APK4125 Exercise Prescription Exam 1
Anthropometry
the measurement of the human individual
A female client that weighs 60kg performs a leg press 1-RM and achieves a maximum weight of 200lbs. What is this clients strength ratio?
1.52
When performing an isometric handgrip strength test what should the angle of the elbow joint be?
90 - 180 degrees
What Is Body Composition?
A branch of human biology which mainly focuses on the in vivo quantification of body components, the quantitative relationships between components, and component alterations related to various influencing factors
Common 7-Site Skinfold
Abdominal Triceps Chest Midaxillary Subscapular Suprailiac Thigh
Dynamic Endurance Testing
Ability of a muscle group to: •Execute repeated contractions over a period of timesufficient to cause muscular fatigue...OR... •Maintain a specific % of the MVC or 1-RM for a prolonged period of time
Methods for Measuring and Estimating Body Composition: Direct Method (in vivo)
Dissection
A handgrip dynamometer can only be used to measure muscular strength and not muscular endurance.
False
Potency of Exercise
For a given exercise what's the amount of change
Net vs. Gross Rates of Oxygen Consumption
Gross VO2: caloric cost of rest and exercise Net VO2: caloric cost of exercise alone (Resting VO2 is essentially your MET)
ACSM Recommended Lifts
Lower Body Strength •Leg Press or Leg Extension •Constant Resistance Machine
Cable Tensiometers
Measure static strength on 38 diff. muscle groups
If you are performing a muscular fitness test that has the client perform 15 repetitions, which component of muscular fitness would this test best evaluate?
Muscular Endurance
Physical Inactivity
Not meeting the recommended guidelines for PA
Progression
The process of altering training stress as a client adapts
Any submaximal test that reaches above 85% of the client's %HR Max is terminated because values above 85% can no longer be considered "sub-maximal".
True
Performing a pre-participation health screening on a client before exercise training is NOT a federal law.
True
The American College of Sports Medicine recommends that the Valsalva maneuver be avoided during any resistance exercise.
True
How is Obesity Calculated?
While obesity is defined as an excess amount of fat, most major health organizations (World Health Organization, Center for Disease Control, National Institute of Health) quantify obesity with bodyweight or body mass index. •Center for Disease Control Obesity is a label for a range of weight that is greater than what is generally considered healthy for a given height. The term also identifies ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems.
Direct Calorimetry
almost never seen in human fitness measurements. Only in extreme laboratory research methods is it used.
In all sub-maximal tests the client must reach volitional fatigue before the client stops.
false
VO2peak
highest VO2 achieved when a true VO2max has not been attained or validated
VO2max
rate of oxygen uptake during maximal aerobic exercise
Open-circuit spirometry
the air that the organism is taken in from the surrounding air (and in general we assume that it is comprised of 78% Nitrogen, 21% Oxygen, .03% carbon dioxide and 1% other gases). When the organism exhales the air is collected and compared to the assumed composition of the air they inhaled. •The overwhelming majority of metabolic carts used for VO2 analysis today are open-circuit spirometry. Including the Parvo-medic carts used in Lab.
Push-up Test Procedures
•"Traditional" vs. "modified" starting position •Start in the "down" position •Hands under shoulders •Raise body by straightening elbows and return to down position until chin touches mat...stomach should not touch the mat •Straight back at all times •Record max number of consecutive push-ups w/o rest •Stop when subject strains forcibly or is unable to maintain proper technique w/in two reps
Skill Related Fitness Components
•Agility •Balance •Coordination •Speed •Power •Reaction Time
2018 PA Guidelines for Americans
•All adults should avoid inactivity...some PA is better than none •150 min of mod-intensity or 75 min of vig-intensity aerobic PA (or a combo) •Min of 10-minute increments at a time •For more benefits: 300 min of mod-intensity or 150 min of vig-intensity aerobic PA (or a combo) •At least two days/week of resistance exercise at mod- or vig-intensity
How to measure skinfold on: Suprailliac
•Ask subject to locate iliac crest (Hip Bone) for you •Taken immediately superior to the iliac crest (in line with natural angle of iliac crest) at Anterior Axillary Line •Diagonal Fold
Modality of VO2 Testing: Arm Ergometry
•Beneficial with clients that have lower body disabilities. •HR, BP tend to be higher at submaximal loads for Arm ergometry relative to lower body modalities
Collect blood and/or respiratory gases (more direct estimate)
•Consumed air can be masured in two ways, either closed-circuit spirometry or open-circuit spirometry. •Open-circuit spirometry is used more often, because of greater availability, easier setup and cheaper cost.
How can VO2max be estimated from exercise data?
•Nomogram (indirect estimate) •Regression equations (indirect estimate) •Collect blood and/or respiratory gases (more direct estimate)
Reasons to Conduct Screening
•Identify those with medical contraindications to PA participation. •Identify those who should receive a medical/physical evaluation/exam prior to PA or assessments. •Identify those who should participate in a medically supervised PA program. •Identify those with significant health/medical concerns (e.g., orthopedic injuries). •Provide benchmark data as an effective motivational tool for client goal setting. •Provide normative data for screening assessments, and to determine meaningful fitness assessment choices.
Reasons for measuring CRF:
•Identifying physiological strengths and weaknesses •Ranking people for selection purposes •Predicting future performances •Evaluating the effectiveness of a training program or trial •Tracking performance over time •Assigning or manipulating training dosage (Resting and exercising assessments should be completed)
Pacer Test
•Maximal Field Estimation test •Originally created by Luc Leger at the University of Montreal in 1983 •Wanted an option for testing in a confined area (20m), that multiple subjects could be tested at once. •Like the Cooper test although it's a maximal test no heart rate is required for the estimation of VO2 •Make sure that the 20 meter course is marked with cones and tape and each runner has a lane. •At the sound of the beep subject runs to the 20 meter mark before another beep is heard. •Subject waits until another beep and returns to the starting position. •In original pacer test a triple beep indicates an increase in speed. •Subject keeps running until they are no longer able to keep up with the beeps, or they stop.
Three items to address when determining the assessments used:
•Physiologic Demands of the goal •Biomechanic and movement demands of the goal •Injury Risk analysis for client and goal
How to measure skinfold on: Tricep
•Posterior midline of upper arm, half-way between acromion and olecranonprocesses •Make sure subject's arm is relaxed and held freely on the side •Vertical Fold
Why is Body Composition Important for Exercise Prescription
•The overwhelming majority of exercise goals in commercial fitness are body composition related. "I want to be more toned" "I want to lose 5-10lbs" "I want to be healthier" "I want to lean out" "I want to have bigger muscles" •To monitor these goals a trainer need to have a good method of assessing the clients body composition. -If you don't have a starting place and it's hard to give directions •In addition, these goals need to be transformed into S.M.A.R.T. goals
Waist Circumference Measurement
•Waist circumference measurement is simple, reliable, and correlates well with abdominal fat content irrespective of the BMI. •A horizontal measure at the narrowest part of the torso (above the umbilicus and below the xiphoid process) •Waist circumference alone may be used as an indicator of obesity-related health risk because abdominal obesity is the primary issue.
