Level Personal Training Online Theory Flashcards
3 media we communicate through snd their approximate percentages.(3)
- Body language(55%)
- Voice and tonality(38%)
- Words we use(7%)
What composes the Nervous system.(4)
- Central nervous system (CNS)
- Peripheral nervous system (PNS)
- Somatic / conscious branch (skeletal muscle)
- Autonomic / unconscious branch (smooth + cardiac muscle).
What composes the muscular system?(2)
*hint number of muscles
- 650 muscles in the body to support movement (i.e. controlling walking, talking, sitting, standing, eating and other daily functions consciously performed)
- Maintenance of posture, assisting with the circulation of blood and lymph throughout the body.
What composes the skeletal system?(3)
*hint number of bones and joints
- 206 bones in total spread across five categories: flat, long, short, irregular and sesamoid
- 300+ joints / articulations with specific biomechanical functions
- Bones function as levers as they move through their range of motion to allow for movement.
Other components of connective tissue that are not ligaments or tendons. (3)
In fact, connective tissues are the most widespread and abundant of all the body tissues. Other tissues that many do not realise fall into this group are blood cells, bone matrix and adipose tissue.
What is fascia? Give examples.(3)
All the collagenous-based soft tissue in the body.
Examples: tendons, ligaments, bursae and all the fasciae in and around the muscles (endomysium, perimysium and epimysium)
Other examples: fasciae around the organs: the coelomic bags that hold the organs in the peritoneum and mesentery in your abdominal cavity; the mediastinum, pericardium and pleura that hold the organs in the chest cavity; and the membranes (dura, pia and perineuria) that surround the brain, spinal cord and peripheral nerves.
Which germ layer during embryonic development does the fascial web grow from?(1)
Mesoderm-develops very early and envelopes p much everything in the body aside from eg open tubes or digestives and respiratory tracts
What is the aponeurosis?(1)
a sheet of pearly white fibrous tissue that takes the place of a tendon in flat muscles having a wide area of attachment.
What is DRCT?(2)
Dense connective tissue (DCT) can be further subdivided into regular and irregular tissue. Dense regular connective tissue (DRCT) is smooth and white in appearance, with massive tensile strength in one direction. It is formed almost exclusively of collagen fibres, which as the name suggests, are densely packed in a tight parallel formation. Also contained within DRCT are small numbers of elastic fibres; these, plus the slightly wavy nature of the collagen fibres, give the tendons and ligaments that they form a degree of flexibility.
Ligaments.(3)
- Ligaments surround and protect synovial joints and are composed of dense, regular collagen fibres, which can withstand high tensile forces in the directions of the fibres.
- Can stretch around 6% of its original length before it may not be able to return and will therefore stay in the stretched state-lessening stability around the joint
- Ligaments do have a limited blood supply, as there is little room for capillaries within the dense arrangement of collagen fibres.
What are proprioceptors and where are they located?(2)
In articular cartilage and ligaments-nerve endings which detect changes in movement and the stresses applied to a given area
In response, the brain sends out motor signals to recruit the muscles that cross the joint, generating the reactive restoration of balance and stability.
What is the purpose of myofascial lines?(1)
Thought that these body parts work in unison to produce human movement and therefore are linked/chained together.
What is the superficial back line/what does it consist of?(7)
A chain of muscle and fascia along the back of the body
- Fascia of scalp, eyebrow ridge
- Sacrum, thoracolumbar fascia
- Ischial tuberosity, sacrotuberous ligament
- Femoral condyles, hamstrings
- Achilles tendon, gastrocnemius
- Muscles of phalanges, plantar fascia to calcaneus.
What is the superficial front line/what does it consist of?(6)
A chain of muscle and fascia along the front of the body:
- Sternocleidomastoid
- Rectus abdominus, sternum, fifth rib
- Quadriceps, pelvic fascia
- Tibialis anterior, patella tendon
- Muscles of phalanges, dorsal surface.
What is the lateral line/what does it consist of?(6)
A chain of muscle and fascia along the side of the body
- First and second ribs, sternocleidomastoid, splenius capitus
- Internal and external intercostals
- Iliac crest, internal and external obliques
- IT band, TFL (anterior pelvis), gluteus maximus (posterior pelvis)
- Peroneus muscles, head of fibula
- Base of first and fifth metatarsals, dorsal surface.
- note in diagram this criss-crosses down the side of the body until the legs
What is the functional back line/what does it consist of?(7)
A chain of muscle and fascia forming an ‘X’ over the back of the body:
- Shaft of humerus
- Extends in diagonal pattern to midline
- Latissimus dorsi, sacrum, thoracolumbar fascia
- Gluteus maximus
- Shaft of femur, vastus lateralis
- Patella tendon, tibial tuberosity.
What is the functional front line/what does it consist of?(7)
A chain of muscle and fascia forming an ‘X’ over the front of the body:
- Shaft of humerus
- Extends in diagonal pattern to midline
- Lower edge of pectoralis major, fifth / sixth rib
- Rectus abdominus, pubis symphysis
- Adductor longus.
- note in diagram it cuops the pecs and ends in the middle of the adductors
What is difficult when defining the core? What is one wya to define it?(2)
All mysofascial lines run through the centre of the body and each line is a connection of the fascial tissues
- The ‘core musculature’ can be defined generally as the 29 pairs of muscles that support the lumbo-pelvic-hip complex in order to stabilize the spine, pelvis, and kinetic chain during functional movements.
- The core is also commonly referred to as the ‘powerhouse’ or the foundation of all limb movement. These muscles are theorized to create this foundation for movement through muscle contraction that provides direct support and increased intra-abdominal pressure to the inherently unstable spine.
What are the roles of the core?(3)
-To maintain correct vertebral alignment
-To support the ability of the body to control the whole range of motion of a joint so that there is no major deformity and / or pain
-To stabilise the spine during functional demands
the ligamentous spine (stripped of muscle) will fail or buckle under compression loads of as little as 2 kg
-More often than not, to prevent motion, rather than initiating it.
