Lesson 7: Relationship Building, Interviews + Risk Factors Flashcards
What 3 attributes are essential to successful relationships?
empathy
warmth
genuineness
What distance from the client is considered ideal?
1 1/2 to 4 feet
What is considered as effective non-verbal communication?
- distance and orientation (body positioning) whereby the trainer faces the client and maintains appropriate distance
- posture and position whereby the trainer adopts an open, well-balanced, relaxed posture with a slight forward lean to show confidence and interest
- mirroring and gestures whereby the trainer sensitively mimics the client’s gesture and tone to help place ease
- constant eye contact that is relaxed and instills comfort
- facial expressions that convey emotion and work to the trainer’s benefits
What 3 postures/positions can convey disinterest, fatigue, aggressive behaviour and/or defensive behaviour from a trainer?
- leaning on a desk/wall and stooping suggests boredom and fatigue
- rigid hands on hips can be interpreted as aggressive behaviour
- crossing arms/legs conveys a closed/defensive stance
What are the 4 different levels of listening?
- indifferent: not really listening/tuned out
- selective: listens only to key words
- passive: gives the impression of listening by using minimal noncommittal agreements
- active: shows empathy/listens
What is the difference between cognitive and affective messages?
Cognitive messages are more factual whereas affective ones are composed of feelings, emotions, behaviours and often expressed in verbal + nonverbal communication
What interview techniques can and should you use?
- minimal encouragement
- paraphrasing
- probing
- reflecting
- clarifying
- informing
- confronting
- questioning
- deflecting
What is the difference between paraphrasing and reflecting?
Paraphrasing is responding to the client’s communication by restating the essence of the content whereas reflecting is restating the feelings.
What is confronting?
Using mild to strong feedback with a client to encourage accountability/improvement.
Why is deflecting ill-advised?
deflecting is changing the focus of one individual to another and usually devalues or diminishes the communication, therefore, it shouldn’t be used unless the trainer is trying to show empathy with appropriate experiences.
What are 4 different styles of communication? Briefly describe each.
- preaching: judgement and delivers info in a lecture-type format
- educating: informational and provides relevant info in a concise manner
- counseling: supporting, utilizing collaborative effort to problem-solve
- directing: instructive and directional
What is done after a trainer has developed a foundation of rapport through effective communication + appropriate interview techniques?
The PT should identify the client’s readiness to change behaviour and the stage they’re at in the behavioural change process.
What is the purpose of a pre-participation screening?
- identify the presence/absence of known cardiovascular, pulmonary and/or metabolic disease or any signs/symptoms
- identify those with medical contraindications who should be excluded from exercise until these are corrected
- detecting at-risk individuals who should first undergo medical evaluation and clinical exercise testing before initiating exercise
- identify individuals with medical conditions who should participate in medically supervised programs
What is the PAR-Q?
Physical Activity Readiness Questionnaire is a short and simple medical/health questionnaire that serves as a minimal health-risk appraisal prerequisite, is non-invasive to administer but limited by its lack of detail.
If someone has many flags on a PAR-Q, what should you do?
conduct a more in-depth health-risk appraisal
What are the reasons for performing a risk stratification prior to engaging in a physical activity program?
To determine:
- the presence or absence of known cardiovascular, pulmonary and/or metabolic disease
- the presence/absence of cardiovascular risk factors
- the presence/absence of signs/symptoms suggestive of cardiovascular, pulmonary and/or metabolic disease
What are the 3 basic steps for the risk stratification process?
- Identifying coronary artery disease risk factors
- Performing a risk stratification based on CAD risk factors
- Determining the need for a medical exam/clearance and medical supervision
In risk stratification, there is a negative point for what?
A high level of High Density Lipoprotein, a point is subtracted if their HDL Cholesterol is equal to or exceeds 60mg/dL
What age constitutes as a positive point during risk stratification?
Men ≥ 45
Women ≥ 55
What family history constitutes as a positive risk factor during risk stratification?
Myocardial infarction
Coronary Revascularization
Sudden death before 55 years of age in father or other 1st degree male relatives or 65 year of age in mother/1st degree female relatives
What history of cigarette smoking constitutes as a positive risk factor during risk stratification?