History of PA Preparticipation Screening
•Guidelines for preparticipation not legally mandated. •Surgeon General Report (1996) stated that previously inactive men over age 40, women over age 50 and people at risk for CVD should consult a physician before starting an exercise program. •Guidelines are suggestions, ultimately the decision is up to the exercise professional. •If an exercise professional doesn't do any health screening they have the potential of being sued for negligence. •If an exercise professional diagnoses a client with a disorder (e.g., hypertension) than they have may be charged with practicing medicine without a license. Depending on the extent of diagnoses and recommendations this can be charged as a misdemeanor or a felony. (Practicing without a license for the exercise professional who also gives out diet prescriptions, 45-50 states including Florida) •The two most widely recognized screening programs are those put forth by the ACSM and the AHA. •The AHA guidelines make some additional suggestions related to PA restrictions, monitoring, and supervision during exercise. •Originally, ACSM had a risk stratification as the screening tool. In GETP 10thedition, ACSM now relies on physical activity history of the participant as well as the presence of cardiovascular, metabolic or renal disease. •AHA guidelines are still risk stratification. •According to ACSM there are two levels of screening •Self-guided •Professional •The two types of screening are not mutually exclusive.
Current List of Cardio/Metabolic/Renal Diseases
•Heart Attack •Heart Surgery, cardiac catheterization, or coronary angioplasty •Pacemaker/implantable cardiac defibrillator/rhythm disturbance •Heart valve disease •Heart failure •Heart transplantation •Congenital heart disease •Diabetes, type 1 and 2 •Renal disease such as renal failure
ADA 2015 Guidelines
•Hemoglobin A1C ≥6.5% •Fasting (≥8 hours) plasma glucose (FPG) ≥126mg/dL •2-hour plasma glucose (PG) ≥200mg/dL during oral glucose tolerance test (OGTT) •Random plasma glucose (PG) ≥200mg/dL
Competition Formulas
•In powerlifting competitions coefficients are often calculated to allow from comparison between different ages and weight classes. •One of the most popular coefficients is the Wilks coefficient named after Robert Wilks CEO of Powerlifting Australia •Coeff=((500)/(a+bx+cx2+dx3+ex4+fx5)) •For men a=-216.0475, For women a=594.3174 •For men b=16.2606, For women b=-27.2384 •For men c=-0.0024, For women c=0.8211 •For men d=-0.0011, For women d=-0.0093 •For men e=7.0186-6, For women e=4.7316-5 •For men f=-1.291-8, For women f=-9.054-8 •X=bodyweight of the lifter
Factors Influencing BMI
•Infancy and childhood •Ageing •Racial differences •Athletes/Athletic Training •Military and civil forces personnel • Special Health and Clinical circumstances
How to measure skinfold on: Chest
•Locate Anterior Axillary line (Front of Armpit line) and nipple •Men: 1/2 distance between Anterior Axillary Line and nipple •Women: 1/3 distance between Anterior AxillaryLine and nipple •Diagonal Fold
Guidelines
•Many associations (ACSM, NSCA, NASM, ACE) have guidelines. These guidelines are just suggestions for the given population they aren't set in stone for each client. •They can be modified, but with modification there must be validation. •Exercise Prescriptions require modification in accordance with observed individual responses and adaptations. •Guidelines represent averages and ranges. The most important part of a prescription is: THE INDIVIDUAL! •The goals and needs of this individual and their reaction to the prescription is what dictates the program.
Bruce Protocol
•Maximal Graded Exercise Treadmill Laboratory test •Most commonly used protocol, especially in combination with ECG •Duration of each stage: 3 minutes •Beginning workload: 1.7 mph, 10% grade •Ideal Population: works best for young and fit individuals, but it is not an athletic based test. It is used for cardiovascular diagnostics. •Drawbacks: no plateau in VO2 commonly seen
12 minute test (Cooper Test)
•Maximal field estimation test •Originally created by Kenneth Cooper military use. •Estimation of VO2 based off of distance covered in 12 minutes •Needed to create a fast way of getting the best estimation of cardiovascular performance (i.e., VO2) without any equipment •VO2max (ml · kg−1 · min−1) = (22.351 × distance covered in kilometres) − 11.288
Skinfold Testing
•Measures the amount of subcutaneous fat and assumes that subcutaneous fat is proportional to total body fat •Dr. Karl Lange created the Lange calipers in the 1950's •Proportion of subcutaneous fat to total fat does vary with gender, age, and ethnicity •Subcutaneous fat = adipose tissue deposited directly underneath the skin •Numerous sites have been standardized for assessment •Calipers should deliver specific amount of force (12g/mm2) •Drawbacks include accuracy, technique is difficult to master •Cost ~ $125.00 (Baseline Medical) •SEE ~±5% (typically see 3.5%, but that's relative to hydrostatic weighing.
Standard Operating Procedure
•Medical History Review •Risk Factor Assessment •Prescribed Medications (and supplements) •Level of Physical Activity (current and past) •Establishing the need for physician consent - now because of the new ACSM guidelines this is reserved for individuals looking to perform high intensity exercise. •Administration of fitness tests AND evaluation of results •Setup of exercise prescription •Evaluation of progress with follow-up tests. (M.R. P.L.E.A.S.E)
Purpose of PreparticipationScreening
•Minimize risks associated with PA (more specifically exercise) •Involves gathering and analyzing demographic and health-related information on a client along with some medical/health assessments such as the presence of signs and symptoms in order to aid decision making on a client's physical activity future •Allows the exercise physiologist to make informed decisions about an individuals physical ability and limitations when engaging in a PA program
Rating of Perceived Exertion
•Modified Borg Scale 1-10 •OMNI is a contemporary contraction of the word omnibus. Used in the context of perceived exertion metrics, OMNI means a RPE scale having broadly generalizable properties. The scale has both verbal and mode specific pictorial descriptors distributed along a comparatively narrow numerical response range, 0 -10. •1-10 may be used when medications or age skew the results of a Borg Scale
Bruce Procedures
•Monitor HR every minute •Take BP prior to every 3rd minute •Ask RPE prior to every 3rd minute •Terminate test either when subject reaches volitional fatigue, or if any physiological indication for terminating the test is observed •There are Nomograms and regression equations for the Bruce protocol if gas isn't collected.
Multi-frequency Bioelectrical Impedance Analysis
•Multi-Frequency systems measure impedance (Z), resistance ( R ), and reactance (X), which are mathematically linked: Z2=R2+X2 and use empirical linear regression models to estimate total body water •MF-BIA uses different frequencies (in the case of seca mBCA 514: 1, 2,3, 5, 7.5, 10, 15, 20, 30, 50, 75, 100, 150, 200, 300, 500, 750 1,000kHz) •Measurements are made as follows: right arm, left arm, right leg, left leg, trunk, right side of the body, left side of the body •Uses regression equations from 4 compartment model to adjust fat-mass estimation. •Drawbacks include accuracy (while more accurate than most indirect methods it's still not a criterion method), cost •Cost ~ $13,000 •SEE ~±1.5%
Procedural Considerations for VO2max Testing
•Multiple technicians are needed: •RPE collector/motivator •Spotter/personal assistant •Timer/met cart •Recorder •Communication with each other (noise) •Communication with the subject (hand signs) •Safety precautions •Sanitation •Cool down importance
New Blood Pressure Guidelines (ACC/AHA 2017)
•Normal: Less than 120/80mmHg •Elevated: Systolic between 120-129 and diastolic less than 80; •Stage 1: Systolic between 130-139 or diastolic between 80-89 •Stage 2: Systolic at least 140 or diastolic at least 90mmHg
General Procedures for Submaximal Testing of Cardiorespiratory Fitness
•Obtain resting HR and BP immediately prior to exercise in the exercising posture •The client should be familiarized with the equipment being used. •The exercise test should begin with 2-3 minute warm up to acquaint the client with the feeling of exertion and prepare him or her for the first level of intensity •Most accurate protocols will consist of stages of different intensity (Graded exercise test) •Each stage of exercise the heart rate should be monitored and the heart rate should be at steady state (within 5 beats per minute) •Blood pressure should be measured once per stage •RPE should be monitored •Client's signs should be monitored throughout the test •If the client goes above 85% of age-predicted HRmax the test should be terminated •An appropriate cool-down should be initiated. •All physiological measurements should be continued for 5 minutes after test stops.
