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NSCA's Essentials of Personal Training > Part 5 Clients with unique needs > Flashcards

Part 5 Clients with unique needs Flashcards

1
Q

True or false? You should be alarmed if a child breathes rapidly during exercise

A

False

Kids have a higher breathing frequency and lower tidal volume than adults, they breath more rapidly. Children will exhibit a lower stroke volume and higher heart rate at all exercise intensities.

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2
Q

Why should kids participate in a diversity of sports and activities?

A

They don’t really exhibit metabolic specialty. E.g. the strongest kid is also likely to have good aerobic endurance. Whereas adults can be very strong (e.g. weightlifters) but have poor aerobic endurance.

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3
Q

What is the recommended amount of physical activity in children?

A

60 minutes per day of moderate to vigorous physical activity.

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4
Q

True or false? Children should not participate in resistance training

A

False

The myth about closure of epiphyseal plates is unfounded. Children are okay and recommended to participate in resistance training for muscular strength and bone health. They must be accompanied by qualified supervision however, home gym use by children typically leads to injury.

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5
Q

Children can increase their strength by resistance training. How is this possibly physiologically?

A

They do not produce enough androgens for hypertrophy so this is likely by neural adaptations and muscle composition changes.

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6
Q

How can sports injuries be prevented in children?

A

Six to eight weaks of preseason preparatory fitness conditioning before sport participation. Particularly with girls to prevent knee injury.

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7
Q

What is a good rep scheme for children resistance training?

A

10-15 reps to start then 6-15 reps.

2-3 times per week.

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8
Q

True or false? Competition can be a good motivator for training pre-adolescents

A

false. Should instead focus on skill improvement, personal successes and having fun.

Regimentation should be avoided

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9
Q

True or false? Regular aerobic activity increases the volume of both gray and white matter in various regions of the brain after six months of training

A

TRUE

Good for older adults.

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10
Q

What are the four ways in which resistance training lowers the risk of cardiovascular disease?

A
  • Reduced body fat (especially because of positive impact on resting metabolic rate-may actually be better for body fat reduction than aerobic training)
  • Decreased resting blood pressure
  • Improving blood lipid profiles
  • Enhanced vascular condition, improved endothelial function and peak flow mediated dilation in the brachial artery.
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11
Q

What exercises modalities might decrease risk of colon cancer? Why?

A

Running and resistance training

They hasten gastrointestinal transit speeds.

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12
Q

What two exercises modalities might decrease risk of type ii diabetes?

A

Aerobic endurance training and resistance training

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13
Q

What can prevent osteoporosis

A

Resistance training

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14
Q

What can treat pain from arthritis?

A

Resistance training. Stronger muscles can improve joint function and reduce arthritic discomfort.

There is not much evidence on prevention though.

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15
Q

True or false? Resistance training seems productive in counteracting depression in older adults

A

True

Probably partly because of increased functionality in daily life.

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16
Q

What are the two biggest impacts to quality of life from aging AND can be counteracted with resistance training?

A
  • Sarcopenia

- Slowing of metabolism

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17
Q

Aging causes mitochondrial impairment. What type of training can improve mitochondrial function?

A

Circuit training

The anearobic exercise sets coupled with the aerobic rest intervals can increase mitochondrial content and oxidative capacity of trained muscle tissue

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18
Q

How long should reps be for seniors?

A

4-6 seconds per rep. Full ROM (excluding positions with discomfort) and 2-3 non-consecutive training days per week.

10-15 reps for beginners
8-12 for more advanced older adult lifters (e.g. once they can do 15 reps the resistance should be increased 5%)

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19
Q

What is the recommended resistance % of max with corresponding repititions

A

Acceptable (higher strength)
90% - 4 reps
85% - 6 reps

Recommended
80% - 8 reps
75% - 10 reps
70% - 12 reps

Acceptable (lower strength)
65% - 14 reps
16% - 16 reps

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20
Q

What is the recommended aerobic endurance frequency for older adults?

A

2-5 days per week, 20-60 minutes

60-90% of maximal heart rate

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21
Q

When training seniors what is more important? Perceived exerted effort or percent of maximal heart rate achieved?

A

Perceived effort. Medication and other factors can mess with heart rate. Though both measures should be used together for best practice.

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22
Q

What should be the exercise order for older adults?

A
  1. Aerobic acitivty
  2. Resistance training
  3. Static stretches
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23
Q

What is the best trimester for a pregnant women to train?