If they are a current smoker or if they quit within the last 6 months or are usually exposed to second-hand smoke
A sedentary lifestyle constitutes as a positive risk factor during risk stratification, how little exercise does this involve?
Not participating in at least 30 mins of moderate-intensity physical activity on at least 3 days of the week for at least 3 months
What BMI/Waist Girth of obesity constitutes as a positive risk factor during risk stratification?
BMI ≥ 30kg/m2
Waist Girth > 102cm/40 inches for men
Waist Girth > 88cm/35 inches for women
Hypertension is a positive risk factor during risk stratification, what are the BP levels that show this?
SBP ≥ 140mmHg
DBP ≥ 90mHg
Confirmed on 2 or more separate occasion
OR currently on antihypertensive medications
Dyslipidemia is a positive risk factor during risk stratification, what are signs of this?
LDL Cholesterol ≥ 140mg/dL or HDL Cholesterol < 40mg/dL or on lipid-lowering medication
If total serum cholesterol is the only thing available, what serum cholesterol level suggests dyslipidemia?
≥200mg/dL
Prediabetes is a positive risk factor during risk stratification, what are signs of this?
Fasting plasma glucose ≥ 100mg/dL
but ≥ 125mg/dL or impaired glucose tolerance where a 2 hour oral glucose tolerance test value is ≥ 140mg/dL but ≤199 mg/dL confirmed on 2 or more occasions.
High Density Lipoprotein Cholesterol is a negative risk factor for risk stratification, what shows this?
a level of ≥60 mg/dL
If the prediabetes criteria is missing or unknown during risk stratification, when should prediabetes be counted as a risk factor?
for those ≥ 45 year olds especially with a BMI ≥ 25 kg/m2
and those <45 years old but with a BMI ≥ 25 kg/m2 with additional CVD Risk factors for prediabetes
What is VO2R?
VO2 Reserve
If someone has <2 risk factors and is asymptomatic during risk stratification, where do they fall in the classification? What do you need to do?
They are low risk therefore do not need a medical exam, exercises test or doctor supervision.
If someone has ≥2 risk factors and is asymptomatic during risk stratification, where do they fall in the classification? What do you need to do?
They are moderate risk and will need a medical exam before vigorous exercise but no exercise test or doctor supervision.
If someone is symptomatic or has known cardiovascular, pulmonary, renal or metabolic diseases during risk stratification, where do they fall in the classification? What do you need to do?
They are considered high risk and will need medical exams before both moderate + vigorous exercise, an exercise test before both moderate + vigorous exercise and doctor supervision of the exercise tests for submaximal and maximal.
What constitutes as moderate exercise?
40% to <60% Vo2 Reserve at 3-6 METs
What constitutes as vigorous exercise?
≥60% Vo2 Reserve at ≥ 6 METS
What signs/symptoms must only be interpreted by a qualified licensed professional within a clinical context during risk stratification?
- pain/discomfort in chest, neck, jaw, arms or other areas that may be due to ischemia
- shortness of breath/difficulty breathing at rest or mild exertion
- ankle edema
- orthopnea or paroxysmal nocturnal dyspnea
- palpitations or tachycardia
- intermittent claudication
- known heart hurmur
- unusual fatigue/difficulty breathing
- dizziness or syncope due to reduced perfusion to the brain
After a client’s risk for exercise has been assessed, what several forms beyond the initial PAR-Q/CAD Health-Risk Assessment should be reviewed?
- informed consent/assumption of risk
- agreement and release of liability waiver
- health-history questionnaire
- exercise history + attitude questionnaire
- medical release
- testing forms
What is atherosclerosis?
A process in which fatty deposits of cholesterol and calcium accumulate on the walls of the arteries, causing them to harden, thicken and lose elasticity.
What is the result of atherosclerosis?
If the vessels that supply blood/oxygen to the heart are narrowed from atherosclerosis then the blood supply and increased oxygen demand during exercise by the heart are both limited which results in angina or myocardial infarction.
Where is angina felt? What is the pain accompanied by?
either a pressure or tightness in the chest, arm, shoulder or jaw that is accompanied by shortness of breath, sweating, nausea and palpitations
If someone’s BP is already high, why should you hold off on exercising?