Total Body Water
•On average the adult human body has 50-65% water. •Total Body Water can fluctuate up to 5% daily (Stevens, 2006) •Example: -200lb man, 65% water -200lb*.65 à 130lbs -130lb*.05 à 6.75lbs -Variance from day to day can be ±6.75lbs (13.5lb total)
Dual Energy X-ray Absorptiometry (DEXA)
•Originally developed for the diagnosis of osteoporosis and the measurement of bone mineral density through densiometry. of DEXA scans are very accurate •The transmission of photons at two energy levels. •Drawbacks, high-costs low doses of radiation •Cost ~ $80,000 •SEE ~±1.5%
Self-Guided Screening Tools
•PAR-Q (1992) •PAR-Q+ (2010) - Hasn't been used long enough to accumulate sensitivity and specificity data. •ePARmed-X+Physician Clearance Follow-Up Questionanaire •AHA/ACSM Health/Fitness Facility Preparticipation 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 the AHA/ACSM Questionairre
Signs and Symptoms of CVD
•Pain or discomfort in the chest, neck, jaw, arms, or other areas that may be due to ischemia or lack of oxygenated blood flow. •Dyspnea or SOB at rest or at mild exertion may be an indication of underlying cardiac and/or pulmonary disease. •Syncope and dizziness during exercise •Orthopnea, and paroxysmal nocturnal dyspnea •Ankle edema or swelling (not injury-related) •Palpitations and tachycardia. •Intermittent claudication •Heart murmurs •Known disease
Criteria for Determining VO2max
•Plateau in VO2 with an increased intensity <150mL/min (Repeatedly been shown <50% of subject reach a plateau (Bassett and Howley, 2000)) •Post-exercise blood lactate >8 mmol / L •RER > 1.15 •Reach age-predicted max heart rate (220 - age) ± 10 bpm •RPE > 17 (Not mentioned by Bassett and Howley, 2000) •If no plateau in VO2, two of the other indices must occur for the GXT to be considered a valid max test •If the above criteria are not satisfied, VO2 obtained from maximal exercise testing is termed by most exercise physiologist as a VO2peak •VO2peak is commonly obtained in untrained and unmotivated individuals
Diagnostic Testing
•Predominantly used in cardiovascular testing •Preliminary diagnostic exercise testing is best used in patients with an intermediate probability of CAD as determined by age, gender and symptoms. •Diagnostic exercise testing is indicated in those who are about to start a vigorous exercise program. Or those involved in occupations in which cardiovascular events may affect public safety. •Always monitored by a physician •EKG tests, Echocardiogram, thallium scintigraphy, cardiac MRI,
80/20 Rule
•Proposed in fitness by Gray Cook •This rule is a reminder that not all exercise is helping the client get to their goal. •In the average individual's workout, 80% of the positive results from an exercise prescription are derived from 20% of the total workout. •i.e., After 6-weeks a 15 exercise workout routine increased 1-RM Bench press 40lbs. •The 80/20 rule would suggest that 30lbs of the increase in bench press came from 3 exercises in that workout •This isn't a defined law of exercise, but what is the overall take away message? •Start looking at workouts and ask yourself do all of these exercises go towards the goal of the client?
Muscular Assessment in Young Clients
•Protocols and norms specifically developed for children •Safety considerations: •Informed consent from guardian •Supervision! •Max testing is safe, but estimation is advised •Psychological Considerations: •Language: "pass/fail" or "tests" •Terminology such as "challenges" are better
Considerations in Selecting an Appropriate Test for CRF:
•Purpose of the test (functional capacity? ExRx?) •Physician supervised or not •Health status of participant •Length of test •Willingness of the participant •Cost •Personnel (qualifications?) •Equipment/facilities •Safety concerns •Max vs submax GXT
Bod Pod (Air Displacement Plethysmography)
•Released in 1995 •Similar to hydrostatic weighing, Bod Pod measures body volume doing so through changes in air volume. •In the manual it says that a person up to 7ft tall and weighing 500lbs can fit... •Drawbacks include high cost, calibration. •Cost ~ $35,000 •SEE ~±3.5%
Resting Assessments
•Resting HR and BP •Resting ECG
Muscular Assessment in Older Clients
•Senior Fitness Test (SFT) - battery of assessments used for adults over 60 years of age: •Strength •Endurance •Agility •Balance
YMCA 3 Minute Step Test Protocol
•Set metronome to 96 beats per minute •Have the subject stand facing the step •When ready, start the stopwatch and being stepping on and off the step to the metronome. •Take RPE at end of 1st-3rd minute. •Once 3 minutes is reached, have subject sit-down on the step. •Take their pulse manually for 60 seconds
Submaximal VO2 Testing
•Similar to maximal tests, except they don't allow the client to go to maximal intensities. •Submaximal tests estimate maximal effort from submaximal loads •Typically the estimation is a comparison of workload, size, age and heart rate. • Any submaximal test that reaches above 85% of a client's %HR Max is terminated because it's no longer considered a submaximal test
An increase in mitochondrion will increase ______________, which will in turn increase VO2 max
(a-v) O2 diff
Single Frequency Bioelectrical Impedance Analysis (handheld)
•Single Frequency systems measure impedance (Z), resistance ( R ), and reactance (X), which are mathematically linked: Z2=R2+X2 •Sends current through the body at a frequency of 50kHz. •No current BIA method measures total body impedance. Because no bioelectrical impedance device has current travel through the head. •SF-BIA permits estimate of fat-free mass and total body water, but cannot determine intra-cellular water •Drawbacks include low reliability, inability to measure dehydrated individuals, low accuracy. •Cost ~ $50 •SEE ~±10%
3 Assumptions with Skinfold Testing
•Skinfold is a good measure of sub-cutaneous fat •The distribution of fat (sub-cutaneous vs. internal) is similar for all individuals within each sex. •There is a LINEAR relationship between the sum of skinfolds and Body Density
Static Testing Equipment
•Spring-loaded Dynamometers •As force is applied to the instrument, a spring is compressed and moves an indictor needle
Muscular fitness includes:
•Strength - ability of the muscle to exert force (single max effort) Traditionally: <3 reps •Endurance - ability of the muscle to continue to perform successive exertions or many repetitions (multiple submax efforts) Traditionally: >12 reps
Relative Fat Estimation from Correlation with Body size
-Bodyweight measurement -Body Mass Index -Waist Circumference
Methods for Measuring and Estimating Body Composition: Indirect Methods
-Skinfolds -DXA Scan -Hydrostatic Weighing -Air Displacement Plethysmography -Bioelectrical Impedance Analysis (Single & Muli-Frequency)
Borg Rate of Perceived Exertion
-This particular scale was created by Gunnar Borg a Swedish Psychologist . There are several other RPE scales that are in use. -Borg Scale based off of the Heart Rate of a 20 year old person -If rating doesn't correlate with heart rate then exertion could be coming from something other than
Dynamic Endurance Test Battery
-arm curl, bench press, lat pull down: %BW > for men than women -triceps extension, leg extension, and leg curl: % BW same for men and women -add up the total reps (max of 15 for each exercise)
Muscle Balance - Agonist-Antagonist Pairs
•Strength imbalance between opposing muscle groups can affect joint health and stability •Crude index: compare relative 1-RM for opposing muscle groups *Note Muscular balance should also be kept 1:1 for all left and right muscles of the body Hip extensors and flexors- 1:1 Elbow extensors and flexors- 1:1 Trunk extensors and flexors- 1:1 Ankle inverters and everters- 1:1 Shoulder extensors and flexors- 3:2 Knee extensors and flexors- 3:2 Shoulder internal and external rotators- 3:2 Ankle plantar and dorsiflexors- 3:1
Handgrip Dynamometer: Assessing Endurance
1 min MVC •Squeeze as hard as possible for 1 minute •Measures % decline in force •Higher endurance = less decline 50% MVC •Squeeze at 50% MVC for as long as possible •How long can this force be maintained?