A

Second trimester after the vomiting and nausea of first trimester has resolved and before physical limitations of third trimester begin.

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24
Q

What are 11 benefits of prenatal exercise programs?

A
  • Improved cardiorespiratory and muscular fitness
  • Facilitated recovery from labor
  • Faster return to prepregnancy weight, strength, and flexibility levels
  • Reduced postpartum belly
  • More energy reserve
  • Fewer obstetric interventions
  • Shorter active phase of labor and less pain
  • Less weight gain
  • Improved mood and self-concept
  • Reduced feelings of stress, anxiety, and depression
  • Increased likelihood of adopting permanent healthy lifestyle habits
  • Reduced likelihood of preeclampsia (pregnancy induced hypertension) and gestational diabetes mellitus
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25
Q

What intensity of exercise is best for pregnant women?

A

Moderate

Intense exercise can lead to lower birthweight due to less subcutaneous fat (undesirable). Exercises DOES NOT however increase incidence of preterm labor or delivery

Pregnancy elevates a woman’s basal metabolic rate and heat production, which may further increase by exercise. Overheating should be monitored and should result in immediate cool-down.

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26
Q

What two groups are ratings between 12-14 on the RPE scale appropriate?

A
  • Older adults

- Pregnant women

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27
Q

What pose should pregnant women not exercise in after the first trimester of pregnancy?

A

Supine (on back)

Increasingly large uterus restricts venous return back to the heart in this position.

The large uterus also changes a pregnant woman’s centre of gravity, in which case machines may be more advisable over free weight movements.

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28
Q

What respiratory considerations need to be made for pregnant women?

A
  • Pregnant women may increase their minute ventilation by almost 50%, resulting in 10-20% more oxygen utilization at rest. Less oxygen is available for aerobic activity.
  • The uterus puts pressure on diaphragm, increasing effort of breathing.
  • Valsalva maneuver should be avoided as it puts pressure on abdominal contents and pelvic floor
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29
Q

What muscles are most important to strengthen in pregnant women?

A

Postural/abdominal and pelvic muscles (kegels) as these will avoid trauma from falls and also help with delivery.

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30
Q

List 8 absolute contraindications to a pregnant woman exercising

A
  • Pregnancy induced hypertension (preeclampsia)
  • Ruptured membranes
  • Premature labor during the current pregnancy
  • Persistent bleeding after 12 weeks
  • A cervix that dilates ahead of schedule (incompetent cervix)
  • Significant heart disease or restrictive lung disease
  • Multiple-birth pregnancy that creates a risk of premature labor
  • A placenta that blocks the cervix after 26 weeks.
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31
Q

Give nine signs and symptoms that suggest discontinuing of exercise in pregnant women and seeking of medical advice

A
  • Bloody discharge from vagina
  • Dyspnea (labored breathing) before exertion
  • Headaches or unexplained dizziness
  • Chest pain
  • Muscle weakness
  • Calf pain or swelling
  • Preterm labor
  • Decreased fetal movement
  • Amniotic fluid leakage
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32
Q

Why can exercises like skating, outdoor cycling, and horseback riding not be considered for pregnant clients?

A

Risk of trauma to abdomen

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33
Q

Give the BMIs for the following classiciations

Underweight
Normal
Overweight 
Obese
Extremely obese
A 
Underweight: <18.5
Normal: 18.5-25
Overweight: 25-30
Obese: 30-40
Extremely obese: >40
34
Q

True or false? Clients who are overweight may benefit simply by increasing physical activity along with some minor changes in their diets. Those who are obese should concentrate on both reducing caloric intake and increasing physical activity.

A

TRUE

35
Q

Define gynoid and andoid obesity

A

Gynoid (pear shaped, mostly in thighs)

Android (apple shaped, mostly in abdomen, riskiest)

36
Q

True or false? Skin fold measurements for body fat in obese patients are recommended

A

False, for practical reasons.

37
Q

Why is exercise more important for diet for weight loss in obese clients?

A
  • Lowers risk factors for CVD
  • General physiological benefits
  • General psychological benefits
38
Q

What is considered a low calorie diet for men and women?

A

men: 1200-1600 kcal per day
women: 1000-1200 kcal per day (up to 1600 per day for active or over 165 lb women)

Very low calorie diets (VLCD) should be monitored by a physician, typically involve special supplements and are 800 kcal per day or less. After one year LCDs have the same success rate as VLCD.

