Chapter 6 Building Rapport & Initial Investigation Stage

Question 1

Attributes of a Successful
Relationship

Answer 1

• Rapport implies a relationship of mutual trust, harmony, or emotional affinity.
• Three attributes are essential to successful relationships:
  
  • Empathy
  • Warmth
  • Genuineness

Question 2

Empathy

Answer 2

• Trainers must be attentive and empathetic, regardless of personal opinion.
  
  • Separate meaningful content from superfluous information.
  • Be aware of how the client’s emotional patterns change based on the nature of the content being discussed.
  • Be conscious of how cultural and ethnic differences affect communication.

Question 3

Motivational Interviewing

Answer 3

• Motivational interviewing helps the client feel in control.
  
  • A client-centered, directive method for enhancing intrinsic motivation by exploring and resolving ambivalence
    
    • It involves careful listening and strategic questioning.
    • It is an interviewing technique to help get clients “off the fence” about exercise or behavior change.

Question 4

Risk Stratification

Answer 4

• The purpose for performing a risk stratification prior to engaging in a physical-activity program is to determine:
  
  • The presence or absence of known cardiovascular, pulmonary, and/or metabolic disease
  • The presence or absence of cardiovascular risk factors
  • The presence or absence of signs or symptoms suggestive of cardiovascular, pulmonary, and/or metabolic disease
• Specific risk factor categories are used to score client risk for stratification.
• Client risk is stratified (categorized) as low, moderate, or high.

Question 5

Cardiovascular Conditions

Answer 5

• Atherosclerosis is a process in which fatty deposits of cholesterol and calcium accumulate on the walls of the arteries.
• When this process affects the arteries that supply the heart, it is called (CAD).
• If the vessels that supply this blood to the heart are narrowed from atherosclerosis, the blood supply is limited.

Question 6

Respiratory Conditions

Answer 6

• The lungs extract oxygen from inhaled air and deliver it to the body’s tissues via the cardiovascular system.
• A problem in the respiratory system will interfere with the body’s ability to provide enough oxygen for aerobic exercise.
• Bronchitis, asthma, and chronic obstructive pulmonary disease (COPD) are common respiratory problems.
• Anyone with a respiratory system disorder should have a physician’s clearance.

Question 7

Musculoskeletal Conditions

Answer 7

• Most minor sprains and strains are easily managed, but a persistent problem or a more serious injury requires physician referral.
• Overuse injuries are the most common type of injury sustained by persons participating in physical activity.
• Any musculoskeletal disorder that a trainer is not qualified to deal with should be referred.

Question 8

Metabolic Conditions

Answer 8

• Diabetes
  
  • A group of diseases that results in too much sugar/glucose in the blood
• Thyroid disorders
  
  • Hyperthyroid
  • Hypothyroidism

Question 9

Medications

Answer 9

• Drugs alter the biochemistry of the body and may affect a client’s ability to perform or respond to exercise.
• Many prescription and over-the-counter medications or illicit drugs affect the heart’s response to exercise.
• The following two slides list many medication categories that may affect a person’s response to exercise.

Question 10

Types of Antihypertensive
Medications

Answer 10

• Beta Blockers
  
  • Beta-adrenergic blocking agents, or beta blockers, block beta-adrenergic receptors and limit sympathetic nervous system stimulation.
• Calcium channel blockers
  
  • prevent calcium-dependent contraction of the smooth muscles in the arteries.
• Angiotensin-converting Enzyme (ACE) Inhibitors
  
  • ACE inhibitors block an enzyme secreted by the kidneys.
• Diuretics
  
  • Increase the excretion of water and electrolytes through the kidneys.
  • They are usually prescribed for high blood pressure, or when a person is accumulating too much fluid
• Asthma medications
  
  • also known as bronchodilators, relax or open the air passages in the lungs, allowing better air exchange.

Question 11

Physiological Assessments

Answer 11

• Conduct baseline physiological assessments in the first initial sessions in order to:
  
  • Identify areas of health/injury risk for potential referral
  • Collect baseline data
  • Educate client about his or her present physical condition and health risks
  • Motivate client by helping them reach established realistic goals

Question 12

Typical Physiological Assessments

Answer 12

• The physiological assessments that merit consideration generally include:
  
  • 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

Question 13

Sequencing Assessments

Answer 13

• Physiological influences on an assessment must be considered when establishing the testing sequence and timeline for a client.
  
  • Resting BP and HR should be measured before any exertion.
  • Skinfold measures for body composition should be taken before activity.
  • Cardiovascular testing following resistance exercise may elevate HR responses and invalidate the results.

Question 14

Criteria for Exercise Test Termination

Answer 14

• Trainers must be aware of signs or symptoms that merit immediate test termination and referral.
  