YMCA 3-Minute Step Test
•Sub-maximal, single stage step estimation test •Extremely portable and low amount of necessary equipment •Unlike McArdle 3-minute step, the YMCA step test was not originally created to estimate VO2 But an estimation equation may be used to estimate. •Can be too difficult for some out-of-shape, sedentary, older individuals •Equipment Needed: •12 inch step •Metronome •Stopwatch
Rockport Walking Test
•Submaximal field estimation test. •Developed at the University of Massachusetts at Amherst as a submaximal field test for a broad spectrum of users that was low-impact and safe. •Started using it at the Rockport Walking institute in 1971. •Algorithm developed equation based off of HR and individual characteristics •The subject is required to walk as fast as possible (always walking, i.e., one foot must always be on the ground) for the duration of the test. •At the end of the test measure heart rate and input variables into the following equation: VO2 max (ml/kg/min)= 132.853-(0.0769*weight)-(0.3877*age)+(6.315*gender)-(3.2649*time)-(0.1565*HR) •Weight -> kg •Age -> yrs with decimal •Gender -> 1=male 0=female •Time -> minutes with decimal •HR -> beats per minute
Procedures for Assessing Strength for Isometric Handgrip Dynamometer
1. Participant is in the standing position 2. Participants head is in the mid-position (facing straight ahead) 3. The grip size may need to be adjusted so the third digit's second phalanx is approximately at a right angle -Grip adjustments of 1.3cm on the Jamar dynamometer are made by removing the moveable handle and repositioning grip into one of the five manufactured slots: slot 1 = innermost position for smallest grip size; slot 5 = slot at the outermost position for the largest grip size 4. The grip setting (1-5) is recorded by the technician 5. The participants forearm is placed at any angle between 90 and 180 degrees of the upper arm 6. the participants wrist and forearm are positioned in the mid-prone position 7. the participant is instructed to exert maximally and quickly after hearing the technician's following instructions: "Are you ready?" "Squeeze are hard as you can" As the participant begins the technician says, "harder!...harder!...relax" 8. Participant will be asked to complete two or three trials, alternatively with each hand 9. the participants will be given a 30-second or up to a 1 minute rest between trials for the same hand 10. the technician records the force in kg and then converts the circled best score to newtons by multiplying the kg value by 9.8066 11. the technician resets the dynamometer pointer to 0 after each trial
Astrand-Ryhming Cycle Ergometer Test
•Submaximal single stage cycle ergometer estimation test. •Originally created in 1954, first submaximal cycle exercise test. •Per-Olof Astrand thought of the idea and performed the test with his future wife Irma Ryhming. •All based on a nonogram, which was created for cycling, running, and stepping. •Astrand-Rhyming Cycle test has been shown to have ±10% standard error. •Only 6 minutes long
Proper Skinfold Technique
•Take measurements on the right side of the body •Locate the site to be measured •Use a tape measure if needed to locate the correct anatomical site, mark site if necessary •Grasp the skinfold firmly with the thumb and index finger (NOT DIRECTLY on the SITE) approximately 1.5 inches to each side of the site (ACSM's Health-Related Physical Fitness Assessment Manual). Calipers should be 1 cm from thumb and index finger •Place caliper perpendicular to skinfold halfway between the crest and base of the fold •Release the caliper all the way so the caliper is applying the proper pressure on the fold •Read the thickness to the nearest 1 mm after approximately 2 seconds •A minimum of 2 measurements should be taken at each site--if the measurements vary by > 2 mm, then a third measurement must be taken The measurements should be taken sequentially; cycle through all of the sites before taking the second measurement at each site
Procedures for YMCA Cycle Ergometer Test
1. Record ambient conditions for the lab. 2. Select a subject and record body weight in kilograms. 3. Generate any other pre-GXT data that are necessary to provide a comprehensive view of the subject's cardiovascular risk (resting blood pressure, resting heart rate, health history, PAR-Q). 4. Calibrate the bicycle ergometer. 5. Provide the subject with a complete explanation of the purpose of the procedure. Prepare the subject for ECG and BP monitoring as described previously. 6. Set the metronome to 100 clicks per minute and instruct the subject to pedal so that one foot is in the "down" position with each click. 7. Instruct the subject to begin pedaling at 50 revolutions* min-1. 8. Adjust the resistance to the appropriate first workload (150 kgm*min-1). 9. Start the clock to begin the GXT. 10. The subject will exercise for three (3) minutes at workload #1. During the second minute of this stage, obtain blood pressure and Borg RPE rating. During the third minute, the subject's heart rate should be recorded. 11. Based on the heart rate response to workload #1, adjust the resistance for workload #2 accordingly by referring to the branching protocol chart. 12. Repeat step #10 above. The heart rate response to workload #2 should be between 110 and 150. In this range, there is a linear increase in heart rate with external work. Stimuli other than external work may affect rates lower than 110. 13. At the end of the third minute in stage #2, repeat steps #10 and 11 for the third workload. During the last (third) minute of stage #3, palpate the heart rate. The subject should be in a steady state of work with a variation of no more than 5 beats between successive heart rate determinations. The heart rate should be greater than 110 contractions/min and less than 85% Age Predicted HRmax. 14. Terminate the GXT and monitor the subject through an adequate cool down.
Time Line For Benefits
•There are different doses (meaning different weekly volume) and timelines necessary to see different adaptations •These effects occur at different times during the exercise (i.e., immediate, acute, delayed, chronic) •Look at your client's health-history, fitness level and their current goals; do you have an appropriate timeline and dose to have your client reach their goal in the allotted time?
