Practice Test- Wrong Answer Review Flashcards
Components of Physical Fitness
Refers to a set of health or skill-related attributes that can be MEASURED by SPECIFIC TESTS including:
- Muscular Strength (1RM)
- Muscular Endurance ( # of reps)
- Cardiorespiratory Fitness (VO2 max)
- Flexibility (E.g. Thomas Test)
- Body Composition (BIA, Hydrostatic Weighing etc)
2008 ACSM Guidelines for increasing muscular strength and endurance
- Do 8-10 exercises for the major muscle groups (legs, hips, back, chest, shoulders, arms)
- To maximize strength development, use a resistance that allows 8-12 repititions of each exercise, at which point fatigue is experienced
- One set of each exercise is sufficient, although more can be gained with 2 or 3 sets
- Do resistance training on 2 or more non consecutive days each week
MR PLEASE
- Make a classification as to wheter or not the individual currently exercises regularly
- Do they exercise?
- Review medical hx for established CV, metabolic or renal disease
- Do they have CV/DM/CKD?
- Pertinent signs of CV, metabolic or renal disease identified
- Do they have s/s of CVD/DM/CKD?
- Level of desired aerobic exercise intensity
- How difficult should their exericse be?
- Establish if medical clearance is necessary
- Should we get clearance for this level of exercise?
- Administration of fitness tests and evaluation of results
- Let’s check your current level of fitness
- Setup of exercise prescription
- This is the plan
- Evaluation of progress with follow up tests
- How are we progressing?
Positive Risk Factors
for Risk Statification Scoring
- Age ( MEN >=45, Women >=55)
- Family Hx: MI, coronary revascularization or sudden death before 55 years of age in father or other 1st degree male relative OR before 65 years of age in mother or other 1st degree female relative
- Cigarette Smoking: Current or quit in the last 6 mo
- Sedentary Lifestyle: Not participating in at least 30 mintues of mod-intensity PA on at least 3 days/week for at least 3 months
- Obesity: BMI >30, or waist girth >40” men, >35” for women
- Dyslipidemia: LDL >130, HDL <40, On lipid lowering meds. Total chol >200
- Prediabetes Fasting BG >100, impaired OGTT >140 and <200
Negative Risk Factors for Risk Stratification Scoring
High HDL >= 60 mg/dL
Describe ACSM’s Risk Stratification for Low Risk
& Need for Medical Exam / Doctor Supervision
Low Risk
Asymptomatic, <=1 Risk Fctor
Medical Exam & GXT before exercise?
XX
NOT NECESSARY FOR EITHER MODERATE OR VIGOROUS EXERCISE
Doctor Supervision of Exercise Test?
XX
NOT NECESSARY FOR EITHER MODERATE OR VIGOROUS
Describe ACSM’s Risk Stratification for MODERATE Risk
& Need for Medical Exam / Doctor Supervision
MODERATE Risk
Asymptomatic,
>= 2 Risk FActor
Medical Exam & GXT before exercise?
Moderate: NOT necessary
Vigorous: GXT not necessary, YES medical exam
Doctor Supervision of Exercise Test?
SubMax: NOT necessary
Max: RECOMMENDED
Describe ACSM’s Risk Stratification for HIGH Risk
& Need for Medical Exam / Doctor Supervision
HIGH Risk
SYMPTOMATIC
KNOWN cardiac pulmonary or metabolic disease
Medical Exam & GXT before exercise?
Moderate: RECOMMENDED
Vigorous: RECOMMENDED
Doctor Supervision of Exercise Test?
SubMax: RECOMMENDED
Max: RECOMMENDED
Anatomical Plane for Oblique Twists
TRANSVERSE plane AKA Horizantal plane
Cuts the body into top and bottom halves. Twisting movements.
TRANSVERSE = TWIST
Number of Bones in Body
200
Short Bone
Tarsals (ankle)
Carples (Wrist)
Approximately as wide as they are long
Planes and their Axis and movements
The mediolateral axis is perpendicular to the SAGGITAL plane
The Saggital Plane splits from Left from Right and describes FLEXION/EXTENSION movements
FORWARD AND BACK movements
The Anteroposterior axis is perpendicular to the FRONTAL plane
The Frontal Plane splits from front and back and describes ABD and AD-duction movements
SIDE TO SIDE movements
The longitudinal/vertical axis is perpendicar to the TRANSVERSE plane
Transverse plane splits top from bottom and in in regards to ROTATING movements
TWIST
Axes of Movement
-
Mediolateral (or horizantal) axis: Perpendicular to the Sagittal Plane. FLEXION and EXTENSION occur around this axis
- S-M-F-E : Sam Moves, Flexes and Extends
-
Anteroposterior axis: Perpendicular to FRONTAL Plane. ABDUCTION AND ADDUCTION occur around this access
- FAAA
- Fiona Acts, Abducts and Adducts
- FAAA
- Longitudinal Axis: Perpendicular to the TRANSVERSE plane. INTERNAL AND EXTERNAL ROTATION occur in this plane
- TLR
- Tyler’s Loopy, Rotates
- TLR
Axis Perpendicular to the Transverse Plane
LONGITUDINAL Axis
Name the 3 Major Muscle Actions
- Concentric Action - when a muscle shortens under tension
- Requires the muscle to overcome the force of gravity
- E.g. the flexion of a Bicep curl
- NOTE: A ballistic movement contains both concentric and eccentric action
- Eccentric Action
- E.g. the extension of a bicep curl
- The tension is not great enough to cause movement but instead SLOWS the speed of movement in the opposite direction
- Muscle lengthens and the joint moves in the opposite direction than the muscle is pulling caused by another force (e.g. gravity)
- NOTE: A ballistic movement contains both concentric and eccentric action
- Isometric Action
- STATIC action.