39
Q

What is a reasonable weight loss goal for obese clients?

A

Reduction of body weight by 10% in 6 months.

40
Q

True or false? Dietary prescription or counseling is within the scope of a personal trainer’s practice

A

False

Personal trainers can only offer nutritional education (e.g. readings labels, holiday eating tips, low calorie food choices etc.)

41
Q

At the beginning for obese patients which is more recommended?

  • Longer sessions of moderate intensity
  • Shorter sessions of higher intensity
A
  • Longer sessions of moderate intensity

Longer durations and lower intensities are advisable, at least at the beginning, to avoid injury and promote adherence.

42
Q

What is hyperpnea?

A

Hyperpnea or hyperpnoea is increased depth and rate of breathing. It may be physiologic—as when required to meet metabolic demand of body tissues (for example, during or after exercise, or when the body lacks oxygen at high altitude or as a result of anemia)—or it may be pathologic, as when sepsis is severe.

A concern with obese clients.

43
Q

List seven concerns with training obese patients

A
  • Heat intolerance
  • Movement restriction and limited mobility
  • Weight-bearing stress on joints
  • Posture problems and lower back pain (inadequate strength of abdominal wall muscles + stress of abdominal weight on spine)
  • Stronger than normal hip flexors contribute to muscular imbalance and posture pain as well
  • Balance concerns (balance training should be considered)
  • Hyperpnea and dyspnea (deep fast breathing and labored breathing respectively, can bring client fear, can be ameliorated by having clients exercise according to perceived exertion)
44
Q

What sort of disordered eating can lanugo hair (baby-fine hair over face and body) be attributed to?

A

Anorexia

There may also be yellow tint to skin, palms and soles of feet due to high levels of carotene

45
Q

How is bulimia nervosa different from anorexia?

A
  • Anorexia is characterized by highly controlled food intake which may or may not be followed by purging.
  • Bulimia is characterized by loss of control in food intake (bingeing) followed by purging and perhaps excessive exercise as well. People with bulimia typically have large (ten lbs or more) weight swings
46
Q

What is the female athlete triad?

A

Disordered eating can result in females having the following interrelated disorders

  • Disordered eating
  • Amenorrhea
  • Osteoporosis
47
Q

What is an antiatherogenic diet?

A

TLC diet, heart healthy diet. Lowers cholesterol levels if combined with physical activity and weight loss.
- Limited intake of saturated fats and cholesterol (<200 mg a day)
-

48
Q

What are exercise recommendations for clients with hyperlipidemia?

A

5 or MORE sessions of physical activity a week of at least 30 min in duration with 40-70% VO2R or HRR

49
Q

What sort of exercises are contraindicated for clients with hypertension?

A

THose that increase intrathoracic pressure and thereby reduce blood flow return to the heart with a corresponding decrease in cardiac output.

ANY exercises with a valsalva maneuver is contraindicated and the onus is on the personal trainer to ensure client is breathing correctly.

50
Q

How should hypertensive clients resistance train?

A

If they have bp over 140/90 than they cannot train, they must see doctor first.

Once bp is controlled. They should do reps from 16-20 per set 50-60% 1RM, and only one set per exercise.

Rest interval should be 2-3 minutes.

These numbers can increase to numbers more in line with a healthy adult over time.

51
Q

How should post-myocardial infarction be trained?

A

These patients should never perform valsalva maneuver.

Long warm up and cool down.

20 reps per set at first. 2-3 sets per exercise. 40% of VO2 max.

2-3 days per week at 15-40 min per session.

Big focus is rebuilding confidence on doing simple things

52
Q

True or false? A VO2 and 1RM need to be determined for victims of cerebrovascular accident (e.g. stroke) before beginning training

A

False

VO2max and 1RM are not usually knowable in these clients due to how detrained they have become by the event. Trainer needs to pick up where medical team left off in rehabilitation

53
Q

What is the aim when training clients with peripheral vascular disease?

A

These patients have pain when they walk. The goal is to increase duration they are able to walk incrementally over time.

54
Q

How should clients with asthma be trained?

A

In morning due to timing of cortical steroid release (less risk of triggering bronchospasm). Also intensity should be measured by perceived exertion as this will reach a max threshold before heart rate (11-13)

Emphasis on progression is duration instead of intensity in order to desensitize the client o the dyspnea

55
Q

What are METs?

A

Metabolic equivalent of task

A unit of energy to monitor aerobic intensity.

