Practice Test #3

Paraphrasing Why? When using paraphrasing the health coach repeats words back to the client in a way that demonstrates a general and accurate understanding of what the client said. "Let me repeat back to you what I think you just said, so that I can be sure I understood correctly." This lets the client know that the health coach is trying to understand. Other verbal listening skills include: Reflecting: The health coach attempts to empathize, or reflect, the feeling the client expresses. "It sounds to me like you feel..." Reflective listening involves the words the speaker uses, the words the listener hears, what the listener thinks the speaker means, and what the speaker means. This is a key to motivational interviewing, and comprises much of the work the health coach will do in terms of active listening.Explaining: This involves offering an interpretation of what the health coach heard. "I wonder if you considered..." Similar to "validating" in active listening, this collaborative, non-directive step focuses on opening the client's mind to other possibilities based on what the coach believes makes sense given the client's current thoughts and goals. Linking: The health coach keeps the client's thoughts connected with a simple, "and then" or "please continue." Summarizing: The health coach synthesizes what he or she heard the client say in a sentence or two. "So, to summarize, it seems that you are making three important points. One..." This prevents the health coach from falling into "selective perception," where the listener is expecting the speaker to react in a certain way. Including a question in the summary is also effective. "What might be some other options for you besides the three you mentioned?" Encouraging: The health coach, during all forms of communication, should always offer supportive comments such as "good point," "well said," or a simple "uh-huh." Reference: ACE Health Coach Manual, pages 111-112 Study Tip: Verbal listening skills are a key element of active listening and will make the coaching relationship more meaningful and efficient. Checking for understanding throughout a coaching session and making sure the meaning behind the words and actions used during times of exploration will ensure the flow of a coaching session moves in the right direction. Practice using verbal listening skill throughout your day and become aware of how much you are hearing and understanding during conversations. These skills take practice. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2473/what-is-rapport-and-why-is-it-so-important?topicScope=client-consultations https://www.acefitness.org/education-and-resources/professional/expert-articles/6532/ignite-behavior-change-with-motivational-interviewing

During the initial meeting, a client informs the health coach of her fitness goals. The health coach tells the client, "Let me repeat back to you what I think you said, so I can ensure that I understood you correctly." This demonstrates which verbal listening skill?

A client who recently discovered he is hypertensive and has taken steps to improve health by increasing physical activity Why? Some clients will begin with health goals established mostly as a result of direct input from social contacts or other environmental stimuli, and are therefore primarily extrinsically motivated at the outset. This may derive from the need to be a caregiver for an aging parent, the need to physically keep up with grandchildren as a part-time babysitter, the result of a stern warning from the doctor after some test results, or a spouse or partner who is pressuring the client to get back in shape to maintain physical attraction. Reference: ACE Health Coach Manual, pages 371-373 Study Tip: It is common for clients to present with goals that are initially a combination of intrinsic and extrinsic factors, as both motivations exist within individuals to different degrees. In many ways, this can be helpful, since the goals will originate from many aspects of the client's life, so there are more opportunities to reinforce the goals. However, the majority of a client's motivation should become intrinsic for long-term success to become more likely. This ensures that there is enough internal drive to overcome obstacles and enjoy successes while staying focused on the daily tasks required for health-behavior change. Working with clients to discover from where their motivation is coming is essential to the long-term success of a program. How will you as a coach work with clients to move the dial more toward intrinsic motivation? Setting meaningful goals, building confidence, and keeping the process enjoyable may help shift the balance toward greater intrinsic motivation. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes

Which client would be described as primarily extrinsically motivated?

The health coach should acknowledge the client's concerns and inform the client that a postural assessment may identify muscular imbalances that could lead to injury Why? New clients often enter a supervised fitness program with a desire to lose weight, increase energy levels, tone muscles, or even reduce certain health risks. Exercise is an integral component in achieving any of these goals. Nonetheless, both cardiorespiratory-endurance and resistance-training activities place extra stress upon the body. For this reason, it is important to assess potential areas of cardiorespiratory or musculoskeletal weakness so as not to exacerbate any underlying conditions. Functional imbalances, such as those that can be detected through basic posture and muscular fitness assessments, should be addressed prior to initiating any physical activities. Reference: ACE Health Coach Manual, page 337 Study Tip: As a health coach, it is important to consider when assessments are necessary, which assessments are appropriate, and when they should be used. When working with new clients, consider what type of assessments, if any, are needed to begin a program targeting lifestyle modification. If a client is clearly deconditioned, does it make sense to perform initial cardiovascular assessments with the objective of determining cardiovascular fitness? Will performing an assessment like this do more harm than good when you consider, motivation and self-efficacy? Health history should always be conducted prior to beginning a behavior change program to make sure goals are safe and appropriate, but what else is needed before getting started? Conducting postural assessments and movement screens are methods for identifying areas for improvement when it comes to exercise-related goals. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/5413/practical-application-of-functional-assessments-static-postural-analysis

A health coach deems it appropriate to perform a static posture assessment on a new client. The new client has some reservations and inquires if it is necessary. What is the MOST appropriate way for the health coach to proceed?

150 minutes of moderate-intensity physical activity per week Why? The 2008 Physical Activity Guidelines for Americans suggest that adults should participate in structured cardiorespiratory-related physical activity at a moderate intensity for at least 150 minutes per week or a vigorous intensity for at least 75 minutes per week to experience the health benefits of exercise Reference: ACE Health Coach Manual, page 336 Study Tip: Throughout your materials you will encounter various recommendations regarding nutrition and physical activity that you must commit to memory. Some strategies you may use are: (1) create flash cards because when you write something down you are more likely to recall it; (2) find a friend or family member with whom you can share the information, as repeating it to someone helps with retention; and (3) put it into practice by trying to implement it into your daily life. Links: https://www.acefitness.org/education-and-resources/lifestyle/blog/5768/how-to-build-strong-bones

According to the 2008 Physical Activity Guidelines for Americans, what is the minimum recommendation for structured cardiorespiratory-related physical activity for adults?

Morbidity and Mortality Why? Low levels of cardiorespiratory fitness have been linked to an increased risk of premature death from all causes, especially from cardiovascular disease.High levels of cardiorespiratory fitness are associated with increased levels of regular physical activity, which translates to numerous health benefits. Reference: ACE Health Coach Manual, page 336 Study Tip: Think about how this information is important to you as a health coach and when you might share these facts with your clients. For example, this type of information may be provided to a client who is in the precontemplation stage of change who believes there is nothing to change and that everything is just fine the way it is. As a coach, selecting the right time to share information is important and can prompt change or change talk to occur. However, it is important to remember to ask permission from you client before sharing information.

Cardiorespiratory fitness is a strong predictor of which of the following factors?

Helping the client find an extrinsic form of motivation to help him or her stay inspired Why? While extrinsic motivators often help people to start a behavior change program, intrinsic motivators are more relevant to the client and most likely to generate program adherence. To help clients with lapse prevention the health coach should help him or her focus on intrinsic motivators.The health coach should assist the client in putting her plan into action by offering support and encouragement, celebrating any and all success, and continuing to review solutions to any difficulties that arise. The coach provides information and references for further study, such as access to Smartphone "apps." The key is to provide the client with useful information on how to anticipate and overcome obstacles that reduce motivation and interfere with adherence. Goal-setting—using SMART goals—is particularly useful during the action stage (see Chapter 13). Reference: ACE Health Coach Manual, page 58, 393-394, 544-545 Study Tip: Consider what is taking place for clients by the time they reach the action stage of change. In this stage, people are engaging in regular structured physical activity but have been doing so for fewer than 6 months. Think about the types of specific goals you will work together with your client to set to keep him or her focused and on track toward reaching maintenance. Anticipation of obstacles is crucial to overcoming them. Think of this as creating a game plan for as many perceived barriers to success as possible. Links: https://www.acefitness.org/certifiednewsarticle/709/ace-ift-model-for-cardiorespiratory-training/

For the past month, a new client has been walking at a low to moderate intensity for 30 minutes, 5 days a week. The client is now finding it difficult to maintain her daily walks as her work and family life have become more demanding. The client begins skipping her walks on some days and is on the brink of dropping her walking habit altogether. The client approaches a health coach about this concern to explore some options. For a health coach who is helping a new client become more physically active, which of the following actions would MOST likely set up the client to relapse to a previously sedentary lifestyle?

Subjective Why? Subjective: This section is used to document a client's feelings or subjective complaints or symptoms. For example, if a client states, "I felt depressed and had two desserts last night," this section documents his or her personal feelings or experiences. Reference: ACE Health Coach Manual, Page 38 Study Tip: The use of SOAP notes is a great way to stay organized when documenting client interactions. The best way to get familiar with this style of documentation is to practice. You can make up scenarios and practice writing them in SOAP note format or begin documenting client coaching sessions using this format. You can think of this format like an equation. S = subjective information provided from the client (e.g., mood, feelings) O = objective information, or anything measurable (e.g., height, weight, and blood pressure) A = S + O this section is for you to provide an assessment of the objective and subjective information gathered P = S + O + A this section will cover what the plan for the client based on the coach's assessment of all other sections

In which section of a client's SOAP notes would it be most appropriate to record the following information? A client reports walking for 30 minutes, two times per week since the last coaching session and bringing a healthy lunch to work three times per week for the last two weeks. The client states that she is pleased with how the last two weeks have gone and that she is excited to keep moving forward.

Work together to set meaningful goals and identify strategies for overcoming potential barriers to success. Why? Within the preparation stage of change, the following strategies may be implemented: Verify that the individual has the underlying skills for behavior change and encourage small steps toward building self-efficacy Identify obstacles and assist with problem-solving strategies Help the client identify social support and establish goals Reference: ACE Health Coach Manual, pages 60, and 106-107 Study Tip: Strategic intervention is key for guiding clients through behavior change. Implementing a specific strategy at the wrong time can limit client progress. Look at the strategies suggested in the other options for this question and see if you can identify at what stage of change they would make the most sense to implement. You will notice this topic comes up often and this is intentional for stressing the importance of meeting clients where they are along the journey toward leading a healthier life. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3646/goal-setting-create-a-goal-the-smart-way

A new member at a fitness facility is seeking the help of a health coach for added accountability and guidance in shifting her sporadic activity into a structured regimen. What is the MOST appropriate initial strategy a health coach could implement to assist the client in progressing towards making healthy decisions?