- Muscle exerts a force that is EQUAL in magnitiude to an opposing force
- Muscle length does not change and the joint position is maintained
- The Contractile part of the mmuscle shortens, but the eleastic connective tissue lengthens proportionately, so there is no overall change in the entire muscle length
- E.g. Plank
Muscle Structure and Function
Muscle Fibers
Myofibrils
Sarcomeres
Muscle Fibers: Each cylindrical fiber forms one cell. It is composed of a large number of myofibrils
Myofibrils: Run the length of the muscle and give skeltal muscle its striated apperance. A myofibril is composed of a series of sarcomeres
Sarcomeres: The fundamental units of contraction which contain the thick filament Myosin and Thin filamin Actin (thin is actin’), bouded by connective tissue called the Z line
Energy Sources and Duration of use
ATP
Phosphocreatine (PC)
Glycolysis
Flycogenolysis and Fat Oxidation
- ATP
1. Small amount available immediately, good for ~1 second - Phosphocreatine (PC)
- Stored in muscle cells
- Lasts 3-5 seconds e.g. muscle contraction
- Glycolysis
- Anaerobic breakdown of glucose
- Provides ~2 minutes of energy. e.g sprints, 400 meter dash, MAX WORK
- Produces lactic acid, Hydrogen ions which accumulate and interferes with muscle contraction
- Flycogenolysis and Fat Oxidation
- Oxygen must be present to create long term energy
- Comes from muscle glycogen, blood glucose, fatty acids (triglycerides), and intramuscular fat
- Used for SUBMAXIMAL activities >2 minutes and less than 2 hours. E.g. marathon
Protein for Athletes
Endurance
High-intensity, high-volume resistance training
Vegetarian Athletes
Endurance: 1.2-1.4 g/kg BW
High-intensity, high-volume resistance training: 1.2-1.7 g/kg BW
Vegetarian Athletes: 1.3-1.8 g/kg BW
Hydration for Exercise
Before exercise
During Exercise
Dehydration increases risk of heat cramps, heat exhaustion, and heat stroke
BEFORE: Athletes should consume 5-7 ml/kg BW of water or sport beverage at least four (4) hours prior to competition. IF this consumption does not yield urine OP, consume additional 3-5 ml/kg BW Two (2) hours before the event
DURING: Consuming 400-800 mL during endurance exercise is adequate for most
AFTER: Replace 16-24 oz water for each pound lost
Prescribing Exercise: Key Definitions
Dose
Effect
Potency
Slope
Maximal Effect
Variability
Side Effect
- Dose
- Amount of exercise prescribed. The “bout”of exercise
- The dose is different for elite performance than functional health
- Effect
- The body’s response to the dose
- Potency
- the ABILITY of an exercise to BRING ABOUT a certain result
- Intensity of the exercise.
- Closely related to dose
- High intensity may be done less frequently than moderate. Running vs walking
- Slope
- Reflects how much of an effect RESULTS from a change in dose
- Changes can be short term or long term, depending on the effect being measured
- E.g. HR and lactate response vs serum cholesterol
- Maximal Effect
- Getting the highest response from the dose
- Specific doses may impact some risk factors / outputs, but not others.
- Moderate exercise improves risk factors
- Strenuous exercise can modify, or revers risk factors and improve VO2Max
- Variability
- The effect of a specific dose of exercise differs from one individual to another, OR within one individual depending on the circumstance
- Side Effect
- Possible adverse effects such as injury or death
Characteristics of an Exercise Dose
FITT Principle
-
F: Frequency: How often? 5 days a week, 3-4 days a week. 7 days a week
- # of times per day or week
-
I: Intensity: How hard? Moderate, Vigorous/Hard, Very Hard
- % VO2 max, % max HR, RPE, Lactic Threshold
- T: Time: How Long? Duration in minutes: 30 min/day, 30-45 min per day, 60-120 min/day
-
T: Type: What Kind? Mode or kind of activity
- Aerobic vs Anaerobic .
