Domain I: Interviews and assessments Flashcards
Fast twitch muscle fiber
Muscle fibers that contract rapidly with low oxidative capacities. Also called type II fibers.
Fascia
The fibrous connective tissue that covers muscle while providing structural support.
Isometric
A muscular contraction in which the joint angle and muscle length doesn’t change.
Hyperextension
An extension of a part of the body beyond the normal range of motion.
Plantarflexion
A movement that flexes the toes toward the sole of the foot from the ankle.
V02 Max
The maximal oxygen uptake the body can use during a specified timeframe. Measures cardiovascular endurance through 1 minute per kilogram of bodyweight. Also referred to as maximum aerobic capacity.
Transverse Plane
An imaginary horizontal line that divides the body between upper and lower sections. Also referred to as the horizontal plane.
Adduction
Movement of a limb toward the midline or middle axis of your body.
Abduction
Movement of a limb away from the midline or middle axis of the body such as extending your arms outward.
Anaerobic Threshold
When the level of exercise intensity places demands on the body causing lactic acid to build up faster than it can be cleared away.
Basal Metabolic Rate
The amount of energy needed to maintain the basic functions of living.
Antagonist
When a muscle action counteracts the contraction produced by another muscle.
Base of Support
The area beneath your feet that includes all points of contact.
Axis of Rotation
The center line around which a joint or other body part moves in rotation.
Bone Mineral Density
Measures the mineral density in your bone. Indicates bone strength through calcium content.
Co-contraction
The simultaneous activation of antagonist muscles.
Distal
The furthest distance from the origin of a muscle; away from the center of the body.
Contusion
Injured tissues or skin where blood capillaries may have broken but the skin is not. Similar to a bruise.
Contraindication
Any physical condition that makes a movement or exercise inadvisable or inappropriate.
Delayed Onset Muscle Soreness
Describes muscle pain and soreness that typically occurs within 24 to 48 hours following strenuous exercise. It can result in restricted range of motion, tenderness and muscle weakness for a short period.
External Rotation
A movement of the body away from the midline; turning outward.
Dyspnea
Having difficulty in breathing; shortness of breath or labored breathing.
Elasticity
One of the functional characteristics of muscles that explains when a muscle is stretched, it returns to its original resting length.
Dorsiflexion
A movement that flexes the foot in an upward direction from the ankle.
Frontal Plane
An imaginary vertical line that divides the body between front and back sections. Also referred to as the vertical plane.
Glycogen
The primary storage form for glucose in the liver and muscles. It is processed as part of the energy producing cycle.
Glucose
The simple sugar that represents the form in which all carbohydrates are used as a primary energy source by the body.
Heart Rate Reserve
Represents the resting capacity of the heart as measured by the difference between heart rate and maximal heart rate.
Heat Stroke
A serious condition brought on by excessive heat and measured by a body temperature of greater than 105 degrees. Considered a medical emergency with symptoms of red and dry skin, dizziness, seizures, coma and possibly death.
Insulin Resistant
A condition where the body has a lower level of response to insulin. Muscle tissue is not able to properly transport glucose into the bloodstream.
Inversion
An action which happens in the frontal plane and represents the inward rotation of the foot.
Medial
Positioned toward the midline of the body or median plane.
Lactate Threshold
Refers to the intensity of exercise where lactate accumulates into the bloodstream. Lactate concentrations rise above resting levels.
Ligament
The short band of fibrous tissue that holds a joint together by connects two bones.
Range of Motion
The full movement of a joint from full extension to full flexion.
Proximal
Position near the center of the body or point of attachment.
Prime Mover
When a muscle acts specifically to produce a desired movement. Commonly referred to as an agonist.
Posterior
Refers to the backside of the body or further back in a position.
Anterior
Refers to the front side of the body or nearer the head.
Bursitis
Inflammation of the bursa which is located between bones, tendons, joints and muscles. Moat typical areas affected are the hip, shoulders and elbow.
Relative strength
A ratio which compares the total amount lifted versus a person’s body weight as measured in a ratio. It allows for comparative strength measurements across different individuals.
Sagittal Plane
An imaginary vertical line that divides the body between right and left sections.
Tendinitis
An inflammation of a tendon commonly caused by overuse
Sciatica
Compression of the sciatic nerve which causes pain to shoot down the leg. Often the result from a lumbar herniated disc.
Slow Twitch Muscle Fiber
Muscle fibers that contract slowly during lower intensity or longer duration activities. Used for fatty acid oxidation and aerobic glycolysis.
Sprain
A stretching or tearing that occurs from a traumatic twist causing pain and swelling. Usually involves ligaments or joint capsules.
Strain
A muscle tear, stretch, or injury caused by overexertion. Can affect the muscle, tendon or fascia.
Supine
Lying on your back while in a face up position.
Static Balance
The ability of the body to remain balanced between its base of support and weight distribution.
Tinnitus
A condition which causes a ringing, beating sound or buzzing in one’s ear.
Testosterone
A steroid hormone produced in the testes and responsible for the growth and development of male sexual characteristics.