Discuss with the client options for moderate-intensity exercise, explaining that regular exercise at this level has been found to reduce body weight and symptoms of osteoarthritis. Why? Weight loss combined with a moderate exercise program can improve function and reduce the pain from osteoarthritis. A study found that a 5% reduction in body weight, combined with a moderate exercise program (such as walking 30 minutes a day, five days a week), results in a 24% increase in function and a 30% decrease in osteoarthritic knee pain over an 18-month period. Reference: ACE Health Coach Manual, pages 445-446 Study Tip: For clients who have obesity it is important to consider their physical limitations, particularly with musculoskeletal pain. While as a health coach you might not design a detailed and progressive fitness program, providing general guidelines for initial participation in physical activity will allow the client to take steps toward weight loss and pain reduction. Having a tangible goal for the client may be helpful. For example, given that within an 18-month period a client could experience a 5% decrease in weight, calculate this for the client based on his or her current weight and suggest it as an initial goal. Coaching clients through small incremental changes will not only benefit weight loss and pain reduction, but will increase participation in physical activity and the likelihood of long-term adherence. Links: https://www.acefitness.org/education-and-resources/professional/prosource/february-2015/5236/working-with-clients-affected-by-obesity-how-avoiding-weight-bias-can-improve-everyone-s-chances-for

A client approaches a health coach with interest in becoming physically active. The client has been sedentary most of her life and has been diagnosed with obesity and osteoarthritis. The client would like to reduce symptoms of osteoarthritis while losing weight and wants to know where to begin. What is the MOST appropriate response the for the health coach to provide?

55% Why? 1 gram of protein is equal to 4 calories. This product contains 11 grams of protein 11 grams X 4 calories = 44 calories44 (calories from protein) / 80 (total calories) = .55 (or 55% percent of calories from protein) Reference: ACE Health Coach Manual, pages 127 and 135 Study Tip: See if you can calculate the percentage of calories for the other macronutrients (i.e., fat and carbohydrate). Also, practice reviewing common food labels in your home and look at the macronutrient ratios. Being able to educate clients on how to read/interpret a food label is a valuable tool. As you are becoming more comfortable with reading and understanding food labels, think about how you will explain what you are learning to someone who may know nothing about food labels. Consider the types of questions you may be asked about food labels and what information might be most important for clients with specific conditions. Links: https://www.acefitness.org/ptresources/pdfs/Formulas.pdf https://www.acefitness.org/education-and-resources/lifestyle/blog/3319/what-you-need-to-know-about-reading-nutrition-labels

A client brings in the following information from a food label of a favorite snack. What percentage of total calories comes from protein?

Introduce intervals above and below the first ventilatory threshold to improve fitness and performance Why? Once a client can sustain steady-state cardiorespiratory exercise for 20 minutes in zone 1 (RPE of 3 to 4) and phase 1 of the ACE IFT Model (aerobic base), he or she can move onto phase 2 (aerobic efficiency). Phase 2 has a principal training focus of increasing the time of cardiorespiratory exercise, while introducing intervals to improve the ability to exercise at greater workloads to improve fitness. Clients training in phase 2 who have a goal to complete an event, such as a 5K run, can reach their goal of completing the event within the training guidelines of this phase. Reference: ACE Health Coach Manual, pages 476-479 Study Tip: As clients begin to participate in physical activity, they may desire to progress past their current level of fitness. Understanding where a client falls along the ACE IFT Model continuum will allow you to provide the necessary recommendations as he or she continues to build adherence and improve health. For health coaches who do not hold a personal trainer credential, referring the client to a certified professional is the best course of action. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/5563/steady-state-vs-interval-training-which-one-is-best-for-your-clients

A client has been working with a health coach for the past 6 months and has consistently engaged in 20-30 minutes of continuous cardiorespiratory exercise, 5 times per week. The client would like to improve her cardiorespiratory fitness and states she is considering participating in her first 5K run event. What recommendation would be MOST appropriate for the health coach to provide at this time?

Negative reinforcement Why? Negative reinforcement, which consists of the removal or avoidance of aversive stimuli following a desirable behavior (i.e., removing a negative condition to strengthen a desired behavior), increases the likelihood that the behavior will occur again. Reference: ACE Health Coach Manual, page 52 Study Tip: It is important to consider how consequences influence the occurrence of future behaviors. Often, people have a hard time understanding the difference between negative and positive reinforcement and how they both contribute to an increase in behavior. One way to think about the difference is that with positive reinforcement a positive stimulus is being presented after a behavior, which is leads to the likelihood of the behavior occurring again. In other words, there is a positive reward because of a behavior. For example, if a child receives a sticker (positive stimulus) each time she puts her plate in the sink (behavior), she is likely to put her plate in the sink again to earn another sticker. With negative reinforcement, an aversive stimulus is being taken away after a behavior is completed. In other words, with positive reinforcement, something is gained and with negative reinforcement something is taken away or avoided. For example, if you apply sunscreen (behavior) before spending a day at the beach and the consequence is that you avoid getting a sunburn (aversive stimuli) you are likely to apply sunscreen again in the future. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2473/what-is-rapport-and-why-is-it-so-important?topicScope=client-consultations

A client has started packing an orange and a bottle of water in her lunch instead of her usual chips and soda. The client claims to no longer feel bloated, lethargic, and defeated after eating lunch and plans to continue to exclude chips and soda from her lunch. This is an example of what type of response consequence?

Provide the client with general healthy weight loss guidelines and education around using ChooseMyPlate.gov Why? Every health coach must ultimately determine what topics are appropriate to discuss with clients based upon his or her level of education and expertise. A health coach should not hesitate to refer a client to a registered dietitian (R.D.) or more qualified professional if the client's needs exceed the health coach's training and level of expertise. Appropriate Nutrition Topics for a Health Coach MyPlate Guidelines • Suggestions for weight loss • Pre-evaluations and use of food diary • Lifestyle changes • Hydration • Recipes • Support • Basic pre- and post-exercise nutrition • Weight-loss physiology Nutrition Areas That Should Be Referred • Specific meal plans • Tailored plans • Medications • Diseases: Cardiovascular disease - Hypertension - Hyperlipidemia - Diabetes - Eating disorders - AIDS • Medical diagnoses ° Anemia ° Osteoporosis Polycystic ovary disease • Post-op • Yo-yo dieting • Supplements • Large weight loss or morbid obesity Reference: ACE Health Coach Manual, page 429 (table 15-2) Study Tip: Many new health coaches are confused about scope of practice when it comes to nutrition information. Mainly, it is important to remember that meal planning and telling clients exactly what to eat or not eat is outside the scope of practice. Think about the creative ways you can work within your scope of practice when it comes to nutrition while also considering the need to recognize when a referral is appropriate. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3646/goal-setting-create-a-goal-the-smart-way

A client informs an ACE Certified Health Coach that she is ready to set nutrition goals to increase efforts with weight loss. What would be the MOST appropriate next step to take with this client?

Low-carbohydrate diets have been associated with micronutrient deficiencies including vitamins A, B6, folate, and potassium. Why? The health coach could inform him that low-carbohydrate diets typically are below the Acceptable Macronutrient Distribution Range of 45 to 65% of total calories from carbohydrates. Low-carbohydrate diets have been associated with deficiencies of vitamins A, B6, C, and E, as well as thiamin, folate, calcium, magnesium, iron, potassium, and fiber. Reference: ACE Health Coach Manual, pages231 - 232 Study Tip: Research common or "fad" diets find potential pros and cons of each so that if a client asks about them, you can educate him or her on the purpose of the diet, when it might be appropriate or inappropriate, and any potential health risks. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/4922/how-to-select-the-right-intensity-and-repetitions-for-your-clients

A client is considering restricting the amount of carbohydrates he consumes to under 45% of his total caloric consumption and is seeking advice. As an ACE Certified Health Coach, which of the following responses would be MOST appropriate regarding low-carbohydrate diets?

The health coach should encourage the client to take a walk when he notices his stress level rising. Why? Stress is the most common reason that people abandon their plans to change behavior. Stress depletes self-control, lowers feelings of self-efficacy, and decreases energy and motivation. Too much stress triggers negative emotions such as anxiety, anger, and sadness. Some people respond to feelings of stress and to extreme emotional states (both negative and positive) by eating, even when they are not hungry. Eating triggered by emotional states is referred to as emotional eating which becomes a problem when people are trying to reduce food intake. Guiding clients to monitor and manage stress levels must be an integral and continuing component of all lifestyle-modification and behavior-change recommendations. Lifestyle modifications should create as little stress as possible, and clients, especially emotional eaters, must learn new ways of coping with stress and negative moods—such as taking a walk or performing meditative exercises—instead of simply reaching for their favorite comfort foods. Reference: ACE Health Coach Manual, page393 Study Tip: Can you relate to emotional eating? Many people have eaten foods as a part of an emotional response, so it can be easy to place ourselves in the shoes of those who are currently met with this challenge. The stress from taking on a lifestyle modification program can add to the stress of everyday life and lead to emotional eating. This is an unfortunate consequence of reducing caloric intake to lose weight. Eating less than normal causes stress which may ultimately lead to overeating. Consider tools and techniques you will implement with clients to guide them through managing and monitoring stress levels. The identification of new ways to cope with stress is crucial and can lead to overall program success. In addition, if you are working with clients focused on weight-loss, think about the connection between exercise and reduced stress levels, as this can be both a coping strategy and process goal for weight loss. Links: https://www.acefitness.org/education-and-resources/lifestyle/blog/6784/type-2-diabetes https://www.acefitness.org/education-and-resources/professional/expert-articles/5137/5-things-fitness-professionals-should-know-about-diabetes

A client is in the initial stages of a weight-loss program and has been trying to make healthier choices with his diet. However, the stress of his job leads to emotional eating of foods high in saturated fat. Which of the following techniques would be BEST for the health coach to suggest to help the client avoid overeating when stressed?

