Chapter 6 Building Rapport And The Initial Investigation Stage Flashcards
Define Empathy
The ability to experience another person’s world as if it were one’s own
Define warmth
An unconditional positive regard, or respect, for another person regardless of his or her individuality and uniqueness. This quality will convey a climate that communicates safety and acceptance to the client
Define genuineness
Authenticity; The ability to be honest and open
What are the four essential stages in building client-trainer relationships?
- Rapport
- Investigation
- Planning
- Action
What are the specific steps of the Investigation Stage?
- Identify readiness to change behavior
- Identify the stage of behavioral change and personality style of the client
- Collect health and safety information
- Learn about lifestyle preferences, interests, and attitudes
- Understand previous experiences
- Conduct Assessments
What are the details of the Rapport Stage?
- Impressions of professionalism
- Developing Trust
- Demonstrating warmth/genuineness
- exhibiting empathy
What are the steps of the Planning Stage?
- Collaborative goalsetting with the client
- Programming considerations
3 . Designing motivation and adherence strategies
What are the steps of the Action Phase of the Client-Trainer Relationship?
- Instruction, demonstration, execution (tell, show, do)
- Implementing strategies to improve motivation and promote long-term adherence
- Providing feedback and evaluation
- Making necessary adjustments to the program
-  Monitoring overall exercise experience and progression towards goals
When is the “counseling communication style” most effective?
A counseling style is supportive, utilizing a collaborative effort to problem solve and help the client make an informed decision. This is the most effective style and is recommended when implementing a plan and/or modifying a program design
When is a “directing communication style” most effective?
A directing style is more instructive, and that the trainer provides instructions and direction. The style is most effective when safety and proper form and technique essential
What are some good questions to ask a client “pre-exercise stage” to get to know their lifestyle better?
- “ Tell me about a typical week in your life”
2 “ What types of physical activities are part of your daily routine )for example things to do at work or around the house)?”
- “ Do you participate in consistent business activities, such as traveling or entertaining, then extend the hours of your work day or week?”
- “How do you spend your time away from work?”
- “ Do you participate in any regular exercise or recreational sports?”
- “ When was the last time you engaged in an outdoor activity?”
- “ Do you experience any pain during movement?”
What is a medical contraindication?
A health condition or risk factor
What is the purpose of the preparticipation screening?
- Identify the presence or absence of known cardiovascular, pulmonary, and/or metabolic disease, or signs or symptoms suggestive of cardiovascular, pulmonary, and/or metabolic disease
- Identifying individuals with medical contraindications who should be excluded from exercise or physical activity until those conditions have been corrected or are under control
- Detecting at-risk individuals who should first undergo medical evaluation and clinical Exercise testing before initiating an exercise program
- Identifying those individuals with medical conditions who should participate in medically supervised programs
What is a PAR-Q and when is it appropriate?
PAR-Q = The Physical Activity Readiness Questionnaire
This serves as a minimal health risk appraisal prerequisite. It is quick, easy and non-invasive to administer. It is, however, limited by its lack of detail and may overlook important health conditions, medications, and past injuries
What is normal blood pressure for most adults?
<120 systolic bp/<80 diastolic bp
According to the Atherosclerotic Cardiovascular disease risk factor thresholds for use with ACSM risk stratification, what is a “risk factor” for Hypertension blood pressure +1?
- 140 or more systolic bp and/or 90Hg diastolic bp
- If taking antihypertensive medication
What is a risk factor +1 for dislipidemia (LDL cholesterol)?
- LDL greater than or equal to 130 mg/dl or HDL less than 40mg/dl
- If taking lipid-lowering medication
- Total serum cholesterol is greater than or equal to 200mg/dl
- If HDL cholesterol is greater than or equal to 60 mg/dl then -1 point
What is a risk stratification for obesity? +1
Men:
-BMI of 30 kg/meter squared or a waist girth of more than 40 inches
Women:
-BMI of 30 kg/meter squared or a waist girth of more than 35 inches
What is a risk stratification for Prediabetes +1?
More than 45 years old with a BMI greater than 25 kg/m2
How to handle a client with a Low Risk (Asymptomatic) Client with less than 2 risk factors?
- No medical exam needed
- No exercise test before exercise
- No doctor supervision during exercise test
How to handle a client with a Moderate Risk (Asymptomatic) Client with 2 or more risk factors?
- Medical exam NOT need for moderate exercise
- Medical exam NEEDED for vigorous exercise
- No exercise test needed
- No doctor supervision required during exercise test
How to handle a client with a High Risk (Symptomatic) Profile? They have known cardiovascular, pulmonary, renal, or metabolic disease?