Type 1 Diabetes
A condition where the pancreas produces little to no insulin. It usually develops in childhood and is also referred to as juvenile diabetes or insulin dependent diabetes.
Type 2 Diabetes
A condition that develops in adulthood and is also referred to as noninsulin dependent diabetes. The body is unable to use insulin properly and is often seen in those who are overweight or obese.
Vestibular System
The sensory mechanism in the central nervous system that monitors balance. Reflexes of the eyes and ears are coordinated to provide feedback on spatial orientation and allows the body to maintain equilibrium.
Waist to Hip Ratio
A ratio used to determine health concerns from weight distribution. Measured by girth calculations at the waist and hip.
Visceral
Refers to the internal organs of the body.
Vasoconstriction
Describes the constriction of blood vessels by the small muscle walls.
Vasodilation
Decreases in blood pressure due to the dilation of blood vessels.
Subcutaneous Fat
The fatty tissue that lies beneath the surface of skin.
Stroke volume
The amount of blood pumped from the left ventricle during each contraction of the heart.
Syncope
Commonly referred to as fainting; a person has a temporary loss of consciousness when not enough oxygen reaches the brain.
Tachycardia
A heart rate with a faster beat than normal; measured at over 100 beats per minute.
Tendon
A tough band of fibrous connective tissue which attaches muscle to bone.
Motor Unit
Consists of a motor neuron and the muscle fibers which are stimulated.
Muscular Power
The relationship between force output and speed of movement. The ability to generate as much force as possible, as quickly as possible.
Myofascial release
A manual massage like treatment designed to release tension in the fascia.
Microcycle
A minimum cycle in a periodized training program between one to four weeks long.
Neuromuscular efficiency
The ability of the neuromuscular system to effectively recruit muscles to work in a synergistic fashion.
Mobility
Refers to the freedom of movement around a joint.
Lordosis
Excessive inward curvature of the spine in the lower region.
Lateral epicondylitis
A painful inflammation of the tendon that originates at the lateral epicondyle. A repetitive use injury caused from excessive loads at the wrist and finger extensors.
Kyphosis
Excessive curvature of the spine which causes hunching of the back.
Insertion
The attachment of a muscle to its distal and more moveable structure.
Isokinetic
A muscular contraction in which the muscle changes throughout the range of motion; also commonly called “variable resistance”.
Isotonic
A muscular contraction in which joint movement occurs and muscle tension is created.
Hypertension
High blood pressure that exceeds the average and recorded as resting blood pressure at or above 140/90 mmHg.
Gait
The way a person moves on foot in sequence such as walking, running, stepping, etc.
Eccentric
A muscle action where the muscle lengthens against resistance. It is also commonly referred to as “negative work”.
Extension
A movement which involves straightening a joint or extending it. It typically refers to the straightening of an arm or other limb.
Connective Tissue
A fibrous tissue that binds, supports and protects muscles, organs and structures of the body. This includes tendons, ligaments, joint capsules, etc.
Ketosis
When the body has an elevated level of ketone bodies in their tissues. Typically the result of a low carbohydrate or starvation style diet.
Concentric
A muscle action where the muscle shortens under tension. It is commonly referred to as “positive work”.
Atrophy
A decrease in muscle size and functional ability as a result of inactivity or lack of use.
In what stage of the client-trainer relationship are health-history and lifestyle questionnaires administered?
Investigation Stage
Dan is a new client whom you are meeting with for the first time today. He will most likely be evaluating you as a trainer through both your verbal and non-verbal communication. What stage of the client-trainer relationship are you in with Dan?
Rapport Stage
Kristin is in for her second session and you are conducting fitness assessments. While you are checking her body fat percentage you ask her about types of exercise she prefers to do. What stage of the client-trainer relationship are you in with Kristin?
Investigation Stage
John understands that his family has a history of heart disease and that being overweight can increase his risk for such conditions. He has no intention of beginning on any kind of exercise program since he believes he has never had any weight loss succes
Precontemplation
In which stage of the Transtheoretical Model of Behavior Change (TTM)Âis a client ready to adopt and live a healthy lifestyle?
Preparation
According to the ACE Integrated Fitness Training Model, what step in the training process best follows the testing of resting measures such as heart rate and blood pressure?
Static Posture
This Questionnaire serves as a non-invasive, minimal health-risk appraisal designed to determine contraindications to exercise.
Physical Activity Readiness Questionnaire (PAR-Q)
When answering the Physical Activity Readiness Questionnaire (PAR-Q), your client answers “yes” to chest pain during physical activity as well as currently taking a prescription blood pressure medication. What is the next step in his fitness program?
Talk with his doctor about his readiness for exercise.
When answering the Physical Activity Readiness Questionnaire (PAR-Q), your client answers “yes” to a bone or joint problem that could be made worse by a change in physical activity. What is the next step in his fitness program?
Talk with her doctor about her readiness for exercise.
Bill is a 50-year-old man with a family history of heart disease. His body mass index is 20 and he has been running 3 miles 3-4 days a week for a year. What are the exercise testing recommendations according to risk stratification based on his cardiovascu
Moderate risk, medical exam necessary before vigorous exercise.