Discuss opportunities for continued activity and a plan for maintaining activity during various seasons, vacations, and schedule changes. Why? This client has been regularly exercising for at least six weeks, placing her in the action stage of change. It is important to help this client to make this a sustainable behavior over time. When people initially begin a program, they will typically be motivated but as time goes on life stressors may cause them to get off track. Developing strategies for these variances in a person's schedule can help him or her be successful in adhering long-term. Option A would be more appropriate for someone in precontemplation, B would be more appropriate for someone in contemplation, and D would be more appropriate for someone in maintenance. References: ACE Health Coach Manual, Pages 7, 23, 57-62, 277, 387-388 Study Tip: Consider the important bench marks of each stage of change and the strategies that help clients move forward to the next stage, leaving behind actions that might cause them to relapse. For example, if someone is in the contemplation stage, he or she is thinking about becoming active (benchmark) so strategies that would help him or her move into preparation could be identifying and discussing the perceived pros and cons of exercise and discussing how to work with or around them to get started with some activity. Finally, by the time the action stage is reached, the client already sees the value in exercise so there is no need to lecture him or her on the health benefits of becoming physically active, the way you might with someone in precontemplation. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2473/what-is-rapport-and-why-is-it-so-important?topicScope=client-consultations https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3646/goal-setting-create-a-goal-the-smart-way

A client who has obesity has been regularly jogging for 30 minutes during her lunch break and attending group exercise classes 3 times a week for the past 6 weeks. She is beginning to feel confident with her exercise program, but is concerned with her ability to keep up since recently starting a new job. Which of the following coaching strategies would be MOST appropriate at this time?

Offer to help the client do some research, but refer him to a dietitian for specific recommendations Why? Recommending specific diets, meal plans, or supplements is outside the scope of practice for a fitness professional. It is okay to review research with clients to help them become more educated on the topic, but to determine whether a specific diet or supplement is needed, the client should speak with a more qualified professional, such as a registered dietitian. Reference: ACE Health Coach Manual, page 599 Study Tip: Ultimately, a health coach's scope of practice as it relates to nutrition is determined by state policies and regulations, education and experience, and competencies and skills. While this implies that the nutrition-related scope of practice may vary among fitness professionals, there are certain actions that are within the scope of practice of all fitness professionals. However, health coaches should never prescribe anything; that should be left to the client's physician or dietitian. You wouldn't want to say he or she must consume a certain supplement when you don't know the client's medical background and/or if they could have an adverse reaction to a supplement you "prescribe." Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/6248/nutrition-scope-of-practice-what-you-can-do-as-a-personal-trainer

A client who wants to lose weight tells a health coach that a friend has been taking a protein supplement that was purchased online and wants to know whether he should take it, too. What is the MOST appropriate response to the client's question about taking a protein supplement?

Address the client's concerns, explain each assessment's purpose, and reassure the client that the assessments will allow for an individualized program to be designed Why? To enhance the evaluation experience, it is important for the client to feel at ease and have an idea of what to expect in the evaluation process. If possible, the health coach should provide a packet of paperwork prior to the initial meeting. The packet should include an overview of the evaluation process, including information on what to wear. Certain assessments also require avoidance of food, beverages, and/or prior exercise. Explaining to clients that postural assessments are a necessary component of uncovering postural changes so that interventions to minimize deviations can be created may be a good place to begin when bringing up the idea to new clients. It is also important to explain the purpose of any other assessments being performed and to make sure they are absolutely needed for the creation of an exercise plan. Reference: ACE Health Coach Manual, pages 315, 339-341,348 Study Tip: Put yourself in the shoes of the client in this situation and think about how uncomfortable being assessed might make you feel. Now imagine how you would feel if you did not know the purpose of the assessment, the expected outcomes, or possible interpretations of the results. This could be compared to going to the doctor for a physical and the doctor ordering a series of labs to be done without any explanation. Conducting postural assessments and basic assessments of mobility may assist in creating an effective and efficient exercise plan. Because stability and mobility training takes place during the initial stage of the ACE IFT model, it is important to utilize some type of assessments to identify areas of improvement throughout the entire kinetic chain. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3771/posture-and-movement-assessments https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/5413/practical-application-of-functional-assessments-static-postural-analysis https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/5590/practical-application-of-functional-assessments-movement-assessments

A client with obesity is to ready engage in physical activity, and expresses an interest in adding exercises to her program. The health coach explains that prior to designing the program basic postural and mobility (body weight squat) assessments would be beneficial. The client seems a bit wary and concerned about the assessments and wants to know the purpose of them. What is the MOST appropriate response?

Having the client bring her feet from a hip-width stance to a narrow stance Why? Moving the feet from a hip-width stance to a narrow stance would decrease the base of support, thereby increasing the balance challenge. When designing static balance-training programs, health coaches should follow the stance-position progressions illustrated in Figure 17-22. The health coach should identify which stance position challenges the client's balance threshold and then repeat the exercises with progressions. Reference: ACE Health Coach Manual, pages 501 - 502 Study Tip: Balance is a crucial component of all activities of daily living and it is likely that as a health coach you will work with many clients with balance-related goals. Increasing the balance challenge simply means you are adding a balance technique that is more challenging than what is currently being performed. For example, if you move from a hip-width stance to a narrow stance you are decreasing the base of support and making balance more challenging. It is important to consider meeting clients where they are when it comes to balance training. Remember not all clients will enter a program at the same starting point, or with the same goals, so it is important to start balance training in the safest and most appropriate positions as possible before progressing from one challenge to the next. When it comes to progressions for balance, it is imperative that clients are not progressed too aggressively. For example, you would not want to take a client who has mastered balancing at a hip width stance and progress him or her directly to balancing on a wobble board. Many steps would be skipped within this type of progression. Think of the various methods for increasing the balance challenge and when you may elect to implement them. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/5212/techniques-for-managing-and-reducing-stress https://www.acefitness.org/education-and-resources/professional/expert-articles/3810/how-stress-affects-your-waistline

A client with osteoporosis is looking to improve her balance. After working with the client for a few months, a health coach determines that she is ready to increase the challenge during a balance exercise. Which of the following changes to the client's stance position would INCREASE the difficulty during a balance exercise?

Make the client aware of the threshold for hypertension, suggest that he meet with his doctor, and proceed with moderate-intensity exercise Why? Because this client has not been active for nine months, has not seen a physician in two years, and may have undiagnosed hypertension, it would be in his best interest to schedule an appointment with his physician. A health coach would not diagnose hypertension, but educating the client about the threshold for hypertension and informing him that he has been above that threshold during the last two sessions, warrants further investigation from a more qualified professional. Reference: ACE Health Coach Manual, pages 30-33, and 597 Study Tip: Ask yourself, "What is in this client's best interest?" If a client has hypertension, he or she is aware of it, the physician is aware of it, and he or she is taking steps to manage it through medications and/or exercise, then sending him or her to a physician is probably not necessary. However, if you suspect your client may have undiagnosed hypertension and has not been to a physician in a while, it is in his or her best interest to refer to a physician for further evaluation. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3492/applying-risk-classification-as-a-fitness-professional

A health coach has been working with a client on a periodic basis for several years. During the last two sessions, the health coach measured the client's blood pressure, recording values of 146/93 mmHg and 142/94 mmHg. Upon asking the client if his physician has ever told him that he has high blood pressure, the client responds that he hasn't been to see a doctor for at least two years. What would be the MOST appropriate action for the health coach to take at this time?

Self-efficacy Why? Self-efficacy is the belief in one's own capabilities to successfully complete a task. Self-efficacy beliefs are thought to influence thought patterns, affective responses, and action. Additionally, self-efficacy is positively related to motivation. It is essential to understand how people develop self-efficacy. There are six sources of self-efficacy information: Past performance experience Vicarious experience Verbal persuasion A client's appraisal of his or her own physiological state The appraisal of one's emotional state Imaginal experiences Reference: ACE Health Coach Manual, pages 61 and 63-64 Study Tip: Self-efficacy is an important concept for all aspects of the client-coach relationship and acts as both a determinant and outcome of behavioral change. In other words, self-efficacy levels may determine if a behavior change will take place and self-efficacy levels may change as a result of behavior change. Past-performance experience has the greatest influence over current self-efficacy levels, so it is important to assess. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence

A health coach is working with a client who, after their first session, appears to be optimistic and has a strong sense of confidence in her ability to follow the program to accomplish her weight loss goals. The client has seen her siblings overcome similar challenges and believes she can take the same steps towards improving her health. This client's positive attitude can be BEST described by strength in which of the following?

The Socio-ecological Model Why? The Socio-ecological Model (SEM) looks at the interrelationships between individuals and the environments in which they live and work, and examines the many levels at which individuals are influenced, both in terms of support for healthy behaviors and barriers to improving healthy behaviors: individual, interpersonal, organizational, community, public policy. Option A looks to identify a stage of change, option C considers one's personal perception around a health condition or behavior, and option D considers one's need to feel competent, autonomous, and connected to others in many domains of life. References: ACE Health Coach Manual, pages 386-387, 534-535 Study Tip: Consider the factors within each of the 5 layers of this model and how you can cater your recommendations to each client's unique wants and needs. For example: Individual: knowledge, skill, attitudes; What are at the client's strengths? What does the client enjoy? Interpersonal: social network; What do the client's friends and loved ones like to do? Could they do activities together? Organizational: school, work, places of worship; Do they offer opportunities to be healthy? Are there people or places from which you can obtain resources? Is there an opportunity to start something there? Community: cultural values, norms; Is there a strong cultural presence? What are ways you can incorporate cultural values and norms into the program? Public Policy: What policies would inhibit or promote healthy behaviors within a community? What are ways you might be able to get involved to improve or change these policies? Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes

A health coach must consider not only a client's personal attributes and access to resources when beginning a program, but also social and cultural values of the community in which the client lives and works that could influence health. Which of the following BEST describes this important consideration?

