ACE PTM Ch. 6 Flashcards
Rapport implies:
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?
1) Empathy
2) Warmth
3) Genuineness
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)
2) Investigation
3) Planning
4) Action
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?
Postural changes.
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)
3) Probing
4) Reflecting (restate feelings)
5) Clarifying
6) Informing
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?
Counseling style.
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?
1
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.