Wendy is a 50-year-old woman who has not exercised in 3 years. She has no family history of heart disease and is a non-smoker. What are the exercise testing recommendations according to risk stratification based on her cardiovascular disease risk factors?
Low risk, medical exam not necessary.
Bob is a 45-year-old man who quit smoking 2 months ago. He has not participated in any exercise program in 2 years. His body mass index (BMI) is 32. What are the exercise testing recommendations according to risk stratification based on his cardiovascular
High risk, medical exam before moderate exercise.
What information does the Health History Questionnaire collect?
Detailed medical and health information.
What information does the Informed Consent form collect?
Evidence of disclosure.
What information does the Exercise History and Attitude Questionnaire collect?
Previous exercise including adherence experience.
What blood pressure measurement is considered to be a risk factor for cardiovascular disease?
140/90 mmHg
Chronic Obstructive Pulmonary Disease (COPD. is s condition that affects mainly which system?
Respiratory
Your client has been complaining of pain in her anterior lower leg. What is the best course of action to take in continuing her exercise program?
Modify the program with cross training.
Your client is complaining of pain with extension of her elbow. She has a history of lateral epicondylitis (tennis elbow). What is the best course of action to take in continuing her exercise program?
Modify the program with cross training.
Your new client informs you that she has diabetes and is taking insulin. What is the most important thing to do for this client?
Refer her to a physician prior to beginning an exercise program.
When filling out the “medications” portion of the Health History Questionnaire, your client lets you know that he is taking a beta-blocking medication. Once obtaining a physician’s release for exercise, what is the most important difference in this client
Use Rate of Perceived Exertion (RPE) to determine the level at which he is exercising as his heart rate will not go up.
When beginning an exercise program with a client, you determine that he has checked “yes” to 4 risk factors on the Health Questionnaire. The next step in the training process is to:
Give your client a form to be signed by his physician, approving the exercise program.
When checking a client’s heart rate, what is a commonly palpated site?
Carotid artery
When checking a client’s heart rate, what is a commonly palpated site?
Radial artery
A client’s resting heart rate should always be checked ____________________.
When the client is sitting
When measuring a client’s blood pressure, where should the stethoscope be placed?
On the inside of the client’s arm at the bend of the elbow.
After taking the Exercise-Induced Feeling Inventory 12 weeks into their program, your client appears to have the mood profile of “Positive Engagement”. What might your client have answered to feeling very strongly?
Enthusiastic
When performing a Static Postural Assessment on your client, you determine that your client has a slight posterior pelvic tilt. This means that the line of symmetry is __________________.
Tilted Posteriorly
When an anterior pelvic tilt is determined, which muscles are suspected to be tight?
Hip Flexors and Erector Spinae
When an anterior pelvic tilt is determined, which muscles should you aim to strengthen through restorative exercise?
Rectus Abdominis and Hamstrings
When a posterior pelvic tilt is determined, which muscles are suspected to be tight?
Rectus Abdominis and Hamstrings
When a posterior pelvic tilt is determined, which muscles should you aim to strengthen through restorative exercise?
Hip Flexors and Erector Spinae
Tight hip adductors and weak gluteus medius muscles can lead to which compensation?
Knees moving inward
Tight plantarflexors can lead to which compensation?
Raised heels
You have a new client who is extremely obese, and you realize that your body fat calipers (skinfold measurement) may not be an accurate method to determine their body fat percentage. You want to have a starting measurement to determine their progress. Wha
Utilize Body Mass Index (BMI) and girth measurements.
What three sites are suggested for skinfold measurement in women?
Triceps, thigh and suprailium
What three sites are suggested for skinfold measurement in men?
Chest, thigh and abdominal
What are the correct units of measurement for calculating body mass index (BMI)?
Weight (kg)/Height (m)
Jeanette is a 55-year-old woman who exercises regularly. What is her estimated maximum heart rate?
165 bpm
Mark is a 32-year-old man. What is his estimated maximum heart rate?
188 bpm
What component of fitness does the push-up test measure?
Muscular endurance
What component of fitness does the body weight squat test measure?
Muscular endurance
What is an example of testing absolute strength?
1 RM leg-press test
The Vertical Jump test assesses what component of fitness?
Power
In which stage of the client-trainer relationship should the trainer learn their client’s likes and dislikes?
Investigation Stage
In which assessment can a personal trainer determine potential movement compensations associated with poor posture?
Static postural assessments
What is the best method for discussing nutrition with your client?
Instruct them to go to choosemyplate.gov and to follow the instructions on the web site.
A one-repetition maximum test evaluates which type of strength?
Absolute strength
In what specific location is the abdominal circumference measured?
At the level of the umbilicus.
In what specific location is the circumference of the upper thigh measured?
Just below the gluteal fold.
In what specific location should the arm be measured?
Midway between the acromion and the olecranon process with the arm relaxed.
How do you determine a person’s waist-to-hip ratio?
Waist measurement divided by hip measurement
Jose is 18 years old. What is his estimated maximum heart rate?