- Walk. Jog. Run.
- Resistance or cardiorespiratory endurance.
- Swimming vs running vs rowing
Calculating Heart Rate Reserve
HRR = HRmax − HRrest
How much your Heart Rate can speed up with exercise. Allows a better target heart rate to be determined for optimum training capacity based on both maximum and resting heart rate.
E.g. 34 yo F
Max HR: 208-0.7(34) = 184.2
RHR: 66 bpm
HRR: 184.2-66 = 118
Determining Target Heart Rate
Direct Method
Indirect Method
Direct Method - GXT method. HR is monitored at each stage and plotted on a graph against the VO2/MET equivalent of each stage
Indirect Methods
- Heart Rate Reserve- HRR: Difference between HRmax and HRrest
-
Percent Heart Rate Max - % HRmax - Fixed percentage of max HR. Simple and validated. Direct relationship between %MaxHR and %VO2 max;
- 55-75% VO2 max = 70-85% HRmax
- 60-80% VO2 max = 75-90% HRmax
Comparison of Resistance Training Modes
Weight Machines
Free Weights
Body Weight
Balls & Chords
-
Weight Machines
- Both single joint and multijoint
- Occurs in only ONE anatomical plane
- Motion is controlled by the machine
-
Free Weights
- Require use of stabilizing and assiting muscles to hold the correct body position during an exercise
- Can occur in different planes.
- Encourages different muscle groups to work together while performing exercises that are similar to the participatn’s chosen sport or activity
- Greater variety of exercises
-
Body Weight
- Minimal equipment
- Difficulty in adjusting the body weight to the individual’s strength level
-
Balls & Chords, tubing
- Inexpensive. Can be used to enhance strength, lcal musclar endurance and power.
- Challenge proprioception. Helps with agility, balance and coordination
Warm up
Cool Down
Warm Up - Increases body and muscle temperature, increases blood flow and may enhance performance. 5-10 minutes of moderate to high intensity aerobic exercise such as slow jogging or stationary cycling
Cool Down - May reduce risk of cardiovascular issues (E.g. low BP)
Priciples of Training (PROS)
Principle of Progression
Principle of Regularity
Principle of Overload
Principle of Specificity
-
Principle of Progression- increase demands
- Demands must continually increase over time to realize goals
- denotes the concept of systematically manipulating program variables to optimize training adaptations over time
- Important after the first 2-3 months, when the training threshold for adaptations is higher
- Increase weight incrementally by 5-10% and decrease repetitions after each goal is met
-
Principle of Regularity - HOW OFTEN
- Training must be completed several times weekly
- Use it or lose it - training adaptations cannot be stored
- Long term gains in strength and performance require consistent training
-
Principle of Overload - increase in level of difficulty
- Body must be stressed beyond the point to which it has alrady adapted
- If the training stimulus is not challenging, adaptations will not occur
- Overload can be maniupated by changing
- INTENSITY,
- VOLUME,
- SPEED,
- REST INTERVALS, AND
- TYPE OF EXERCISE
-
Principle of Specificity - changing variables for specificity
- Adaptations are specific to muscle actions, velocity, ROM, muscle groups, energy systems, intensity, and volume of training
- Training-induced adaptations are consistent with the design of a resistance training program
- SAID - Specific Adaptations to Imposed Demand
- Training adaptations do not transfer from one body part to another, or one activity to another
- Systematically manipulating program variables to optimize training adaptations over time
Spinal Curves
Changes in Thoracic Kyphotic Curve and
Lumbar Lordotic Curve
Issues: Increased anterior pelvic tilt
Tightness in hip flexors
Sitting at desk all day
Increased anterior pelvic tilt: Increases LORDOTIC curve in the lumbar area, which increases the stresses on the ligaments, vertebrae and musculature of the spine (Especially L5)
Tightness in hip flexors: Can cause increased lordosis by causing an anterior pelvic tilt
Tightness in hamstrings: Can reduce lordosis, causes forward placement of the head for balance
Sitting at desk all day: Increases the thoracic Kyphosis and Decrease the lumbar lordotic curve. Putting a towel in the lumbar spine can help with maintaining lordotic curve
Being overweight, wearing high heels, lacking appropriate muscle length or sterngth - all effect degree of lordosis
Effect of sleep on spine health
The spine is particularly vulnerable at the beginning of the day because the discs imbibe tissue fluid while recumbent in sleeping postures, resulting in tighter discs that are more vulnerable to sprain or other injury
ACSM Guidelines for STRETCHING
Frequency
- 2-3 times per week with daily producing the best results
- Total of 60 seconds per stretch (10-30 sec per rep can be effective) repeated 2-4 times.