- Medical exam recommended before exercise of any kind
- Exercise Teat prior to exercise with doctor supervision is recommended
What is “moderate” and “vigorous” intensity?
Moderate: 40-60% VO2R; 3-6 METs
Vigorous: 60% or more VO2R; 6+ METs
What are some signs and symptoms that could be risk stratifications?
-
- Pain(tightness) ANGINA in the chest, neck, jaw or arms resulting from ischemia (inadequate blood supply to the heart of an organ)
- Shortness of breath or difficulty breathing with mild exertion (dyspnea)
- Orthopnea (dyspnea in a reclined position usually 2-5 hours into sleep
- Ankle edema
- Palpitations or tachycardia (above normal resting heart rate)
- Intermittent claudication (pain sensations or cramping in the lower extremities associated with inadequate blood supply
- Known heart murmur
- Unusual fatigue or difficulty breathing with usual activities
- Dizziness or syncope most commonly caused by reduced perfusion to the brain
What are the three basic steps for performing risk stratification?
- Identify CAD risk factors
- Performing a risk stratification based on CAD risk factors
- Determining the need for medical clearance/supervision
What is an “Informed Consent/Assumption of Risk Form?
- client is acknowledging risks associated with the activity
- intended only to communicate risks/dangers of exercise when individual had a condition
- used prior to assessments and provides evidence of disclosure of the purposes, procedures, risks, and benefits associated with assessments
- THIS IS NOT A LIABILITY WAIVER so it doesn’t provide the Trainer with legal immunity
What is an “Agreement and Release of Liability Waiver”?
- a document to release the Trainer from liability for injuries resulting from the exercise program
- does not necessarily protect against negligence
What is the “Health-History Questionnaire”?
- a form which collects more medical and health info such as:
- past & present exercise and physical activity information
- Medications and supplements
- Recent/current illnesses, injuries, chronic or acute pain
- Surgery and injury history
- family medical history
- Lifestyle info (work, sleep, stress, nutrition)
What is an “Exercise History & Attitude Questionnaire”?
- a form which provides a detailed background of the client’s previous exercise experience and adherence
What is a “medical release?”
- this form provides the personal trainer with the client’s medical information and explains physical activity limitations or guidelines as outlined by their physician
What are “Testing Forms?”
- used to record testing and measurement data during fitness assessment
- Tables are used to determine the client’s ranking in each fitness test
What are the three primary systems of the body that are utilized during exercise?
- Cardiovascular System
- Respiratory System
- Musculoskeletal System
What are some health conditions that affect physical activity?
Cardiovascular Disease Respiratory Problems Metabolic Disorders Pregnancy Antihypertensive Medication Cold Medications Hypertension Musculoskeletal Problems Hernia Illness or infection Bronchodilators
Atherosclerosis
Fatty deposits of cholesterol and calcium accumulate in the arterial walls causing them to harden
CAD
Coronary Artery Disease
Hardening of the arteries which supply the heart
Angina
Pressure in the heart, chest, arm, shoulder or jaw
Shortness of breath, sweating, nausea, palpitations
Hypertension
Prevalent in the African American community (older adults)
Increases risk of CAD, stroke, or kidney disease
Dyspnea
Labored breathing
Common respiratory conditions that call for a doctor’s recommendation
Bronchitis
Emphysema
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
What is the most common type of injury sustained by someone participating in physical activity?
Overuse injuries caused by poor training techniques or poor body mechanics
For example: shin splints, tennis elbow, ITBS (iliotibial band syndrome)
What are some common musculoskeletal conditions to screen for in the health-history interview?
Sprains or strains Herniated discs Bursitis (joint inflammation) Tendinitis Arthritis
How does exercise help people with diabetes?
Exercise helps regulate blood glucose and facilitates fat loss
What is a metabolic disease?
A disease which interferes with metabolism (the utilization of energy)
What are some examples of metabolic disorders?
Diabetes and thyroid disorder
What is the main function of the thyroid
The thyroid secretes hormones thyroxine and triiodothyronine
These hormones increase oxygen consumption and heat production
Hyperthyroidism= more of these hormones
Hypothyroidism= less of these hormones
What are Beta Blockers?
A medication (antihypertensives) which block the affects of epinephrine and norepinephrine, thus reducing heart rate
Can’t use HR to monitor intensity; must use RPE
What are Calcium Channel Blockers?
