A relationship of mutual trust, harmony or emotional affinity. The development of a professional relationship with mutual respect and understanding.
What 3 attributes are essential to successful relationships?
Why is rapport different from the other 3 essential stages of a successful client-trainer relationship?
Because it continues to develop throughout the relationship.
What are the 4 stages of a client-trainer relationship?
1) Rapport (ongoing)
What does the Rapport stage of a client-trainer relationship involve?
- Impressions of professionalism
- Developing trust
- Demonstrating warmth and genuineness
- Exhibiting empathy
What does the Investigation stage of a client-trainer relationship involve?
- Identifying stage of behavioral change
- Identifying personality style
- Collecting health and safety information
- Learning about lifestyle preferences, interests & attitudes
- Understanding previous experiences
- Conducting assessments
What does the Planning stage of the client-trainer relationship involve?
- Collaborative goal setting
- Programming considerations
- Designing motivation & adherence strategies
What does the Action stage of the client-trainer relationship involve?
- Instruction, demonstration & execution of programs
- Implementing strategies to improve motivation & promote long-term adherence
- Providing feedback and evaluation
- Making necessary adjustments to programs
- Monitoring the overall exercise experience and progression toward goals
What is a common mistake when trainers begin collecting information from a client?
Collecting information before developing rapport.
What is crucial to the client-trainer relationship, aside from developing rapport?
Understanding the personality type of the client.
What two components are related to general communication for a personal trainer developing rapport?
Environment and effective communication.
How can a trainer create an environment that helps develop rapport with a client?
- Quiet & comfortable (nurturing but professional). Free of distractions; avoid high traffic areas.
- Attention to personal appearance (clothing, grooming, scent, jewelry, breath)
At the first meeting, how should a trainer avoid trying to establish rapport?
With a simple facility tour or orientation.
How can a trainer use effective communication to help develop rapport with a client?
-Nonverbal communication (facial expression, posture, gestures, eye contact)
What should a trainer’s distance and orientation (body positioning) be, in general?
Face the client squarely and maintain appropriate distance to demonstrate respect for personal space. 1-1/2 to 4 feet is considered ideal.
What should a trainer’s posture and position be, in general?
Open, well balanced, erect but relaxed posture. Slight forward lean to show confidence and interest.
What physical thing should a trainer avoid when listening, but utilize when preparing to speak?
How can trainers use eye contact for good communication?
Maintain a relaxed look but avoid fixed stares.
How can trainers use facial expressions for good communication?
1) Try to smile
2) Be aware that eye expressions say a lot
How can trainers mirror a client to help place the client at ease and facilitate open communication?
Trainers can mimic posture, gestures, and voice tone or tempo.
What physical movements should a trainer avoid?
1) Distracting movements (foot tapping, pen clicking, etc.)
2) Pointing or other intimidating gestures
3) Leaning on a desk or wall (indicates boredom or fatigue)
4) Hands on hips (can look aggressive)
4) Crossing arms or legs (conveys defensive stance)
How should a trainer use voice quality for good communication?
A weak, hesitant voice does not inspire confidence, but a loud, overbearing noise can make people nervous. Trainers should have a firm, confident, professional voice that also displays warmth and compassion.
What is the primary nonverbal communication skill and what does it mean?
Listening effectively. The listener pays attention to both the content and the emotions behind the speaker’s words.
What type of listening should a trainer use?
Active listening. A person shows empathy and listens as if he or she is in the speaker’s shoes.
When using active listening skills, what are 4 things a trainer needs to do?
1) Separate meaningful content from superfluous information
2) Don’t get caught on trigger words that distract from the overall message
3) Be aware of client’s emotional pattern changes based on content of discussion (ie: becoming defensive when discussing weight)
4) Be conscious of how cultural and ethnic differences affect communication
What are cognitive vs. affective messages?
Cognitive messages are more factual. Affective messages are composed of feelings, emotions, and behaviors and can be expressed both verbally or non verbally.
What are good interviewing techniques for asking questions?
1) Minimal encouragers (ie: please explain what you mean)
2) Paraphrasing (restate content)
4) Reflecting (restate feelings)
7) Confronting (mild to strong feedback)
8) Questioning (open or closed ended questions)
9) Deflecting (shift focus away from yourself)
What is a “preaching” style of communication?
Judgemental. Delivers information in lecture type format. Minimizes chances of developing rapport.
What is an educating style of communication?
Informational. Provides relevant information in a concise manner. Allows the client to make an informed decision.