What are the deep “stabilising” components of the core?(4)
-anterior/posterior spinal ligaments muscles: -rotatores -interspinals -intertransversarii
Difference between the anterior/posterior spinal ligaments.(1)
The anterior are on the front and the posterior back
anterior aim to prevent hyperextension
-the posterior are weaker but aim to also prevent hyperflexion / excessive flexion of the vertebral column and posterior protrusion of the nucleus pulposus of the intervertebral disc.
Rotatores.(1)
a group of 22 small, four-sided muscles found on the vertebrae of the spine. Specifically, these 22 muscles are found in the thoracic region of the spinal column (middle of the spine). There are 11 rotatores muscles on each side of the thoracic vertebrae. Each of the rotatores muscles originates from the transverse processes of a thoracic vertebra. The transverse processes are bony prominences that stick out the back sides of each vertebra. These prominences function to provide areas on the vertebrae to which muscles and tendons can attach. Each of the rotatores muscles inserts or attaches to the spinous process of the thoracic vertebra that is located either one or two vertebra above its originating vertebra. The spinous process is a bony prominence that sticks out the back of the vertebrae.
Intertransversarii.(3)
- These muscles are small fascicles that span between the transverse processes of adjacent vertebrae.
- They are most developed in the cervical region.
- They assist with lateral flexion and stabilizing the spinal column.
What muscles are the inner unit core musculature.(6)
The following musculature form a ‘cylinder’ around the lumbo-pelvic region: -Transversus abdominis -Multifidus -Internal oblique -Quadratus lumborum -Diaphragm -Pelvic floor Unlike the thorax, the abdominal wall has no bony reinforcement; this means that protection of the lumbar spine and abdominal organs is left to the muscles in this region.When contracting together, these muscles increase tension of the thoracolumbar fascia and increase intra-abdominal pressure, which increases spinal stiffness in order to resist forces acting on the lumbar spine.
What muscles are the outer unit core musculature.(7)
he following represent some of the main muscles that generate gross movement across the spine and hips:
-Rectus abdominis
-Lateral fibres of external oblique
-Erector spinae
-Iliocostalis (thoracic portion)
Also included are the multi-joint muscles, namely the Gluteals, Latissimus Dorsi and Psoas, which pass through the core, linking it to the pelvis, legs, shoulders and arms.
What are the roles of the pelvic floor muscles (deep pelvic diaphragm and superficial urogenital diaphragm layers). (3)
- Support of the abdominopelvic viscera (bladder, intestines, uterus, etc.) through their tonic contraction
- Resistance to increases in intra-pelvic / abdominal pressure during activities such as coughing or lifting heavy objects
- Urinary and faecal continence. The muscle fibres have a sphincter action on the rectum and urethra. They relax to allow urination and defecation.
The connective tissue with the least amount of elasticity is…
out of ligaments or cartilage.(1)
ligaments.
The core muscle that forms the base of the inner unit is….(1)
the pelvic floor.
Soft tissue limitations to movement.(1)
If a muscle is overused for repetitive motions or held in a specific position during extended periods of inactivity, then collagen can form between the layers of skeletal muscle, creating adhesions or knots that restrict the ability of muscle sheaths to slide against one another. Collagen is a protein molecule bound in a triple-helix formation to give it rigidity. It is a component of fascia that is produced in response to applied mechanical stress.
Sensations of pain cain be brought about by fascial tightness. When dehydration results and / or a lack of movement is experienced in the affected region collagen molecules can bind together for stability, which can create an adhesion between the various layers of muscle.
Benefits associated with foam-rolling, what is it a type of?(5)
Self-myofascial release (SMR)
- Increased range of motion (acute increases of 3–23% persisting for 20 minutes)
- Diminished perceived pain
- Accelerated recovery from exercise-induced muscle damage
- Improved athletic performance (unlike the stretching literature, which has reported impaired performance following prolonged static stretching, the rolling literature generally reports no significant deficits in subsequent muscle strength.
What is autogenic inhibition?(5)
- Golgi tendon organs (GTOs) sense a change in muscle tension from pressure of the roller (located in the muscle-tendon junction)
- GTO activation creates an inhibition effect in the same muscle
- A sensory signal to the CNS informs of the need to reduce muscle tension
- Muscle spindles sense a change in the length of muscles and signal for muscle contraction
- A sensory signal from the CNS informs of the need to allow muscle fibres to lengthen
How to foam-roll effectively.(2)
Guide the client to use a pain scale of 1–10. Some discomfort is acceptable, but pain above seven may create further tension or tissue damage.
Foam rolling acts to hydrate tissues, which act like a sponge, where water is ‘squeezed’ out before being ‘sucked’ back in. For this to be effective, slow and gentle movements should be encouraged.
Note this is good practise to foam roll along the myofascial lines and then follow up with appropriate exercises for these lines also.
Once ROM has been improved via foam rolling, in order to help improve mobility what are the 2 approaches a trainer could take.(2)
Approach 1. Proprioceptively rich input where dynamic actions use momentum, gravity and ground reaction forces. Groups of muscles must first load and lengthen eccentrically as they enter the desired range of motion before they can unload and shorten concentrically to carry the joint out of that range.
E.g. reverse lunge with overhead reach with medicine ball (momentum of the medicine ball being driven up and overhead loads tissues on the front of the shoulder, front of the torso and front of the hip).
Approach 2. Move into the new range of motion slowly and create isometric contractions in the new range to improve strength and muscular balance between agonists, antagonists, synergists and fixator muscles. Momentum is eliminated which removes any proprioceptive assistance to get in and put of the range. Rather, spending a prolonged duration in the new range creates a strong neural drive to the muscles that need to learn how to control the joint in that position.
E.g. Isometric lunge with cable overhead front raise (facing a cable machine, the lunge is held with pelvis and ribs stacked in neutral whilst a cable is raised slowly overhead and then held for 10-seconds, before being lowered under control).
DOMS recovery strategies.(7)
- Progress slowly with a new exercise programme, especially when including new exercises
- Begin with low exercise volumes and programme small weekly increments
- Avoid excess use of eccentric muscle actions (although this may be desirable in some circumstances)
- Pre-workout: caffeine ingestion prior to workouts (supported by some research)
- Post-workout: omega 3 fatty acids (supported by some research)
- Post-workout: some studies report that SMR using a foam roller may reduce perceived soreness and increase the pressure pain threshold as a result of DOMS during the 48 hours following damaging exercise
- Post-workout: light cardiovascular exercise.
