Chapter 17 - Introduction and Client Intake Process

Question 1

the role of evaluation and assessment for a CSNC

Answer 1

serve as objective and subjective tools used to measure the success in the coach–client relationship

CSNCs use evals and assessments to build self-efficacy in the client

Question 2

3 steps in the client intake process

Answer 2

1. Pre-appointment data gathering and screening
2. The initial appointment
3. Nutritional needs analysis

Question 3

client intake process

Pre-Appointment Data Gathering and Screening

Answer 3

focused on building rapport, establishing athlete goals, and establishing a working coach–client relationship

1. Identify individuals with increased risk of cardiovascular, pulmonary, or metabolic diseases or identify their signs or symptoms, as those individuals should first undergo more thorough medical evaluations
2. Identify those individuals with medical contraindications who should participate in medically supervised programs
3. Educate individuals about their current physical condition
4. Enable effective program evaluation using baseline and follow-up data
5. Motivate individuals through realistic goal setting

Question 4

PAR-Q+ (physical activity readiness)

Answer 4

A physical activity questionnaire that is utilized to assess clients’ readiness.

completely confidential

Any information collected about an individual during the assessment process cannot be shared without written consent from that individual. Further, the information must be securely stored away from other coworkers and the public

Question 5

health history questionnaire

Answer 5

A questionnaire designed and utilized to assess clients’ health history.

completely confidential

Age
Gender
Height
Weight
Physician’s name and contact information
Emergency contact information

Question 6

medical history quesitonnaire

Answer 6

vital information that provides the Sports Nutrition Coach with information about known or suspected chronic diseases, such as coronary heart disease, high blood pressure, or diabetes

CSNC should inquire if their athlete smokes or uses tobacco products

medical history provides information about the athlete’s past and current health status, any past or recent injuries, surgeries, or other chronic health conditions

Gathering this information helps determine if a medical referral is necessary.

Question 7

medical history assessment

past injuries

Answer 7

All past (or recent) injuries should be recorded and discussed

Previous history of musculoskeletal injury is also a strong predictor of future injury during physical activity

Question 8

medical history assessment

past surgeries

Answer 8

Surgical procedures create trauma for the body. These procedures may produce effects similar to injuries in the way the human body functions and the safety and efficacy of exercise or sport competition

check for surgeries at any of the 5 kinetic chain checkpoints

Question 9

medical history assessment

chronic disease

Answer 9

• Cardiovascular disease, coronary heart disease, coronary artery disease, or congestive heart failure
• Hypertension (high blood pressure)
• High cholesterol or other blood lipid disorders
• Stroke or peripheral artery disease
• Lung or breathing problems
• Obesity
• Diabetes mellitus
• Cancer

Question 10

medical history assessment

medications

Answer 10

All past (or recent) injuries should be recorded and discussed. Previous history of musculoskeletal injury is also a strong predictor of future injury during physical activity

The effect of injuries on the functioning of the human body is well documented and should be recorded by the Sports Nutrition Coach during the initial client intake process

Question 11

lifestyle habits assessment

Answer 11

The key lifestyle habits to collect information and data on include habitual behaviors and goals, exercise and sport conditioning, general dietary habits, sleep, stress and stress management, and occupation.

Question 12

lifestyle habits assessment

habitual behavior and goals

Answer 12

Ask the client to recall their
* any previous nutrition intervention
* prior and future goals
* living environment
* daily food preparation
* supplement use
* overall daily routine
* training schedule
* likes + dislikes
* sleeping pattern
* supplements currently used
* injury history
* sport

collecting information on any ordinary training schedule (including a training day) may help with designing strategies

Question 13

lifestyle habits assessment

Exercise and Sport Conditioning

Answer 13

the Sports Nutrition Coach should inquire about their athlete’s:
* sporting activities
* including the type of sport they play
* how long they have been playing
* their training and competition schedule
* intensity of practices and games

These questions will provide opportunities to learn more about a athlete’s physical demands, which are critical for providing nutritional coaching. In addition, it is important to inquire about an athlete’s general thoughts and impressions about fitness testing and evaluations.

Question 14

lifestyle habits assessment

general dietary habits

Answer 14

This type of pre-appointment nutrition assessment is focused on understanding general nutrition habits.