- Older adults may benefit form 30-60 sec with each stretch
- Can be passive, static, dynamic, ballistic, or contact-relax style as in proprioceptive neuromuscular facilitation (PNF)
- PNF = 3-6 sec light to moderate volutional muscle contraction with 10-30 sec assisted stretch
- Should not cause pain
- Should not take joint past normal ROM
Types of Stretches
Static
Active
Passive
Ballistic
Dynamic
Proprioceptive Neuromuscular Facilitation (PNF)
-
Static
- Muscle is slowly lengthened to a point where further movement is limited, and it is held for a period of time
- Preferred when designing a flexbility program for older adults
-
Active:
- Assume a position witha muscle in a lengthened position and hold it there wit NO assistance other than the strength of the agoist muscles.
- E.g. Quadricept holds the leg straig in the active hamstring stretch
- The tension of the agonist in an active stretch helps to relax the muscles being stretched by reciprocal inhibition
-
Passive:
- No active muscular contraction in the stretched muscle
- E.g. fitness pro holds the leg of a client in a hamstring stretchand gently presses the leg into a stretch as the client is totally relaxed
-
Ballistic
- Involves using velocity and a fast bouncy movement to stretch the muscle
- May be considered for adults in sports that involve ballistic movements but may not be safe because the forces involved with bouncing may push tissues past a safe length where the client can control the movement and prevent injury
-
Dynamic
- Includes moving while stretching, but it does not include bounding or pushing muscles past their normal ROM.
- e.g. Arm circles, progressing from smaller to larger as shoulders warm up
-
Proprioceptive Neuromuscular Facilitation (PNF)
- Used in clinical setting
Foundation of the Spine
The Pelvis serves as the foundation for the spine
The ability of the trunk muscles to control pelvic positioning is essential for maintaining a neutral spine and a healthy back.
If either hip flexors or hip extensors are too tight, posture may be compromised
Low back Pain
In Adults
In Youths
In Adults: most often caused by series of inappropriate movements and deconditioning over time
In youths: most often caused by: Stress fracture of the pars interarticularis
Functional Curve
Structural Curve
-
Functional Curve
- can be removed and resumed by a deliberate change in posture
- May be present due to a spasm or tightness of a particular muscle group and will disappear when the client is lying down or bending or when the spasm has dissipated
- A functional curve may eventuall become structural if one assumes an unhealthy posture over several years
-
Structural Curve
- Always present independent of the person’s position
- Fixed
- Not flexible
*
Spinal Anatomy
Motion Segment
Facet Joint
Ligaments
Discs
-
Motion Segment
- Consists of two vertebrae and their intervening discs
-
Facet Joint
- Involves the jjunctions of both the superior and inferior processes
- Supports load and controls the amount and directon of spinal movement
-
Ligaments
- A series of ligaments reinforces spinal support
-
Discs
- Allow flexibility and act as shock absorbers
Muscular Strength and Endurance in Older Adults
- Decreases with age b/c of decrease in motor units as well as reduction in the size of the remaining muscle fibers
- Intense resistance training (80% 1RM) results in large increases in strength which is attributed to neural factors
- Begin with light intensity 40-50% ROM for the first few weeks to allow for adaptation to the activity
- at least 1 set of 10-15 reps of 8-10 exercises that use the major muscle groups
- For the frail elderly, resistance training may be more important than aerobic conditioning to help maintain balance and posture, thus reducing risk for falls
Balance And Falls
Progression of difficulty in Balance Exercises
Ordered from easiest to hardest
-
Narrow the base of support
- Stand with feet apart with assistive device
- With feet apart w/o device
- with feet together
- heel to toe
- one-legged stance
-
Displace the center of mass -
- Turn in a circle
- Shift weight side to side
- Step over obstacles
- Do crossover or sideways walking
- Move weighted arms to front and side
-
Minimize contributions of visual and proprioceptive pathways
- Close eyes with movements mentioned above. Stand on foam, pillow or mattress
Calcium intake in children
25% of boys and 10% of girls achieve recommended levels for calcium intake
Recommendations for Aerobic Exercise Programming in outpatient cardiac rehab (phases II and III)
Phase IV : Maintenance Phase
F: 3-5 days per week
I: Moderate intensity equivalent to 40-80% VO2max or HRR or RPE 12-16 on a 20 point scale
T: 20-60 min per day (min 10 min)
T: prolonged, rhythmic, dynamic exercises using large muscle groups
5-10 min warm up and cool-down exercises
Phase IV : Maintenance Phase
Hypertension
Definition (systolic / diastolic)
“Stage 1 HTN” per the book
Q: According to the ACSM, which of the following individuals would meet the threshold criteria for the risk factor of hypertension
SBP 140-159
OR
DBP 90-99
Answer: A teenager whose last two blood pressure (BP) readings were 112/84 mmHg and 125/88 mmHg, controlled with medication
Why? THIS PERSON IS ON ANTIHYPERTENSIVE MEDS, despite having “normal” readings
Coronary Heart Disease accounts for what percentage of CVD deaths in the US?