Because their BP may elevate to dangerous levels during exercise and result in a stroke
A problem in the respiratory system will interfere with what during exercise?
the body’s ability to provide enough oxygen for the increasing demand during aerobic exercise
What is the most common type of injury sustained by people participating in physical activity? What are examples.
the overuse injury are usually a result of poor training techniques, poor body mechanics or both.
Examples are runner’s knee, tennis elbow, swimmer’s shoulder, shin splints, iliotibial band syndrome.
Define cross-training
A method of physical training in which a variety of exercises and changes in body positions or modes of exercise are utilized to positively affect compliance and motivation and stimulare additional strength gains or reduce injury risk.
What is the difference between someone that is hyperthyroid and hypothyroid?
Hyperthyroid individuals have an increased level of both thyroxine and triiodothyronine whereas hypothyroidism is a reduced level that requires thyroid medication to regulate their metabolism to normal levels.
Why is it important PTs know if their client suffers from thyroid disease?
because exercise also influences their metabolism which can be affected from their condition
What is hernia?
a bulge or protrusion of the abdominal contents into the groin or through the abdominal wall.
What is the Valsalva maneuver?
The Valsalva maneuver is a breathing method that may slow your heart when it’s beating too fast. To do it, you breathe out strongly through your mouth while holding your nose tightly closed. This creates a forceful strain that can trigger your heart to react and go back into normal rhythm.
True or false, a hernia is a relative contraindication for weight lifting?
True unless cleared by a physician.
What are the effects of antihypertensives on the heart, peripheral blood vessels, brain and/or kidneys?
Heart - reduce its force of contraction
Peripheral Blood Vessels - open or dilate them to allow more room for the blood
Brain - reduce the sympathetic nerve outflow
Kidneys - reduce blood volume by excreting more fluid
What medications will cause the resting HR to decrease?
Beta-adrenergic blocking agents, calcium channel blockers, anxiety reducing tranquilizers
What is the result of Beta-adrenergic blocking agents on the resting HR, exercising HR and max HR?
Decreases all of them.
What is the effect of diuretics on the resting HR, exercising HR and max HR?
No significant change.
What are the effects of calcium channel blockers on the resting HR, exercising HR and max HR?
Resting + exercising - either increases, stays the same or decreases
Max - usually stays the same
These are dependant on the dosage.
What is the effect of antihistamines on the resting, exercising and maximal exercising HRs?
There is no significant change.
What is the difference between cold medications with sympathomimetic activity and with no SA and their effect on the resting/exercising/max exercising HRs?
Ones without SA have no significant change whereas ones with SA can increase all HRs.
What is the effect of tranquilizers on the resting, exercising and max exercising HRs?
No significant change unless they reduce anxiety in which case the resting value will decrease.
What effect do antidepressants and some antipsychotic medications have on resting, exercising and max exercising HRs?
There is no significant change except they can potentially increase resting values.
What effect does alcohol have on resting, exercising and max exercising HRs?
It has no significant change generally but can potentially increase both resting and exercising HRs.
What effect do diet pills with SA have on resting, exercising and max exercising HRs?
They can potentially increase the resting and exercising levels but generally have no significant change.
What effect do diet pills with amphetamines have on resting, exercising and max exercising HRs?
They increase both resting and exercising values but have no significant impact on max exercising levels.
What effect do diet pills without SA or amphetamine have on resting, exercising and max exercising HRs?
No significant change
What effect does caffeine have on resting, exercising and max exercising HR levels?
It can increase both resting and exercising levels but generally has no significant impact.
What effect does nicotine have on resting, exercising and max exercising HR levels?
It can increase both resting and exercising levels but generally has no significant impact.
Many antihypertensive medications can cause positional hypotension, what is this?
This means BP drops when changing positions therefore a client may become dizzy if he or she moves too fast.
What do beta-blockers do?
They block the effects of catecholamines throughout the body and reduce resting, exercise and max heart rates.
What are calcium channel blockers used for?
to prevent calcium-dependent contraction of the smooth muscles in the arteries, causing them to dilate which lowers BP.
they are also used for angina and heart dysrhythmias.
What do Angiotensin-converting Enzyme Inhibitors do?
they block an enzyme secreted by the kidneys that prevents the formation of a potent hormone that constricts blood vessels. If this enzyme is blocked, the vessels dilate and cause BP to decrease.