One Repetition Maximum Testing Procedure
1. Tester demonstrates/explains proper mechanics of intended movement using only the bar 2. Practice intended movement with bar only until movement is corrected by technician 3. Two warm-up trials are recommended 4. For the first warm up trial, the tester instructs the lifter to complete 5-10 reps with a load that the lifter reports as "easy" using the correct form, followed by a 1-minute rest (the rest interval should have the lifter perform 30 secs of flexibility movements) 5. The second warm up trial requires the lifter to complete three to five repetitions of the exercise movement at 60%-80% of the estimated 1-RM load, following by a 2 minute rest interval of active recovery. (for example: if the estimated 1-RM was 100lbs, then the second warm up trial should be completed using 60-80 lb) 6. The third warm up trial requires the lifter to complete two to three repetitions of the exercise movement at ~90%-95% of the estimated 1-RM. (for example: if the estimated 1-RM was 100lbs, then the third warm up trial should be completed using 90-95 lbs). The lifter should attempt 2-3 repetitions. Upon completion, the lifter rests 2-4 minutes or longer with active recovery 7. The technician increases the load, equivalent to the lifter's estimated 1-RM determined by the following 1-RM prediction equation: 1-RM = 100 x rep wt / (102.78 - 2.78 x reps) 8. The lifter attempts only one repetition with this weight. A successful/unsuccessful lift will require the lifter to rest 2-4 minutes to allow for a full recovery before attempting another 1-RM (for example: if the 100 lbs was successfully lifted, an additional 2.5%-5% load should be added for the next 1-RM trial, if the 1-RM attempt was unsuccessful, the load should be reduced 2.5%-5%) 9. Continue the process in step 8 until participant fails to complete the movement in correct form (1-RM is generally achieved in 3-5 trials) 10. Record the 1-RM value as the max weight lifted with correct form
Sub-maximal tests are based on these fundamental assumptions:
1.Linear relationship between HR and VO2 (work) between 110-150 bpm 2.HR from two workloads can be plotted against VO2 and used to extrapolate HRmax •HRmax is then used to estimate VO2max 3.HRmax is similar for individuals of similar age 4.Steady-state HR can be achieved in 3-4 min at the same workload 5.Equal mechanical efficiency for everyone at a given workload •Same caloric expenditure and same absolute oxygen requirements
If a client is exercising at a constant VO2 of 3 L/min and exercises for roughly 10 minutes, how many calories would that burn?
150kcals
Using the traditional maximum heart rate estimation equation what would the maximum heart rate of a 45 yr old client be?
175 +/- 10bpm
You have a new male client that's 56 years old. The client has blood pressure of 136/82, and a resting blood sugar of 96mg/dL. Their BMI is 33 and their waist girth is 42inches. Out of the items listed how many risk factors does this client have?
2 - Age and BMI
When generally performing a 1-RM assessment how many warm-up trials are given?
3
If a 50kg client has a relative VO2 of 60mL/kg/min, what is her absolute VO2?
3 L/min
1 MET
3.5 ml/kg/min oxygen consumed - Light (<3 METs) - Moderate (3-5.9 METs) - Vigorous (> 6 METs)
On average, for every person what is resting VO2 assumed to be?
3.5mL/kg/min
ACC/AHA Cholesterol Recommendations 2013
4 groups most likely to benefit from statin therapy •Patients with any form of clinical ASCVD •Patients with primary LDL-C levels of 190mg/dL or greater •Patients with diabetes mellitus, 40-75 years of age, with LDL levels of 70 to 189mg/dL •Patients without diabetes, 40-75 years of age, with an estimated 10-year ASCVD≥7.5%
You have a new female client that's 56 years old. The client 's total blood cholesterol is 206 mg/dL, their LDL cholesterol is 142mg/dL, and their HDL cholesterol is 64 mg/dL. They exercise twice a week at 40 minutes with a moderate intensity. Their BMI is 29 and their waist girth is 36inches. Out of the items listed how many risk factors does this client have?
4 positive risk factors: Age, Blood Cholesterol, Amount of exercise, and waist girth 1 negative risk factor: HDL over 60mg/dL Total risk factors: 3
Purpose for Exercise Testing
•There are two main reasons in the health field to perform an exercise test (prognostic and diagnostic) •Identifying physiological strengths and weaknesses •Ranking people for selection purposes •Predicting future performances •Evaluating the effectiveness of a training program or trial •Tracking performance over time •Assigning or manipulating training dosage
Maximum Heart Rate Estimation Equations
•Traditional Equation is: •HRmax = 220-age •Revised equation (Tanaka, Monahan, and Seals (2001))is: •HRmax = 208 - (0.7 x age) •Diffs from traditional equation, particularly in people over 40 yrs old •Age: 65 yrs •Traditional Equation: 220- 65 = 155 bpm •Revised Equation: 208 - (0.7 x 65) = 162.5 bpm
What's an exercise physiologist/trainer's role in a client's diet?
•Trainers and physiologists are not supposed to "prescribe diets." Only licensed dieticians are supposed to prescribe diets. •However, diet has an influential role on the results of an exercise program •Trainers and physiologists should monitor diet and can give suggestions.
Obesity
Abnormal or excessive fat accumulation that presents a risk to health. •Associated Health Risks -Type 2 Diabetes -Cardiovascular disease -Some cancers -Strokes -Gallstones -Sleep apnea -Osteoarthritis •The estimated annual cost of obesity in the United States is $152 billion in medical expenses and lost productivity.
Field Test
Advantages of Field Test •Multiple people can be measured at once •Less equipment •Can be performed in multiple locations •If it is for athletic performance, specificity of the sport can be matched Examples of Field Test •12 minute Test •1.5 mile test •Pacer Test •*Field test can use actual air collection to increase accuracy of measurements
Laboratory Test
Advantages of Laboratory Test •More accurate •Tester has more control of test variables (reliability increases) •Because of the increased control there is an increased safety Examples of Laboratory Tests •Bruce Protocol •Balke Protocol •YMCA cycle ergometer test
Crunch (Curl-up) Test Procedure
•Two strips of masking tape on the floor: •<45 yrs: 12 cm apart •≥45 yrs: 8 cm apart •Supine position, knees at 90° •Arms at sides, palms down, middle finger touching the nearest strip of tape •Subject performs controlled curl-ups at 40bpm (use metronome) moving fingers from starting tape to 2nd tape •Test is concluded when subject reaches 75 crunches or the cadence is broken •Practice repetitions should be given
Health History Questionnaire (HHQ)
•Used to establish medical/health risks for both activity assessment and activity participation. •At minimum, should address: •Family history of CMR •History of various diseases and illnesses including cardiovascular disease •Surgical history •Past and present health behaviors/habits •Current use of various drugs/medications •Specific history of various signs and symptoms suggested of CVD and other chronic or metabolic disease
Velocity-Based Training
•Uses a device (transducer, accelerometer etc..) to measure velocity. The measurement is then used to program the athletes workouts. •Velocity-based training is not a new concept, but the ability to accurately track athletes is fairly new. •Each athlete has an individual load/velocity profile and those are exercise unique as well. •This type of training either uses linear position transducers, wearable accelerometers, or motion capture software
Hydrostatic Weighing
•Very accurate measurement based off of Archimedes principle: The buoyant force which water exerts on an immersed object is equal to the weight of water that the object displaces. •While the body density measurement is typically very accurate from hydrostatic weighing assumption there is still an inherent error, due to the major assumption of the 2 compartment model. •The estimation of residual volume of air in the lungs and gastrointestinal tract can also create error •Water temperature also must be accounted for because it slightly changes the density of water •Drawbacks include high cost, very high maintenance •Cost ~ $15,000 •SEE ~±1.5percent
Tips for Exercise Prescription
•Weight-loss can be faster than weight-gain. Weight-loss is primarily dependent on how large of an energy deficit the client can achieve. •Weight-gain takes longer because of the time it takes for muscular hypertrophy to occur. These goals should have a longer time frame. •These goals are going to have a high dependency on the client's diet. Don't over step the scopes of practice of your field by prescribing a diet. Find a dietician that you respect and refer clients to the dietician. •Clients trying to lose weight should maximize their moderate-vigorous physical activity.