On a scale of 0 to 10, do you consider your overall diet to be healthy (0 for unhealthy and 10 for very healthy)?
Are you currently following any kind of diet? If so, what diet, and for what reason(s)?
How would you rank your daily salt intake: low, medium, or high?
How would you rank your daily sugar intake: low, medium, or high?
How would you rank your daily fat intake: low, medium, or high?
On a scale of 0 to 10, how effectively are you able to control your temptations for junk food (0 for easily and 10 for very difficult)?
How many alcoholic drinks do you consume per week?
Do you consume caffeinated beverages such as coffee, tea, soda, and/or energy drinks? How many per week?

Question 15

lifestyle habits assessment

sleep

Answer 15

In the pre-appointment questionnaire, the Sports Nutrition Coaches should inquire about their athletes’ sleeping habits, including the number of hours slept each night, the quality of sleep, and even the difficulties associated with falling asleep

CSNCs use the global sleep assessment questionnaire

Question 16

lifestyle habits assessment

stress

Answer 16

inquire about their athletes’ stress levels, which can be done using a similar 0 to 10 rating scale as presented

Have a converesation to assess
* if the athlete is aware of their sources of stress
* the frequency of stressor exposure
* the magnitude of each stressor
* whether the athlete has identified or implemented any stress management methods

Question 17

lifestyle habits assessment

occupation

Answer 17

• The nature of the occupation
• Whether the job requires extended periods of time standing, sitting, or performing repetitive movements (with explanations)
• The workspace environment and typical attire

gives CSNC insights into motor patterns at work and potential consequences athletically as a result

Question 18

Client Schedule Assessment

Answer 18

This schedule inquiry includes their day-to-day, weekly, monthly, and yearly schedules, as well as any seasonal schedule. Having an athlete share their written schedule prior to the first appointment can help establish both realistic coach and client expectations and an understanding of how best to ensure the coach is meeting the athlete’s needs.

Question 19

Knowledge and Skill Assessment

Answer 19

• how much do you know about your body’s energy requirements for your sport
• how confident are you in your nutrition knowledge
• how would you rate your skills in preparing food
• how would you rate your sport-specific nutrition knowledge

Question 20

detailed dietary assessment

Answer 20

As a Sports Nutrition Coach, collecting detailed data about an athlete’s current dietary and nutritional habits and behaviors is most important next to the general dietary habits data. These assessments include:
* 24-hour recall
* usual intake worksheet
* diet record worksheet
* Food Frequency Questionnaire

While beneficial, these methods tend to be inaccurate, misreport food consumption, and have an associated measurement error

Question 21

24-hour recall

Answer 21

Quick list: Obtain a simple list of all food and drink items eaten within a 24-hour period without focusing on specific details and amounts.
Forgotten foods: Ask the athlete about specific food categories that may have been forgotten, such as nonalcoholic or alcoholic beverages, sweets or desserts, and snacks
Time and occasion: state what time foods were consumed
Describe the food: where the food was obtained (home, restaurant, etc.), brand or restaurant associated with food, preparation method, how the food or drink was served (alone, with anything else, etc.), and the quantity of the food or drink.
Final review or probe: Briefly review the 24-hour recall for completeness

For example, individuals who self-assess intake using 24-hour recalls tend to underreport their energy intake by ~25%

Question 22

usual intake

Answer 22

A method of assessing a client’s dietary intake that involves asking them to describe their typical eating habits and behaviors without doing a full 24-hour recall

This includes asking the athlete about the types of foods they consume, how often they consume them, how often they eat out at restaurants, and what restaurants they eat at. This assessment can also be used to help identify differences in food habits and behaviors on regular weekdays and on weekends.

Question 23

diet record

Answer 23

A method of assessing a client’s dietary intake that requires the client to record all food and beverages consumed over a specific period of time

Question 24

food frequency questionnaire

Answer 24

A method of assessing dietary intake that utilizes a questionnaire developed by NHANES that measures how often specific foods are consumed.

contains 139 questions

Question 25

Remote Food Photography or Snap-n-Send

Answer 25

photographs of food consumed.