202 bpm
What is the approximate standard deviation of an individual’s maximum heart rate?
12 bpm
At what times should heart rate be monitored throughout a cardiorespiratory assessment?
Continuously
What is the workload of 1 MET associated with?
Oxygen consumption at rest
How often should Ratings of Perceived Exertion (RPEs) be taken throughout a cardiorespiratory assessment?
Once every minute
What is the best definition of VO2 max?
Maximum amount of oxygen a person can utilize in one minute per kg of body weight.
At what point in a maximal aerobic capacity assessment are carbohydrates the primary source of fuel?
After reaching the first ventilatory threshold
Peter is a 47 year old male with a BMI of 31. He has been leading a sedentary lifestyle until recently hiring you. What is his risk stratification?
3
What is considered the easiest method for assessing a client’s exercise intensity?
Talk test
Which term describes muscle action which shortens to create muscle tension?
Concentric
The trunk lateral endurance test measures the endurance of which primary muscle?
Obliques
In what stage of the client-trainer relationship will the trainer first establish understanding and trust by listening to a new clients questions and concerns regarding her anxiety and insecurity of working out in a new environment?
Rapport Stage
1-RM calculation table
- 2 reps = 95% - 3 = 93% - 4 = 90% - 5 = 87% - 6 = 85% - 7 = 83% - 8 = 80% - 9 = 77% - 10 = 75% - 11 = 70% - 12 = 67% - 15 = 65%
Absolute contraindications to exercise testing that clients should only participate after stabilized and cleared by MD
- sig change in resting ECG - unstable angina - uncontrolled cardiac dysrhythmias - severe symptomatic aortic stenosis - uncontrolled symptomatic heart failure
Absolute contraindications to exercise testing that clients should only participate after stabilized and cleared by MD continued
- acute pulmonary embolus or pulmonary infarction - acute myocarditis or pericarditis - suspected or known dissecting aneurysm - acute systemic infection
Anterior pelvic tilt postural deviation exercise plan
- tilts downward and forward - stretch: hip flexors, erector spinae - strengthen: hamstrings, rectus abdominis
Avg resting HR
- 70-72bpm - 60-70 in males - 72-80 in females
Body composition measurements
- Ht - Wt - BMI - Skinfold - Waist-to-Hip ratio
Criteria for good relationship between muscles for McGill’s Torso Muscular Endurance Test Battery
- flexion:extension = less than 1.0 - right-side bridge:left-side bridge = 0.05-1.0 - side bridge (either side):extension = less than 0.75
Days per week of cardiorespiratory training in different phases
- Phase 1: 3-4 - Phase 2: 3-5 - Phase 3: 5 - Phase 4: 5
During Sharpened Romberg Test, client is unable to reach 30seconds, what does this indicate?
- inadequate static balance and postural control
During the bend-and-lift screen heels are unable to keep contact with floor, what muscles are lengthened?
None
During the bend-and-lift screen heels are unable to keep contact with floor, what muscles are tight?
plantar flexors
During the bend-and-lift screen hip and knees initiate movement, what muscles are lengthened?
- insufficient activation of gluteus group
During the bend-and-lift screen hip and knees initiate movement, what muscles are tight?
- quad and hip flexor dominance
During the bend-and-lift screen knees move inward what muscles are lengthened?
- gluteus medius and maximus
During the bend-and-lift screen knees move inward what muscles are tight?
- hip adductors - TFL
During the bend-and-lift screen lack of foot stability is observed: ankle collapse inward/feet turn outward what muscles are lengthened?
- medial gastrocnemius - gracilis - sartorius - tibialis group
During the bend-and-lift screen lack of foot stability is observed: ankle collapse inward/feet turn outward what muscles are tight?
- Tight: soles, lateral gastrocnemius, peroneals
During the bend-and-lift screen the back excessively arches, what muscles are lengthened?
- core - rectus abdominis - gluteal group - hamstrings
During the bend-and-lift screen the back excessively arches, what muscles are tight?
- hip flexors - erector spinae - rhomboids - traps - lats
During the bend-and-lift screen the back rounds forward, what muscles are lengthened?
- upper back extensors (traps, rhomboids)
During the bend-and-lift screen the back rounds forward, what muscles are tight?
- Lats - teres major - pectoralis major and minor
During the bend-and-lift screen the hamstrings contact the back of the calves, what muscles are lengthened?
- muscle weaknesses and poor mechanics, resulting in an inability to stabilize and control the lowering phase - weak: quads, hamstrings, glutes, calf muscles, dorsiflexors
During the bend-and-lift screen the head is downward, what muscles are lengthened?
- hip extensors (gluteus maximus, hamstrings) - trunk extensors (erector spinae)
During the bend-and-lift screen the head is downward, what muscles are tight?
- increased hip and trunk flexion (rectus abdominis, rectus femoris, iliopsoas, TFL, pectineus, sartorius)
During the bend-and-lift screen the head is upward, what muscles are lengthened?
- cervical flexors
During the bend-and-lift screen the head is upward, what muscles are tight?