What is a counseling style of communication?
Supportive. Utilizes a collaborative effort to problem solve and help the client make an informed decision. This is considered the most effective style and is recommended.
Which style of communication is recommended for personal trainers?
What is a directing style of communication?
Provides instruction and direction. Most effective when safety and proper form and technique are essential.
After developing rapport, what information should a trainer seek next?
The client’s readiness to change and/or stage of change.
Motivational interviewing can help facilitate behavioral change because:
1) It helps the client see that he/she has control.
2) It enhances intrinsic motivation to change.
What should trainers keep in mind about clients who complete self-administered questionnaires?
They may not always be fully honest.
Who has an increased risk of harm from moderate exercise?
Any individual who is unhealthy, presents with a disease, or is at risk for a disease.
What are the purposes of a pre-participation screening?
1) Identifying the presence or absence of known cardiovascular, pulmonary, and/or metabolic disease, or signs and symptoms indicative of the above
2) Identifying individuals with medical contraindications who should be excluded from exercise until these conditions are corrected or under control
3) Detecting at-risk individuals who should first undergo a medical evaluation and clinical exercise testing before initiating an exercise program
4) Identifying individuals with medical conditions who should participate in medically supervised programs
What does contraindication mean?
Health conditions and risk factors
What is PAR-Q?
The Physical Activity Readiness Questionaire. This is a short, simple, minimal pre-screening tool, and may be limited in its details.
What should a trainer do if someone using PAR-Q is identified as having multiple health risks?
Conduct a more detailed health appraisal.
What information does a detailed health appraisal contain?
1) Review of health information
2) Review of medical history
3) Review of lifestyle habits
What can a detailed assessment enable a trainer to do?
1) Determine risk stratification
2) Determine the need for medical examination
3) Develop recommendations for lifestyle modifications
4) Develop strategies for exercise testing & programming
Who published a pre-screening tool that is more comprehensive than PAR-Q?
ACSM & The American Heart Association.
According to the ACSM and The American Heart Association, what three things are the basis for performing risk stratification?
1) The presence or absence of known cardiovascular, pulmonary, and/or metabolic disease
2) The presence or absence of cardiovascular risk factors
3) The presence or absence of signs or symptoms suggestive of cardiovascular, pulmonary, or metabolic disease
Why is risk stratification important?
Because someone with only one positive risk factor will be treated differently than someone with several positive risk factors.
What categories exist in risk stratification?
Low, moderate, and high.
What three basic steps should be followed chronologically in risk stratification?
1) Identifying coronary artery disease (CAD) risk factors
2) Performing a risk stratification on CAD risk factors
3) Determining the need for a medical exam/clearance and medical supervision
During risk stratification, each positive risk factor equals how many points?
What condition is a negative risk factor that allows a point to be subtracted during risk stratification?
High-density lipoprotein (HDL) equal to, or exceeding, 60mg/dL.
For males and females, what age is considered a +1 risk factor?
Men: 45 years and older
Women: 55 years and older
What family history is considered a +1 risk factor?
Myocardial infarction, coronary revascularization, or sudden death before 55 in father or other first degree male relative, or before 65 in mother or other first degree female relative.
What details related to cigarette smoking are considered a +1 risk factor?
1) Current cigarette smoker
2) Quit smoking within last 6 months
3) Exposure to secondhand smoke
What details regarding a sedentary lifestyle are considered a +1 risk factor?
Not participating in at least 30 minutes of moderate physical activity (40 to 60% VO2R) at least 3 days per week for at least 3 months
What details regarding obesity are considered a +1 risk factor?
1) BMI of 30 or over
2) Waist girth over 102 cm (40 inches) for men
Waist girth over 88 cm (35 inches) for women
What details related to hypertension are considered a +1 risk factor?
1) Systolic blood pressure of 140 mm/Hg or more, and/or diastolic blood pressure of 90 mm/Hg or more, confirmed by measurements on at least 2 separate occasions
2) Currently on antihypertensive medications
What details related to dyslipidemia are considered a +1 risk factor?
Low-density lipoprotein (LDL) cholesterol of 130 mg/dL (3.37 mmol/L) or more, or high-density lipoprotein (HDL) cholesterol of less than 40 mg/dL (1.04 mmol/L), or on a lipid lowering medication. If total serum cholesterol is all that is available, use serum cholesterol at or over 200 mg/dL (5.18 mmol/L).
What details related to prediabetes are considered a +1 risk factor?
