Exam 1 Flashcards
Theories provide a ______ for understanding the process through which a complex behavior changes & is ______ over time.
- framework
- sustained
3 ways exercise physiologists use theories?
- Support
- Intervention
- Evaluation
The stage of motivational readiness to change [SOC] model is also called what
the transtheoretical model [TTM]
What are the 3 basic concepts of the TTM ?
- People progress through 5 basic changes at varying rates
- people move back & forth along the continuum
- People use different cognitive and behavioral processes or strategies
Components of other theories are often used in conjunction with the SOC model. What are they ?
- Decisional balance (decision-making theory)
2. Self-efficacy (social cognitive theory) – what do you feel about yourself
what are the 5 stages of change?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
The SOC [TTM] model also states that individuals use a variety of _______ of ______ as they progress through the stages
processes of change
Five _____ and five ______ processes have been identified
experiential, behavioral
What are the 5 experiential processes
- Dramatic relief (be aware of risks)
- increase Consciousness (increase knowledge)
- Self re-evaluation (comprehend benefits)
- Social liberation (increase healthy opportunities)
- environmental re-evaluation (care about consequences to others)
Use of experiential processes usually peaks in which stage ?
preparation stage
What are the 5 behavioral processes?
- reinforcement management (reward yourself)
- Counter-conditioning (substitute alternatives)
- Self liberation (commit yourself)
- Stimulus control (remind yourself)
- Enlist social support
use of behavioral processes usually peaks in what stage
action stage
What is the goal for the individual in the pre contemplation stage ?
begin thinking about physical activity
what is the nickname for the pre contemplation phase
“not ready”
how does the individual feel when they are in the pre contemplation phase
cons greater than pros, low self-efficacy
What experiential processes are involved in the pre contemplation phase
- Dramatic relief - make them aware of risk of being unhealthy
- Consciousness rating - increase the knowledge
- Environmental re-evaluation - understand lifestyle impacts others
What is the nickname for the contemplation phase
“getting ready”
What is the goal for the contemplation phase
begin taking steps to become physically active; think about goals to set
how does the person feel if they are in the contemplation phase?
pros greater than cons
increase in self-efficacy
6 month intention
what experiential processes are involved in the contemplation phase
- dramatic relief
- consciousness rating
- Environmental re-evaluation
- self re-evaluation
what is the nickname for the preparation phase
“ready”
What is the goal for the preparation phase
increase physical activity to the recommended level
how does the person feel if they are in the preparation phase?
increased self efficacy; pros greater than cons; start within 30 days
what behavioral processes are involved in the preparation phase?
self-liberation [committed; change is possible]
What is the nickname for the action phase
“working the program”
What is the goal of the action phase
continue to make physical activity a regular part of life (habit)
how does the person feel if they are in the action phase?
probably only last 6 months [new years resolution dilemma]; pros are way greater than cons; much higher self-efficacy
what behavioral processes are involved in the action phase?
- stimulus control [remind yourself of the importance]
- reinforcement management [reward yourself]
- counter conditioning [substitution of healthier alternatives]
- Helping relationships [enlist social support]
What is the nickname of the maintenance phase
“keep it going”
What is the goal of the maintenance phase
prepare for future setbacks; continue to increase enjoyment
how does the person feel if they are in the maintenance phase?
6 months/change in behavior; lifestyle change
what behavioral processes are involved in the action phase?
avoid boredom reflect on benefits schedule check-in appointments plan for high-risk situations reassess goals, etc.
what is the basic concept of the decision making theory?
people decide whether to engage in a particular behavior based on their comparison of the benefits verses the costs
the decision making theory is used in conjunction with the ______ model
SOC [TTM]
in later stages of the SOC people perceive more ______ for being physically active, but in early stages they perceive more ______
benefits; disadvantages
The social cognitive theory is also called what
reciprocal determinism
what is the basic concept of the social cognitive theory?
behavior change is influenced by interactions between the environment, personal factors and the behavior itself
what are 3 important components of the social cognitive theory?
- self-efficacy
- outcome expectations
- self-regulatory strategies
definition of self-efficacy?
an individuals belief & confidence about his or her ability to make specific behavior changes
research indicates that self-efficacy levels predict ________ in physical activity
participation
potential results that one anticipates after performing a particular behavior can be defined as
outcome expectations
3 major forms of outcome expectations
- positive & negative physical effects
- positive & negative social effects
- positive & negative self-evaluative reactions to the change in behavior
ability to mobilize oneself to perform a behavior regularly in the face of a variety of barriers
self-regulatory strategies
4 major processes of self-regulation
- self-monitoring
- proximal goal setting
- strategy development
- self-motivating incentives
4 practice implications for learning theory
- increase self-efficacy
- learn how to set goals
- plan for physical activity
- have realistic expectations
4 ways to improve self-efficacy?