What od angiotensin-II receptor antagonists do?
These are selective for angiotensin II (type 1 receptor) and treat hypertension.
What do diuretics do?
Increase the excretion of water and electrolytes through the kidneys.
What can diuretics lead to?
They can cause dehydration and lead to cardiac arrhythmias due to water and electrolyte imbalance.
What do bronchodilators do?
They relax or open the air passages in the lungs to allow for better air exchange by stimulating the sympathetic nervous system.
What do decongestants do?
These act directly on the smooth muscles of the blood vessels to stimulate vasoconstriction which reduces the volume of swollen tissues and results in more air space in the upper airways.
What should baseline physiological assessments do?
- identify areas of health/injury risk for potential referral to appropriate professionals
- collect baseline date that can be used to develop a personalized fitness program + allow comparison of subsequent evaluations
- educate the client on their current physical condition and health risks by comparing to normative data
- motivate client by helping them establish realistic goals
Physiological assessments that merit consideration include:
- resting vital signs (HR, BP, height, weight)
- static posture and movement screens
- joint flexibility + muscle length
- balance + core function
- BMI
- cardioresp fitness
- muscular endurance + strength
- skill-related parameters (agility, coordination, power, reactivity and speed)
Why should a skinfold measurement be taken before exercise?
To avoid underestimation of fat stores from dehydration or overestimation of fat stores due to vasodilation related to thermoregulation
What steps must you take when conducting assessments?
- distribute instruction in advance that clearly outline the client’s responsibilities
- obtain signed informed consent from the client
- organize all necessary documentation forms, data sheets, assessment tables etc.
- communicate + demonstrate skills in a confident manner
- calibrate all exercise equipment
- environmental control to ensure the room temp is ideal between 68 and 72 F (20-22C) with a relative humidity below 60%
When conducting the needs assessment with a client interested in performance-related training, what questions should the PT ask?
- what are the needed performance-related skills/abilities to be successful in the client’s chosen activity?
- which of these skills/abilities are currently lacking in this client?
- what are the prevalent injuries and weaknesses associated with the activity?
- which energy systems are required to be successful in this activity?
- which integrated movement patterns + planes of movement will need to be trained to be successful in this activity?
Where can you read someone’s pulse rate?
- radial artery (ventral aspect of the wrist)
- carotid artery (in neck, lateral to trachea)
- brachial artery
- femoral artery
- posterior tibial artery
- popliteal artery
- abdominal aorta
Resting Heart Rate is influenced by?
- fitness status
- fatigue
- BMI
- drugs/medication
- alcohol
- caffeine
- stress
A slow HR or sinus bradycardia is categorized as RHR of
<60 BPM
A normal sinus rhythm is categorized as a RHR of __ to ___ BPM.
60 - 100 BPM
A fast HR or sinus tachycardia is categorized as a RHR of >___ BPM.
> 100 BPM
What is the average RHR for males and females?
males - 60-70
females - 72-80
Why do females generally have higher RHR?
Due to:
- smaller heart chamber size
- lower blood volume circulating less oxygen throughout the body
- lower hemoglobin levels
Why does digestion increase RHR?
because the processes of absorption and digestion require energy to necessitate the delivery of nutrients/oxygen to the GI tract
What methods are used to measure HR both at rest and during exercise?
- 12-lead electrocardiogram
- telemetry
- palpation
- auscultation with a stethoscope
How do you measure RHR?
To be completely accurate, the client should take the measurement when they first wake up. But in a gym setting, the client should sit for a couple minutes before either placing their middle + index fingertips on a pulse site or using a stethoscope.
- Pulsation: Count the number of beats for 30 - 60 seconds and then correct that to beats per minute.
- Auscultation: place the stethoscope just above or below the client’s nipple line and to the left of the sternum.
How do you measure exercise HR?
Measure either a 10 or 15 second window and multiply the counted number by either 6 (10 sec) or 4 (15 sec)
What do SBP and DBP represent when reading Blood Pressure?
SBP represents the pressure created by the heart as it pumps blood into circulation via ventricular contraction - it represents the greatest pressure during one cardiac cycle.
DBP represents the pressure that is exerted on the artery walls as blood remains in the arteries during the filling stage or between beats, this is the minimum pressure that exists.