Fasting plasma glucose at or over 100 mg/dL (5.55 mmol/L) or impaired glucose tolerance (IGT) where a 2 hour oral glucose tolerance test (OGTT) value is at or above 140 mg/dL &.77 mmol/L), but at or lower than 199 mg/dL (11.04 mmol/L), confirmed by measurements on at least two separate occasions.
If the presence or absence of a cardiovascular risk factor is not disclosed or available, what should happen?
It should be counted as a +1 risk factor, with the exception or prediabetes.
If prediabetes criteria are missing or unknown, when should they be counted as a +1 risk factor?
1) For those 45 or older, especially with a BMI over 25.
2) For those younger than 45, with a BMI over 25 and additional cardiovascular risk factors for prediabetes.
Low risk individuals have how many risk factors?
Fewer than 2.
Moderate risk individuals have how many risk factors?
2 or more.
High risk individuals have:
Symptomatic, or known cardiovascular, pulmonary, renal, or metabolic disease.
Between low, moderate, and high risk categories, which categories display symptoms?
Only high risk. Low and moderate risk individuals are asymptomatic.
Is a medical exam or exercise test recommended before a low risk individual can do moderate or vigorous exercise?
No medical exam or exercise test, for either moderate or vigorous exercise.
Is a medical exam or exercise test recommended before a moderate risk individual can do moderate or vigorous exercise?
No medical exam or exercise test for moderate exercise. A medical exam is needed before vigorous exercise, but no exercise test is needed.
Is a medical exam recommended before a high risk individual can do moderate or vigorous exercise?
Yes, both a medical exam and an exercise test are needed for either moderate or vigorous exercise.
For low, moderate, and high risk individuals, when is a doctor’s supervision needed for an exercise test?
If an individual is high risk, for both submaximal and maximal.
What is the definition of moderate exercise?
- 40% to 60% V02R
- 3 to 6 METs
- An intensity that causes noticeable increases in heart rate and breathing
What is the definition of vigorous exercise?
- 60% V02R
- At or above 6 METs
- An intensity that causes substantial increase in heart rate and breathing
If tests or medical exams are not recommended for a client, when might they be considered?
1) When there are concerns about risk
2) When more information is needed for the exercise test
3) When they are requested by a patient/client
According to the scope of practice of personal trainers, what is important about signs or symptoms of medical conditions that are included in risk stratification?
They require special training to make a diagnosis, and must only be interpreted by a qualified licensed professional within the clinical context in which they appear.
Name the signs and symptoms of medical conditions that are included in risk stratification.
1) Pain (tightness) or discomfort (or other angina equivalent) in the chest, neck, jaw, arms, or other areas that may result from ischemia
2) Orthopnea (dyspnea in a reclined position) or paroxysmal nocturnal dyspnea
3) Ankle edema
4) Palpitations or tachycardia
5) Intermittent claudication
6) Known heart murmur
7) Unusual fatigue of difficulty breathing with usual activities
8) Dizziness or syncope, most commonly caused by reduced perfusion to the brain
Definition of ischemia:
Restriction of blood supply to tissues, causing a shortage of oxygen that is needed for cellular metabolism.
Definition of dyspnea:
Difficult or labored breathing
Definition of perfusion:
The passage of blood, a blood substitute, or other fluid through the blood vessels or other natural channels in an organ or tissue.
Definition of syncope:
Temporary loss of consciousness due to a fall in blood pressure.
Definition of tachycardia:
An abnormally rapid heart rate
How should trainers respond to the additional signs and symptoms of medical conditions included in risk stratification?
1) Be aware of them
2) Note them in a client’s file/encourage client to discuss with physician, if the client has a history of any of these symptoms or develops symptoms during training
What should a trainer know about the additional signs and symptoms of medical conditions included in risk stratification?
1) They are more likely to be apparent in individuals with a greater number of positive risk factors
The stratification between low, moderate and high risk individuals only requires:
Differentiation between one and two risk factors.
What forms should be signed before a PAR-Q or health risk assessment is done?
- Informed consent (or assumption of risk)
- Liability waiver
What is the purpose of an informed consent form?
It provides evidence that the client acknowledges being specifically informed about any risks/dangers associated with the activity.
What is the difference between an informed consent form and a liability waiver?
An informed consent form does not provide legal immunity.
What should a trainer do in addition to having the client sign an informed consent form and liability waiver?
Verbally review the contents of the forms to promote understanding.
What two things does an agreement and release of liability waiver do?
1) It releases a personal trainer from liability for injuries resulting from a supervised exercise program.