This approach is similar to the diet record method but uses photographs instead of written records.

can have errors in intake between 250–900 calories per day.

Question 26

what is the only way to accurately measure body composition?

Answer 26

autopsy. All other approaches are estimates, regardless of how accurate or which method is used.

Question 27

how many different compartment models are there for measuring body composition?

Answer 27

single
two
three
four

These different models attempt to provide more and more detailed information about the composition of the body, with the single-compartment model providing the least amount of detailed information and the four compartment model providing the most detailed information

Question 28

single-compartment model

Answer 28

attempts to determine body composition by a singular measure or metric
* body weight
* body mass index (BMI)

Body weight is simply a measure of a person’s mass and the effect of gravity on that mass

Question 29

2 formulas for calculating BMI

Answer 29

Imperial formula: BMI = 703 × weight (lb) ÷ [height (in)]2
Metric formula: BMI = weight (kg) ÷ [height (m)]2

Question 30

two compartment model

Answer 30

assess fat-free mass and fat mass

Most commercial methods of assessing body fat use a two-compartment model, including bioelectrical impedance analysis, air displacement plethysmography, skinfold, ultrasound, dual energy X-ray absorptiometry, and hydrostatic (underwater) weighing

Question 31

two compartment model

bioelectrical imedance analysis

Answer 31

A method of estimating body composition that utilizes small electrical currents. Based on the premise that muscle and fat conduct electricity at different rates, making them identifiable through electrical current

Question 32

two compartment model

Air displacement plethysmography

Answer 32

A method of estimating body composition that utilizes air displacement to assess density

Question 33

two compartment model

skinfold

Answer 33

A method of estimating body composition that estimates body fat based by measuring the thickness of the adipose tissue layer directly under the skin (subcutaneous fat).

can have an error of up to 10-15%

assess 8 different areas on the body

Question 34

two compartment model

ultrasound

Answer 34

A method of estimating body composition that utilizes high-frequency waves to measure the thickness of subcutaneous fat.

Question 35

two compartment model

dual x-ray absorptiometry

Answer 35

A method of estimating body composition that utilizes X-rays to measure differences in tissue density.

takes special expertise and permitting to complete

Question 36

two compartment model

hydrostatic weighing

Answer 36

A method of estimating body composition that utilizes water displacement to assess density.

Question 37

VO2 max

Answer 37

The maximal amount of oxygen that the human body utilizes during sustained peak or maximal exercise.

VO2 max tests require a client to exercise on a bike or a treadmill and increase intensity at set intervals until they reach exhaustion

Question 38

Resting Metabolic Rate Testing

Answer 38

assesses energy expenditure and metabolism

Additionally, information about the athlete’s metabolism, specifically their respiratory exchange ratio (RER), is a measure of how much carbohydrate and fat their body uses at rest to provide energy

Question 39

peak oxygen consumption

Answer 39

A measure of oxygen consumption, referring to the single highest measure observed instead of the steady state maximal measurement; similar to VO2 max measure

Question 40

ventilatory threshold

Answer 40

The exercise intensity at which ventilation increases at a faster rate than the increase in oxygen volume.

Question 41

lactate threshold

Answer 41

The level at which blood levels of lactate increase above baseline as a result of lactate accumulating in circulation faster than it can be cleared.

Question 42

onset of blood lactate accumulation

Answer 42

The intensity of exercise at which blood lactate begins to accumulate much more quickly and performance becomes impaired

Question 43

nutritional needs analysis

Answer 43

A component of an intake assessment that examines an individual’s body composition, health status, current nutrition habits and behaviors, and the energy and nutrient needs of the individual’s sport or activity.

Question 44

data collection for the sport nutrition coach

Answer 44

can be in any form that is convenient (pen and paper, digiatal records).

MUST BE SECURE

Question 45

data visualizations

Answer 45

an excellent way to demonstrate visual information through trends, graphs, and other visual forms

Question 46

On average, how many calories per day does the general fitness enthusiast require?

Answer 46

25 to 35 kcal/kg

Question 47

When utilizing diet records, individuals tend to overestimate protein intake by how much?

Answer 47

10%

Question 48

On average, how many calories per day do athletes with high training volume require?

Answer 48

60 to 80 kcals/kg