  • Onset of angina pectoris or angina-like symptoms that center around the chest
  • Significant drop (>10 mmHg) in SBP despite an increase in exercise intensity
  • Excessive 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 skin
  • Increased nervous system symptoms
  • Leg cramping or claudication
  • Physical or verbal manifestations of severe fatigue

Question 15

Testing Environment

Answer 15

• Environmental conditions can limit a client’s performance on a cardiorespiratory endurance test.
• Privacy issues and distractions can also have a negative impact on testing outcomes.
• Trainers should be aware of the following considerations for testing:
  
  • Proper calibration and routine maintenance (documented) of all equipment
  • The ability of equipment to accommodate a range of exercise intensities and body sizes, as well as the client’s specific needs
  • Adequately illuminated areas for testing
  • Proper emergency response protocol and access to emergency supplies
  • Appropriate temperature range between 68 and 72º F (20 to 22º C)
  • Avoid outdoor testing on excessively hot and humid days

Question 16

Conducting Assessments: Heart Rate

Answer 16

• The pulse rate is measured where an artery’s pulsation is close to the surface.
  
  • Commonly palpated sites:
  • Radial artery
  • Carotid artery

Question 17

Resting and Exercise Heart Rates

Answer 17

• A traditional classification system exists to categorize resting heart rate (RHR):
  
  • Sinus bradycardia HR (slow HR): RHR <60 bpm
  • Normal sinus rhythm: RHR = 60 to 100 bpm
  • Sinus tachycardia HR (fast HR): RHR >100 bpm
• Average RHR is approximately 70 to 72 bpm, averaging 60 to 70 bpm in males and 72 to 80 bpm in females.
• The higher values found in the female RHR is attributed in part to a few key physiological differences.

Question 18

Key Notes About Heart Rate

Answer 18

• Any elevation in RHR >5 bpm over the client’s normal RHR that remains over a period of days is good reason to taper training intensities
  
  • Certain drugs, medications, and supplements can directly affect RHR.
  • Body position affects RHR.
  • Digestion increases RHR.
  • Environmental factors can affect RHR.

Question 19

Methods of Measuring Heart Rate

Answer 19

• Several methods are used to measure heart rate, both at rest and during exercise:
  
  • 12-lead electrocardiogram (ECG or EKG)
  • Telemetry (often two-lead)
  • Palpation
  • Auscultation with stethoscope
  • Telemetry and palpation are the most common methods used in a fitness setting.

Question 20

Measuring Exercise Heart Rate

Answer 20

• Measuring for 30 to 60 seconds is generally difficult.
  
  • Therefore, exercise heart rates are normally measured for shorter periods.
  • Generally a 10- to 15-second count is recommended.

Question 21

Blood Pressure

Answer 21

• Blood pressure is the outward force exerted by the blood on the vessel walls.
  
  • SBP represents the pressure created by the heart as it pumps blood into circulation via ventricular contraction.
  • DBP represents the pressure that is exerted on the artery walls as blood remains in the arteries during the filling phase of the cardiac cycle.
  • Blood pressure is measured within the arterial system.

Question 22

Korotkoff Sounds

Answer 22

• Blood pressure is measured indirectly by listening to the Korotkoff sounds.
• These sounds are only present when some degree of wall deformation exists.
• Under pressure of a blood pressure cuff, vessel deformity facilitates hearing these sounds.

Question 23

Blood Pressure Measurement Errors

Answer 23

• Common mistakes associated with measuring blood pressure include:
  
  • Cuff deflation that is too rapid
  • Inexperience of the test administrator or inability of the test administrator to read pressure correctly
  • Improper stethoscope placement and pressure
  • Improper cuff size
  • Inaccurate/uncalibrated sphygmomanometer
  • Auditory acuity of the test administrator or excessive background noise

Question 24

Blood Pressure Measurement During Exercise

Answer 24

• Accurate blood pressure is very difficult to obtain during exercise due to excessive movement and noise.
• A sphygmomanometer with a stand and a hand-held gauge are better choices for measuring BP during exercise.

Question 25

Application of Blood Pressure
Measurement Results

Answer 25

• For individuals 40 to 70 years old, each 20 mmHg increase in resting SBP or each 10 mmHg increase in resting DBP above normal doubles the risk of cardiovascular disease.
• If the trainer discovers an abnormal BP reading, it is prudent to recommend that the client visit his or her physician.
• Blood pressure can be reduced with medication or certain behavior modifications, including:
  
  • Exercise
  • Weight loss
  • Sodium restriction
  • Smoking cessation
  • Stress management

Question 26

Recommendations for Using
RPE (Ratings of Perceived Exertion)

Answer 26

1. The 6-to-20 scale is difficult to use:
   
   1. Use when HR equivalents are needed and the actual exercise HR is not a reliable indicator of exertion.
   2. The 0-to-10 scale should always be used to gauge intensity when the trainer does not need to measure HR equivalents via the RPE.