2) It represents the client’s voluntary abandonment of the right to file suit.
In what way does an agreement and release of liability waiver not protect a personal trainer?
It does not protect a personal trainer for being sued for negligence.
What types of information are collected on a health history questionnaire?
- Past and present exercise and physical activity info
- Medications and supplements
- Recent or current illnesses or injuries, including chronic or acute pain
- Surgery and injury history
- Family medical history
- Lifestyle information (related to nutrition, stress, work, sleep, etc.)
What does a medical release form do?
It provides the personal trainer with the client’s medical information, and explains physical activity limitations and/or guidelines as outlined by his or her physician. Deviation from these guidelines must be approved by the physician.
What does an exercise history and attitude questionnaire do?
Provides the trainer with a detailed background of previous exercise history, including behavioral and adherence experience.
Why is an exercise history and attitude questionnaire useful?
It gives important information for goal setting and designing programs based on the client’s preferences and attitudes about exercise, and implementing strategies for improving motivation and adherence.
What risks increase with regular physical activity?
1) Musculoskeletal injury
2) Cardiovascular problems such as cardiac arrest
What two situations do injuries related to physical activity usually happen in?
1) Aggravating an existing condition (either known or unknown by the client)
2) Precipitating a new condition
What should clients know about the risks of exercise?
Risks in the general population are low, especially when weighed against the health benefits of regular exercise.
What 3 primary systems of the body experience stress during physical activity?
What is atherosclerosis?
Atherosclerosis is a process in which fatty deposits of cholesterol and calcium accumulate on the walls of the arteries, causing them to harden, thicken, and lose elasticity. When this process affects the arteries that supply the heart, it is called CAD.
Why does exercise place people with heart disease at greater risk for a myocardial infarction?
The greater the exercise intensity, the larger the demand for blood and oxygen to the heart muscle. If the vessels that supply this blood are narrowed from atherosclerosis, the blood supply is limited, and the increased oxygen demand by the heart cannot be met.
What is angina?
Angina is usually described as a pressure or tightness in the chest, but can also be experienced in the arm, shoulder or jaw. This pain may be accompanied by shortness of breath, sweating, nausea, and palpitations (pounding or racing of the heart).
Should people with CAD exercise?
Regular exercise may be an important part of treatment and rehabilitation for CAD, but limitations may be necessary.
In what populations is hypertension more prevalent?
The elderly and African Americans.
CAD stands for:
Coronary artery disease.
An individual’s risk of stroke, CAD, and kidney disease increase progressively with higher levels of:
Systolic blood pressure (SBP) and diastolic blood pressure (DBP).
SBP stands for:
Systolic blood pressure.
DBP stands for:
Diastolic blood pressure.
With progressively higher levels of systolic blood pressure and diastolic blood pressure, what three risks increase?
3) Kidney disease
Why is it important for a personal trainer to be aware that progressively higher levels of systolic or diastolic blood pressure can increase risks for CAD, stroke and kidney disease?
Blood pressure increases with exercise, especially in activities involving heavy resistance, such as weight lifting, or isometric exercises. If a person’s resting blood pressure is already high, it may elevate to dangerous levels during exercise, increasing the likelihood of a stroke.
What exercise activities particularly increase blood pressure?
Exercises involving heavy resistance, such as weight lifting, or isometric exercises.
Why are respiratory conditions such as asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD) important to consider during exercise?
All tissues of the body need oxygen. A problem in the respiratory system will interfere with the body’s ability to provide enough oxygen for the increasing demand that occurs during aerobic exercise. Regular exercise may improve or aggravate the listed conditions.
Who must have a physician’s clearance before beginning exercise?
1) Anyone with a heart or respiratory condition.
2) Anyone with an injury more severe than a simple strain/sprain.
3) Anyone with diabetes or thyroid disorder.
4) Pregnant or postpartum mothers
5) Anyone on medication that could affect exercise
What respiratory conditions should be considered with caution when attempting exercise?
4) Chronic Obstructive Pulmonary Disease (COPD)
COPD stands for:
Chronic Obstructive Pulmonary Disease
The musculoskeletal system contains what 3 things that support the body?
What body system is most commonly injured during exercise?
The musculoskeletal system.
What complications or concerns accompany a musculoskeletal injury from exercise, which make it important to try to avoid injury in the first place?
1) Pain and discouragement for client
2) Client motivation
3) Trainer scope of practice
What is the most common injury sustained by persons participating in physical activity?
What are overuse injuries the result of?