Exercising Assessments
•With the exception of some recovery heart rate tests, all cardiorespiratory tests are variations of estimating or measuring VO2 •Measure HR, BP, RPE
Goals
•You need to understand what they want, and they need to understand what they want •Goals are indispensable information for a trainer/exercise physiologist. •Goals can come before or after assessments. •Without a goal your clients have no direction, and are setting themselves up for failure. •Regardless of clients goals the two underlying general goals of any client are: •Avoiding Disease •Improving Fitness/Athletic Performance
Isokinetic Dynamometers
•a dynamic form of exercise that prevents the subject's limb from accelerating beyond a preset angular velocity around a joint •Used in research, training, and in rehabilitation •Keeping the velocity constant provides safe contractions for soft tissue injuries
Nomogram (indirect estimate)
•a graphic representation that consists of several lines marked off to scale and arranged in such a way that by using a straightedge to connect known values on two lines an unknown value can be read at the point of intersection with another line •Nomograms essentially still use correlational regressions between multiple values and then arrange them geometrically so others don't have to perform math.
PAR-Q
•contains seven YES-NO questions •is widely used to assess physical readiness and identify those for whom strenuous PA is not recommended. •Has been show to identify 89% of true positives (sensitivity), and only 42% of true negatives (specificity).
Atherosclerotic Cardiovascular Disease (CVD) Risk Factors and Defining Criteria
Age: Men>(or equal to) 45 years old; Women>(or equal to) 55 years old Family History: Myocardial infarction, 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 Physical inactivity: Not participating in at least 30 minutes of moderate intensity physical activity (40%-59% VO2) on at least 3 days of the week for at least 3 months Obesity: Body mass index >(or equal to) 30 kg or was it girth >102 cm (40in) for men and >88 cm (35 in) for women Hypertension: Systolic blood pressure >(or equal to) 140mm Hg and/or diastolic >(or equal to) 90 mmHg, confirmed by measurements on at least two separate occasions, or on antihypertensive medication Dyslipidemia: Low density lipoprotein cholesterol >(or equal to) 130 mg or high density lipoprotein cholesterol <40mg or on lipid-lowering medication. It total serum cholesterol is all that is available, use >(or equal to) 200mg Diabetes: Fasting plasma glucose >(or equal to) 126 mg or 2 h plasma glucose values in oral glucose tolerance test >(or equal to) 200 mg or HbA1C >(or equal to) 6.5% Negative Risk Factors: HDL-C: >(or equal to) 60 mg
Who Needs Muscular Fitness Assessment?
Arguably, everyone •Goal: muscular strength/endurance/mass building - obviously YES •Goal: cardiovascular health? •Goal: body composition? •Goal: balance? •Goal: flexibility? •Prior to beginning an intervention •During/throughout the intervention •After an intervention
General Maximal VO2 max Procedures
Before test day: •Pretest instructions (at least 24 hrs. prior) •Review consent and prescreening forms •Review emergency response plan Testing day: •Data collection forms ready •Equipment calibrated and ready •Verify appropriate room temperature (68-72°F) and humidity <60% •Comfort level/preparedness of participant •Baseline/resting assessments (weight, HR, BP) •Begin GXT with 2-3 min. warm-up •Monitor HR, BP, RPE, and physical appearance/symptoms throughout test •Discontinue GXT when termination criteria are met •Have client cool-down...continue monitoring for 5 minutes after the test
Calorimetry
Calorimetry is simply the measurement of the amount of heat involved in a chemical reaction or other process. We use this in humans to estimate energy balance and energy expenditure.
If a client had a myocardial infarction, but it occurred over 5 years ago , then it does not count as a cardiovascular disease.
False
If you perform a VO2 max test on a new client, and you calculate the client's calories burned during the test, but you do not include resting VO2 into the calculation, that is considered gross VO2.
False
The valsalva maneuver increases a lifter's ability to lift without increasing their blood pressure
False
When performing a 1-RM test on a constant resistance exercise machine a spotter is recommended for all lifts.
False
In health and wellness body composition is often reported as 2 component model:
Fat Mass (Essential body fat, Surrounds internal organs, fat in CNS, in bone marrow, mammary glands) and fat-free mass (Water, Minerals, Bones, Muscles)
Dynamic Testing Equipment
Free Weights •Require more neuromuscular coordination to stabilize body parts and maintain balance •Spotter(s) may be needed Constant Resistance Exercise Machines •No spotter(s) needed •Limit joint ROM and plane of movement •Large weight increments...potentially less accurate •Not useful for individuals with very short limbs or very large limb/body circumferences
Based on the standardizing the condition of the tests, which muscular strength test would have a higher reliability?
Handgrip Dynamometer
Which form would be best for an exercise physiologist to learn about a client's current medications?
Health History Questionairre
Which value is most important in being able to estimate a VO2 max froma submaximal VO2 test?
Heart Rate
Efficacy of exercise
How effective the exercise is at improving the intended goal •These are all determined by F.I.T.T. principle
Dose of Exercise
How much exercise is given to the client in a given period (i.e., session, week, how many exercises, how many repetitions, total volume)
Static contraction
Isometric
Dynamic contraction
Isotonic (DCER)
If you're performing a 1-RM for lower body strength which exercise would be the best for following ACSM recommendations?
Leg Press
Cooper 1.5 mile run/walk Test
Maximal Field estimation Test •VO2 max=3.5+(483/time)
Isometric Endurance of Trunk Muscles
Muscle endurance is more protective against low back injury than muscle strength - Trunk extensors - 60 degree trunk flexion - Lateral trunk flexion
The Individual
No individual is the same. All clients will have different health-histories, motivation levels and adaptations to exercise. Creating one perfect plan for improving a group of individuals is impossible. Exercise prescription has to be tailored to the individual. Optimally, no two people should ever have the same workout.
Test Organization for NSCA
Nonfatiguing test (i.e. resting measurements, anaerobic power tests, body composition) Agility test (e.g., T-test, pro agility test) Maximum power and strength tests (e.g., 1RM, power clean, 1RM squat) Sprint tests (e.g. 40m sprint) Local muscular endurance tests (e.g., push up, curl-up tests) Fatiguing anaerobic capacity tests (e.g., 300-yard shuttle) Aerobic Capacity tests (e.g., V02 max, 1.5 mile run)
Dynamic Strength Testing: 1-RM
One Repetition Maximum (1-RM) •Max weight lifted for one complete rep of through the full ROM Standardized conditions for strength assessments: •Strict posture •Consistent rep duration (movement speed) •Full range of motion •Spotters when necessary •Equipment familiarization •Proper warm-up •Lifting technique and breathing should be monitored closely
Astrand-Rhyming Test Protocol
Pedal rate = 50 bpm Goal: To obtain HR values between 125 -170 bpm. - HR measure during 5th & 6th minute. i) Average of two HR is used to estimate VO2max Test terminates when subject completes 6 min of exercise
Overload
Refers to a training stress or intensity that is greater than what a client is used to. •The progressive manipulation of frequency, intensity and duration to stress the body and stimulate adaptation. •Milo of Croton and the overload of his bull. •If you go into the gym every other day and do 3 sets of 10 reps of bench press with as much weight as possible how long will you be able to increase? •Overload needs to be done manipulating different variables
Variation
Refers to the manipulation of specific training variables such as volume, intensity, exercise selection, frequency of training, rest interval and speed of movement. •If exercise prescriptions aren't varied overtraining or plateaus are likely to take place. •Variation can mean changing the frequency, intensity, mode, duration, or combination. •Too much variation can hinder adaptation. •Typically prescriptions are sequenced and broken up into phases (mesocycles). These typically last 2-6 weeks.