- compression and tightness in the cervical extensor region
During the bend-and-lift screen the tibia and torso are unable to achieve parallel between the two, what muscles are lengthened?
- lack of dorsiflexion (which usually allows tibia to move forward)
During the bend-and-lift screen the tibia and torso are unable to achieve parallel between the two, what muscles are tight?
- poor mechanics - plantarflexors
During the bend-and-lift screen torso laterally shifts to the side, what muscles are tight?
- lateral flexors on flexed side are tight - lengthened: lateral flexors on opposite side - side dominance and muscle imbalance due to potential lack of stability in the lower extremities during joint loading
During the external/internal rotation test inability to rotate the forearms 70 degrees toward the mat or discrepancies are observed b/w the limbs, what muscles are tight?
- external rotators of arm (infraspinatus, teres minor) - joint capsule and ligaments may be tight as well
During the external/internal rotation test inability to rotate the forearms 90 degrees to reach the floor or discrepancies are observed b/w the limbs, what muscles are tight?
- internal rotators of arm ( subscapularis, pectoralis major, lats) - joint capsule and ligaments may be tight as well
During the hurdle step screen anterior tilt of the pelvis with forward torso lean is observed, what muscles are lengthened?
- rectus abdominis - hip extensors
During the hurdle step screen anterior tilt of the pelvis with forward torso lean is observed, what muscles are tight?
- stange-leg hip flexors
During the hurdle step screen hiking of the raised hip is observed, what muscles are tight?
- stance-leg hip flexors–limiting posterior hip rotation during raise
During the hurdle step screen hip adduction is observed >2 inches, what muscles are lengthened?
- Gluteus medius and maximus
During the hurdle step screen hip adduction is observed >2 inches, what muscles are tight?
- Hip adductors - TFL
During the hurdle step screen knees move inwards, what muscles are lengthened?
- Gluteus medius and maximus
During the hurdle step screen knees move inwards, what muscles are tight?
- hip adductors - TFL
During the hurdle step screen lack of ankle dorsiflexion is observed, what muscles are lengthened?
dorsiflexors
During the hurdle step screen lack of ankle dorsiflexion is observed, what muscles are tight?
plantarflexors
During the hurdle step screen lack of foot stability: ankles collapse inward/feet turn outward is observed, what muscles are lengthened?
- medial gastrocnemius - gracilis - sartorius - tibialis group - gluteus maximus and medius - inability to control internal rotation
During the hurdle step screen lack of foot stability: ankles collapse inward/feet turn outward is observed, what muscles are tight?
- soleus - lateral gastrocnemius - peroneals
During the hurdle step screen limb deviates from sagittal plane, what muscles are lengthened?
- raised-leg hip flexors
During the hurdle step screen limb deviates from sagittal plane, what muscles are tight?
- raised-leg hip extensors
During the hurdle step screen posterior tilt of pelvis with hunched-over torso lean is observed, what muscles are lengthened?
stance-leg hip flexors
During the hurdle step screen posterior tilt of pelvis with hunched-over torso lean is observed, what muscles are tight?
- rectus abdominis - hip extensors
During the hurdle step screen stance-leg hip rotates inward, what muscles are lengthened?
- stance-leg or raised leg external rotators (6 deep external rotators)
During the hurdle step screen stance-leg hip rotates inward, what muscles are tight?
- stance-leg or raised leg internal rotators (adductor longus & brevis, TFL pectineus, gluteus medius and minimus)
During the hurdle step screen torso has a lateral tilt, forward lean, rotation, what is indicated?
- lack of core stability
During the PSL raise the raised leg achieves <80 degrees of movement before the pelvis rotates posteriorly or there are any visible signs in the opposite leg lifting off the mat or table, what muscles are tight?
Hamstrings
During the shoulder flexion/extension test inability to extend the shoulders 50 degrees or discrepancies between limbs, what muscles are tight?
- pectoralis major - abdominals - subscapularis - anterior deltoid - coracobrachialis - biceps brachii
During the shoulder flexion/extension test inability to flex the shoulders to 170 degrees or discrepancies between limbs are observed, what muscles are tight?
- Pectoralis major and minor - Latissimus dorsi - Teres major - Rhomboids - Subscapularis
During the shoulder push stabilization hyperextension or collapsing of the low back is observed during the push-up movement, what are the suspected compensations?
- lack of core, abdominal, and low-back strength, resulting in instability
During the shoulder push stabilization screen winging of the scapula is observed during the push-up movement, what are the suspected compensations?
- inability of the parascapular muscles (serratus anterior, trapezius, levator scapulae, rhomboids) to stabilize the scapulae against the rib cage. - could also be due to a flat thoracic spine
During the Thomas Test the back and sacrum are flat, but the back of the lowered thigh does not touch the table and the knee does not flex to 80 degrees, what muscles are tight?
- primary hip flexor muscles
During the Thomas Test the back and sacrum are flat, the back of the lowered thigh does not touch the table but the knee flexs to 80 degrees, what muscles are tight?