List the four patterns of fascicle organisation.(4)
- parallel/fusiform muscles
- convergent muscles
- pennate muscles
- circular muscles.
Difference between parallel and fusiform muscles/similarities.(4)
- Fusiform-tendons, parallel-aponeuroses
- Most of the skeletal muscles in the body are parallel muscles.
- The biceps brachii muscle of the arm is a fusiform muscle with the central body. When a parallel muscle contracts, it gets shorter and larger in diameter. You can see the bulge of the contracting biceps brachii on the anterior surface of your arm when you flex your elbow.
- A skeletal muscle cell can contract until it has shortened by roughly 30 percent. Because the fibres in a parallel muscle are parallel to the long axis of the muscle, when the fibres contract together, the entire muscle shortens by the same amount.
Convergent muscles.(4)
- In a convergent muscle, the muscle fibres are spread over a broad area, but all the fibres converge at one common attachment site. They may pull on a tendon, an aponeurosis (tendinous sheet) or a slender band of collagen fibres known as a ‘raphe’.
- The muscle fibres typically spread out, like a fan or a broad triangle, with a tendon at the apex. The prominent chest muscles of the pectoralis group have this shape.
- A convergent muscle has versatility because the stimulation of only one portion of the muscle can change the direction of the pull. However, when the entire muscle contracts, the muscle fibres do not pull as hard on the attachment site as a parallel muscle of the same size would. The reason is that the convergent muscle fibres pull in different directions, rather than all pulling in the same direction.
- This idea gives rise to the need to use different variations of exercises to fully stimulate all the muscle fibres within a target muscle, for example when training for muscle hypertrophy (e.g. flat, incline, decline bench press).
The 3 types of pennate muscles.(3)
- If all the muscle fibres are on the same side of the tendon, the pennate muscle is unipennate. The extensor digitorum muscle, a forearm muscle that extends the finger joints, is unipennate.
- MORE commonly, a pennate muscle has fibres on both sides of the tendon. Such a muscle is called ‘bipennate’. The rectus femoris muscle, a prominent muscle that extends the knee, is bipennate.
- Multipennate muscles have multiple rows of diagonal fibres, with a central tendon which branches into two or more tendons. An example is the Deltoid muscle which has three sections, anterior, posterior and middle.
Pennate muscles.(2)
In a pennate muscle, the fascicles form a common angle with the tendon. Because the muscle cells pull at an angle, contracting pennate muscles do not move their tendons as far as parallel muscles do. But a pennate muscle contains more muscle fibres and, as a result, produces more tension than does a parallel muscle of the same size. (Tension production is proportional to the number of contracting sarcomeres; the more muscle fibres, the more myofibrils and sarcomeres.)
A steeper angle of the fascicles means that more fascicles can fit into the area occupied by the muscle; the result is…
Greater tension generation within the muscle.
The extensor digitorum muscle is which of the following?
Unipennate.
Superior/inferior in anatomy.(1)
Superior is closer to the head/inferior further from head in anatomical position.
Medial/lateral in anatomy.(1)
Medial towards midline of boyd/lateral away from midline.
Planes of movement and their corresponding axes.(3)
Medio-lateral axis-sagittal plane
anterior-posterior axis-frontal plane
longitudinal axis-transverse plane
An imaginary line that runs from superior to inferior down the centre of the body represents the…
Longitudinal axis.
Which of the following refers to - the top surface of the feet and hands?(1)
Dorsal.
Some anatomy definitions/prefixes/shapes
1) Stasis/Stan
2) Scler/Sclero
3) Ischi
4) Ante
5) Anti
6) Cata
7) Infra
8) Inter
9) Intra
10) Ipsi
11) Rectus
12) Transverse
13) Oblique
14) Deltoid
15) Serratus
16) Piriformus
17) Gracilis. (17)
1) Stand still
2) Hard
3) Hip
4) Before
5) Against
6) Down/Lower/Under
7) Beneath
8) Among/Between
9) Within/Inside
10) Same
11) parallel with midline
12) perpendicular with midline
13) diagonal to midline
14) triangle
15) saw-toothed
16) pear-shaped
17) slender
The anatomical term ‘epi’ refers to which body region / direction?
upon/on/above
Glenohumeral joint.(1)
Ball and socket shoulder joint. It consists of the head of the humerus, which inserts into the shallow glenoid cavity/fossa of the lateral border of the scapula.
What are four muscles (SITS) that are designed to stabilise the glenohumeral joint during close-range movements and can be trained to increase stability at this joint. Why?(6)
Unlike the hip joint the shoulder joint is not fully encapsulated and therefore the joint is more mobile but less stable
1) Rotator cuff muscles
2) Supraspinatus (abduction action),
3) Infraspinatus (lateral rotation action,
4) Teres Minor (lateral rotation action),
5) Subscapularis (medial rotation action).
Hip joint.(4)
- The large ball-and-socket joint of the hip consists of the rounded head or ball of the femur and the cup-like acetabulum of the pelvis.
- The rounded head or ball of the femur is at the proximal end and is held by an obvious neck. At the base of the neck, the bone flares out laterally to form a collar, named the ‘greater trochanter’. This body protuberance provides attachment sites for the muscles of the thigh and buttocks.
- The rounded end or ball fits snugly into the acetabulum of the pelvic girdle and is held in place by the labrum: a fibrocartilage lip. An internal ligament and strong external ligaments provide further support (7 ligaments in total).
- At the distal end of the femur, the bone widens again, forming two rounded condyles (knuckle-like processes) that fit neatly into the complementary condyles of the tibia (the lower leg) to form the knee joint.
Sterno-clavicular joint
Acromio-clavicular joint.(4)
- Each clavicle articulates proximally with the top / superior end of the sternum (the sternoclavicular joint). This is the clavicle’s only bony link to the axial skeleton.
- The sternoclavicular joint is a synovial double gliding joint that has the characteristics of both a gliding joint and a saddle joint, but it also has a cartilaginous disc that absorbs considerable stress (e.g. when falling on the shoulder). In fact, this joint is so strong that the clavicle itself is much more likely to break with the jarring that occurs.