Specificity
Refers to training a client in a specific way to produce a targeted change or result. The personal trainer can accomplish this by targeting specific muscle group, energetic systems, movement velocities, movement patterns, or muscle action types. •The improvements seen with one particular exercise are unique to that exercise. Another exercise will not see the same improvements. •Rules of specificity apply for fitness tests, fitness goals, variables of the exercise prescription and the actual exercises. •Exercise Examples •Machine and non-machine exercises may appear to be similar but may not provide the same ability to help clients reach their goals. R •Different forms of the same exercise •Open Chain vs. Closed Chain exercises
Test Organization for ACSM
Resting measurements Body Composition Cardiorespiratory endurance Muscular strength and endurance Flexibility
What's the most common mode used for VO2 testing?
Running/Walking
Which of the following is NOT a sign or symptom of CVD?
Shortness of breath Heart Murmurs Ataxia Syncope Answer: Ataxia
Sedentary Behavior
Sitting or reclining while engaging in minimal energy expenditure (≤1.5 METs)
Cardiorespiratory Fitness (CRF)
The ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. •This component of fitness reflects the functional capacities of the heart, blood vessels, lungs, and skeletal muscles to perform work. •Defined by ACSM as the ability to perform large-muscle, dynamic, moderate-to-high intensity exercise for prolonged periods. •Health-related component of fitness most highly related to all-cause mortality, with an inverse relationship.
Maximal Effect of Exercise
The maximal amount of change; Tolerance of exercise
The number of times that a person participates in vigorous physical activity greatly influences their risk of having an acute myocardial infarction.
True
Test Organization
When multiple tests are to be administered, the organization of the testing session can be very important depending on what physical fitness components are to be evaluated. Resting measurements and body composition should be obtained first. An optimal testing order for multiple health-related components of fitness has not been established, but sufficient time should be allowed for HR and BP to return to baseline between tests conducted serially. Additionally, test procedures should be organized to follow in sequence without stressing the same muscle group repeatedly. To ensure reliability, the chosen order should be followed on subsequent testing sessions.
You have a new client who had a coronary artery stent surgically place a year ago, this client has been physically active for the past 2 months. However they have 4 cardiovascular risk factors, while showing no signs or symptoms of a CMR . Do they need to see a physician before starting an moderate intensity exercise program?
Yes
You have a new client who has no known diseases, this client has been physically active for the past year, but they show 1 sign or of a CMR . Do they need to see a physician before starting a moderate intensity exercise program?
Yes
You have a new client who has no known diseases, this client has been physically active for the past year, but they show 1 sign or of a CMR . Do they need to see a physician before starting a vigorous intensity exercise program?
Yes
VO2
[CO] x [a-v O2 diff] •Delivery (Central): capacity of heart, lungs, blood to transport oxygen to the working muscles •Extraction (Peripheral): utilization of oxygen by the muscles during work/exercise
Norms for Isometric Lumbar Stabilization Tests
ratio= time/time for trunk extension -mens ratios > womens ratios trunk extension: m-1.00; w-1.00 trunk flexion: m-.99; w-.79 side bridge R: m-.64; w-.38 side bridge L: m-.66; w-.40
Closed-circuit spirometry
the air that the organism is taking in comes from a sealed container where the precise amounts of elements are known. When the organism exhales the air is collected in a diff
Indirect Calorimetry
used much more often, which would be the estimation of calories from oxygen consumption. In all the tests studied in detail in this class, indirect calorimetry is used. •5 kcal are expended with the consumption of 1 liter of oxygen
How to measure skinfold on: Abdomen
•2 cm to right side of umbilicus (Belly Button) •Vertical Fold
Graded Exercise Test
•A graded exercise test is simply a fitness test that uses multiple stages of increasing intensity to measure or estimate cardiorespiratory fitness •Examples of Graded Exercise Test •Bruce Protocol BalkeProtocol
Single-stage Protocols
•A single stage protocol has a client exercise at one intensity and then the cardiorespiratory fitness is estimated from their performance. •Examples of Single Stage Exercise Test •Astrand Cycle Ergometer Test •YMCA bench step test •By classification of how VO2 max is measured, a true max test cannot be measured on a Single Stage Protocol.
YMCA Cycle Ergometer Test
•A submaximal branching protocol (graded exercise test), cycle ergometer VO2 max estimation test. •Extremely popular because of it's association with the YMCA. •Uses 2-4 three minute stages of continuous exercise designed to raise steady state HR •At least 2 consecutive HR measurements must be obtained, where HR must be >110 (& less than 85% of APMHR) •An estimation of maximal work rate is made from the 2 stages measured and from that a VO2 max is estimated. •Additional assumptions made during the YMCA protocol •A steady state heart rate is obtained during each stage of the test Equipment Needed: •Monarch Cycle Ergometer •Metronome •Stopwatch •Calibration
Body Composition Measurement
•Actual body composition measurements where fat mass and fat-free mass are directly evaluated are often overlooked in favor of Bodyweight and BMI because of cost and time. •More accurate calculations of body composition change can help better understand the associated health implications •More accurate body composition estimations can help monitor progress of clients and write more accuarate exercise prescriptions
Astrand-Ryhming Cycle Ergometer Test Protocol
•Adjust the saddle height to suit the subject. There should only be a slight bend in the leg with the pedal fully down •Set initial workload •The participant then cycles at this workload for 6 minutes. Record that heart rate at 5 and 6 minutes •If the mean heart rate is between 125 and 170 beats per minute, the test can be terminated. •If the mean heart rate is less than 125 beats per minute, increase the work load by 150kg/min (.5kp) and continue test for another 3 minutes. (Measure heart rate at 8 and 9 minutes) •If heart rate is over 85% of estimated HR max the test should be terminated.
History of Body Mass Index
•Adolphe Quetelet was a Belgium mathematician fascinated by an ability to calculate the dimensions of man •1835 - Quetelet published a book entitled "A Treatise on Man and the Development of His Aptitudes" with the conclusion that individual's weight increases as a function of the square of their height and introduced the anthropometric index "Quetelet Index" •1972 - Ancel Keys published Indices of relative weight and obesity. In the paper Keys compared several methods of relative weight to body fatness and decided that the Quetelet Index was the best estimation of body fatness and called it body mass index. In the paper he acknowledged this method should be used for populations and not individuals. •1995 - The World Health Organization adopted BMI to gauge obesity •1998 - The federal government and the CDC adopt BMI to gauge obesity.
Regression equations (indirect estimate)
•An equation that is derived from the correlational relationship between multiple variables that estimates another variable (in this case VO2) •Regression equations are typically based off of normative data, the more data that has been collected, the more accurate the equation. •We can use the same protocol using regression equation or collection of gas samples
How to measure skinfold on: Midaxillary
•Ask subject to move arm back or raise it up •Locate the midaxillary line at the level of xiphoid process of sternum •Vertical Fold
How to measure skinfold on: Subscapular
•Ask subject to put arms behind his/her back to help locating sites •Locate scapula and pinch 1-2 cm below inferior angle of scapula •Diagonal Fold
How to measure skinfold on: Thigh
•Ask subject to shift body weight to left leg, and have the right knee slight flexed and right leg totally relaxed •Locate Anterior midline of thigh •Taken 1/2 way between proximal (nearest) border of patella (kneecap) and inguinal crease (hip) •Vertical Fold
Calculating Relative Strength
•Based on relative strength: weight lifted divided by body mass Sample Calculation: •Frank can leg press 300 lbs •Frank weighs 110 lbs •300/110 = 2.72 •Can be compared to normative data for categorization •Can be used to measure progress
Estimating 1-RM
•Because there is a strong relationship between muscular endurance and the % of 1-RM lifted...you can predict 1-RM (strength) from sub-max endurance tests Sample Method 1: •1-RM = weight lifted (lb)/[1.0278-(reps to fatigue x 0.0278)] •a subject lifts 100 lbs, 7 times to failure •1 RM= 100 lbs/ [1.0278 - (7 reps x 0.0278)] = 120 lbs Sample Method 2: •1-RM = [(RM1-RM2)/(REP2-REP1)] x (REP1-1) + RM1 •5-RM value =120 lbs, 10-RM value = 80 lbs •1-RM = [(120-80)/(10-5)] x (5-1) + 120 = 152 lbs Sample Method 3: Prediction Equations •Males: 1-RM (kg) = (1.55 x YMCA bench press test reps) + 37.9 •Females: 1-RM (kg) = (0.31 x YMCA bench press test reps) + 19.2
Fitness Tests and General Assessment
•Before any exercise prescription there must be assessment. • You should not write an exercise prescription without any exercise testing. •No exercise professional can write a sufficient exercise prescription without first assessing the client. What is the purpose of the assessment? •To determine health-risk and status of client, to identify at-risk clients AND to understand what the fitness level of the client is. •In general you want to assess the 5 components of health-related fitness, and any specific areas of fitness related to the clients goals. •In addition to the health-related components, assessments need to be made regarding the clients goals.