Poor training techniques, poor body mechanics, or both.
Name some examples of overuse injuries.
Runner’s knee, swimmer’s shoulder, tennis elbow, shin splints, iliotibial band syndrome (ITBS)
What is lateral epicondylitis?
What strategy for allowing healing of an injury or avoiding aggravating an injury, should trainers use?
What are common conditions to screen for in the health history interview?
Sprains, strains, herniated discs, bursitis, tendonitis, arthritis.
What is the difference between a sprain and a strain?
A sprain relates to ligaments. Strains relate to a muscle or its tendon.
Disuse atrophy of muscles surrounding an injury may begin after how many days of inactivity?
Regarding general injuries, when is communication with the physician paramount?
If the client has had surgery within the last year.
What are two of the most common metabolic conditions?
Diabetes and thyroid disorders.
Why is exercise important for an individual with diabetes?
It facilitates fat loss and helps regulate blood glucose.
When is physician referral especially important for a diabetic client?
If the client receives insulin.
Where is the thyroid gland and what does it do?
In the neck. Secretes hormones that increase oxygen uptake and heat production and affect many metabolic functions.
Define hyperthyroid patients.
Increased level of thyroid hormones and a higher metabolic rate.
Define hypothyroid patients.
Decreased level of thyroid hormones and a lower metabolic rate. Require medication to regulate to normal levels.
What is a hernia?
A bulge or protrusion of the abdominal contents into the groin or through the abdominal wall.
What activity could particularly aggravate a hernia?
One that involves increasing abdominal pressure, such as the Valsalva maneuver.
How does a hernia relate to weight lifting?
It is a relative contraindication unless cleared by a physician.
If there is a history of a hernia, what is important for a trainer to do during weight lifting?
Instruct and educate the client on proper breathing and lifting techniques.
Explain what kind of exercise clearance pregnant mothers need from their physicians.
Pregnant mothers should have a physician’s approval during pregnancy and during the 3 months after pregnancy.
During mild illness such as a cold, is exercise ok?
Moderate exercise may be ok.
What should a trainer do if a client wants to start a program while sick?
Wait until the client is feeling better, so the body’s energy can be spent on fighting sickness.
What are the potential negative effects of giving a client a lot of assessments initially?
The client may not want that many assessments and may become discouraged, frustrated, uncomfortable, overwhelmed, or embarrassed.
When trying to avoid too many initial assessments, what one assessment MUST be given to the client?
A pre-screening for health risk factors.
What assessments typically are considered to have merit?
- Resting vital signs
- Static posture and movement screens
- Joint flexibility and muscle length
- Balance and core function
- Cardiorespiratory fitness
- Body composition
- Muscular endurance and strength
- Skill-related parameters (agility, coordination, power, reactivity, speed)
What should a trainer do before health assessments?
- Develop rapport
- Identify personality style
- Identify stage of change/willingness to change
When measuring for assessments, what should be taken into consideration?
Physiological influences on the assessment, such as exercise raising blood pressure and heart rate. These would be monitored first to avoid elevated scores.
Why should skinfold caliper measurements be taken before exercise?
To avoid either underestimation of fat stores from dehydration, or overestimation of fat stores due to vasodilation in surface vessels associated with thermoregulation.
Rather than a change in muscle physiology, what causes significant gains in strength during the first 1 to 4 weeks of strength training?
Why would an assessment of strength gains within the first few weeks have the potential to be incorrect?
Due to neurological adaptations, rather than a change in muscle physiology.
What disease/condition information is important to know about someone who has been sedentary and is beginning an exercise program?
A sedentary person may have an unknown condition or dysfunction that may start to appear with exercise because of the physiological demands that exercise places upon the body.
What signs or symptoms require an immediate stop of exercise and referral to a physician?
1) Onset of angina or angina-like symptoms around chest
2) Significant drop (>10 mmHg) in SBP despite an increase in exercise activity
3) Fatigue, shortness of breath, difficult or labored breathing, or wheezing (heavy breathing is ok)
4) Signs of poor perfusion
5) Increased nervous system symptoms
6) Leg cramping or claudication
7) Physical or verbal manifestations of severe fatigue
The definition of cyanosis is:
Bluish colored skin resulting from poor circulation or inadequate oxygenation of the blood.
The definition of claudication is:
Cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.
What are signs of poor perfusion?
2) Pallor (pale skin)
Aside from signs and symptoms of medical conditions, what are other reasons an exercise test should be stopped?