Have the primary goal and focus of each session be about feeling good and accomplishing smaller, manageable tasks Why? Most new lifestyle-modification clients will start the program with very low self-efficacy. As a health coach, what are you doing to combat this issue from the very start? Because past performance experience is the most important source of self-efficacy information, each early experience should be focused on creating success and building confidence. As such, it may be a mistake to schedule the entire first session for only assessments. When a person is out of shape and overweight, what is the result of the assessments? An important goal as a health coach is to make each new client leave the first session feeling good and looking forward to being a part of the program. Reference: ACE Health Coach Manual, pages 59-61, 64-65, and 84-85 Study Tip: Self-efficacy levels change as clients move through the transtheoretical model of behavior change. If self-efficacy is a belief in one's ability to stick with and be successful in a behavior change endeavor consider all of the things that contribute to self-efficacy. As you are practicing identifying a client's stage of change, consider if you would suspect their self-efficacy levels to be low, moderate, or high. Also, consider how past experience is a driving force behind current levels of self-efficacy. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence

A new client informs a health coach that he feels worried about his ability to reach his fitness goals. He's exercised in the past and really struggled with adhering to a regular program. What would be the MOST appropriate initial approach for a health coach to implement with this client?

Refer the client to an appropriate health care professional for medical clearance. Why? A health coach is not qualified to diagnose any condition and should be vigilant in referring to a healthcare professional when necessary. If a client reports persistent musculoskeletal pain (i.e., lasting longer than two weeks), or if a structural or congenital condition (e.g., scoliosis) is suspected, the client should be referred to his or her primary healthcare professional and receive medical clearance prior to engaging in a new exercise program Reference: ACE Health Coach Manual, page 341 Study Tip:Becoming aware of common signs and symptoms for medical conditions is important for health coaches and the identification of these signs and symptoms is a crucial part of the client-trainer relationship. It is imperative that you work within your scope of practice and make appropriate referrals when necessary. At this point, you should become familiar with common signs and symptoms of diseases and musculoskeletal conditions that warrant referral. In addition, it is a good idea to practice having these types of conversations wherein you are not providing a diagnosis but are making a referral, and also providing motivation to continue with behavior change at the same time. Think about how you will go from suspecting a certain condition to making the client aware, and then making a referral. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2949/health-risk-appraisal-and-risk-stratification

A new client informs a health coach that he has had persistent pain in his knees for the past month when standing. What would be the MOST appropriate response to give to this client?

Recommend that the client engage in weight-bearing exercises Why? Osteoporosis is a disorder, primarily affecting postmenopausal women, in which bone density decreases and susceptibility to fractures increases and is characterized by weakness and susceptibility to bone fracture at common sites such as the hip, spine, and wrist. Engaging in weightbearing physical activity decreases the risk of osteoporosis. Reference: ACE Health Coach Manual, pages 191, 447 Study Tip:As a health coach, it is important to understand how to evaluate a client's log to provide the appropriate recommendations based on your observations. By knowing the most current research on common conditions and any associated nutrition and physical activity recommendations, you will be equipped to coach clients in their next steps. Try putting this into practice. Have a friend or family member complete his or her own activity or nutrition log, and determine what recommendations you would provide based on what you know of his or her current state of health and physical activity. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/5563/steady-state-vs-interval-training-which-one-is-best-for-your-clients

A new client informs her health coach that she has been diagnosed with osteoporosis. After evaluating the client's activity log, the health coach observes that she mostly participates in stationary recumbent cycling for cardiorespiratory exercise. Which response is the MOST appropriate regarding this client's program?

Encourage continued evaluation of pros and cons and validate lack of readiness to change Why? Within the contemplation stage of change, the following strategies may be implemented: Validate lack of readiness to change and clarify that the decision to change is the client's Encourage evaluation of the pros and cons of making the change Identify and promote new, positive-outcome expectations and boost self-confidence Offer invitations to become more active (e.g., free trials) Reference: ACE Health Coach Manual, page 60 Study Tip: Strategic intervention is essential for guiding clients through behavior change. Implementing a specific strategy at the wrong time can minimize progress and have an opposite effect of what is wanting to be achieved. At this point in your studies, it is important to not only be able to identify a client's current stage of change, but also be able to think of the most appropriate strategy to implement during that. Think of scenarios for working with clients in each stage of change and think about tools and strategies you can use to effectively prompt and guide clients from one stage to the next. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence https://www.acefitness.org/education-and-resources/professional/expert-articles/6532/ignite-behavior-change-with-motivational-interviewing

A new client reveals that he wants to lead a healthier life. The client has been weighing the pros and cons of making changes but is not yet ready to get started. What strategic intervention would be most effective for this client based on his current stage of change?

The focus of your initial exercise program should be on creating a positive exercise experience while walking at a pace that allows you to speak comfortably. Why? When clients begin an initial exercise program for sedentary clients they will begin in the initial phases of cardiorespiratory training where the initial focus is on creating positive exercise experiences to move the client toward becoming a regular exerciser. During this initial phase of training the client should work at an intensity below the talk test threshold where the ability to talk is not compromised. Clients will continue in this initial stage until they can sustain steady-state cardiorespiratory exercise for 20-30minutes below the talk test threshold. Reference: ACE Health Coach Manual, pages 470 - 472 Study Tip: Understanding various methods for monitoring exercise intensity is an important concept for health coaches to understand. While you may not work in an environment that requires you personally measure and monitor exercise intensity you may encounter clients who have questions about knowing how hard they are working. Consider the general recommendation given to perform 150 minutes of moderate intensity exercise on five days per week. What questions do you think clients may have about this recommendation. Clients may wonder what type of activity they should do, what they should wear, and how do I know if what I am doing is moderate or not? The use of the talk test and ratings of perceived exertion are user friendly methods of determining exercise intensity. While there are other methods for monitoring intensity (e.g., heart rate monitoring and % HRR) the use of the talk test is easy to administer, requires no equipment, and is a great predictor of exercise intensity. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3734/math-as-a-fitness-professional-part-i https://www.acefitness.org/ptresources/pdfs/Formulas.pdf

A new client, who was previously sedentary, began a walking program by implementing two, 10-minute bouts each day at a pace at which talking was uncomfortable. What would be the MOST appropriate recommendation for the health coach to make regarding exercise intensity?

Losing 24 pounds (10.9 kg) Why? Adults with a BMI =25 kg/m2 should be encouraged to engage in a weight-loss program. An initial weight-reduction goal of 5 to 10% of body weight should be targeted over a three- to six-month period. Losing 24 pounds would be the most appropriate, as 10% of 240 is 24 lb. Reference: ACE Health Coach Manual, page 461 Study Tip: There are many unique attributes to a behavior change program targeted specifically at overweight and obesity. The ACSM has come up with several determinants for setting goals for metabolic success. These goals may include: Encouraging adults with a BMI =25 kg/m2 to exercise (think about how this conversation will be different depending on the current stage of change.Weight loss 5-10%Enhancement of communication between healthcare professionals.Reduction of calories by 500-1,000 per dayIncrease PA to a minimum of 150 minutes per dayProgress to 200-300 minutes per week.Implement resistance trainingIncorporate behavioral modification strategies

A new sedentary client who stands 6'2" (188.0 cm) tall and weighs 240 pounds (108.8 kg) wants to set a new weight-loss goal. Which would be the MOST appropriate initial weight-loss goal for the client to set to be accomplished in the next three to six months?"

Umbrella liability insurance Why? Most insurance agents now recommend that all professionals purchase an umbrella liability policy. The umbrella policy provides added coverage for all of the other insurance (e.g., auto, home, and professional liability) that a person may have in place. For example, if a health coach was sued and the judgment exceeded his or her professional liability coverage, the umbrella policy would cover the insurance shortfall. When purchasing an umbrella policy, health coaches should be sure that it covers professional activities associated with health coaching. In addition, every liability policy should be examined to ensure that it covers the health coach while working in various locations (e.g., fitness center, personal home, clients' homes, and outdoors). Reference: ACE Health Coach Manual, pages 600-601 Study Tip: It is important to understand the different types of insurances available and what type of coverage would be best for the types of services you plan on providing as a health coach. If working as an independent contractor it may be helpful to create a list of what services you plan on providing, and where and how you anticipate these services taking place. Once you have this list, you can reach out to an insurance provider to discuss your plans. The insurance provider will be able to offer specific recommendations about the type and limits needed for your services. If planning on working as an employee, it is always a good idea to confirm with potential employers that your services and role are covered under their specific insurance policy or if you need to obtain your own insurance. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2668/the-ins-and-outs-of-liability-insurance

A newly certified ACE Health Coach is purchasing professional liability insurance in preparation for meeting with her first clients. The health coach would like to add more coverage to the already existing policies. What type of additional insurance would be the most appropriate to purchase?

Paid per job completion Why? Being a direct employee of a facility often provides professionals with stable employment, training, and use of the equipment within the facility. However, employees are typically paid an hourly rate or salary, whereas independent contractors are usually paid for each session or job as described in their contract. Reference: ACE Health Coach Manual, Pages 581 & 582 Study Tip: There can be a lot of uncertainty in this industry when distinguishing between an independent contractor and an employee. It is important to understand the difference and know how you are classified when working in the field. What it ultimately comes down to is who is in control? Independent contractors are in control of their work and manage many of their professional responsibilities, such as taxes and payment for each job. An employee will have regular hours and get paid on a regular schedule, as well as have certain rights (such as worker's compensation benefits, disability, and/or leave of absence).

A recently certified ACE Health Coach is trying to decide whether to be an independent contractor or an employee at a facility. Which of the following is associated with being an independent contractor?

Educate the client, reassure him that lapses are normal, and work together to set new goals. Why? Identifying high-risk situations will make health coaches more prepared to deal with program barriers and program relapse. Vacations, schedule changes, injuries, and holidays are some common situations in which many people relapse. Health coaches must be prepared for these events as they arrive and talk to their clients about the challenges of remaining physically active through these times. Also, identify clients who appear to be most at risk for program relapse. Reference: ACE Health Coach Manual, pages 68, 107 Study Tip: Although it is most common to see clients relapse while in the maintenance stage, it is important to note that relapse can occur at any stage of the TTM. As a health coach, it is important to develop strategies problems come up that could interfere with adherence. It is important for all fitness professionals to step back and remind themselves that the ultimate goal is simply behavioral change. Health coaches should be celebrating the small victories and creating activity experiences that people want as part of their lives. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence

After participating in regular physical activity most days of the week for almost one year, a client stopped her routine following several changes at work and home. What approach would be MOST appropriate in helping the client to cope with this lapse?