- Mastery experiences (list of performance accomplishments)
- Social modeling (observe through vicarious experience)
- Verbal/social persuasion (communication)
- understand physiological states (reading articles/journals)
what is the basic concept of learning theory?
overall complex behaviors arise from many small simple behaviors
learning theory says it is possible to shape the desired behavior by doing what 2 things?
- reinforcing “partial behaviors”
2. modifying cues [stimuli]
setting a series of intermediate gold that lead to a long-term goal is known as what ?
shaping
when is shaping especially important?
when applied to increasing FITT; setting short term goals
positive or negative consequences for performing or not performing a behavior is called what ?
reinforcement
3 parts to include in reinforcement
verbal & material incentives & natural reinforcement
techniques that prompt the initiation of a behavior
antecedent control
basic concept of the health belief model
extent people engage in a health action is determined by their readiness to take action couples with their belief of the threat of not taking action
6 main component of the health belief model
- perceived susceptibility
- perceived severity
- perceived benefits
- perceived barriers
- self-efficacy
- cues to action
4 practice implications for health belief model
- educational needs
- interest in health matters
- do they feel susceptible ? what worries them?
- do they it could be reduced by behavior change?
What 3 psychosocial needs for the premise of the SDT theory ?
- Self-determination
- Demonstration of competence
- Relatedness [meaningful social interaction with others]
Those with high levels of ________ have greater intentions to exercise, self-efficacy, & physical self-worth
autonomy
practice implications for self-determination theory
- encourage choice (ex: they decide what cardio)
2. start with a simple program to grow mastery & joy
explain theory of planned behavior
places the intention to perform a behavior as the main determinate as to whether of not an individual will exercise
in theory of planned behavior, intentions are often determined by what 3 things
- attitude toward behavior
- subjective norms [social motivation]
- perceived behavioral control
which theory says an individual intends to become physically active if they believe exercise will benefit them, make them feel good, have the approval of significant others in their life, & that they are capable of doing it
theory of planned behavior
practicer implications for theory of planned behavior
identify intentions & develop plan that will fit
basic concept of social ecological theory
importance of constant interaction between someone’s behavior & his or her environment
social ecological theory emphasizes two key influences:
- sociocultural factors
- quality of environment
* best programs target both
* important to change environment to be activity friendly
practice implications of social ecological theory
programs should combine environmental components with individual & community based physical activity promotion efforts
basic concept of relapse prevention
maintain long term behavior change by anticipating high risk situations & devising strategies
relapse prevention combines what 3 things
- behavioral skills training
- cognitive intervention
- lifestyle change
relapse prevention makes an important distinction between the terms _____ & ______.
lapse : brief error, slip up
re-lapse: complete return to beginning stage
behavior (should/should not) be viewed as a complete success or a complete failure
should not
practice applications for relapse prevention
- establish collaborative relationship
- reflect on importance of exercise
- remind them of when they overcame physical barriers
- teach them to identify high risk situations
- anticipate them & problem solve
practitioner tries to understand the underlying meaning of what a patient is saying
active listening
understanding that is conveyed by a counselor to a patient
empathy
questions that allow the patient to provide expansive responses [beyond a simple yes or no] which they can explore their thoughts & feelings
open-ended questions
patient-centered counseling method where the patients own motivation for change is elicited & enhanced by exploring & resolving ambivalence to change
motivational interviewing
counseling style that takes the patients perspective into account, features collaboration between the patient & counselor & includes genuine respect for patient opinions
patient-centered approach **
positive [professional] relationship counselors establish with their patients
rapport
statements that repeat back to the patient what the counselor has heard & understood the patient to say. can reflect underlying meaning/feeling of what patient is saying if done in conjunction with active listening
reflective statements
approach the patient with ______ regard
positive
behavior change is based on a genuine, _______ relationship
respectful
_______ of the patient occurs when the practitioner seeks to enter the world of the patient to understand his or her _______
- assessment
- perspective
each contact with the patient is an opportunity to build the ________
relationship
4 patient-centered techniques
- ask simple open ended questions
- listen & encourage verbally & non-verbally
- clarify & summarize
- Use reflective listening
what is the 5 A’s model?
- address agenda
- assess
- advise
- assist
- arrange follow-up
4 techniques involved in the cognitive behavioral approach
- behavioral counseling
- goal setting
- self-monitoring
- reinforcement
7 strategies involved in the cognitive behavioral approach
- stages of change
- tracking activity
- decisional balance
- problem solving
- goal setting
- confidence
- relapse prevention
What are the SMART goals? (do not give up. do not give in.)