1) If the equipment fails
2) If the client requests it to stop
How can a trainer act as a professional in relation to conducting an exercise test?
1) Inform the client of what is expected (hydration & food requirements, avoiding stimulants, etc.)
2) Signed documentation
3) Organization of data collection forms
4) Calibration and working of all equipment
5) Proper room temperature
What questions should a trainer ask him/herself when conducting an assessment to determine how to build a program?
1) What are the needed performance-related skills and abilities to be successful in the client’s chosen activity (recreational or otherwise)?
2) Which of these needed skills and abilities are currently lacking in this client?
3) What are the prevalent injuries and weaknesses associated with the activity in which the client wants to participate?
4) Which energy systems are required to be successful in this activity?
5) Which integrated movement patterns and planes of movement will need to be trained to be successful in this activity?
Why is it important to note the physical limitations of the client when conducting exercise tests?
It is important not to place undue stress on a client. If the client has a physical limitation (such as chronic knee inflammation due to arthritis), results of certain tests (such as a weight bearing walking test) might be affected not by the typical reasons (cardiorespiratory endurance) but by the client’s physical limitation problem (pain in the knees).
What environmental conditions can limit a client’s performance ability on a cardiorespiratory endurance test?
Extreme heat or cold, uneven surfaces, a crowded track, privacy issues, distractions.
What things must a trainer consider when preparing the exercise test?
1) Client physical limitations and age
3) Calibration and documented maintenance of equipment
4) Ability of equipment to accommodate a range of exercise intensities and client’s needs
5) Adequate lighting
6) Proper emergency protocol and access to emergency supplies
7) Appropriate temperature range between 68 and 72F. Avoid outdoor testing on excessively hot or humid days.
Why is attention to the client’s age important during an exercise test?
Age can carry certain health risks, which are important to identify in pre-screening. Typically, an older, deconditioned individual will not be able to perform the same battery of tests as a younger person.
Name the common sites for taking a pulse.
1) Radial artery: the ventral aspect of the wrist on the side of the thumb (less commonly, the ulnar artery on the pinky side)
2) Carotid artery: in the neck, lateral to the trachea.
What should one know about taking a pulse at the carotid artery?
1) It is easier if the neck is slightly extended.
2) The client should be instructed not to push too hard, which may evoke a vagal response and slow down the heart rate.
What less common sites can also provide a pulse location?
1) Brachial artery
2) Femoral artery
3) Posterior tibial artery
4) Popliteal artery
5) Abdominal aorta
What is a valid measurement of work intensity or stress on the body, both at rest or during exercise?
Measurement of the heart rate.
What do a lower resting and submaximal heart rates indicate?
Typically, higher levels of fitness. This is because cardiovascular adaptations to exercise increase stroke volume (SV), thereby reducing heart rate.
What do higher resting and submaximal heart rate levels indicate?
Typically, lower levels of fitness.
What can affect resting heart rate (RHR)?
1) Fitness status
3) Body composition
4) Drugs and medication
Explain the traditional classification system to categorize RHRs:
1) Sinus bradycardia, or slow HR: RHR <60 bpm
2) Normal sinus rhythm: RHR 60 to 100 bpm
3) Sinus tachycardia, or fast HR: RHR >100 bpm
Resting heart rate
What is the average RHR?
70 to 72 bpm, averaging 60 to 70 bpm in males and 72 to 80 in females.
What is sinus bradycardia?
Slow HR (RHR <60 bpm)
What is normal sinus rhythm?
Normal RHR of 60 to 100 bpm
What is sinus tachycardia?
Fast HR (RHR >100 bpm)
Why do females typically have a higher RHR?
1) Smaller heart chamber
2) Lower blood volume circulating less oxygen throughout the body
3) Lower hemoglobin levels
What does knowing a client’s heart rate help prevent?
Overtraining. Any RHR >5bpm over the client’s norma RHR that remains over a period of days is a good reason to offload or taper training exercises.
What things should a trainer be aware of that can affect the heart rate?
1) Certain drugs, medications and supplements
2) Standing or sitting elevates HR more than supine or prone positions
3) Digestion increases RHR.
4) Environmental factors such as noise, temperature, and sharing personal information can increase HR as the body attempts to deal with stressors
How long should non-prescription stimulants or depressants be avoided before measuring RHR?
Why does standing or sitting elevate the HR more than supine or prone positions?
The involvement of postural muscles and the effect of gravity.
Why does digestion increase RHR?
The processes of absorption and digestion require energy, necessitating the delivery of nutrients and oxygen into the gastrointestinal tract.