It works well for asthmatic patients.

It is essentially the amount of energy being used to perform an activity in multiple of resting activity (e.g. 1 MET is equivalent to rest, 2 METs is equivalent to burning 2x the resting rate etc.)

56
Q

Why is it important to incorporate balance work into client’s programs with low back pain?

A

People without low back injury tend to stabilize or fulcrum the ankle, but those with low back pain tend to stabilize or fulcrum about the hip and low back to keep an upright posture. This makes them prone to falling and having difficulties with postural balance. Working on this can lead to improvement.

57
Q

What type of movements should be limited for individuals with lumbar disc injuries?

A

Any that cause flexion or rotation of the lumbar region. So sit ups, deadlifts, squats, rows etc. (anything that can round the back - as this can cause posterior protrusion of the disc material)

58
Q

What are contraindicated movements for individuals with spondylolysis and spondylolisthesis?

A

Lumbar extension

Squat, shoulder press, push press

Abdominal exercises are good for strengthening stabilizer muscles

59
Q

What two types of shoulder injuries should avoid overhead work and what one shoulder injury should avoid anterior/posterior movements?

A

Avoid overhead

  • Impingement syndrome
  • Rotator cuff pathology

Avoid posterior/anterior movements
- Instability

The first two should only do rotator cuff and pain free strengthening exercises until recovered

Instability injuries should limit client to rotator cuff strengthening exercises, scapular strengthening exercises, and stabilization static to dynamic exercises.

60
Q

How should shoulder exercises be anchored to prevent injury?

A

Using an approach that ensures stability of the joint during functional activities through engagement of the scapular and rotator cuff muscles.

61
Q

How are knee injuries typically approached?

A

Each of the knees joint structures requires a specific type of exercise to return the client to full function after injury or surgery.

With anterior knee pain the focus is on reducing inflammation and pain with partial squats/leg presses, partial lunges, and stair steppers with SHORT choppy steps.

With Total knee arthroplasty the emphasis is on ROM with partial squat and leg press, partial lunge, leg extension and leg curl, stationary bicycle and swimming.

Quadriceps and hip strengthening is a common goal in nearly all knee injury rehabilitation and is a key to returning more normal function after injury

62
Q

How is a hip arthroplasty (replacement) approach as a PT?

A

As tissue healing advances, hip arthroscopic rehabilitation must progressively address strength, balance, and sport-specific training for the entire lower extremity.

Contraindications: forceful hip flexion, hip abduction and rotation (early phase of rehabilitation). No ballistic or forced stretching.

Exercise indication: aquatic walking

63
Q

How should arthritis be approached as a pt?

A

Clients with OA or RA both benefit from performing strengthening and aerobic exercise. The difference between the two is the body’s response to activity. Exercises should not increase joint pain for either group. Particular care must be given to the client with RA during periods of exacerbation.

Contraindication: high impact activities. Running, snow skiing, jogging

Exercise indications: bicycle, stair stepper, elliptical trainer, aquatics, swimming.

64
Q

What is the main limitation for training individuals with rheumatoid arthritis (not present with osteoarthritis)?

A

With RA special care should be made not to cause excessive flexion of the neck or do behind the neck movements (e.g. shoulder press)

Flexibility exercises are good and isometric exercises for the unstable joint are good.

65
Q

What is autonomic dysreflexia?

A

A relatively common manifestation of spinal cord injury.

Autonomic dysreflexia is a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above).

Can be triggered by noxious stimuli such as infection, full bladder, constricting clothing, or any pain or irritating stimuli below injury level. PT can ask client to void bladder before each session and ask them if they are experiencing symptoms of hypertension before starting.

Some SCI athletes attempt to increase BP, called boosting. Can increase performance by almost 10% but is very dangerous.

66
Q

What is the most common type of injury to people with spinal cord injuries?

A

Overuse injuries. Such as carpal tunnel or shoulder/wrist injuries. Especially for patients in wheelchairs.

These injuries may be prevented through an exercise program designed to stretch the anterior and strengthen the posterior muscle groups of the shoulder girdle.

67
Q

At baseline, what are the vitals like for a client with a spinal cord injury?

A
  • Higher heart rate
  • Lower blood pressure
  • Individuals with high lesions are unable to increase skin blood flow in paralyzed areas and therefore unable to thermoregulate well. Increases risk for both cold and heat related injuries.
  • Venous return is low and blood pooling can occur. This can lead to decreased stroke volume and hypotension during exercise. Exercising supine on a bed or with compression clothing can prevent this.
68
Q

How does the heart typically adapt to spinal cord injuries?