51%
Stroke = 17%
HTN: 7%
CHF 7%
Statins and their effect on muscle
Lipid lowering drugs such as statins can cause a significant degree of muscle problems (myalgia, myositis and rhabdomyolosis) that could negatively affect exercise
Weight loss goal for clients who are overweight or obese?
0.5-1 kg/week
May be done through calorie reduction and increase in physical activity
Percentage of American Children that are Obese
- 3% (at or above 95th percentile for BMI)
- 2% are overweight (at or above 85% for BMI)
Transtheoretical Model Stages of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance
- Precontemplation:
- Individual is not seriously thinking about changing an unhealthy behavior in the next 6 mo or is denying need to change
- Contemplation
- Individual is seriously thinking about changing an unhealthy behavior in the next 6 mo
- Preparation
- Transitional stage in which the individual intends to take action with the next one (1) month. Some plans have been made, and the individual tries to determine what to do next
- Action
- The stage is the 6 mo following the overt modification of an unhealthy behavior.
- Motivation and investment in behavior change are sufficient in this stage, but it is the busines and least stable stage and has highest risk of relapse
- Maintenance
- Begins after the individual has successful adhered to the healthy behavior for 6 mo
- The longer someone stays in maintenance, the lower the risk of relapse
Intervention Strategies for the Stages of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance
- Precontemplation
- Implement a media campaign promoting exercise, educate about personal benefits of exercise, foster values clarification, conduct HRAs and fitness testing
- Contemplation
- Market benefits of exercise, foster self and environmental reevaluation, provide clear and specific guidelines for starting an exercise program, be a positive role model, idnetify social support for exercise
- Preparation
- Conduct psychosocial and fitness assessments, evaluate supports/benefits and barrers/costs, design personalized exercise prescription, set goals, develop behavioral contracts, teach time management skills
- Action
- Identify social support for maintaining exercise, set up stimulus control, teach self-reinforcement, implement self-efficacy enhancement strategies, set goals, teach self-monitoring, employ relapse prevention
- Maintenance
- Encourage new activities with others, reinforce self-regulartory skills, review and revise goals, introduce cross training, conduct periodic fitness testing
Characteristics of an Effective Helper
Empathy
Respect
Concreteness
Genuineness
Confrontation
- Empathy - Expression of Understanding
- Respect - Positive Regard for the Participant
- Concreteness - Specific and Clear Communication
- E.g. Helping a client be more specific about their feeligns and goals (through communicatoin)
- Genuineness - Being authentic and sincere
- Confrontation - Telling the person what you see differently. Honesty
Enhancing Adherence: Methods for participants in the action and maintenance stages
Assessment
Self-Monitoring
Goal Setting
Reinforcement
Behavioral Contracts
Relapse prevention
-
Assessment: Necessary to select and implement the appropriate strategies
- Part of the reassessment process involves identifying motivation, finding out what previous attempts at change, setting realistic goals and identifying high risk situations
-
Self-Monitoring: Recording info about behavior, thoughts, feelings, and situations before, during and after the behavior
- Can identify motivators
- Barriers become evident and fit pro can help develop strategies to overcome them
- TIME MANAGEMENT is important part of Self-monitoring
-
Goal Setting: to accoplish a specific task in a specific time frame
- SMART, behavioral
-
Reinforcement: Social and self-reinforcement are crucial
- Rewards important to the individual
-
Behavioral Contracts
- Increase adherence
- Clear and realistic objectives and deadlines
- Consequences of meeting and not meeting goals s/b clearly established
-
Relapse prevention
- Help them realie that relapse doesn’t mean failure
- ID strategies for dealing with high risk situations
- Determine strategies for prevention
Care for Seizures
Immediate Care
After Seizure
Critical Care
-
Immediate Care
- Activate EMS
- Note time of onset
- Assist individual in SUPINE position
- Protect head with soft materials/padding
- Remove nearby objects
- Remove glasses and loosen clothing
-
After Seizure
- Open airway and assess breathing
- Place on SIDE
- stay with individual until fully awake
-
Critical Care
- If lasting 5 min or successive seizures
- Activate EMS
- Document Length of time and number
- If lasting 5 min or successive seizures
Soft- Tissue Injuries
Sprains
Strains
Sprains -
- Acute- Caused by a single tensile force that produce a stretch or tear (partial or complete) of a ligament (E.g. lateral ankle sprain)
- Chronic- occurs from repetitive forces acting on a ligament (e.g. tennis elbow, little league elbow)
Strains (S-T- SKELETAL MUSCLE/TENDON)
- Involves a tensile force caused by overstretching or partial or complete tear of a MUSCLE OR TENDON
- E.g. Hamstring Strain
Cold-Realated Problems
Superficial Frostbite
Deep Frostbile
Mild Hypothermia
Moderate-Severe Hypothermia
- Superficial Frostbite
- Freezing of skin layers and subcutaneous tissue