Why is measurement of the HR a valid indicator of the demands placed upon the body?
The heart plays a pivotal role in supplying oxygen, nutrients, and removing waste products.
What methods are used to measure HR, both at rest and during exercise?
1) 12-lead electrocardiogram (ECG or EKG)
2) Telemetry (often two-lead, including commercial HR monitors)
4) Auscultation with stethoscope
When is true RHR measured?
As soon as client gets out of bed in the morning.
In most personal training environments, why will RHR measurements not be entirely accurate?
Because the client has not just gotten out of bed in the morning.
Explain how to measure RHR with palpation.
1) The client should be resting comfortably for several minutes prior
2) RHR may be measured indirectly by placing fingertips on a pulse site (no thumb), typically the radial artery, and creating light pressure
3) Count number of beats per 30 or 60 seconds and correct that score to beats per minute, if necessary
The definition of palpation is:
Placing fingertips on a pulse site.
The definition of auscultation is:
Listening to the heart with a stethoscope.
Explain how to measure RHR with auscultation.
1) The client should be resting comfortably for several minutes prior
2) Place the bell of the stethoscope to the left of the client’s sternum just above or below the nipple line. (It is important to be respectful of the client’s personal space.)
3) Count number of beats per 30 or 60 seconds and correct that score to beats per minute, if necessary
What is different when measuring exercise heart rate?
Measuring for 30 to 60 seconds id generally difficult. Therefore, exercise HR is normally measured for shorter periods that are then corrected to equal 60 seconds.
Aside from measuring a client’s RHR at the time of training, what is another option?
Having the client measure RHR at home in the morning and reporting numbers.
What amount of seconds for counting is recommended for HR during exercise, and why?
10 to 15 second counts are recommended over a 6 second count, given the larger potential for error with a shorter count.
What do you do with a 10 or 15 second HR count during exercise?
Multiply by 6 (10 sec) or 4 (15 sec) to get bmp.
Should HR counting typically start with a 0 or a 1?
A 1, especially in group exercise settings where exercisers begin counting at different points in their cardiac cycle.
How is blood pressure defined?
The outward force exerted by blood on the vessel walls.
When taking blood pressure, which is the higher number?
What are Korotkoff sounds?
Sounds made from vibrations as blood moves along the walls of the vessel. These sounds are what are indirecly measured to find blood pressure.
Explain the procedure for preparing to take blood pressure.
1) Have the client sit with flat feet on the floor for two full minutes.
2) While the cuff on the right arm is standard, many prefer the left because of its proximity to the heart, which amplifies heart sounds
3) Smoothly and firmly wrap the cuff around the arm with its lower margin about 1” above the antecubital space (front of the elbow)
4) The tubes should cross the antecubital space.
5) It is important to ensure the correct size cuff
6) The client’s arm should be supported either on an armchair or by the trainer at an angle of 0 to 45 degrees
Explain the procedure for measuring blood pressure, after preparing.
1) Turn the bulb knob to close the cuff valve (turning all the way to the right, no more than finger tight) and rapidly inflate to 160 mmHg, or 20 to 30 mmHg above the point where the pulse can no longer be felt at the wrist.
2) Place the stethoscope over the brachial artery using minimal pressure. It should lie flat against the skin and should not touch the cuff or tubing.
3) The client’s arm should be relaxed and straight at the elbow.
4) Release the pressure by slowly turning the knob to the left at a rate of about 2 mmHg per second, listening for the Korotkoff sounds.
5) SBP is determined by reading the dial at the first perception of sound (a faint tapping sound)
6) DBP is determined by reading the dial when the sounds cease to be heard or when they become muffled.
7) If a BP reading needs to be repeated on the same arm, allow at least 60 seconds.
8) Share measurements with the client as well as classification of values
What should be done if a blood pressure reading is abnormal?
Repeat the measurement on the opposite arm. If there is a significant discrepancy between readings from arm to arm, it could represent a circulatory problem, and the client should be referred to a physician for medical evaluation.
Name some common causes for mistakes in blood pressure readings.
1) Cuff deflation that is too rapid.
2) Inexperience of the administrator, or inability to read the pressure correctly
3) Improper stethoscope placement and pressure
4) Improper cuff size or an inaccurate /uncalibrated sphygmomanometer
5) Auditory acuity of the administrator, or background noise
What are the blood pressure classifications for adults age 18 and over?