- iliopsoas - it is preventing the hip from rotating posteriorly and inhibiting the thigh from being able to touch the table
During the Thomas Test the back and sacrum are flat, the back of the lowered thigh touches the table but the knee does not flex to 80 degrees, what muscles are tight?
- rectus femoris - it is not allowing the knee to bend
During the Thoracic Spine Mobility screen bilateral discrepancies are noted (assuming no congenital issues exist), what are the possible biomechanical problems?
- side dominance - differences in paraspinal development - torso rotation, perhaps associated with some hip rotation
Exercise history and attitude questionnaire
- important for developing goals and designing program
Forward head position is indicated during postural assessment, what is your plan?
- stretch: cervical spine extensors, upper trapezius, levator scapulae - strengthen: cervical spine flexors, lower trapezius, rhomboids
Health-history questionnaire
- medical hx - meds & sups - exercise hx - illness and injuries - lifestyle information (nutrition, sleep, stress, work)
High health risk waist circumference
- Men: >/= 39.5” - Women: >/= 35.5”
High health risk waist-to-hip ratio
- Men: > 0.95 - Women: >0.86
High risk for risk stratification
- symptomatic or known cardiovascular, pulmonary, renal or metabolic disease - med exam, exercise test with doctor supervision needed prior to moderate and vigorous exercise
Hip adduction postural deviation exercise plan
- stretch: hip adductors on hiked hip side - strengthen: hip abductors on hiked hip side
How to treat away-back strengthen-wise? Sway-back posture: hyperextended cervical spine, thoracic flexion, lumbar extension, posterior pelvic tilt
- strengthen: iliopsoas, internal oblique, multifidi, erector spinal, neck flexors
How to treat flat-back posture stretch-wise? Flat-back posture: extended cervical spine, increased thoracic extension, flexion in lumbar, posterior pelvic tilt, slight plantar flexion.
- stretch: rectus abdominis, rhomboid major, traps, neck extensors, plantar flexors
How to treat sway-back posture stretch-wise? Sway-back posture: hyperextended cervical spine, thoracic flexion, lumbar extension, posterior pelvic tilt
- stretch: hamstrings, upper fibers or posterior obliques, erector spinal, neck extensors
How to treat sway-back strengthen-wise? Sway-back posture: hyperextended cervical spine, thoracic flexion, lumbar extension, posterior pelvic tilt
- strengthen: iliopsoas, rectus femoris, external obliques, rhomboid major, traps, neck flexors
Inability to extend shoulders 50 degrees during shoulder flexion/extension test, what could tightness in the abdominals be creating?
prevent normal extension of the thoracic spine and rib cage
Inability to extend shoulders 50 degrees during shoulder flexion/extension test, what could tightness in the biceps brachii be creating?
may prevent adequate shoulder extension with an extended elbow (but may permit extension with a bent elbow)
Inability to flex the shoulders 170 degrees during shoulder flexion/extension test, what could thoracic kyphosis be creating?
rounding of the thoracic spine can prevent arms from touching floor
Inability to flex the shoulders 170 degrees during shoulder flexion/extension test, what could tightness in the abdominals be creating?
may depress the rib cage, tilting the scapulae forward (anterior tilt), preventing arms from touching floor
Inability to flex the shoulders 170 degrees during shoulder flexion/extension test, what could tightness in the latissimus dorsi be creating?
forcing low back to arch
Inability to flex the shoulders 170 degrees during shoulder flexion/extension test, what could tightness in the pectoralis minor be creating?
may tilt the scapula forward (anterior tilt) and preventing the arms from touching the floor
Isotonic
same tone through movement
Low health risk waist circumference
- Men: >/= 31.5” - Women: >/= 27.5”
Low risk for risk stratification
- <2 risk factors - asymptomatic - No med exam, exercise test needed prior
Medially rotated humerus is observed during postural assessment, what is your plan?
- stretch: pectoralis major, lats, subscapularis - strengthen: teres minor, infraspinatus, deltoids, and supraspinatus
Moderate risk for risk stratification
- > /= 2 risk factors - asymptomatic - med exam needed prior to vigorous exercise - no exercise test needed prior
Overweight and obese individuals seeking to manage their weight weekly exercise recommendations
- 300min of moderate-intensity or - 150min of vigorous-intensity
Physical Activity Readiness Questionnaire (Par-Q)
- minimal, yet safe, pre-exercise screening measure for low to moderate exercise training - could overlook important health conditions
Positive family hx risk factors for risk stratification
In father before 55yrs or first degree male relative or mother before 65yrs or first degree female relative: - MI - coronary revascularization - sudden death
Positive HTN risk factors for risk stratification
- SBP >/= 140 and/or - DBP >/= 90 - on two separate occasions
Positive obesity risk factors for risk stratification
- BMI >/= 30kg/m2 - waist girth: Men >40” or Women >35”
Positive pre diabetes risk factors for risk stratification
- FPG 100-125 - 2 hr glucose tolerance test 140-199 - measured on two separate occasions
Positive sedentary lifestyle risk factors for risk stratification
- not participating in at least 30min of moderate-intensity physical activity (40 to 60%Vo2R) on at least 3 days/wk for at least 3 months
Posterior pelvic tilt postural deviation exercise plan
- tilts upward and backward - stretch: rectus abdominis, hamstrings - strengthen: hip flexors, erector spinae
Protracted and rounded shoulders indicated during postural assessment, what is your plan strength-wise?