Specific Measurable Achievable Realistic Timely
two most common risks of health & fitness testing
sudden cardiac events
orthopedic injury
3 purposes of the health appraisal
- safety
- risk factor identification
- exercise prescription & programming
identification of individuals for whom exercise requires limitations, modifications or is contraindicated falls under what category
safety
identification of persons with clinically significant disease who should participate in medically supervised programs & identification of individuals with other special needs falls under what category
exercise prescription & programming
most common form of a health appraisal?
standardized forms (aim is to ID high risk participants who should get medically advice before physical activity)
purpose of a medical screening evaluation?
evaluate the risk of starting a new physical activity program
minimal requirements of a medical screening evaluation
medical history; physical examination
what does the term database refer to in this chapter?
body of knowledge shared between exercise physiologist & patient
where does the database come from?
clinical records; patient interview for updates or missing info
what are the components of the medical history?
- reasons for referral
- demographics
- history of present illness
- current medications
- allergies
- past medical history
- family history
- social history
4 reasons for referral to health appraisal /fitness testing
- improve exercise tolerance
- improve muscle strength
- increase ROM
- provide relevant intervention & behavioral strategy to reduce future risk
What is meant by demographics?
age, gender, ethnicity, prescription of present illness
predictor for heart disease, osteoarthritis & virtually every cardiopulmonary condition
age
influences behavioral compliance and disease management
gender
socioeconomic status & access to care; some conditions are more common in certain populations
ethnicity
what is meant by prescription of current illness? (don’t be brain dead. THINK. & be prepared to answer like an adult)
primary information related to the referral condition
where do you incorporate reported information?
with medical record
What should you include in a medical record?
- chief complaint (1 sentence)
- manifestations (paragraph)
- important elements described in patients own words (paragraph)
Useful mnemonic to describe any symptom?
O - onset {when did it start}
P - provocation & palliation {what makes it worse & better}
Q - Quality {what does it feel like}
R - region & radiation
S - Severity of pain
T - timing {when it hurts/how long}
A - associated signs & symptomsmedications can alter what?
exercise responses
What information should you include with medications
- dose
- frequency of dose
- time taken {before exercise}
what is PMH?
past medical history; concise relevant list including dates
what topics does a PMH cover?
- orthopedic
- muscular
- neurological
- gastrointestinal
- immunological
- respiratory
- cardiovascular
family history is limited to known relevant heritable disorders in ____ ______ family members
first degree
what does family history include? (DONT GIVE UP)
- cancer
- adult onset diabetes
- familial hypercholesterolemia
- sudden death
- premature coronary artery disease (CAD)
Social history is an important component to understand, but it can be lengthy. what are the 11 points to include when gathering social history?
- significant partner status
- employment
- transportation
- housing
- diet
- routine/leisure
- alcohol smoking drugs
- work hours
- childcare
- family responsibilities
- exercise
ADL
activities of daily living
bid
twice a day
HPI
history of present illness
pt
patient
qd
once daily
qid
four times a day
Rx
prescription
Sx
signs & symptoms
tid
three times a day
A physician tackles a physical exam using a head to toe approach, but how does it differ for an exercise physiologist?
the goal is to determine if it is safe to allow exercise & focuses more on complaints/symptoms, abnormal findings… not in place of physical eval
red flags when it comes to blood pressure
systolic >200, 110
8 components of the physical evaluation
- general state
- BP, HR, RR (respiratory rate)
- Obesity
- Pulmonary system
- Cardiovascular system
- Musculoskeletal system
- Nervous system
- Metabolic/other organ systems
what does general state refer to?
patients general appearance
healthy vs. frail; well-developed or under-nourished
normal blood pressure? high & low?
140 systolic, >90 diastolic
Hypotension:
normal pulse rate? high & low?
60-100 BPM
tachycardia: >100 BPM
bradycardia:
normal respiratory rate
12-20 breaths/min
what is the equation for BMI?
kg/m squared
In measuring waist circumference, an individual is classified as obese when:
___ inches for males; _____ inches females
> 40 inches
> 35 inches
underweight BMI
normal BMI
18.5-24.9
overweight BMI
25-29.9
Class I Obesity BMI
30-34.9
Class II Obesity BMI
35-39.9
Where do you place the stethoscope on your patient when checking the point of maximal cardiac impulse
4-5th intercostal space at the mid-clavicular line
how do you tell if a person is well-perfused or poorly perfused
warm/dry vs. cold/clammy
arterial pulse grading
0 - absent, non palpable
1 - reduced
2 - normal
3 - bounding
what are bruits?
high velocity swooshing sounds created as blood becomes turbulent when it flows past a narrowing artery
where are bruits commonly found?
carotid, abdominal & femoral arteries
swelling of lower leg ankles or feet is known as
peripheral edema
peripheral edema grading
1 - mild
2 - moderate
3 - severe
what is “pitting edema”
when an indention remains after pressure is applied
pitting edema is a result of what 3 things
- congestive heart failure
- medications
- chronic venous incompetence
inflammation is associated with what 3 things
- redness
- swelling
- increased heat
3 parts to a musculoskeletal system assessment
gait, joint health, muscle strength
8 types of gait
- normal
- antalgic (limp)
- slow
- hemiplegic
- shuffling (parkinsons)
- wide-based (cerebellum issue)
- foot drop
- slap
* 7&8 result in injury to dorsiflexors
what are you looking for when you palpate a joint?