Help the client plan for continued support, reinforce intrinsic motivation, and maintaining the changes already made. Why? This person is in the maintenance stage of change. When someone is in maintenance, it is important to: Help the client plan for continued supportReinforce intrinsic motivationDiscuss how the client will cope with relapseFocus on maintaining the changes the client has made Reference: ACE Health Coach Manual, pages 106-107 Study Tip: Being able to identify the stage of change in which a client is can be very helpful, and it is important to take that skill to the next level by implementing appropriate strategies based on the current stage of change. These stages are fluid so the strategies we use as coaches will need adjustments throughout the client-coach relationship. Familiarize yourself with the different stages and come up with a game plan for working with clients within each stage of change. Also, consider unique wording used to describe the things a client might say or do that acts as an identifier indicating their current stage of change. For example, the words sporadic, inconsistent, and occasional may be used to describe the physical activity taking place for someone in the preparation stage. It may also be helpful to visualize or imagine clients in each stage of change and think about what they might say, and their attitudes, facial expressions, and body language. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes https://www.acefitness.org/education-and-resources/professional/expert-articles/6532/ignite-behavior-change-with-motivational-interviewing

An ACE Certified Health Coach has been working with a client for the past year. The client is now in the maintenance stage of change regarding exercise and physical activity. What strategies would be most important to implement in this stage?

Ask the client to provide evidence for and against thinking that way. Why? Cognitive distortions are at play here.A health coach can help a client actively dispute his or her erroneous beliefs by identifying the type of distortions he or she is making from among the following 10 cognitive distortions: All-or-nothing thinking: Looking at things in black-and-white terms Overgeneralization: Viewing a negative event as a continual pattern of defeat Mental filter: Dwelling on the negatives and ignoring the positives Discounting the positives: Believing that accomplishments or positive qualities are meaningless Jumping to conclusions: (a) Mind reading—assuming that people are reacting negatively with no basis in reality; (b) Fortune-telling—erroneously predicting that things will turn out badly Magnification or minimization: Blowing negative things out of proportion or diminishing positive things Emotional reasoning: Reasoning from how one feels; "I feel like a failure, so I must really be one," or "I don't feel I can succeed so I won't try" "Should" statements: Demanding that oneself or other people "should" or "shouldn't," "must," "ought to," or "have to" be different Labeling: Calling oneself names. Instead of saying "I made an error," telling oneself "I'm a loser" or "stupid" or "a failure." Personalization and blame: Blaming oneself or others inappropriately The health coach will find the following questions useful when helping a client reevaluate irrational, erroneous, and inaccurate thinking. The health coach asks the client to self-reflect with these questions: What is the evidence for and against thinking that...? What would I tell a friend in this same situation who was thinking what I am? What is the worst that could realistically happen? How bad would that be? Would it really be 100% bad? Would it be the worst thing that could happen? Is it really true that I must, should, ought to, have to...? Are there any other possible explanations besides blaming myself? Is there any other conceivable way to look at this positively? The goal is to help the client move from an absolutistic demanding, all-or-nothing approach to health improvement to a full preference that things be different, but with the ability to accept it when they are not. This is based on guided discovery, where the health coach asks the client a series of questions to bring the client's awareness to his or her thinking. Reference: ACE Health Coach Manual, page 13 Study Tip: See if you can identify your own cognitive distortions and try listening for erroneous beliefs in your day-to-day conversations. Practice asking questions that encourage exploration into distorted thinking. It can be challenging to confront someone who has a distorted image of the way things may be and it is important to address these distortions in a positive and meaningful way. Some other questions to ask when exploring these distortions include: Is it true? What is the grain of untruth? Is this thought empowering or disempowering? What thought would be more empowering? How can you leverage this experience to become even better? What can you do to rework this to catapult you forward? What is one thing you could stop doing today that would have the most positive impact in your life? What could you start doing that would have a more positive impact on your life? What is it that you are not facing? Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes

An ACE Certified Health Coach is working with a client who is displaying examples of cognitive distortion. The client views negative events as a continual pattern of defeat and dwells on the negative while ignoring the positives. Which of the following responses would be the MOST appropriate to dispute these erroneous beliefs?

Walk at a pace that allows you to walk and speak comfortably at the same time Why? Walking at pace that allows the client to speak comfortably means that he or she is working below the talk-test threshold and remaining in zone 1 of the three-zone intensity training model. The client in this question appears to be in Phase one of the IFT model (aerobic base) and the focus of cardiovascular programming should be initially on enjoyment, with a goal of increasing duration to 20 to 30 minutes of steady state exercise below the talk-test threshold. Reference: ACE Health Coach Manual, pages 470-472 Study Tip: Consider ways to let your client know how to monitor intensity while exercising. Many clients may not have access to equipment for monitoring intensity and will need to rely on using methods such as the talk test and RPE. Try using the talk test during your own training and begin implementing and exploring methods for monitoring intensity. When considering methods for monitoring intensity, you can use table 17-1 (p. 470-471) to see how several different methods relate to each other. It may also be helpful to start thinking about how things like specific medications may influence the method used for monitoring intensity. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/5296/exercise-progressions-for-clients-who-are-overweight-or-are-affected-by-obesity

An ACE Certified Health Coach is working with a new client toward increasing physical activity. The initial goal for this client is to walk for 5-10 minutes, 3 times per week at a low to moderate intensity. Which of the following coaching cues would be MOST appropriate for adopting the desired level of intensity?

10 to 20 weeks Why? Guidelines for safe and effective weight loss from most health organizations range from 1 to 2 pounds (0.45 kg to 0.91 kg) per week.For weight loss, it is advisable to reduce daily caloric intake by 250 calories per day and to increase daily expenditure (through physical activity) by 250 calories. This 500-calorie difference, when multiplied by seven, creates a weekly negative caloric balance that results in a loss of 1 pound (0.45 kg). These numbers may be doubled to achieve a loss of 2 pounds (0.91 kg) per week, but that may be too great a goal for some clients. Most health organizations recommend a weight-loss rate of 1 to 2 pounds (0.45 kg to 0.91 kg) per week. Also, weight loss is more easily maintained when the weight is lost slowly (about 1 to 2 pounds per week). If 1-2 pounds of weight loss per week is recommended, this is how you would determine an ideal range of time to achieve the weight loss goal: If losing 1 pound per week, it would take 20 weeks to lose 20 pounds (1 pound x 20 weeks = 20 pounds). If losing 2 pounds per week, it would take 10 weeks to lose 20 pounds (2 pounds X 10 weeks = 20 pounds). The goal timeframe for this client would be 10-20 weeks. Reference: ACE Health Coach Manual, pages 433 and 636 Study Tip:Practice the math. Create weight-loss scenarios by thinking about how much weight a client would like to lose and how quickly he or she would like to lose it (for example, losing 10 pounds in 20 weeks, or 15 pounds in 12 weeks). Another way this scenario could come up is with a client who has an event in the near future, such as a wedding or family reunion, and wants to lose a specific amount of weight for it. Think about how you'd would address these scenarios with clients in a realistic, informative, and inspiring fashion. Links: https://www.acefitness.org/ptresources/pdfs/Formulas.pdf

An ACE Certified Health Coach is working with a new client who would like to lose 20 pounds (9.1 kg). What is the most appropriate timeframe for this client to safely reach the weight-loss goal?

"It makes sense that you would feel the way you do." Why? The OARS Model includes the following actions: O = Ask open-ended questions: The goal is for the client to open up and share his or her thoughts/feelings; "What do you believe are some good reasons to begin this weight-loss and exercise program?" A = Affirm the client's thinking: Validate the client's desires, needs, and thinking; "It makes sense that you would feel the way you do, given that ____." R = Listen reflectively: Demonstrate to the client that the health coach hears and comprehends what is being said by rephrasing or mirroring what the client says; "Let's see if I get what you are saying... _______." S = Summarize: The health coach briefly restates what the client says and means; "So in summary, I hear you saying _____." Reference: ACE Health Coach Manual, pages 110, and 570-571 Study Tip: Using Models such as OARS and GROW can make health coaching significantly easier. During coaching sessions with clients, the last thing you want to be thinking about is what tools you should be using. Rather, you should be focused on the client. Practice using these models as a simple way to stay on track during client sessions without having to think about what to do next. This takes practice. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/6532/ignite-behavior-change-with-motivational-interviewing

An ACE Health Coach uses the OARS model to facilitate communication with a new client. Which of the following statements would MOST likely be used during the affirming portion of this model?

Risk Evaluation Why? Risk identification: This step involves the specification of all risks that may be encountered in the areas of instruction, supervision, facilities, equipment, contracts, and business structure.Risk evaluation: The health coach must review each risk, with consideration given to the probability that the risk could occur and, if so, what would be the conceivable severity. Table 20-1 can be used to assess the identified risks.Selection of an approach for managing each risk: Several approaches are available to the health coach for managing and reducing the identified risks: Avoidance: Remove the possibility of danger and injury by eliminating the activity.Transfer: Move the risk to others through waivers and insurance policies.Reduction: Modify the risks by removing part of the activity.Retention: Often there are risks that will be retained, especially if the removal of the risk would eliminate a potential benefit (e.g., no risks will occur if exercise is eliminated, but then no health benefits can be accrued).Implementation: Execute the plan.Evaluation: Continually assess the outcome of risk-management endeavors. The standard of care regarding some risks may change over time. Therefore, risk-management approaches may need to be altered over time. Reference: ACE Health Coach Manual, pages 605-606 Study Tip: Whether you are planning on starting your own business or working as an employee, it is a good idea to evaluate the current functions of your role or your business to determine what activities might have greater risk than others. Think about what you plan on doing as a certified health coach and apply those activities to table 20-1. Risk management is an ongoing process and best practices should be implemented regularly. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2949/health-risk-appraisal-and-risk-stratification

An ACE certified Health Coach is starting a coaching business and would like to implement a risk-management plan. In which step of the risk-management protocol would the health coach most likely try to determine the probability that a specific risk could occur and what the conceivable severity might be?