A

Atrophies.

69
Q

What are some considerations for training clients with MS?

A

Persons with MS are prone to heat intolerance. Methods to precool the client and to ensure a cool, comfortable environment for exercise can enhance the physiological benefits and increase adherence. Proper hydration is critical to maintaining temperature balance during exercise in persons with MS.

Resistance training program guidelines for people with MS should resemble those for untrained people without MS. A standard progressive resistance program of 8-10 exercises, 60-80% 1RM at 8-15 repetitions should work. Though MS patients will probably make progress half as fast. Focus should be on reducing spasticity. Daily stretching should also be done to improve ROM, reduce spasticity, and improve balance.

Aerobic exercise to exhaustion should be avoided in clients with MS. Persistent fatigue lasting more than two days should be a warning sign that an exercise program is excessive. Intensity should start around 50% VO2 max for 10-40 minutes

70
Q

What is probably the best way to assess fitness of clients with MS?

A

Submaximal arm or leg ergometer. This is because of incoordination and possible spasticity.

This is ONLY done after a physician has cleared the client of any CVD risk.

71
Q

What is status epilepticus?

A

Seizure lasting more than 30 minutes or a series of seizures that occur so frequently that consciousness is not restored. 911 and transfer to ER is necessary.

72
Q

What are considerations to take when training a client with epilepsy?

A

Regular aerobic exercise may contribute to improved seizure control. However, in 10% of individuals, vigorous exercise may be a seizure precipitant.

73
Q

What are the suggested exercise modifications for the following seizure precipitants?

A

Emotional stress: decrease intensity

Hyperventilation: teach breathing technique and control

Menstruation: modify intensity to a lower level

Sleep deprivation: Avoid exercise

Fever: avoid exercise

Photic stimulation: avoid situations during exercise (e.g. no flashing lights)

Alcohol excess or withdrawal: Modify intensity to lower level

74
Q

What are some considerations for training a client with cerebral palsy?

A

Cerebral palsy is an irreversible condition and medical and rehabilitative therapy focuses on controlling spasticity and athetosis (writhing contortions of appendicular musculature) and improving function and neuromuscular coordination.

Persons with CP can expect a systematic program of physical exercise to yield health and fitness benefits similar to those obtained by persons without CP

In general, maximal loads should not be used for resistance training and maximal effort aerobic/anaerobic endurance activities should only be used in the lowest risk clients.

75
Q

How should a trainer design an athlete’s resistance training program?

A

The more similar the training activity is to the actual sport movement, the greater the likelihood of a positive transfer to that sport. Therefore, the personal trainer should design the resistance training program to include at least one exercise that mimics the movement patter of each primary skill of the athlete’s sport.

76
Q

Define the three main types of cycles and 5 phases that can be programmed as part of periodization

A

Cycles

  • Macrocycle (entire training year or more)
  • Mesocycle (several weeks to a few months)
  • Microcycles (one to 4 weeks of daily and weekly training variations

Phases (mesocycles)

  • Hypertrophy (building foundation)
  • Strength (increase maximal muscle force)
  • Strength/power (increase peed of force)
  • Competition or peaking (high intensity, low volume, sport specific)
  • Active rest (low volume and low intensity resistance training, may be unrelated to sport)
77
Q

What is an undulating periodization model?

A

Involves within-the-week or microcycle vacillations in both assigned training load and volume for most or all core exercises. This is nonlinear and opposed to the linear model (which is more common)

May be better for strength training but trainer must monitor closely because of the high relative loading (even light days include relative loading).

78
Q

Explain a linear periodization model

A

A linear periodization program involves gradual and continual increases in training intensity and gradual and continual decreases in training volume from one mesocycle to the next, but no variation in the assigned number of sets and repetitions within each mesocycle.

Allows for adequate rest in a systematic way.

Used for training throughout a sport’s in season.

79
Q

What makes periodization effective?

A

It programs systematic variation that allows athletes to adequately recover from assigned loads and repetitions.

80
Q

What are the assigned training loads for a linear periodization program with the following

Heavy day
Medium day
Light day

A

Heavy day: 100% of the assigned training load

Medium day: 90% of the assigned training load

Light day: 80% of the assigned training load (even if the client can do more)

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