- Each clavicle articulates distally at the top of the shoulder with the acromion process of the scapula (the acromioclavicular joint), forming a gliding synovial joint. It can be felt at the top of the shoulder and is the point of contact of each scapula with the rest of the skeleton.
- The scapulae are roughly triangular-shaped, thin, flat bones that partially cover the back of ribs 1–7. The posterior surface of each scapula has a raised ridge along its length, known as the ‘spine of scapula’, which ends in a large bony process called the ‘acromion process’. Each scapula is anchored in place by the many muscles of the back and shoulder, giving incredible mobility overall to the shoulder and the associated upper limbs.
Atlantoaxial joint.(4)
-The atlantoaxial joint (articulation of the atlas with the axis) is of a complicated nature, comprising no fewer than four distinct joints.
-The atlas (C1) is the top-most bone, sitting just below the skull. There is a pivot articulation, creating two joints, where the odontoid process (or dens) meets the ring of the axis (C2) (formed by the anterior arch and the transverse ligament of the atlas).
The two joints are:
-Between the posterior surface of the anterior arch of the atlas and the front of the odontoid process
-Between the anterior surface of the ligament and the back of the process.
Is the ulna part of the radiocarpal joint?(3)
-The wrist joint is formed:
Distally – the proximal row of the carpal bones (except the pisiform)
Proximally – the distal end of the radius and the articular disc.
-The ulna is not part of the wrist joint – it articulates with the radius, just proximal to the wrist joint, at the distal radioulnar joint. It is prevented from articulating with the carpal bones by a fibrocartilaginous ligament, called the ‘articular disc’, which lies over the superior surface of the ulna.
What are the two articulations of the knee joint. What do they do?(4)
- Tibiofemoral: the medial and lateral condyles of the femur articulating with the tibia
- Patellofemoral: the anterior and distal part of the femur articulating with the patella.
- The tibiofemoral joint is the weight-bearing joint of the knee, whilst the patellofemoral joint allows the tendon of the quadriceps femoris (the main extensor of the knee) to be inserted directly over the knee, increasing the efficiency of the muscle.
- Both joint surfaces are lined with hyaline cartilage and are enclosed within a single joint cavity. The patella is formed inside the tendon of the quadriceps femoris (sesamoid bone); its presence minimises wear and tear on the tendon.
What are the main ligaments in the knee joint.(3)
- The patellar ligament-a continuation of the quadriceps femoris tendon distal to the patella. It attaches to the tibial tuberosity (labelled ‘patella tendon’)
- Collateral ligaments: these are two strap-like ligaments (both medial (tibial) and lateral (fibial) to the patella). They act to stabilise the hinge motion of the knee, preventing any medial or lateral movement
- Cruciate ligaments: (both anterior and posterior)-these two ligaments connect the femur and the tibia. In doing so, they cross each other, hence the term ‘cruciate’ (Latin for ‘like a cross’).
What are the attachments collateral ligaments.(2)
Tibial (medial) collateral ligament: wide and flat ligament, found on the medial side of the joint. Proximally, it attaches to the medial epicondyle of the femur; distally, it attaches to the medial surface of the tibia
Fibular (lateral) collateral ligament: thinner and rounder than the tibial collateral, this attaches proximally to the lateral epicondyle of the femur; distally, it attaches to a depression on the lateral surface of the fibular head.
What are the attachments of the cruciate ligaments.(2)
- Anterior cruciate ligament (ACL): attaches at the anterior intercondylar region of the tibia and ascends posteriorly to attach to the femur, in the intercondylar fossa. It prevents anterior dislocation of the tibia onto the femur
- Posterior cruciate ligament: attaches at the posterior intercondylar region of the tibia and ascends anteriorly to attach to the femur in the intercondylar fossa. It prevents posterior dislocation of the tibia onto the femur.
Menisci.(4)
-Soft tissue supporting knee
-The medial and lateral menisci are fibrocartilage structures in the knee that serve two functions:
To deepen the articular surface of the tibia, thus increasing stability of the joint
To act as shock absorbers.
-They are C-shaped and are attached at both ends to the intercondylar area of the tibia.
-In addition to the intercondylar attachment, the medial meniscus is fixed to the tibial collateral ligament and the joint capsule. Any damage to the tibial collateral ligament results in tearing of the medial meniscus.
Bursae.(4)
A bursa is a synovial-fluid-filled sac, found between moving structures in a joint – with the aim of reducing wear and tear on those structures. There are four bursae found in the knee joint:
- Suprapatellar bursa: this is an extension of the synovial cavity of the knee, located between the quadriceps femoris and the femur
- Prepatellar bursa: found between the apex of the patella and the skin
- Infrapatellar bursae: split into deep and superficial. The deep bursa lies between the tibia and the patella ligament. The superficial lies between the patella ligament and the skin
- Semimembranosus bursa: located posteriorly in the knee joint, between the semimembranosus muscle and the medial head of the gastrocnemius.
What are the 2 articulations of the elbow joint.(2)
The elbow is the joint connecting the upper arm to the forearm. It is marked on the upper limb by the medial and lateral epicondyles and the olecranon process. Structurally, the joint is classed as a synovial joint; functionally, it is classed as a hinge joint.
It consists of two separate articulations:
- Trochlear notch of the ulna and the trochlea of the humerus
- Head of the radius and the capitulum of the humerus
Interphalangeal joints.(3)
-The fingers consist of:
Five proximal phalanges
Four middle phalanges
Five distal phalanges.
-The proximal end of the metacarpals and phalanges is called the ‘base’, and the distal end is called the ‘head’.
-Each finger has two interphalangeal (IP) joints: a proximal interphalangeal (PIP) and a distal interphalangeal (DIP) joint. The thumb has only two phalanges and therefore only one IP joint.
Talocrural joint.(3)
- The ankle joint is formed by three bones: the tibia and fibula of the lower leg and the talus of the foot.
- The tibia and fibula are bound together by strong tibiofibular ligaments, producing a bracket-shaped socket, which is covered in hyaline cartilage. This socket is known as a ‘mortise’.The body of the talus fits snugly into the mortise, formed by the bones of the leg.