- Deep Frostbile
- Freezing of deep tissue, including muscle and bone
- Mild Hypothermia
- Body temp 37-35 C (98.6-95 F)
- Moderate-Severe Hypothermia
- Core body temp 34-32C (94-90 F)
Dehydration
Occurs when more body water is lost via sweat, vomiting, or diarrhea than can be replaced by fluid intake
Weigh before and after activity to monitor fluid loss
- Up to 2% Water loss is considered Safe
- 3-5% Loss is CAUSE FOR CONCERN
- >5% is considered serious and activity s/b suspended until fluid weight is adequately replaced
TORT LAW - 3 levels of fault
Intentional
Negligence
Strict Liability
- Intentional
- Harms such as assult, battery and invasion of privacy
- Negligence
- Harms due to ordinary negligence or gross negligence
- Strict Liability
- Product liability and vicarious liability
TORT LAW
4 Elements to Prove Negligence
Duty
Breach of Duty
Causation
Harm and Damages
- Duty
- The defendant owed a duty (or standard of care) to the plaintiff
- Breach of Duty
- The Defendant failed to carry out the duty
- Causation
- The breach of duty was the cause of harm
- Harm and Damages
- Harm occured to the plaintiff, resulting in damages (losses) to the plaintiff (e.g. medical expenses, lost wages)
Defense Against Negligence
Primary Assumption of Risk
Informed Consent
Primary Assumption of Risk
Carrying out Legal Duties Properly
Primary Assumption of Risk
- legal theory in which plaintiffs are generally not allowed to seek damages for an injury that was due to inherent risks. For successful defense
- The risk must be inherit to the activity
- the participant must voluntarily agree to participate
- the participant must know, understand and appreciate the inherent risk
- Informed Consent - informing participants of the inherent risks associated with PA can strengtehn this defense
- Waiver - based on CONTRACT LAW that contains a exculpatory clause absolving the defendant from its own negligence
- Since waiver law is complex and can vary significantly from state to state, fitness pros must have a competent lawyer approve any waiver prior to use
Carrying out Legal Duties Properly - THE BEST DEFENSE
CONTRACT LAW
4 ELEMENTS
Agreement
Consideration
Contractual Capacity
Legality
- Agreement
- An Agreement to form a contract includes an OFFER and an ACCEPTANCE
- Consideration
- Any promises made by the parties to the contract must be supported by legally sufficient and bargained-for consideration
- Contractual Capacity
- Both parties entering into the contract must have contractual capacity to do so
- Legality
- The purpose of the contract must be to accomplish some goal that is legal and not against public policy
1RM testing guideliens
- Beginners must learn how to exert maximal effort by participating in several familiarization session s with each testing protocol prior to testing
- Untrained clients tend to misinterpret submax effort due to lack of training experience
- Max or near max stregth tests ARE SHOWN TO BE SAFE and reliable for clinical populations including those with CHD and T2DM
- Caution should be used when testing older adults, patients with clinical conditions and people with certain orthopedic concerns
- Clients should maintain strict posture and maintain a constant speed of contraction.
Normative Strength Scores
Strength Scores have bgeen developed for various age and sex catagories
The normative data are generally derived frp, a relatively homogenous sample of subjects using certain types of resistance training equipment.
Client scores should be compared with norms that were generated from the same testing protocol and equipment used during the testing of the client.
Rheumatoid Arthritis
Occurs more frequencytly in females than males
Can appear ANY TIME time in life
Autoimmune condition that is a chronic inflammatory polyarthritis (affects 5+ joints)
Causes joint stiffness and decreased ROM (chronic low-back dysfuntion)
Osteoarthritis
Much more prevalent (90-95% of arthritis cases)
Usually beings after age 40
Disease of the entire joint involving the cartilage, joint lining, ligaments, and underlying bone.
This leads to pain, joint stiffness, and significant impact on LB dysfunction, loss of ROM
Occurs more in women than men
Facet joint OA is a common case of LB dysfunction, follows lumbar disc degeneration
Age related changes in Spinal ROM
Over time, flexion, lateral flexion and extension dcline 45-79%
The average ROTATION does not decline with age
Iliotibial Band (ITB) Tests
Tightness frequently contributes to KNEE dysfunction and is affected by alignment changes such as overpronation of the feet
Can affect athletes ADDUCTION abilities
OBER’S TEST is performed to assess ITB tightness
SIT and REACH test
The sit-and-reach can be used to measure HIP JOINT flexibility, but does not measure LOW BACK ROM in conventional use (depends on tigthtness of hamstrings)
To make the sit-and-reach test better
- Examine quality of movement (angle of the sacrum).
- Examine smoothness of the spinal curve.
- Test one leg at a time.
The number of centimeters reached is NOT the most valid indicator of perforamcen; it is better advised to examine the subject’s quality of movement (angle of sacrum and smoothness of spinal curve)
If the sit-and-reach test is used, it is better to measure performance as each leg is extended individually rather than making just one measurement as both legs are extended concurrently.