+3 Why? This client has the following positive risk factors for atherosclerotic cardiovascular disease: Age: = 45 in malesFamily History: Mother had a heart attack before the age of 65SedentaryLifestyle: Client is not currently exercising at a moderate intensity on at least 3 days per week for 30 minutes per day for at least the past 3 monthsHypertension: Currently taking antihypertensive medicationThis client also receives a negative (-1) risk factor for having an HDL cholesterol level = 60Because this client has a total of 4 positive (+1) risk factors and 1 negative (-1) risk factor, he has a total of 3 positive risk factors [because the negative cancels out one of the positive risk factors]. Reference: ACE Health Coach Manual, pages 274-275 Study Tip:When learning about cardiovascular disease risk factors, it's important to consider that some memorization is required, but it is also important to know the purpose of why we are looking at risk factors. The objective of conducting a health history is toavoid exposing habitually inactive individuals with known or occult CVD to the transiently heightened risks of unaccustomed vigorous-intensity exercise, including sudden cardiac death and acute myocardial infarction. Consider how gathering this information will allow you as the coach to provide client education, design and set exercise related goals, and make recommendations for lifestyle modification. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2949/health-risk-appraisal-and-risk-stratification https://www.facebook.com/ACEfitnessStudyCenter/videos/1752719591466172/

Client: 49-year-old male Height: 65 inches (165.1 cm) Weight: 145 pounds (66 kg) Family History: Mother had a heart attack at age 63 Cigarette smoking: Does not smoke Lifestyle: walks 30 minutes, twice a week for the last 2 months Hypertension: Currently taking antihypertensive medication Total cholesterol: 203 mg/dL HDL: 75 mg/dl LDL: 128 mg/dL Fasting plasma glucose 83 mg/dL Goals: While weight isn't a concern, he wants to tone up and get in shape so that he can feel good when he plays pick-up games of basketball at the local recreation center. He also wants to improve his understanding of healthful eating because after his recent divorce he is cooking for himself for the first time. According to the ACSM Risk Classification, how many positive risk factors did this client have?

Incorporate exercises to improve core function and maintain or improve range of motion in the pelvis and thoracic spine. Why? Before advancing past the functional movement phase, the client must first improve core function and range of motion. This client will most likely be starting in the stability and mobility phase of the ACE IFT model (phase 1) where the focus will be on strengthening muscles to improve posture. Initially, this may be done by placing the client in positions of good posture while performing a series of low-grade isometric contractions (<50% of maximal effort or maximal voluntary contraction), with the client completing two to four repetitions of five to 10 seconds each. The goal is to condition the postural (tonic) muscles that typically contain greater concentrations of type I muscle fibers with volume as opposed to intensity. Because many deconditioned individuals lack the ability to stabilize the entire kinetic chain, the initial emphasis should be placed on muscle isolation using supportive surfaces and devices (e.g., floor, wall, or chair backrest) prior to introducing integrated (whole-body, unsupported) strengthening exercises. Reference: ACE Health Coach Manual, pages 450-453, and 483-486 Study Tip: With scenario based questions like the ones with this case study, it is important to not lose sight of the big picture within all the details. Consider the wholeness of the coaching relationship and think about how each step of the client-coach relationship leads to the next. In this scenario, you are starting with the initial client interview, gathering health-history information, and designing an initial exercise program or giving suggestions for what an initial exercise program should include. Think about what steps may come next and what you would do as the coach. In addition, as you study chapter 17, practicing all of the different exercises shown can be an effective way to learn the names and purpose of the specific movements. You do not need to memorize each movement depicted but you should have a general idea of exercises that could be used within a stability and mobility exercise program design, for example. Think about the types of questions you may be asked from clients when it comes to exercise programming and plan for effective responses. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/4883/practical-application-of-the-ace-ift-model

Client: 49-year-old male Height: 65 inches (165.1 cm) Weight: 145 pounds (66 kg) Family History: Mother had a heart attack at age 63 Cigarette smoking: Does not smoke Lifestyle: walks 30 minutes, twice a week for the last 2 months Hypertension: Currently taking antihypertensive medication Total cholesterol: 203 mg/dL HDL: 75 mg/dl LDL: 128 mg/dL Fasting plasma glucose 83 mg/dL Goals: While weight isn't a concern, he wants to tone up and get in shape so that he can feel good when he plays pick-up games of basketball at the local recreation center. He also wants to improve his understanding of healthful eating because after his recent divorce he is cooking for himself for the first time. Based on the health-history information, what is the MOST appropriate initial resistance and functional movement program?

Administer a food frequency questionnaire and provide guidance on the choosemyplate.gov resources. Why? The benefit of this tool is that the client is less likely to forget foods, because they are listed on the chart. It is also easy to identify the type of diet the client typically follows (e.g., low-fat/high fiber or high-protein/high-fat). Figure 15-3 (p. 419-420) presents a portion of a sample food-frequency questionnaire. With the release of the 2010 Dietary Guidelines for Americans, the USDA took the old Food Guide Pyramid, which recommends a number of food groups and serving sizes to consume on a daily basis, one step further with the unveiling ofwww.ChooseMyPlate.gov. This new, simplified approach to nutrition and food group recommendations breaks down food groups by balancing the correct portions of each food group on a plate for an easy visual (Figure 15-5). Fruits and vegetables make up one half of the plate, grains take up one quarter, and the final quarter of the plate is protein. Additionally, there is a glass of milk (or any dairy item) paired with the plate of food groups. Reference: ACE Health Coach Manual, pages 418-421 Study Tip: Many clients will want to set goals around nutrition related topics and there are many creative ways to work with clients on nutrition goals while staying within scope of practice. Using tools such as a food-frequency questionnaire can be helpful in gaining insight into a client's current eating patterns. In addition, there are many ways to use technology for tracking and recording dietary habits that can be implemented into a coaching program. Becoming familiar with the various tools and resources available for monitoring, tracking, and recording dietary choices is a way to offer your clients options when it comes to this topic. Many clients may not be open to the idea of counting calories or recording nutrition information, and it may not be needed initially. However, having a variety of methods to suggest for this purpose can allow you to meet people where they are in their health-related journey. Many free tools and resources are available at ChooseMyPlate.gov. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/5792/nutrition-planning-vs-coaching https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3727/how-to-review-a-client-s-food-journal?topicScope=client-consultations

Client: 49-year-old male Height: 65 inches (165.1 cm) Weight: 145 pounds (66 kg) Family History: Mother had a heart attack at age 63 Cigarette smoking: Does not smoke Lifestyle: walks 30 minutes, twice a week for the last 2 months Hypertension: Currently taking antihypertensive medication Total cholesterol: 203 mg/dL HDL: 75 mg/dl LDL: 128 mg/dL Fasting plasma glucose 83 mg/dL Goals: While weight isn't a concern, he wants to tone up and get in shape so that he can feel good when he plays pick-up games of basketball at the local recreation center. He also wants to improve his understanding of healthful eating because after his recent divorce he is cooking for himself for the first time. Based on the health-history information, what would be the MOST appropriate initial nutrition recommendations?

This client is classified as moderate risk and can begin a moderate-intensity exercise program without needing additional clearance from a physician. Why? Clients classified as moderate risk are those who have= 2 risk factors and are asymptomatic. Clients in this classification may begin a moderate-intensity exercise program (40% to <60% VO2R; 3 to < 6 METs) without needing medical clearance, an exercise test, or a medically supervised exercise test. Clients in the moderate-risk category would need medical clearance prior to beginning a vigorous intensity (>60% VO2R; = 6 METs) exercise program. Reference: ACE Health Coach Manual, pages 274-275 Study Tip: Conducting and gathering health-history information is important for identifying the following individuals: Those who should receive medical clearance before beginning an exercise program or increasing the frequency, intensity, and/or volume of an existing program Those with clinically significant diseaseThose who may benefit from a medically supervised exercise program Those with medical conditions that may need to be excluded from exercise until conditions are better controlled Links: Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2949/health-risk-appraisal-and-risk-stratification https://www.facebook.com/ACEfitnessStudyCenter/videos/1752719591466172/

Client: 49-year-old male Height: 65 inches (165.1 cm) Weight: 145 pounds (66 kg) Family History: Mother had a heart attack at age 63 Cigarette smoking: Does not smoke Lifestyle: walks 30 minutes, twice a week for the last 2 months Hypertension: Currently taking antihypertensive medication Total cholesterol: 203 mg/dL HDL: 75 mg/dl LDL: 128 mg/dL Fasting plasma glucose 83 mg/dL Goals: While weight isn't a concern, he wants to tone up and get in shape so that he can feel good when he plays pick-up games of basketball at the local recreation center. He also wants to improve his understanding of healthful eating because after his recent divorce he is cooking for himself for the first time. Based on the health-history information, what would be the MOST appropriate initial strategy to use in working with this client?

Reality Why? Reality questions elicit specific details of the situation and context. What is happening now? Who is involved? What is the outcome? What is likely to happen in the future? Reference: ACE Health Coach Manual, Page 14 Study Tip: Practice applying the GROW model during mock or real coaching sessions. Think about the type of questions you would use to learn more about a client's goals, reality, options, and what they will do now. Using this model allows the coach to remain in the frame of mind that the client is his or her own best expert and not an expert in the client's situation. An effective way to practice using the GROW model is either apply it to current clients with which you are working or to make up scenarios for creating effective goals. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/2473/what-is-rapport-and-why-is-it-so-important?topicScope=client-consultations

During an initial meeting with a client who is struggling with eating more healthfully, an ACE Certified Health Coach asks, "What is happening now?" In which area of the GROW model is the health coach MOST likely trying to gain more information?