- The articulating part of the talus is wedge-shaped. It is wider anteriorly and thinner posteriorly. During dorsiflexion, the anterior part of the bone is held in the mortise, and the joint is more stable (vice versa for plantar flexion).
Ligaments of the talocrural joint.(2)
There are two sets of ligaments, which originate from each malleolus.
-The medial ligament (or deltoid ligament) is attached to the medial malleolus. It consists of four separate ligaments, which fan out from the malleolus, attaching to the talus, calcaneus and navicular bones. The primary action of the medial ligament is to resist over-eversion of the foot.
-The lateral ligament originates from the lateral malleolus. It resists over-inversion of the foot. It comprises three distinct and separate ligaments:
Anterior talofibular: spans between the lateral malleolus and the lateral aspect of the talus
Posterior talofibular: spans between the lateral malleolus and the posterior aspect of the talus
Calcaneofibular: spans between the lateral malleolus and the calcaneus.
The socket of the hip joint is called which of the following? & The cup-like structure of the pelvis that forms the hip joint is known as the…
Acetabulum
Each clavicle articulates distally at the top of the shoulder with which of the following?
Acromion process
Which of the following is a lateral protuberance that provides attachment sites for the muscles of the thigh and buttocks?
Greater trochanter
The tibia and fibula of the lower leg and the talus of the foot articulate to form what joint?
Talocrural/hinge
Which of the following is extension of the ankle joint?
Plantar flexion
Difference between PARQ and PARQ+.(2)
PAR-Q
The Physical Activity Readiness Questionnaire (PAR-Q) is a one-page form to see if you should check with your doctor before becoming much more physically active
PAR-Q+
The Physical Activity Readiness Questionnaire-Plus (PAR-Q+) is a four-page form for pre-screening prior to physical activity participation and includes additional questions on chronic conditions for further probing by the qualified exercise professional
Stages of APSS.(2)
Compulsory for Personal Trainer to use with client:
Stage 1: to identify those individuals with a known disease, and/or signs or symptoms of disease, who may be at a higher risk of an adverse event due to physical activity/exercise. An adverse event refers to an unexpected event that occurs as a consequence of a physical activity/exercise session, resulting in ill health, physical harm or death to an individual. Stage 1 may be self-administered and evaluated by the client. The screening tool can be administered to both regular and casual users of exercise services. Once completed, the form should be filed appropriately with the client’s records for future reference.
Advisable for Personal Trainer to use with client:
Stage 2: this stage is to be completed with the exercise professional to determine an appropriate exercise prescription based on established risk factors. The aim is to identify those individuals with risk factors or other conditions that may result in them being at a higher risk of an adverse event due to exercise.
Questions 8-12 and 15-18 can be used by the Personal Trainer with the client. If the client has knowledge of the values associated with questions 13-14, these can be recorded; however advising on these tests and providing guidance based on the results are beyond the scope of the Personal Trainer’s education and expertise.
Clearance of APSS.(2)
-Stage 1: YES to any of questions 1-6
If they answer NO to all questions, then they are cleared for low–moderate-intensity physical activity and may continue on with any high-intensity activity they have been performing (>150mins/week)
-Stage 2: in the event of an extreme risk factor or multiple risk factors that in the judgement of the exercise professional present a high risk of an adverse event, individuals should be referred to a GP or appropriate allied health professional.
After the GP appointment has taken place (following referral), what are the three potential likely outcomes.(3)
- The GP provides permission/clearance for the patient/client to return to you, the Personal Trainer (some suggestions / contraindications may be advised)
- GP recommends guidance from a L3 Exercise Referral-qualified Personal Trainer, within an Exercise Referral scheme. Exercise Referral is a multidisciplinary intervention that aims to provide safe and effective exercise for patients with low-risk medical conditions. The role of the GP or health professional is to make a referral into a system that is quality assured and to be satisfied to the best of their knowledge that no evidence exists at the time of the referral to suggest that a course of exercise will adversely affect the health and safety of the patient
- The GP refers the patient / client on to a different medical expert for further guidance / treatment.
Which of the following is not a symptom of hyperglycaemia?
Infrequent urination.
For the MSQ what should the client base the answers off (timescale wise).(1)
Symptoms within the questionnaire are rated based upon the health of a client for the past 30 days (if using as a reassessment) or the past 48 hours if using for the first time.
It is recommended for the health symptoms questionnaire to be used every other month (i.e. in eight-week cycles) to allow for interventions (exercise, nutrition and lifestyle) to take effect and to provide positive health benefits.
Anterior vs posterior pituitary hormones and functions.(2)
Anterior:
Thyroid-stimulating hormone Adrenocorticotropic hormone
Gonadotropic hormone
Growth hormone
(Stimulates the thyroid, Stimulates the adrenal cortex, Stimulates the gonads, Stimulates growth in children and young adults, Promotes muscle mass growth, Promotes lipolysis (fat breakdown))
Posterior:
Antidiuretic hormone (Promotes water reabsorption by kidneys)
Bony prominences of the vertebral arches.(5)
- Pedicles: there are two of these – one left and one right. They point posteriorly, meeting the flatter laminae
- Laminae: the bones between the transverse and spinal processes
- Transverse processes: these extend laterally and posteriorly away from the pedicles. In the thoracic vertebrae, the transverse processes articulate with the ribs
- Articular processes: at the junction of the laminae and the pedicles, superior and inferior processes arise. These articulate with the articular processes of the vertebrae above and below
- Spinous processes: posterior and inferior projections of bone – sites of attachment for muscles and ligaments.
Adrenal cortex hormones and functions.(3)
Glucocorticoids (e.g. cortisol) Mineralocorticoids (e.g. aldosterone)
(Promotes gluconeogenesis (a metabolic pathway that results in the generation of glucose from certain non-carbohydrate carbon substrates), Promotes sodium reabsorption by kidneys)
What is humoral stimulus?(1)
When a hormone is released in response to a change in the blood or other body fluids, such as a change in the level of a mineral or a change in temperature, this is called a ‘humoral stimulus’
A very strong stress response occurs during injury and / or trauma. For example…(4)
-The hypothalamus activates the sympathetic nervous system
-There is increased secretion of catecholamines from the adrenal medulla
-The adrenal medulla secretes approximately 20% noradrenaline (norepinephrine) and 80% adrenaline (epinephrine). To carry out this response, the adrenal medulla receives input from the sympathetic nervous system through nerve fibres originating in the thoracic spinal cord at T5–T11
-The increased sympathetic activity results in:
Increased heart rate and blood pressure
Blood vessel constriction in the skin and GI tract
Smooth muscle dilation
Dilating bronchioles and capillaries
Increased metabolism.