BP is measured indirectly by listening to the?
korotkoff sounds
What are Korotkoff Sounds?
These are used to measure blood pressure and are sounds made from vibrations as blood moves along the walls of the vessel.
Why would you not be able to hear Korotkoff sounds without a BP cuff?
Because the BP Cuff creates a deformity within the walls which is vital for the vibrations to be heard. The deformity is created as the air bladder inflates and restricts the flow of blood.
At what phase of taking BP do you take the SBP and DBP readings?
The SBP is in the first phase where there is the onset of tapping sounds that become progressively louder.
DBP is read first in the 4th phase where there is a significant muffling of sounds and secondly in the 5th phase where sound disappears.
If there is a significant difference in readings between arms in BP, what should you do?
Refer them to a physician because this can be a sign of a circulatory problem.
What are the normal SBP and DBP measurements for adults aged 18+?
SBP <120
DBP <80
What readings of SBP/DBP would suggest prehypertension?
SBP - 120-139
DBP - 80-89
What readings of SBP/DBP would suggest stage 1 of hypertension?
SBP - 14-159
DBP - 90-99
What readings of SBP/DBP would suggest stage 2 of hypertension?
SBP ≥ 160
DBP ≥ 100
For 40-70 year old individuals, each __mmHg increase in resting SBP or each __mmHg increase in resting DBP above normal double the risk of cardiovascular disease.
20mmHg SBP
10mmHg DBP
A difference of __mmHg or more in BP between arms increases the risk of?
15 mmHg
It increases the risk of peripheral vascular disease and cerebral vascular disease.
Using the RPE Borg scale, what does each value correspond to? Example: 6
Each value corresponds to a HR.
6 = 60 BPM
What is the EFI?
the exercise-induced feeling inventory survey.
It asks clients to use a scale of 1-5 to indicate the extent to which each word describes how they feel at the moment (e.g refreshed, calm, worn out)
The Exercise-induced Feeling Inventory Survey consists of 4 distinct subscales that define a particular emotional state, what are these?
Positive engagement
Revitalization
Tranquility
Physical exhaustion
How do you score the Exercise-Induced Feeling Inventory Survey?
Each word is associated with one of 4 subscales attached to an emotional state, depending on what number the client has ticked next to each word, add up each score for each subscale.
This should be tracked over a period of 4-6 weeks and the results should be plotted in a graph to show the change/progress.
e.g refreshed 4 = 4 points to feeling of revitalization
worn out 1 = 1 point to feeling of physical exhaustion
How can PTs use the exercise-induced feelings inventory to increase the likelihood of continuing with the exercise program?
They can use it to check the enjoyment and general feeling towards the program, for example, if the client is always putting 4 points to worn out after the session, the trainer should reduce intensity.
What is the name of the essential attribute of successful relationships that is described as ‘the ability to respect another person regardless of his or her uniqueness?’
warmth
How many points does this client have in the risk stratification process? 47 year old male mother has hypertension father had coronary bypass surgery at 59 quit smoking 20 years ago currently walks for 10 mins 2x a day BMI: 29KG/m2 BP: 132/86 total serum: 216 mg/dL LDL: 138 HDL: 48 Fasting plasma glucose: 94 Goal: lose 20 lbs
+3 points
+1 - age over 45
+1 - sedentary lifestyle
+1 - LDL Cholesterol over/equal to 130
How many points does this client have in the risk stratification process? 39 year old female Father has type 1 diabetes Mother has type 2 diabetes Never smoked Currently swims 3-4 days p week for 30-45 mins for past 6 months BMI: 31 kg/m2 BP: 128/82 Total serum cholesterol: 224 mg LDL: 122 HDL: 64 Fasting plasma glucose: 95 Goal: lose 30lbs
0
+1 - BMI over 30kg
-1 -HDL over/equal to 60
A client presents with 0 positive risk factors during risk stratification but has a known heart disorder, what risk category are they placed in?
They are automatically placed in the high risk category because they have a heart disorder.
Individuals are classified as prehypertensive when systolic blood pressure is ___ - ___ mmHg or diastolic blood pressure is __ - __ mmHg.
Individuals are classified as prehypertensive when systolic blood pressure is 120-139 mmHg or diastolic blood pressure is 80-89 mmHg.