The sit-and-reach test can be further refined by permitting plantar flexion of the ankle of the tested leg.
Scoliosis Test
Adam’s Test
Tests for Hamstring Tightness
Straight-leg raise (passive
Active Knee extension (AKE) test
Maximum Voluntary Contraction
Peak force development during a maximal stregth test
YMCA Bench Press Test
The fixed starting weights may be too heavy for the unfit or elderly
The test should begin with the bar in the DOWN position touching the chest, with the elbows flexed and hands shoulder-width apart
Count 1 rep when elbows fully extended. After each extension, lower bar to chest
Complete 1 rep in time to the 60 BPM which should be 30 lifts per min
Count the total number of reps completed in good form
Dynamic Strength Test
The assessment of maximal muscle strength involving movements of the body (e.g., a push-up) or an external load (e.g., a bench press)
Skinfold Measurement Analysis
Lange and Haprenden calipers - precise and reliable
Key points:
Read the measurement on the caliper 1-2 seconds after the jaws contact the skin
Wait at least 15 seconds before taking a subsequent measurement
Take a third measurement if the second varies by more than 1-2 mm
General Guidelines for Cardiorespiratory Fitness Programs
Screen Participants
Encourage Regular Participation
Provide a variety of Activities
Program for participation (a 10% increase in number of mintues per week is reasonable)
Adhere to Format for a Fitness Workout
Conduct Periodic Fitness Tests
Studies suggest that gains in cardiorespiratory fitness (CRF) associated with exercise training increase with the frequency of exercise but level off at about 4 days per wk.
Essential % Body Fat
Men 3-5%
Women 8-12%
Strength
The maximal force that a muscle or muscle group can generate at a specified velocity
Power
Rate of performing work and is the Product of Strength and Speed of movement
Power = Strength x Speed
Plyometrics
“Strength-Shortening Cycle Exercise:” A hallmark of this type of training is rapid eccentric muscle action followed by rapid concentric muscle action.
Examples of this type of training include skipping, hopping, depth jumping, and throwing, hopscotch, jumping jacks
This type of training emphasizes POWER over ENDURANCE
TrA Recruitment
Transverse Admoninus
IT has been shown that an inward movement (drawing in/hallowing) of the lower abdominal wall when the client is in a SUPINE poisition produces the most independent activity of the TrA compared with other abdominal musculature and may be an ideal position to teach TrA recruitment
LAYING DOWN
DCER
Dynamic Constant Extgernal Resistance Training
This type of training involves a lowering and lifting phase.
The term “isotonic” was formerly used to describe this training. Iso (constant) tonic (tension). HOWEVER, tension exerted by a muscle as it shortens VARIES with the mechanical advantage of the joint and the length of the muscle fibers at a particular joint angle, so isotonic does not accurately describe this training method
It is the most common method of resistance training used.
Primary Stabilizers of the Spine
Secondary Stabilizers of the Spine
Primary:
Transverse Abdominis (TrA)
Multifundus (MF)
Secondary:
Obliques (internal and external)
Quadratus Lumborum (QL)
Isokinetic Training
A type of resistance training where the speed of movement rather than the resistance is controlled
This type of training refers to muscle actions performed at the same angular limb velocity.
Involves expensive equipment.
This type of training generally trains only single-joint movements.
Multi joint exercises
They are generally more effective in increasing muscular strength because they involve a greter amount of muscle mass and therefore enable a heavier weight to be lifted
Require more balance and coordination
They have been shown to have the greatest metabolic and anabolic hormonal response (testosterone and growth hormone) - which favorably influence resistance training that targets improvements in muscle size and body comp.