Examples of things regulated by circadian rhythm.(8)
• Sleeping and feeding patterns • Alertness • Core body temperature • Brain wave activity • Hormone production • Regulation of glucose and insulin levels • Urine production • Cell regeneration -many more!
Hormones in sleep/wake.(3)
- The most important hormones affected by the circadian clock, at least insofar as they affect sleep, are melatonin (which is produced in the pineal gland in the brain and which chemically causes drowsiness and lowers body temperature) and cortisol (produced in the adrenal gland and used to form glucose or blood sugar and to enable anti-stress and anti-inflammatory functions in the body).
- Growth hormone, essential to the repair and restoration processes of the body, is also secreted during sleep, particularly during deep non-REM sleep, as are other hormones like testosterone.
- Thyrotropin (or thyroid-stimulating hormone), on the other hand, is actively inhibited or suppressed during sleep, and this makes sense, as it stimulates metabolism and signals for cells to make more ATP.
How long before bed should you avoid strenous exercise?(1)
3-4 hours.
*foods containing tryptophan eg bananas, milk may aid sleep.
Coronary circulation.(5)
-The heart requires a blood supply. There are two major coronary arteries that provide this supply:
Left coronary artery
Right coronary artery.
-The left coronary artery divides into two branches, known as the ‘left anterior descending artery’ (LAD) and the ‘left circumflex artery’.
The left circumflex artery goes around the left side of the heart and distributes oxygenated blood to the walls of the left atrium
The LAD artery goes down the front of the heart and supplies oxygenated blood to the walls of the left ventricle.
-The main portion of the right coronary artery provides oxygenated blood to the right side of the heart (connecting the pulmonary circulation). The rest of the right coronary artery and its main branch, known as the ‘posterior descending artery’, together with the branches of the circumflex artery, run across the lower surface of the heart, supplying the bottom portion of the left ventricle and the back of the septum.
-As the myocardium has virtually no anaerobic capacity, it is crucially dependant on blood flow through the coronary arteries. Due to the pressure the heart is under during systole (ejection), the majority of blood flow through the coronary arteries occurs during diastole.
-As a client’s cardiorespiratory fitness increases through regular physical activity, the resting heart rate, as well as the heart rate at a given exercise workload, decreases. This in turn means that the time the heart spends in diastole (refilling) increases. This therefore allows more blood flow through the coronary arteries, thus improving blood flow.
Blood pressure=?x?
Total peripheral resistance (TPR) x cardiac output (Q).
**note: The average blood pressure across one cardiac cycle is known as the ‘mean arterial pressure’.
Locations of major baroreceptors and where they relay the information to.(2)
- The aorta and the carotid sinus contain important baroreceptors that constantly monitor blood pressure fluctuations through the stretch exerted on the artery walls.
- These baroreceptors transmit their data to the central nervous system: more specifically, to the cardioregulatory centre of the medulla oblongata in the brain (via glossopharyngeal nerve)-reduce BP via vagus nerve
Renin-angiotensin hormone system.(4)
- Kidney cells release renin into the blood stream
- It is activated to angiotensin I-as angiotensin I passes through the lung capillaries, an enzyme in the lungs converts angiotensin I to angiotensin II-angiotensin II stimulates the release of aldosterone when it reaches the adrenal glands (adrenal cortex), angiotensin II is also a vasoconstrictor and therefore raises blood pressure in the body’s arterioles
- The target organ for aldosterone is the kidney-aldosterone promotes increased reabsorption of sodium (salt) from the kidney tubules
- As sodium moves into the bloodstream, water follows. The reabsorbed water increases blood volume and therefore blood pressure.
Remember BP effected by water as plasma 55% water which is 94% water.
Short term effects of cardio on blood pressure.(2)
- post exercise hypotension experienced in both normotensive and hypertensive individuals
- however post exercise ambulatory (throughout the day) is proven but varies considerably in hypertensive individuals-same session is multiple short bouts rather than1 continuous might lengthen this effect-intensity duration not yet confirmed but regular health guidleines should be sufficient
Long term effects of cardio on blood pressure.(3)
- Large-scale studies suggest that aerobic training effects in blood pressure are associated with reductions of 3.3 and 3.5 mmHg in waking systolic and diastolic blood pressures, respectively. Although these reductions appear modest, it has been shown that blood pressure decreases of as little as 2 mmHg are associated with a 6% decrease in stroke mortality and a 4% decrease in coronary artery disease
- The mechanism for long-term blood pressure reductions with aerobic training is likely due to a reduction in peripheral vascular resistance
- In summary, aerobic training can reduce ambulatory blood pressure in hypertensive subjects; however, the specific training parameters that are necessary to maximise this effect are not yet known. Moreover, individual responses to aerobic training are quite variable – this suggests that hypertensive clients should be assessed at regular intervals to assess the effectiveness of an exercise programme.
Immediate Effects of Resistance Training on Blood Pressure.(3)
- Systolic blood pressure does increase slightly
- Diastolic blood pressure shows dramatic increases with this form of exercise
- Muscular contractions provide too much peripheral vascular resistance for an optimal blood pressure response.
Valsalva manoeuvre.(3)
-Specifically, the valsalva manoeuvre is increased pressure developed against a closed glottis – usually done by taking in a large ‘belly-breath’ and closing the mouth whilst attempting to exhale through it. It serves to generate pressure against the inner unit core musculature which are then required to contract in response to this pressure (and thus develop stability in this region). This stability is helpful for moving through the ‘sticking point’ of an exercise (e.g. a back squat).
At this time, blood pressure ‘spikes’ and would be contraindicated for hypertensive clients:
-The primary change is caused by an increase in pressure within the chest (intrathoracic pressure) and the abdomen. During normal breathing, intrathoracic pressure is lower than atmospheric pressure, and this negative intrathoracic pressure aids the flow of blood to the heart from the peripheral veins.