Lower BP and May affect heart rate
ACE Inhibitors
Angiotensin-converting Enzyme Inhibitors
They lower bp at rest and during exercise
Angiotensin-II Receptor Antagonists
Prescribed to treat hypertension
Diuretics
Increase excretion of water and electrolytes for people retaining fluid, as occurs with congestive heart failure
Brochiodilators
Asthma medications that open air passages in the lungs
Increase exercise capacity for people who experience bronchiospasms
What are the effects of cold medication
Decongestants stimulate vasoconstriction which might result in raised blood pressure and increased heart rate
What is the purpose of conducting a physiological assessment at the beginning of the trainer-client relationship?
Identify areas of health/injury risk for potential referral to the appropriate health professionals
Collect baseline data that can be used to develop personalized fitness programs and allow for comparisons of future evaluations
Educate client about his or her present physical condition and health risks by comparing their results or normative data for age and gender
Motivate client by helping them establish realistic goals
When might it not be appropriate to conduct a physiological health assessment?
When the client could be embarrassed about their current condition
Note: A health risk appraisal is always necessary pre-participation
What does a physiological assessment generally include?
Resting vital signs (HR, BP, height, lbs)
Static Posture and Movement Screens
Joint Flexibility and muscle length
Balance and Core Function
Cardiorespiratory Fitness
Body Composition
Muscular Endurance & Strength
Skill-related Parameters (agility, power, coordination)
When should a Trainer perform the physiological assessment?
After the initial rapport-building stage:
- Identify Client’s Personality
- Identify readiness to change behavior
- Identify Stage of Behavioral Change
- Identify Client General Goals
- Conduct Physical Assessment
When conducting a physiological assessment, what are some signs and symptoms that would merit immediate termination of the assessment?
- Angina; Uncomfortable pressure in the chest
- Significant drop (more than 10mmHG) in SBP despite an increase in exercise intensity
- Excessive rise in BP (greater than 250mmHG SBP or greater than 115 mmHG DBP
- Fatigue, shortness of breath, difficult or labored breathing, wheezing
- Lightheadedness, paleness, nausea, dizziness, confusion
- Leg cramping or claudication
How can a Trainer be professional and prepared prior to conducting a physiological assessment of a client?
- Giving client instructions prior to assessment (what to eat, wear, hydration, abstaining from stimulants)
- Obtaining a signed informed consent from the client and ask of the client has any questions about it
- Organization of all forms and tables
- Communication and demonstration of skills; clearly explaining the test and it’s sequence
- Calibration of all exercise equipment
- Environmental control (room temperature between 68•-72•F with relative humidity below 60%….environmental should be private to reduce testing anxiety
- Being prepared for emergencies (exits, first aid equipment)
Why do cardiovascularly fit people have a lower resting heart rate?
One of the cardiovascular adaptations the body makes is it increases stroke volume thus lowering HR
What are some factors that influence Resting Heart Rate?
- Caffeine
- Fitness Levels
- Fatigue
- Body composition
- Drugs/medication/alcohol
- Stress
What is average resting heart rate?
Males: 60-60 BPM
Females: 72-80 BPM
What are some factors that increase resting HR?
Drugs, stimulants, sitting upright as opposed to lying down, digestion
What are some factors that result in a lower blood pressure?
Exercise, weight loss, sodium restriction, smoking cessation, stress management
How do men and women perceive exertion differently?
Men: Tend to underestimate exertion
Women: Tend to overestimate exertion
When should the Borg Scale of Perceived Exertion be used?
Only when an HR is needed; even then it can be inaccurate because of factors such as medications
15 point scale (from 6-20)
6 = 60bpm 12 = 120 bpm 20 = 200 bpm
How do conditioned clients under-estimate their RPE?
If they’re focused on muscular tension rather than cardio respiratory effect then they might under-rate their exercise intensity
What is the Exercise Induced Feeling Inventory (EFI) ?
The EFI quantifies the clients emotions related to exercise. It’s basically taking inventory of how they feel about exercise following the session.
Can and should be used periodically to promote positive feelings associated with exercise and thus ADHERENCE
How is the EFI used to promote adherence?
- Administer during the initial interview regarding past experiences
- Use it every other session for the first 2 weeks
- Taper off (to account for desensitization)
- Readminister when program changes
- Track sub scales over a period of 4-6 weeks to create of graph showing how clients feelings towards exercise improves and perceived exhaustion decreases
After all this is said and done, what is the basic order of initiating a new client?
- Get to know the client and build rapport (trust) using appropriate communication and interviewing techniques
- Conduct a thorough health assessment utilizing appropriate health risk appraisals and risk stratifications to ensure the client is mentally and physically prepared to begin their fitness journey
- Measure HR and BP to further clarify the health status of the client
- Perceive the clients thoughts and feelings towards exercise, and tailor a balanced fitness program that will meet the client’s specific wants and needs