Exertional Heat Illnesses
EHS - Exertional Heat Stroke
Heat Exhaustion
EAMC (heat cramps)
Heat Syncopy
EHS - Exertional Heat Stroke
- Hyperthermia associated with CNS distubances and MOSF. Life threatening condition. Must wait another 2 weeks after recovery to exercise
Heat Exhaustion
- Inability to continue exercise associated with any combinatino of heavy sweating, dehydration, sodium loss, and energy depletion
- Occurs most in hot, humid conditions and shares may of the same s/s of EHS
- In mild cases, no return to activity for at least 24-48 hours
EAMC (exercise associatd muscle cramps - heat cramps)
- Painful, involuntary muscle contractions that occur during or after intense exercise
- Caused by dehydration, electrolyte imbalance, fatigue, or a combination of these factors
- Responds positively to conservative treatment and participants can return safely to activity
Heat Syncope
- Fainting or ecessive loss of strength due to heat
Cold Related Problems
Superficial frostbite
Deep Frostbite
Mild Hypothermia
Moderate to severe hypothermia
Superficial frostbite
- Freezing of skin layers and subcutaneous tissue
- dry waxy cold skin and firm to touch
- redding along w/ white or blue gray patches
- edema
- tingling or burning
Deep Frostbite
- Freesing of deep tissue including muscle and bone
- Skin is Hard, cold, waxy and immobile, White, gray, black or purple
- Burning, aching, throbbing or shooting pain
Mild Hypothermia
- Body temp 37-35C (98.6-95 F)
- Pale skin, shivering, cold extremeties
- amnesia, lethargy
- impaired motor conrol
- excessive urination
- typically concious
Moderate to severe hypothermia
- CoreBody temp 34-32C (94-90F)
- Bluish tinged skin
- impaired neuromuscular function
- impaired mental function
- slurred speech
- reduced respiration and pulse
- dilated pupils
- decreased BP
- cessation of shivering
- loss of conciousness
- muscle rigidity
Periodization Cycles
Macrocycle
Mesocycle
Microcycle
Macrocycle
- about 1 year in length
Mesocycle
- 3-4 months
Microcycle
- 1-4 weeks
Each cycle having a specific goal (hypertrophy, strength or power
At the start of a mjacrocycle, training volume may be high and the training intensity may be low. As the year progresses, the volume decreases as the intensity increases
Resting Between Sets and Exercises
Goal is increasing muscular strength
Goal is local muscular endurance
Beginners
Goal is increasing muscular strength
- Includes heavier weights
- Rests are longer 2-3 minutes (120-180 seconds)
Goal is local muscular endurance
- Lighter weights
- Rests are shorter <60 seconds
Beginners
- Short rests (<30 sec) are not recomended for beginners because of the discomfort and high blood lactate concentrations
Rests can be shortened gradually over time to provide ample opportunity for the body to tolerate increased muscle and blood acid levels (e.g. circuit training)
Repitition Velocity
Unintentionally slow velocities
Intentionally Slow Velocities
- Gains in muscle strength are specific to the training velocity
Unintentional Slow Veolicites: used when a heavy resistance is lifted and the velocity is slow despite the attempt to exert maximal force
Intentional Slow Velocity:
- used when a person trains with a submaximal load and purposefully performs the exercise at a slow velocity. Increasing TIME UNDER TENSION with intentional slow velocities results in greater fatigue and less muscle fiber activation.
- Concentric force production is lower for intentionally slow velocities; therefore, lighter loads performed at an intentioally slow veolcity may not be optimal for maximizing strength development
Muscle Contraction Steps
Sliding Filament Theory
In the sliding-filament theory, the thin ACTIN filaments slide over the thick MYOSIN filaments, pulling the Z LINE toward the center of the sarcomere
- Muscle is depolarized (excited) by a motor nueron
- Action potential spreads through the transverse tubules in the sarcomere
- Sarcoplasmic returiculum releasese calcium into the sarcoplasm
- Calcium binds with troponin (on the Actin filament) which cause the tropomyosin molecules to move, revealing available Myosin attachment sites on the Actin Filament.
- The Pi on the myosin heads get released as they move toward the Acin attachment sites, forming a crossbridge.
- The remaining ADP molecule is expended in use of a powerstroke when the myosin heads pull the actin inward
- Once the ADP is spent, ATP attach themselves to the myosin heads, triggering release of myosin heads from actin attachment sites (recovery stroke)
Detailed:
- In the ready state, the MYOSIN crossbridge (THICK FILAMENT) is tightly bound to the ACTIN filament (Thin filament)
- ATP binds to myosin, allowing it to release from the actin filament
- ATPase on the myosin hydrolyzes the ATP to access energy and the myosin head moves away from the actin filament. ADP and Pi remain bound to myosin
- The myosin head moves and binds to a new actin molecule
- The myosin head releases the Pi which intiates the power stroke, PULLING the thin filament toward the center of the sarcomere
- After the powerstroke, the myosin head relases ADP and returns to the ready state. This process continues until the ends of the muosin filaments reach the Z discs, or until the Ca is pumped back into the SR
Resistance Training for people with Heart Disease
a rating of perceived exertion of 11-14 on am RPE scale of 6 to 20 may be used to guide effort.
Measuring Muscluar Strength and Local Muscular Endurance
According to ACSM, tests allowing fewer than 3 repetitions before momentary muscle fatigue measure muscular strength, whereas those that require more than 12 repetitions measure local muscular endurance.
Genetics and Obesity
Inheritance contributes anywhere from 30% to 70% to the variation in obesity among individuals.
Adopted children have BMIs that are similar to those of their biological parents.
Links between genes and obesity have been suggested scientifically, but the expression of the gene depends on environmental factors.
Prevlance of Overweight and Obesity
US prevealence of obesity: 34.9%
US prevelence of overweight AND obesity: 68.5%
Non-hispanic Blacks: 76.2% (overweight AND obesity) but 56.6% are considered obese
Hispanics 77.9% (overweight AND obesity)
Based on waist circumference, 43.5% of men and 64.7 of women have abdominal obesity