-general recommendation for breathings is inhale during eccentric and exhale during concentric.
Short term effects on blood pressure bc of resistance training.(3)
- All studies that have investigated clinical (single-measurement) blood pressure after resistance exercise have verified a significant post-exercise hypotensive effect; however, data regarding ambulatory (throughout the day) blood pressure is both scarce and controversial
- The effectiveness of resistance training in bringing about a post-exercise hypotensive effect suggests a reduction in cardiac output due to a decrease in stroke volume, probably due to a pre-load reduction (reduced left ventricular filling due to reduced venous return)
- In general, low-intensity resistance exercise seems to have stronger hypotensive effects, and subjects with higher blood pressure seem to experience greater blood pressure reductions after resistance exercise, similar to what is observed for aerobic exercise
Long term effects on blood pressure bc of resistance training.(5)
-It is important to emphasise that frequent participation in resistance training does not trigger hypertension
In the general population, resistance training reduces systolic and diastolic clinical blood pressure by 3.2 and 3.5 mmHg, respectively
-The failure to observe the hypotensive effects from resistance training in hypertensive clients may be linked to the absence of sympathetic nervous activity reduction after this kind of training
-In summary, there is no strong evidence that resistance training is effective in reducing ambulatory blood pressure in hypertensive subjects; however, the lack of data addressing this issue makes any conclusion premature
-Light-/moderate-intensity resistance training performed in a circuit format is likely to be the most effective for a hypertensive client.
Most accurate way to test resting heart rate.(3)
- Do not take your RHR within one to two hours after exercise or a stressful event. Your heart rate can stay elevated after strenuous activities
- Wait at least an hour after consuming caffeine, which can cause heart palpitations and make your heart rate rise
- The American Heart Association recommends checking your RHR first thing in the morning (before you get out of bed).
Taking BP measurements.(3)
- The principle of indirect measurement is to apply pressure by use of an inflatable cuff to the surface of the limb over the artery in order for the blood supply to be temporarily ceased. As the pressure of the cuff is slowly released (3–5 mmHg/second), the pressure at which blood flow is re-established is recorded:
- The value at which the first Korotkoff sound is heard is the systolic pressure (heard when using manual sphygmomanometers)
- As the pressure is released further, the sounds become -muffled to the point of silence. This value is that of the diastolic reading.
- *note: Multiple measurements (e.g. x3), separated by approx. five minutes and averaged, will help to ensure accuracy and reliability.
Blood pressure ranges.(4)
-90 over 60 (90/60) or less:
You may have low blood pressure
-More than 90 over 60 (90/60) and less than 120 over 80 (120/80):
Your blood pressure reading is ideal and healthy
-More than 120 over 80 and less than 140 over 90 (120/80-140/90):
You have a normal blood pressure reading but it is a little higher than it should be
-140 over 90 (140/90) or higher (over a number of weeks):
You may have high blood pressure (hypertension)-lowered to 130/80 in some American bodies**
Caution with the cuff of the sphygmomanometer.(2)
The size of the cuff is important, as a cuff that is too wide will give a low blood pressure reading, whereas a narrow cuff gives higher blood pressure readings due to the surface area it covers.
Automatic cuffs are becoming more and more popular within the industry due to the ease of administration. The Personal Trainer should keep in mind that automated blood pressure monitors may be susceptible to variation in accuracy, particularly for those readings that are at extreme ends of the norms.
When taking blood pressure how full should you inflate the cuff (if manually)?(3)
- Inflate cuff to approx. 160–180 mmHg or 20 mmHg above the predicted systolic pressure
- Deflate the cuff 3–5 mmHg every second. It is at this point that delay should be avoided
- Place the cuff 2-3cm above cuff on brachial artery, make sure tubes arent in the way of the stethoscope listening for sounds (auscultation).
Beta-blockers.(3)
- They are commonly prescribed for high blood pressure, migraine headaches and heart dysrhythmias, i.e. rapid or irregular heart rate.
- They lower the heart rate and blood pressure both at rest and during exercise. This makes readings of heart rate during exercise for predicting exercise intensity unreliable. Other methods of monitoring intensity would therefore be necessary.
- Names: Ends in ‘olol’ (e.g. acebutolol, propranolol and penbutolol)
Vasodilators.(2)
- They relax the blood vessels to relieve pressure in the vascular system. They can cause rapid heart rate or low blood pressure during exercise.
- Cooling down after exercise is very important for a participant on vasodilators, as hypotension may occur at this time.
Alpha-blockers.(2)
- They are similar to vasodilators in that they relax peripheral blood vessels.
- Unlike beta blockers, they do not have an effect on the heart rate. The heart rate of participants using alpha blockers can therefore be used as a good indicator of exercise intensity.
Diuretics.(4)
- They are medications which increase the excretion of water and some minerals known as electrolytes from the body. They are usually prescribed for high blood pressure, or when a person is accumulating too much fluid, as with congestive heart failure.
- They have no primary effect on the cardiovascular system, but they can cause water and electrolyte imbalances, which may lead to dangerous cardiac dysrhythmias. It is also important to monitor for dehydration and heat exhaustion in clients taking diuretics, especially when exercising in hot or humid environments.
- Diuretics are also used by athletes who need to lose weight for sport. This practice can be quite dangerous.
- Generic names: Thiazide, Amiloride
Bronchodilators.(2)
- They are usually given to sufferers of asthma. These medications relax or open the air passages in the lungs, allowing better air exchange.
- In addition to opening the airways, these medications increase the heart rate and may cause the client to have a shaky feeling.
Decongestants.(2)
- They act directly on the smooth muscles of blood vessels to stimulate vasoconstriction. In the upper airways, this constriction reduces the volume of the swollen tissues and results in more air space.
- Because vasoconstriction in the peripheral blood vessels may raise blood pressure, participants on decongestants should be cautious when exercising, especially when performing heavy resistance training exercises.
Antihistamines.(2)
- They are used to stop mucus production and alleviate allergic reactions. These medications do not have a direct effect on the heart rate or blood pressure.