- strengthen: rhomboids, middle trapezius, lats, teres major, infraspinatus, teres minor, lower trapezius
Protracted and rounded shoulders indicated during postural assessment, what is your plan stretch-wise?
- stretch: serratus anterior, anterior deltoid, middle deltoid, pectoralis major, subscapularis, pectoralis minor, serratus anterior, upper trapezius
Reciprocal inhibition
- muscle spindle causes reflexive contraction with muscle being stretched - causes antagonist muscle group to relax
Relative contraindications where exercise testing can only be done after careful evaluation of the risk:benefit ratio
- left main coronary stenosis - moderate stenotic valvular heart disease - electrolyte abnormalities - severe arterial HTN - tachydysrhythmia or bradydysrhythmia (fast or slow HR) - hypertrophic cardiomyopathy
Relative contraindications where exercise testing can only be done after careful evaluation of the risk:benefit ratio continues
- neuromuscular, musculoskeletal, or rheumatoid disorders exacerbated by exercise - high-degree atrioventricular block - ventricular aneurysm - uncontrolled metabolic disease - chronic infectious disease - mental or physical impairment leading to inabilit
Sample assessment sequencing for general client
- 1st session: health-risk appraisal, resting measures
- 2nd session: Med clearance, static posture
- 1st or 2nd session: flexibility, movement screens
- Week 1: Balance, core function
- Week 2: Health-realted assessments
- Week 3: Muscular endurance, muscular strength
- Varies by goals: skill-related assessments
Shoulders are not level during postural assessment, what is your plan?
- stretch: upper trapezius, levator scapulae, rhomboids - strengthen: lower trapezius, serratus anterior
Shoulders indicate asymmetry to midline during postural assessment, what is your plan?
- stretch lateral trunk flexors (obliques, one side rectus abdominis, one side erector spinae) on flexed side - strengthen lateral trunk flexors on opposite side
Sinus bradycardia
less than 60bpm
Sinus tachycardia
faster than 100bpm
Skinfold measurement protocols
- be hydrated - measure on right side of body while client is standing - pull subcutaneous fat away from muscle - measure a minimum of two times
Skin fold measurement sites
- Men: chest, thigh, abdominal - Women: triceps, thigh, suprailium
S/Sx of CVD, pulmonary or metabolic diseases
- pain or discomfort in chest, jaw, neck, or arms - SOB with mild exertion - orthopnea or nocturnal dyspnea (SOB/coughing in sleep) - ankle edema - palpitations or tachycardia
S/Sx of CVD, pulmonary or metabolic diseases continued
- intermittent claudication (pain in muscles d/t ischemia) - known heart murmur - unusual fatigue or SOB with usual activities - dizziness or syncope
S/Sx to immediately terminate assessment
- onset of angina or like symptoms - sig drop in SBP (>10mmHg) even with increased intensity - excessive rise in BP: SBP >250 or DBP reaches 115 - excess fatigue, SOB or wheezing - signs of poor perfusion (pallor, cyanosis, nausea, cold clammy skin)
S/Sx to immediately terminate assessment continued
- increase nervous system symptoms (ataxia, dizziness, confusion, syncope) - leg cramping, claudication - request to stop - physical or verbal manifestations of severe fatigue - equipment failure
Stork Stand Balance categories for men
- Excellent: >50sec - Good: 41-50sec - Average: 31-40 - Fair: 20-30 - Poor: <20
Stork Stand Balance categories for women
- Excellent: >30sec - Good: 25-30sec - Average: 16-24 - Fair: 10-15 - Poor: <10
Stroke volume
amount of blood ejected from the left ventricle of the heart in a single contraction
Subtalar joint pronation is witnessed during a posture screen, what is your plan strength-wise?
- strengthen: anterior tibialis and longus - could also cause the heel to lift causing the ankle to go into plantar flexion –> tightening the calf muscle –> stretch gastrocnemius and soleus
Subtalar joint pronation is witnessed during a posture screen, what is your plan stretch-wise?
- Stretch: peroneus longus and brevis
Subtalar joint supination is witnessed during a posture screen, what is your plan?
- stretch: anterior tibialis and posterior tibialis - strengthen: peroneus longus and peroneus brevis
Subtalar pronation causes internal rotation of knee and femur, what can be done to assist with this?
- stretch: semitendinosus, semimembranosus, popliteus - strengthen: biceps femoris
Subtalar supination causes external rotation of knee and femur, what can be done to assist with this?