Normal: SBP <120 and DBP <80
Prehypertension: SBP 120-139 or DBP 80-89
Hypertension (Stage 1): SBP 140-159 or DBP 90-99
Hypertension (Stage 2): SBP <160 or DBP >100
What is considered a normal blood pressure?
SBP <120 and DBP <80
What is considered prehypertension blood pressure?
Prehypertension: SBP 120-139 or DBP 80-89
What is considered Stage 1 Hypertension?
Hypertension (Stage 1): SBP 140-159 or DBP 90-99
What is considered Stage 2 Hypertension?
Hypertension (Stage 2): SBP <160 or DBP >100
With regards to exercise, when is blood pressure typically monitored?
Both before and after exercise, to monitor against excessive hypotension. During can be difficult, except if client is using a stationary bike.
If blood pressure must be measured during exercise, which is difficult, which method should be used?
A sphygmomanometer with a stand and hand held gauge.
If SBP drops during excercise, what should happen?
It should be immediately remeasured prior to terminating the session, to ensure accuracy in measurement. If the client was anxious prior to the cardiorespiratory assessment, it is likely that the initial SBP reading will drop.
What does CVA stand for?
For individuals 40 to 70 years of age, each 20 mmHg increase in resting SBP or each 10 mmHg increase in resting DBP does what?
Doubles the risk of cardiovascular disease.
For individuals 40 to 70 years of age, what increase in resting BP doubles the risk of cardiovascular disease?
Each 20 mmHg increase in resting SBP
Each 10 mmHg increase in resting DBP
A BP difference of 15 mmHg or more between arms increases what risks?
Peripheral vascular disease and cerebral vascular disease. Also associated with a 70% risk of dying from heart disease.
Increased risk of peripheral vascular disease and cerebral vascular disease, as well as an association with a 70% risk of dying from heart disease is the result of what BP related measure?
A BP difference of 15 mmHg or more between arms.
How can blood pressure be reduced?
Medication and certain behavior modifications (ie: smoking cessation, stress management, exercise, weight loss, and sodium restriction.)
When can RPE (ratings of perceived exertion) be used to complement or replace heart rates?
When a client is taking certain drugs that may alter the heart rate response to exercise, such as beta blockers.
What two standardized ratings exist for RPE (ratings of perceived exertion)?
1) Borg 15-point scale (Original 6 to 20)
2) Modified 1 to 10 revision of Borg scale
On the original Borg 15-point scale for RPE (ratings of perceived exertion), give examples of how ratings correspond with a specific heart rate.
Borg score: 6 = corresponding HR of 60 bpm
Borg score: 12 = corresponding HR of 120 bpm
Borg score 20 = corresponding HR of 200 bpm
What does RPE mean?
Ratings of perceived exertion.
Why do very sedentary individuals find it difficult to use RPE charts at first?
They may find any exercise fairly hard.
What is a common trend regarding males and females and RPE?
Men tend to underestimate and women tend to overestimate.
When might conditioned individuals tend to under-rate their exercise activity?
If they focus on muscular tension requirements rather than cardiorespiratory effort.
Which Borg RPE scale should typically be used?
The revised 1 to 10 scale. The 6 to 20 scale is difficult to use, and should only be utilized if HR equivalents are needed and the actual HR exercise is not a reliable monitor of HR (as with beta blockers).
What does the Exercise Feeling Index (EFI) accomplish?
It quantifies a client’s emotions after an exercise experience. This can help a trainer to promote positive emotional experiences that may help adherence.
When should the Exercise Feeling Index (EFI) be administered?
1) During the initial interview, to assess previous exercise experience
2) After a training session
When using the Exercise Feeling Index (EFI) for training purposes, how often should it be used?
Frequently initially (every session to every other session), and diminishing gradually to avoid a desensitization effect. It can be readministered every time a change is made in the program.
What are the four subscales of the Exercise Feeling Index (EFI)?
1) Positive engagement (4, 7 and 12)
2) Revitalization (1, 6 and 9)
3) Tranquility (2, 5 and 10)
4) Physical exhaustion (3, 8 and 11)
How can the four subscales of the Exercise Feeling Index (EFI) be used?
Track over a period of 4 to 6 weeks to plot the results to demonstrate progress toward positive emotional change with exercise (or note fatigue and reduce intensity).
How does personal touch relate to being a successful trainer?
The trainer sometimes must use personal touch, being mindful of what is appropriate and what the client is comfortable with. Other times, the trainer must remain an objective observer. Interpersonal and teaching skills will allow the trainer to respond appropriately to the situation.