- They do, however, produce a drying effect in the upper airways and may cause drowsiness. Most cold medications are a combination of decongestants and antihistamines and so have the combined effects of both drugs.
Nitrates.(3)
- Ends with ‘nitrate’ (e.g. isosorbide dinitrate)
- Heart rate: Increases at rest, Increases or does not alter during exercise
- Blood pressure: Decreases at rest, Decreases or stays the same during exercise
Calcium channel blockers.(3)
- Ends in ‘ine’ Nicardipine Amlodipine
- Increases or stays the same during exercise
- Lower blood pressure
ACE Inhibitors.(3)
- Ends in ‘pril’: Captopril, Enalapril, Lisinopril
- Heart rate: Does not change
- Blood pressure: Decreases during rest and exercise
According to Hypertension Canada, high blood pressure is associated with stroke, heart attack, heart failure and which of the following?(1)
Dementia.
A female’s RHR generally averages how many bpm higher than a male’s, due to females having proportionally smaller hearts?(1)
5-10
Arteriosclerosis vs atherosclerosis.(3)
- Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff — sometimes restricting blood flow to your organs and tissues.
- Healthy arteries are flexible and elastic, but, over time, the walls in your arteries can harden – a condition commonly called ‘hardening of the arteries’.
- Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the build-up of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow.
- These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body.
Atherosclerosis plaque formation.(5)
- The normal artery has three layers: intima, media and adventitia. The inner layer (intima) has a line of endothelia cells, and these are in contact with the blood as it flows past. Within the intima, there are also smooth muscle cells (SMCs).
- Atherosclerosis begins with some form of damage and injury to the inner lining of the artery, which creates inflammation. This draws inflammatory cells into the area from the immune system. These blood leukocytes find their way into the injured and inflamed inner artery layer. They then turn into another type of immune cell called a ‘macrophage’. Macrophages are effective at ‘scavenging’ other substances from the blood, moving past the injured area, for example LDL cholesterol. This causes the macrophages to grow into foam cells. At the core of these foam cells are the fat molecules that the LDL carrier offloads.
- To assist with repair and recovery, SMCs move from the middle media layer of the artery to the inner intima layer. The intima also continues to make its own SMCs, as well as other proteins, for example collagen. Even new blood vessels try to grow into the area. As the macrophages and SMCs get trapped in the expanding layer of the artery, they can die and the formation of the plaque begins to advance. When a cell dies, it is called ‘apoptosis’.
- The presence of lots of dying cells creates a lipid / fatty core, which grows further and then becomes unstable. Eventually, thrombosis may occur: the ultimate complication of atherosclerosis. This is when the cap of the plaque ruptures. The space of the artery is narrowed because molecules like platelets, which help blood to coagulate and clot, come into contact with contents of the plaque, which are spilling out.
- The body is programmed to react to a soft tissue injury like this by forming a clot over the damaged area, like a scab that forms on a cut on your arm – however, within an important blood vessel, this can cause a blockage
Peripheral arterial occlusive disease (PAOD).(4)
- Results either from atherosclerotic or inflammatory processes causing blood vessel space (lumen) narrowing (stenosis) or from thrombus formation (usually associated with underlying atherosclerotic disease). When these conditions arise, there is an increase in blood vessel resistance, which can lead to a reduction in blood flow to the peripheries.
- Although atherosclerosis is generally a diffuse process affecting all of the arteries to some degree, some arterial segments in the limbs often undergo greater stenosis than others. Therefore, it is common to find stenotic lesions associated with specific arteries, such as the external iliac or the femoral artery of the legs.
- PAOD can lead to limb ischemia (poor blood supply). In mild to moderate PAOD, the increased resistance to flow will lead to decreased flow capacity during limb exercise (i.e. decreased active transport of blood to that exercising region). This can result in ischemic pain during exercise, which is termed ‘intermittent claudication’. The pain is caused by a lack of oxygen delivery to tissue (hypoxia) when oxygen demand is elevated.
- As a result, metabolites formed under anaerobic conditions in the muscle can stimulate pain receptors. Also associated with the relative ischemia during exercise are muscle weakness and fatigue.
Non-modifiable risk factors for CVD.(4)
- Age
- Sex (men more likely-same once women reach menopause)
- Ethnicity (South Asian most likely to, African caribbean more likely to have high BP-both groups more likely to have type II diabetes
- Family history-If a first-degree blood relative has had coronary heart disease or a stroke before the age of 55 years (for a male relative) or 65 years (for a female relative), the risk increases.
Exercise benefits of modifiable risk factors of CVD.(5)
- High blood pressure: regular aerobic activity can lower systolic and diastolic blood pressure by 5-10 mmHg, which translates into a 10–20% reduction in heart attack risk
- Cigarette smoking: smokers who become physically active are more likely to stop smoking or at least reduce the amount they smoke
- Diabetes: regular aerobic activity has a profound effect on improving resting blood sugar levels and reducing the complications associated with diabetes
- High cholesterol: individuals who perform regular aerobic activity lower their ‘bad’ cholesterol (i.e. LDL cholesterol) levels whilst simultaneously significantly increasing their good ‘cholesterol’ (i.e. HDL cholesterol) levels
- Obesity: although regular aerobic physical is only associated with moderate weight loss (e.g. a reduction of approximately 5% in body weight), this amount of weight loss is associated with positive changes in blood pressure, cholesterol and blood sugar.
6-minute walk test protocol.(6)
- Gather equipment: stopwatch, pen, RPE scale (rating of perceived exertion), claudication scale (see below), and relevant paperwork
- Explain to the client that they must walk 6-minutes over a set distance. An athletics track works well so that laps can be counted and a chair can readily be available should he / she need to sit. A treadmill can also be used where the client uses a self-selected pace (they can modify at any time)
- The client must walk at a moderate pace that is comfortable to them. Inform the client that they can stop at any time but encourage them to give their best efforts
- Pre-test: measure blood pressure, heart rate and any symptoms
- Inform client of every 1-2 min of time lapse (to keep them focused and motivated)
- Post-test: measure blood pressure, heart rate and any symptoms. Also assess RPE score, claudication score, and distance / laps completed. If the client could not complete 6-minutes, note the time and distance / laps completed (e.g. 5:33,7 ½ laps)