145 lb (65.8 kg) Why? Step 1: Determine CURRENT body weight distribution: 29% fat mass and 71% fat-free mass = 155 x 0.29 = 44.95 lb fat mass155 x 0.71 = 110.05 lb fat-free mass Step 2: Determine DESIRED fat-free percent: 24% fat and 76% fat-free 0.24 = fat0.76 = fat-free Step 3: Divide CURRENT fat-free mass by DESIRED fat-free percent: 110.05/0.76144.80 = ~145 lb Reference: ACE Health Coach Manual, page 297 Study Tip: Practice this math by creating weight ranges for the various classifications for percent body fat. In this example, 21-24% is in the "fitness" classification, so the client set a goal at the high end of the fitness classification. What would the low end be? If you feel that math is an area where you need improvement, don't forget to take advantage of your fitness math course and practice the math daily, a little at a time, over the course of your studies to become familiar with the math. Repetition with the equations is very beneficial. Also, consider trying to understand what the numbers and values represent in each equation. The more you understand what the numbers represent, the more the equations will make sense. It can be helpful to imagine that you are performing the calculation by hand in front of a client and explaining what each value represents at each step and how you figured it out.

During initial assessments, a health coach determines that a 34-year-old female client is 5 feet 7 inches tall, weighs 155 lb (70.3 kg), and has 29 percent body fat. The health coach works with the client to decide on the goal of decreasing to 24 percent body fat. Assuming the client's lean body weight is maintained, what will her body weight be when she achieves her desired percent body fat?

Suggest that the client walk for 45 minutes three days a week on her lunch breaks Why? The health coach should have the client increase the duration on days she can commit to her walks. As her schedule is demanding, the health coach should adjust her exercise schedule to accommodate to that which she can commit, while but increasing the duration she exercises. Exercise duration is probably the most appropriate variable to manipulate initially, building the exercise session by 10%, or five to 10 minutes weekly over the first four to six weeks. Thereafter, and once adherence is developed, health coaches can implement progressions by increasing exercise frequency and then exercise intensity. Reference: ACE Health Coach Manual, page 473-474 Study Tip:Frequency is inversely related to intensity and duration, meaning that if you're working out most days of the week, you don't necessarily need to work out as long and/or at as high of an intensity. Depending on each client's unique needs figure out which variable is going to be the best one for him or her to manipulate. For example, if you have a client who only has 30 minutes to work out on her lunch breaks, the variable you can adjust to increase health benefits is intensity. As her fitness improves, she may workout at higher intensities during those 30 minutes. On the other hand, if she hates running, but has a fair amount of time to dedicate to fitness, she could workout at a low intensity, but could do it all or most days of the week and/or for longer durations.

For the past month, a new client has been walking at a low to moderate intensity for 30 minutes, 5 days a week. The client is now finding it difficult to maintain her daily walks as her work and family life have become more demanding. The client begins skipping her walks on some days and is on the brink of dropping her walking habit altogether. The client approaches a health coach about this concern to explore some options. How can the health coach modify her exercise program so that it is more feasible for the client?

Agreement to participate Why? Agreement to participate makes participants aware of the risks associated with the activity that they are about to perform. Because exercise has risks associated with it, it is important that clients are made aware of these and are encouraged to move at the pace that is safe for them, as they know their body best. Informed consent gives health coach permission to perform an activity with clients so that they are aware of the protocol and procedures and are okay to move forward with it. For example, a health coach would want to obtain informed consent prior to administering a skinfold caliper assessment, as it can be invasive and uncomfortable. A liability waiver is foregoing any liability of the fitness professional for damages that could occur. For example, if a client twists his ankle during jumping jacks, the health coach would not be liable if the client signed a waiver. Reference: ACE Health Coach Manual, pages 583-590 Study Tip:Health coaches should understand the concept and use of agreements to participate, informed consent, and waivers, as they can be important defenses to litigation for negligence. Ideally, each of these forms should be printed (avoid handwritten agreements) and signed by all clients before beginning the first exercise session. However, it is highly recommended that the health coach consults with an attorney who specializes in, or has experience with, the health and fitness industry before using these documents to ensure their legality and legitimacy in court.

What form is used to have the client acknowledge that he or she has been made aware of the "normal" outcomes of certain types of physical activity and willingly assumed the risks of participation?

Changes in ventilation due to physiological adaptations to exercise Why? Ventilatory threshold testing is based on the physiological principle of ventilation. As exercise intensity increases, ventilation increases in a somewhat linear manner. The first notable point is called the "crossover" point and represents a level of intensity where blood lactate begins to accumulate. This marks the first ventilatory threshold (VT1). Exercise below VT1 is identified as moderate intensity, while exercise above VT1 is classified as vigorous intensity. Some of the characteristics of the "talk test" are: it's based on actual changes in ventilation due to physiological adaptations to increasing exercise intensities; it's very easy for practical measurement; no equipment is required; it can easily be taught to clients; and it allows for individualized programming. Reference: ACE Health Coach Manual, page 329, 470-477 Study Tip: Being able to explain the purpose of each assessment used is crucial to the client-coach relationship and the overall safety of an exercise program. It is important to be able to explain what is taking place physiologically during an assessment, the contraindications, and interpret the results. Think about being able teach clients how to use the talk test, its purpose, and what changes in breathing rates mean. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/1165/understanding-vt1-and-vt2

What is the "Talk Test" best used to assess?

Open-ended questions Why? Open-ended questions often begin with the words "what," "why," or "how." "Describe", "tell," or "explain" are also options. Be selective when asking "why," as it can sometimes start an aimless discussion, leading to the all-too-common response, "I don't know." "What" and "how" are much more dynamic and useful. Effective open-ended question options include: "Describe that for me." "How would you like things to be different?" "Tell me more." "How can I help you?" "What are the positive things and what are the negative things about your situation?" These open-ended stems allow the health coach to actively listen. These techniques are useful when the health coach wants to open a conversation, learn more detail, understand a client's views, or keep a conversation going. Reference: ACE Health Coach Manual, page 108 Study Tip: Getting used to the idea of asking open-ended questions takes some getting used to and their implementation takes practice. Attempt using open ended questions in real life situations whenever you have a chance and observe how their use can steer the direction of a conversation. Open-ended questions are useful in getting clients to open up about their thoughts and feelings and explore ideas at a deeper level. Asking open- ended questions is less threatening to client autonomy and the key is to ask questions in a way that respects the client's choices. Some sample open-ended questions include: What could you do? What ideas can you bring in from past successes? What have you not tried yet? Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3181/how-to-establish-rapport-with-non-verbal-communication?topicScope=communication-and-behavior-change

When meeting with a client for the first time, a health coach asks the following question: "How will you know when it is time to make a change?" What type of questioning skill is the health coach using?

Cat-camel Why? The cat-camel is an exercise that promotes mobility of the hips and improves extensibility within the lumbar extensor muscles Reference: ACE Health Coach Manual, page 487 Study Tip: When it comes to the exercises in chapter 17, it may be a good idea to practice each exercise while thinking about the targeted muscle groups, contraindications, and appropriate progressions. Becoming familiar with the names of the exercises and being able to visualize what they look like may be useful during your studies. Think about different postural assessments and movement screens and how to interpret the results and explain the results, and select appropriate exercises based on the interpretation. Links: https://www.acefitness.org/education-and-resources/lifestyle/exercise-library/15/cat-cow

Which exercise is used to improve extensibility within the lumbar extensor muscles?

A prediabetic client who sees a health coach on his doctor's recommendation, but feels it may not be beneficial because he has a family history of diabetes Why? Individuals within the precontemplation stage of change are typically unaware or under-aware of the problem, or believe that it cannot be solved. Clients in this stage may only be meeting with a health coach at the request of someone else. Goals for working with someone in the precontemplation stage include increasing awareness of the risks of inactivity and benefits of activity, identifying relevant goals on which to focus, and initiating thinking about change. Strategies for working with someone in this stage include: Validate lack of readiness to change and clarify that this decision is theirs Encourage reevaluation of current behavior and self-exploration, while not taking action Explain and personalize the inherent risks of not changing the behavior Utilize general sources, including media, Internet, and brochures to increase awareness Reference: ACE Health Coach Manual, page 60 Study Tip: Working with individuals in the precontemplation stage may be challenging but it can also be very rewarding. You may recognize individuals in this stage by statements such as, "I don't have any problems that need changing" or "My family just has obesity, it's our genetics." Think about what strategies you might deploy when you are interacting with someone in this stage of change and practice using those strategies when you have the opportunity. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes

Which of the following clients is in the precontemplation stage of the transtheoretical model of behavior change?

Emotional eating Why? Some people respond to feelings of stress and to extreme emotional states (both negative and positive) by eating, even when they are not hungry. Eating triggered by emotional states is referred to as emotional eating. This response is fairly widespread in the general population, not just among those who are overweight (Geliebter & Aversa, 2003). Emotional eating becomes a problem when people are trying to reduce food intake. The stress associated with lifestyle modification can compound the problem of emotional eating. In other words, eating less than normal causes stress, which can lead, paradoxically, to overeating. Reference: ACE Health Coach Manual, pages 391-393 Study Tip: Most new clients starting a lifestyle-modification program are dealing with feelings of stress, apprehension, and insecurity, and it is the job of the health coach to acknowledge and address some of these emotions if appropriate. Stress manifests in many ways including emotional eating, depression, and lack of willpower. A health coach should know how to recognize these symptoms. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3808/motivation-behavior-change-and-program-adherence

Which of the following coping mechanisms would be more of a problem for a new client who is concerned with managing food intake?

Social and physical environment Why? People are social creatures, so their eating and physical-activity habits, as well as their stress and coping patterns, are greatly influenced by the social and physical environments in which they live. Reference: ACE Health Coach Manual, page 386 Study Tip: Consider how your environment may or may not help you to stay on track with your goals and consider ways that you can translate that into various settings. Then, consider environments that hinder your adherence, and explore factors that are modifiable. For the factors that are within your control, what ways might you be able to make them more in line with your fitness goals? Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/5792/nutrition-planning-vs-coaching

Which of the following greatly influence a client's eating and physical-activity habits, as well as their stress and coping patterns?