- thickening
- swelling/effusion
- tenderness
- redness/warmth
muscle strength is graded on what kind of scale?
0-5 (note stiffness/soreness)
0 = paralysis
5 = sufficient power to overcome resistance of examiner
what about the nervous system important to a PE ?
orientation, cognition, lack of understanding; disabilities of speech balance muscle tremor
an examination of the nervous system by an exercise physiologist is done to discover what?
- history of stroke
- atrial fibrillation
- left ventricular dysfunction
- aneurysms
- carotid artery stenoses
- uncontrolled hypertension
how do you test resting heart rate?
sit quietly for 5 minutes, palpate pulse 30 seconds
how do you test resting blood pressure?
sitting & standing; based on 2 or more measurements
volume of air expired following a maximal inspiration
forced vital capacity
proportion of the FVC expired in 1 second
forced expiratory capacity at 1 second
max volume of airflow per minute possible
max voluntary ventilation
4 lab tests
resting heart rate
resting blood pressure
lung capacity
blood tests
types of blood tests
- total cholesterol
- LDL & HDL
- TC: HDL ratio
- fasting glucose
- homocysteine
- C-reactive protein
Fitness testing order ~~~* super important
- Resting measurements
- Body composition
- Cardiorespiratory fitness
- Muscular fitness
- Flexibility
criteria for test termination
- attainment of desired performance
2. patient/equipment complications
3 types of tests
body composition
cardiorespiratory fitness
muscular fitness
During a cardiorespiratory fitness test, how often do you check HR, BP, & RPE [rating of perceived exertion]?
HR: once every minute
BP: once per stage
RPE: once per stage
what is the usual sequence for a cardiorespiratory fitness test?
[3 minute stage] minute 2:00 HR minute 2:15 RPE minute 2:30 BP Minute 3:00 HR
2 types of MAX testing
CAD, VO2 max
2 types of sub MAX testing
fitness, estimate of VO2 max
what is a discontinuous test?
a test disrupted for measurements
what to consider when testing the elderly
age-related changes
difference in physiological state
prolonged warm-up
what to consider when testing children
screen for cardiorespiratory disease
what to consider when testing a person with a cardiorespiratory disorder
test duration 8-12 minutes; measure o2 intake, ventilation & saturation
5 modes of testing
- field test
- nuclear & radionuclide testing (substance injected into bloodstream)
- exercise echocardiography
- pharmacologic testing
- holter ECG monitoring (ECG goes home with them)
clinical exercise testing indications (4)
- pre discharge test following MI
- post discharge exercise testing following MI or cardiac surgery
- Diagnostic testing & disease determination
- functional capacity testing
patient walks at predetermined speed & grade
treadmill test modality
3 types of treadmill tests
Bruce (3 MET increase every 3 minutes) Modified Bruce (constant 1.7mph but increase grade) ramp protocol (grade & speed increase)
typically 2-5 minute stages with work increments of 15-50 watts
cycle ergometer
when are measurements normally taken during the exercise as opposed to during the pretest or posttest?
12-lead ECG recorded during last 15 seconds of every state; BP during last minute of each stage; RPE if applicable at the end of each stage
when are measurements normally taken during the post test
- 12 lead ECG immediately after exercise is over then 1-2 minutes for at least 5 minutes
- BP immediately after than 1-2 minutes until baseline
(symptomatic ratings should be obtained as appropriate until symptoms cease)
System designed to record subjected & objective findings and to document the immediate & future treatment plan for the patient
SOAP note
what does SOAP stand for in SOAP note?
S: subjective
O: objective
A: Assessment
P: plan
information that is relevant to the current visit that you obtain by talking to the patient (what the patient tells you)
subjective information
What does subjective information include?
patient ID chief complaint exercise adherence changes in functional abilities feedback regarding program
these findings are a result of inspecting, palpation and assessment
objective findings
what do objective findings include
- vitals
- physical exam
- general appearance
- lab tests
- fitness tests
- med changes (could also be subjective)
- changes to exercise program
assess the patients conditions based on subjective & objective findings–list the diagnoses
assessment
what might the assessment part include?
noteworthy changes in performance
new info from healthcare provider
any exercise contraindications from healthcare provider
what might the plan part include?
- revisions/adjustments
- referrals
- anticipatory guidance
- patient education
- health promotion/prevention
- follow up instructions & next appointment
- how I will accommodate exercise contraindications