- stretch: biceps femoris - strengthen: semitendinosus, semimebranosus, popliteus
Sway back physiology
- long posterior curve of thoracic spine - decreased anterior lumbar curve - backward shift of upper trunk
Synergist muscle definition
- muscles that prevent unwanted movement joint movement and help prime movers perform more efficiently
Waist Circumference categories for men
- very low: <31.5” - low: 31.5-39” - high: 39.5-47.0” - very high: >47.0”
Waist Circumference categories for women
- very low: <27.5” - low: 27.5-35” - high: 35.5-43.0” - very high: >43.5”
Waist-to-hip ratio categories for men
- excellent: <0.85 - good: 0.85-0.89 - average: 0.90-0.96
Waist-to-hip ratio categories for women
- excellent: <0.75 - good: 0.75-0.79 - average: 0.80-0.86
What affect do beta blockers have on HR?
- lower resting HR - lower exercising HR - lower maximal exercising HR
What affects do antidepressants or antipsychotics have on HR?
- can elevate resting HR
What affects do antihypertensives have on HR?
- can lower or elevate resting HR - can lower or elevate exercising HR
What affects do calcium channel blockers have on HR?
- can lower or elevate resting HR - can lower or elevate exercising HR
What affects do diet pills have on HR?
- can elevate resting and exercising HR
What affects does alcohol have on HR?
- can elevate resting and exercising HR
What affects does caffeine and nicotine have on HR?
- can elevate resting and exercising HR
What affects do tranquilizers have on HR?
- if anxiety reducing, it can lower resting HR
What are the hip extensors?
- gluteus maximus - hamstrings
What are the hip flexors?
- rectus femoris - Iliopsoas - Sartorius - TFL - Pectineus
What are the lumbar extensors?
erector spinae
What are the muscles in the anterior chest and shoulder area?
- pectoralis major - anterior deltoid
What are the muscles that are referred to as the “core”
- TVA - multifidi - quadrates lumborum - deep fibers of internal oblique - diaphragm - pelvic floor musculature - adjoining fasciae (linea alba and thoracolumbar fascia)
What are the plantar flexors?
- peroneus longus and brevis - gastrocnemius - soleus - posterior tibialis - plantaris - flexor hallucis longus - flexor digitorum longus
What are the resting measures to assess for a client?
- HR - BP - Ht - Wt
What are the risk factors for atherosclerotic cardiovascular disease with ACSM risk stratification?
- Age - Family Hx - Cigarette smoking - sedentary lifestyle - Obesity - HTN - DLD - Prediabetes
What are the scapular stabilizers?
- pectoralis minor - serratus anterior
What are the upper-back extensors?
- traps - rhomboid major
What is a liability waiver?
- intended to release a trainer from liability for injuries resulting from a supervised exercise program - client’s voluntary abandonment of the right to file suit - does not protect against being sued for negligence
What is an appropriate flexion : extension ratio of the shoulder joint?
2:3
What is the informed consent form?
- assumption of risk - specifically informed about risks associated with activities they are about to engage in
What should be the exercise plan for someone who has a carpal tunnel?
- do not do exercises in full wrist extension or flexion - exercises should be done in mid-range of these motions
What should be the exercise plan for someone who has a elbow tendinitis?
- avoid high reps (15-20) - begin with low wt/reps and gradually progress - full elbow extension should be performed with caution
What should be the exercise plan for someone who has a greater trochanter bursitis?
- avoid side-lying positions - avoid squats and lunges - aquatic exercises can be beneficial
What should be the exercise plan for someone who has a iliotibial band syndrome?
- slowly return to activity with a program that restores flexibility and strength at the hip and lateral thigh
What should be the exercise plan for someone who has a Infrapatellar tendinitis?
- “jumper’s knee” - inflammation of patella tendon connecting to knee - restore strength in hip, knee, and ankle joints - address tightness in IT band complex, hamstrings and calves
What should be the exercise plan for someone who has an achilles tendinitis?
controlled eccentric exercises for the calf muscles
What should be the exercise plan for someone who has an ankle sprain?
- grade 1: can resume 1-2wks - grade 2: can resume 4-8wks - grade 3: can resume 12-16wks - straight plane movements then side-to-side then multidirectional movements
What should be the exercise plan for someone who has an plantar fascitis?
- ligament that connects the heel bone to the toes - stretch plantar fascia and calf muscles - SMR over tennis ball, dumbbell, golf ball can increase ROM
What should be the exercise plan for someone who has a Patellofemoral pain syndrome?
- pain in the front of the knee - restore strength in hip, knee, and ankle joints - address tightness in IT band complex, hamstrings and calves
What should be the exercise plan for someone who has a rotator cuff injury?
- obtain specific guidelines on what exercises/movements should and should not be done - for overhead movements: limit ROM, and adjust shoulder position to avoid impingement - avoid straight arm exercises - movements done in scapular plane (30 degrees ant
What should you strengthen with kyphosis posture?
- strengthen: rhomboid major, traps, serratus anterior, pectoralis minor, neck flexors
What should you strengthen with lordosis posture?
- hip extensors, external obliques
What should you stretch with kyphosis posture?
- pectoralis major, anterior deltoid, neck extensors
What should you stretch with lordosis posture?
- hip flexors, erector spine, Lats
Youth resistance strength-training exercise recommendations
- 1-3 sets - 6-15 reps - resistance increases by 5-10% increments - 2-3 non-consecutive training days per week