Characterized by diagnosis in childhood Why? Type 1 diabetes results from the inability of the pancreas to secrete sufficient amounts of insulin, the hormone that allows the cells to take up glucose from the bloodstream. Type 1 generally develops in childhood and requires regular insulin injections; formerly known as insulin-dependent diabetes mellitus (IDDM) and childhood-onset diabetes. Type 2 diabetes is the most common form of diabetes, typically developing in adulthood and characterized by a reduced sensitivity of the insulin target cells to available insulin. Reference: ACE Health Coach Manual, page 189, 641, 675 Study Tip:Familiarize yourself with the similarities and differences of Type I and Type II Diabetes so that you can make sure that the program you create will support the adaptations that will be most beneficial for both types of clients. It may be helpful to imagine that you are preparing a general presentation about diabetes, including the difference between type 1 and 2, and how exercise affects diabetes. Think about the types of questions you might be asked and prepare for appropriate responses. Understanding information about diabetes at this level will be helpful both professionally and during your studies. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/5904/how-to-determine-macronutrient-needs-based-on-goals https://www.choosemyplate.gov/search

Which of the following is MOST associated with Type 1 diabetes?

Increased anterior pelvic tilt Why? Altered posture and a lack of spinal mobility could be underlying causes of low-back pain in obese individuals. Research comparing the spines of obese subjects with normal weight controls has found significant differences at the lumbar, pelvic, and thoracic levels among the groups. Obesity seems to induce an increase in anterior pelvic tilt. Reference: ACE Health Coach Manual, page 443 Study Tip: Obesity may cause many biomechanical changes. It is important to consider what these changes may look like, how they are described, and where they may manifest with pain. Common presentations of biomechanical changes related to obesity include: Low-back painDecreased mobilityModified gait patternChanges in energy expenditureAltered postureLower extremity pain

Which of the following is a biomechanical adaptation that has been found to be associated with having obesity?

Lower walking cadence and velocity Why? The impact of obesity can affect many aspects of physical activity. For example, changes in lower extremity musculoskeletal function will influence gait patterns. Common changes to gait patterns in clients with obesity include the following: A shorter step lengthLower cadence and velocityA decreased duration of the single-support phaseAn increased duration of the double-support phaseReduced range of motion at the knee and ankle In addition, clients with obesity are likely to have an increased anterior pelvic tilt and are five to six times more likely to have plantar fasciitis when compared to those of a normal BMI. Reference: ACE Health Coach Manual, pages 444- 445 Study Tip:There are many obesity related concerns that health and wellness professionals should be familiar with when it comes physical activity and nutrition. In fact, there are many contributing factors to obesity that are outside the control of the individual. In addition, obesity usually contributes to ill health, functional impairments, serious disease, reduced quality of life, and increased mortality. There is much to consider when working with clients with obesity in addition to the social stigma and discrimination they may face daily. When working with clients with obesity it is important to remember that unless you have been or are currently dealing with personal obesity related challenges it may be difficult to truly difficult to understand what someone in this state is going through. Links: https://www.acefitness.org/education-and-resources/lifestyle/blog/3082/obesity-morbidity-and-mortality-where-do-we-stand

Which of the following is an obesity-related concern when creating an exercise program?

Carbohydrate: 50%; protein: 20%; fat: 30% Why? The Acceptable Macronutrient Distribution Range recommends that approximately 45 to 65% of calories come from carbohydrate, 10 to 35% from protein, and 20 to 35% from fat. Reference: ACE Health Coach Manual, pages 171 - 175 Study Tip: Help your clients determine appropriate caloric intake, and then calculate the appropriate caloric range for each macronutrient so they can understand how many calories they should be getting each day from each macronutrient. This is a great time to review the 2015-2020 dietary guidelines and look for key information that may be useful to share with clients. It is also helpful to continue reviewing food labels and looking to see if the macronutrient distribution found in common foods you eat is aligned with current distribution recommendations. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/5973/4-steps-to-help-your-clients-prevent-a-diet-relapse https://www.acefitness.org/education-and-resources/lifestyle/blog/6436/overcoming-workout-relapses

Which of the following options has percentages for each macronutrient that fall within the Acceptable Macronutrient Distribution Ranges (AMDR)?

Ventilatory threshold test Why? Ventilatory threshold testing is not recommended for individuals with the following conditions:Certain breathing problems [asthma or other chronic obstructive pulmonary disease (COPD)]Panic/anxiety attacks, as the labored breathing may create discomfort or precipitate an attack Reference: ACE Health Coach Manual, page 330 Study Tip: Knowing contraindications for specific types of exercise tests is crucial for selecting appropriate assessments based on health-history information, client goals, and the need to assess at any point during the client-trainer relationship. Throughout your studies, it is important to consider the objective of each assessment, as well as alternative modes of assessing if the preferred method is contraindicated for a specific client. Ventilatory threshold testing is a relatively simple method for gathering important data. However, if it is not appropriate to perform on a specific client, are there other ways to obtain similar information. In addition, exercise testing is not needed for all clients to begin an exercise program. For example, if the client is new to exercise and is in phase 1 of the ACE IFT model, no assessments of cardiorespiratory fitness are needed and the focus of the program will be on enjoyment and building self-efficacy. Links: https://www.acefitness.org/education-and-resources/professional/expert-articles/6385/how-to-work-with-clients-who-have-chronic-conditions

Which of the following physiological assessments is contraindicated for a client with asthma?

A health coach performs an act of commission Why? When a health coach performs an act of commission, it means he or she acted inappropriately, so even though the client may have signed a waiver, a waiver only relieves the health coach of liability when practicing within the standard of care. A health coach could be successfully sued if his or her actions are not in alignment with what is safe or appropriate. While it is always recommended that health coaches obtain liability insurance, especially if they are self-employed or an independent contractor, some health coaches may not need to if they are covered by their employers (see vicarious liability). Letting your certification lapse is in violation of the ACE Code of Ethics, but health coaches may be successfully sued whether their certification is current or has lapsed. While it is outside the scope of practice to recommend specific diets, clients may want guidance on nutrition so sharing healthy recipe ideas and other resources is appropriate. Reference: ACE Health Coach Manual, pages 174, 590, and appendix A (613-620) Study Tip: Familiarize yourself with the legal terminology in chapter 20 so you feel comfortable with the differences in the various forms, waivers, types of negligence and insurance. For example, think of an act of commission as doing something you should not do whereas an act of omission is not doing something you should do. Both could result in negligence, regardless of a waiver being signed. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3792/legal-responsibility

Which of the following scenarios would be MOST likely to result in a health coach being liable for damages, even though a client has signed a waiver?

Time management and prioritizing Why? Health coaches will be better able to help their clients maintain behavioral plans if they take the time to teach them additional coping skills, including time management and prioritizing, work with them on developing a plan for adherence, and remain supportive, understanding, and empathetic. Reference: ACE Health Coach Manual, page73 Study Tip: Consider common high-risk situations that people might face in various occupations and try and come up with various time management and prioritization options that might be helpful for those types of people. Use family and friends for inspiration, and discuss what solutions they use or maybe even help them explore options that might help them. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes https://www.acefitness.org/education-and-resources/professional/expert-articles/6532/ignite-behavior-change-with-motivational-interviewing

Which of the following would be MOST appropriate for a health coach to teach clients about to help prevent relapses?

Encourage evaluation of the pros and cons of making a change Why? When working with clients who are in the contemplation stage, it is important to inform them of available options and provide cues to action with some basic structured direction. The following strategies can be used within this stage to reach these goals: Validate lack of readiness to change and clarify that this decision is theirs Encourage evaluation of the pros and cons of making change Identify and promote new, positive-outcome expectations and boost self-confidence Offer invitations to become more active (e.g., free trials) Reference: ACE Health Coach Manual, page 60 Study Tip: Clients moving from the contemplation stage, wherein they are weighing the pros and cons of adopting a new behavior and are still ambivalent to change, to the preparation stage, stage, wherein they are preparing for the new behavior and may actually be starting to do the new behavior, is a turning point in the journey toward leading a healthier life. While practicing identifying the clients' stage of change, listen to the type of wording they are using within each stage. In the contemplation stage, you may observe people saying things I like, "I may start walking" or "I have a problem and know I should work on it." In this case, the health coach would want to encourage more change talk. In the preparation stage, clients may be testing the waters and may say things like, "I know I have to" or "I will". Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3171/how-to-use-the-transtheoretical-model-to-help-clients-make-healthy-behavioral-changes

Which of the following would be MOST appropriate in helping a client progress from the contemplation to the preparation stage of the transtheoretical model of behavior change?

Claudication or leg pain Why? When performing a cardiorespiratory fitness test, it is normal to experience an increase in heart rate with increases in intensity, sweating, and systolic blood pressure increases. The following signs and symptoms would warrant test termination:Onset of angina pectoris or angina-like symptoms that center around the chest Significant drop (>10 mmHg) in SBP despite an increase in exercise intensityExcessive rise in blood pressure: SBP >250 mmHg or DBP >115 mmHg Fatigue, shortness of breath, difficult or labored breathing, or wheezing (does not include heavy breathing due to intense exercise) Signs of poor perfusion: lightheadedness, pallor (pale skin), cyanosis, nausea, or cold and clammy skinIncreased nervous system symptoms (e.g., ataxia, dizziness, confusion, and syncope) Leg cramping or claudicationPhysical or verbal manifestations of severe fatigue The test should also be terminated if the client requests to stop or the testing equipment fails. Reference: ACE Health Coach Manual, page 325 Study Tip: When deciding to perform cardiorespiratory fitness tests with a client, it is important to have a good understanding of what normal responses to the exercise test might be and the signs and symptoms to be aware of for ending the test. This is also helpful for providing client education in that you will want to let the client know what normal responses to the specific type of assessment in case something abnormal occurs. When studying the various types of assessments, it is important to know the objective or purpose of each assessment, for whom it is appropriate, the contraindications for each assessment, as well as what the results of the assessments mean and how you will explain them to your client. Links: https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/4831/physiological-assessments-cardiovascular-assessments

Which of the following would warrant an immediate stop to a cardiorespiratory fitness test or a client's cardiorespiratory exercise?