Why Is Body Composition Measured?
•Body Composition is a health-related component of fitness. •Body composition can heavily influence athletic performance •Body composition is at the center of one of the largest public health issues of the 21stcentury: obesity.
Bodyweight measurement
•Bodyweight is used as a tool for obesity measurement; either by itself or in association with height (kg/m2) •Bodyweight measurement wasn't practical until 1885 when penny scales were invented. •Bodyweight change is most often measured by taking two measurements and using the difference for the change. •This traditional measurement is unable to differentiate true energy change vs. fluid changes, nonetheless it is often used for that purpose.
Muscular fitness enhances the following:
•Bone mass - prevent against osteoporosis •Glucose tolerance - prevent metabolic disorders •Musculotendinous integrity - prevent injury •Activities of daily living - related to self-esteem •FFM and RMR - related to weight management
ACSM PreparticipationHealth-Screening
•CVD risk factor assessment and risk classification are no longer part of the exercise preparticipationhealth screening process. •The new health-screening process focused on three aspects. 1)The individual's current level of physical activity 2)Presence of signs or symptoms of known cardiovascular, metabolic, or renal disease. 3)The desired exercise intensity, as these variables have been identified as risk modulators of exercise-related cardiovascular events.
Modality of VO2 Testing: Cycle Tests
•Can be a preferred mode for some disabilities that could be made worse by weight-bearing activities. •Smaller individuals can stop prematurely due to local muscular fatigue •YMCA cycle Test, Astrand and Ryhming Cycle Test
Parvo Medics TrueOne 2400
•Cost roughly $23,000 •Indirect Calorimeter using open circuit spirometry and gas analysis for calculation oxygen consumption •Measures the amount and gas composition of expired air of the subject in real-time. •Air enters the tube from the right side of the mask into the breathing tube (open-circuit) •Air goes through the pneumotach; there is a pressure and flow gauge on each side which allows for measure the volume of air •The air enters a mixing chamber because at the beginning of expiration, composition is higher in O2and lower in CO2 than at the end of expiration. Thus it needs to be mixed. •A sampling line goes from the mixing chamber to the measurement module which has individual analyzers for O2 and CO2
Exercise Testing
•Diagnostic Testing is Recommended for the Following clients: •Previously diagnosed CVD without recent test (within a year) •New or changing symptoms suggestive of CVD •Diabetes mellitus and at least one of the following: •Age >35 years •Type 2 diabetes mellitus >10 years' duration •Type 1 diabetes mellitus >15 years' duration •Any additional atherosclerotic CVD risk factor •Microvascular disease evidenced by vision impairment and poor renal function •Autonomic dysfunction (inappropriate heart rate and blood pressure response) •End-stage renal disease •Patients with pulmonary disease
Two-Compartment Model
•Divides the body into fat mass (FM) and FFM. •First introduced by W.E. Siri in 1956 •Since fat mass is not directly measured the two compartment model relies on two Major Assumptions: -Fat mass has a density of 0.9 g/cm3 -Fat-Free mass has a density of 1.1 g/cm3 •This is not the case in all genders, race, age, fitness status, and health status •Researchers have tried to adjust estimation equations to account for these differences.
F.I.T.T. Principle
•Every exercise prescription and exercise should accurately depict each letter of the FITT principle. •Frequency: How many time exercise sessions are performed (i.e. sessions per week) •Intensity: Amount of effort exerted during exercise. (i.e.RPE, Heart rate) •Time: The duration of exercise (i.e. 60 minute session) •Type: Mode of exercise (i.e. free weight resistance training)
Prognostic Testing
•Exercise testing is useful in the evaluation of persons with known or suspected CAD. •Data derived from the exercise test are most useful when considered in context with other clinical data. •Data regarding symptoms, functional capacity, and myocardial ischemia during the exercise test must be considered together. •Performing assessments for health-related components of fitness and comparing to normative data is always prognostic.
Maximal VO2 Testing
•Exercising until "volitional fatigue" •Progressive increases in work load until no more can be tolerated •The idea is the client will go to maximal effort. •Most protocols use the treadmill or leg cycle ergometer •Specificity of client •A maximal test can either use air collection for precise measurement of air consumption or through estimation.
The Valsalva Maneuver
•Expiration against a closed glottis •Originally described by Antonio Valsalva in the 1700's as a way to clear pus out of the ears •1. Initial Pressure rise •2. Reduced Venous Return and compensation •3. Pressure release •4. Return of cardiac output •Stabilizes & increases effectiveness of trunk muscles •Does Valsalva REALLY work that well? •Who performs Valsalva? •The initial rise in blood pressure can cause hiatal hernias, cardiac arrest, Valsalva retinopathy NSCA states that Valsalva maneuver is effective way to increase intra-abdominal pressure and the health risks associated with the Valsalva maneuver remain unconfirmed. ACSM states the Valsalva maneuver should be avoided during any lifts.
Absolute VO2
•Expressed as: L/min or mL/min •Directly related to body size •Used to express energy expenditure in weight-bearing or non-weight-bearing exercises
Relative VO2
•Expressed as: mL/kg/min •Compare across individuals •Used to express energy expenditure in weight-bearing exercises
YMCA bench press test
•Flat bench •Males: 80 lb barbell •Females: 35 lb barbell •Cadence of 30 reps/min (1 total rep every 2 sec) •Terminate when cadence cannot be maintained
Modality of VO2 Testing: Running/Walking
•Generally the chosen preference of most clients and most specific to their goals •Laboratory Tests - Bruce Protocol, Balke Protocol, AstrandProtocol •Field Tests - 12 minute, Pacer Test, 1.5 mile Test, Rockport Mile Test
Modality of VO2 Testing: Step Tests
•Generally the most portable test; have the potential to be tointense for sedentary and deconditioned clients •McArdle Step Test, YMCA Step Test, Harvard Step Test, Queens College Step Test
Health-Related Fitness Components
•Global -Cardiovascular endurance -Body Composition •Joint Specific -Muscular Strength -Muscular Endurance -Muscular Flexibility
Clinical Settings
•Goal: With the presence of a Physician, diagnose cardiovascular disease •Max GXT is best for this, a submaximal test is rarely used. •"Stress test"
Fitness-Wellness Settings
•Goal: general idea of CRF for health and fitness •Establish a baseline and measure progress •Submax GXT is sufficient for this, however it is also dependent on the client's wishes.