraction of skeletal muscles that result in substantial increase in caloric requirements over resting energy expenditure

The term COPD can be used when ______ are present and spirometry documents an obstructive defect

Chronic bronchitis, emphysema, or both

Most common cause of sudden cardiac death among young individuals

Congenital & hereditary abnormalities

Field Tests

Consist of walking or running for a predetermined time or distance Advantages: Easy to administer to to large numbers of individuals at one time Disadvantages: Can be maximal or near maximal for some individuals

Primary submax test

Cycle ergometer

Main goal of BP treatment

Decrease the risk of CVD morbidity and mortality and renal morbidity.

JNC 8

Does not address the classification of prehypertension or hypertension in adults but rather recommends thresholds for pharmacologic treatments

FVC

Forced Vital Capacity

FEV 1.0

Forced expiratory volume in one second

Single stage and multistage submax exefcise tests are available to estimate VO2max from ___ measurements

HR

If an individual is referred for medical clearance, the extent of the preexercise evaluation is based on the discretion of the _____

Health Care Provider

Rockport 1 mile test

Individual walks as fast as possible for 1 mile then HR is measured immediately after completion of 1 mile can get VO2max w equation

ATS based on FEV 1.0 Mild

Less than the LLN but >70%

Norms of body fat

Men: 10-22% Women: 20-32%

______ is the most common exercise-related complication and is often associated with exercise intensity, the nature of the activity, preexisting conditions, and musculoskeletal anomalies.

Musculoskeletal injury

GOLD I

Mild FEV 1.0 ≥80% of predicted

GOLD II

Moderate 50% < FEV 1.0 < 80% predicted

Muscular Endurance

Muscles ability to continue to continue to perform successive exertions or repetitions against a submax load

Muscular Strength

Muscles ability to exert a max force on one occasion

Muscular Power

Muscles ability to exert force per one unit of time

Classification and Management of Blood Pressure for Adults

Normal: <120 SBP and <80 DBP Prehypertension: 120-139 SBP, 80-89 DBP Stage 1 Hypertension: 140-159 SBP, 90-99 DBP Stage 2 Hypertension: Greater than or equal to 160 SBP, greater than or equal to 100 DBP

Cooper 12 minute test

Objective is to cover greatest distance in 12 min can get VO2max w equation

When triglycerides are >500 mg*dL, they become the primary target of therapy due to the increased risk of ____

Pancreatitis

Most apparently healthy subjects reach their subjective limit of fatigue at an RPE of ___ on Borg scale, or ___ on the category-ratio scale

RPE 18-19 9-10

JNC 8 guideline recommends initiating pharmacologic therapy for patients ≥60 yr at

SBP ≥ 150 mm Hg or DBP ≥ 90 mm Hg and to treat to an SBP goal of < 150 mm Hg and a DBP goal of < 90 mm Hg.

GOLD III

Severe 30% < FEV 1.0 < 50% predicted

Muscular Endurance

The ability of muscle to continue to perform without fatigue

Muscular Strength

The ability of muscle to exert force

Cardiorespiratory Endurance

The ability of the circulatory and respiratory system to supply oxygen during sustained physical activity

Power

The ability or rate at which one can perform work

Agility

The ability to change the position of the body in space with speed and accuracy

Speed

The ability to perform a movement within a short period of time

Coordination

The ability to use the senses, such as sight and hearing, together with body parts in performing tasks smoothly and accurately

Balance

The maintenance of equilibrium while stationary or moving

Flexibility

The range of motion available at a joint

Body Composition

The relative amounts of muscle, fat, bone, and other vital parts of the body

Reaction time

The time elapsed between stimulation and the beginning of the reaction to it

Exercise

Type of physical activity consisting of planned, structured, and repetitive bodily movement done to improve and/ or maintain one or more components of physical fitness

Suggested work rate based on sex for AR cycle test

Unconditioned men: 300 or 600 kg*m*min Conditioned men: 600 or 900 Unconditioned woman: 300 or 450 Condition women: 450 or 600

Classification of Disease Risk Based on BMI

Underweight: <18.5 Normal: 18.5-24.9 Overeight: 25-29.9 (Increased) Obesity Class I: 30-34.9 (HIgh) Obesity Class II: 35-39.9 (V High) Obesity Class III: Greater than or equal to 40 (Extremely high)

6 min walk test

Used to estimate CRF in population considered to have reduced CRF and other clinical populations can get VO2peak w equation completing less than 300 meters demonstrate poorer short term survival

GOLD IV

Very Severe FEV 1.0 < 30% predicted respiratory failure

Risk Criteria for Waist Circumference in Adults

Very low: Women- <70 cm (<28.5 in) Men- <80 cm (31.5 in) Low Women- 70-89 cm (28.5-35 in) Men- 80-99 cm (31.5-39 in) High Women- 90-110 cm (35.5-43 in) Men- 100-120 cm (39.5-47 in) Very high Women: >110 cm (>43.5 in) Men: >120 cm (>47 in)

BMI

Weight relative to height calculated by dividing body weight in kilograms height in meters squared

1.5 mi test

cover distance in shortest amount of time can get VO2max w equation

VO2Max is the product of

maximal cardiac output and arterial-venous oxygen difference

muscular fitness test results can be compared to established standards and can be helpful in identifying weaknesses in certain muscle groups or ________ that could be targeted in exercise training programs.

muscle imbalances

Although the content and extent of consent forms may vary, enough information must be present in the informed consent process to ensure that the participant knows and understands

the purposes and risks associated with the test or exercise program in health/ fitness or clinical settings.