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ACSM Certified Exercise Physiologist
Physical Activity Any bodily movement produced by contracting skeletal muscles, with an increase in energy expenditure. Exercise Planned, purposeful, repetitive Physical Fitness Attributes or characteristics that individuals have achieved that related to their ability to perform physical activity 3 metabolic pathways the body uses to creates ATP
- Creatine Phosphate
- anaerobic glycolysis
- 0xidative system Claudication pain in the leg is induced by exercise, usually because of an artery obstruction. Creatine Phosphate system Small amounts of CP are stored within each cell. Simple one-to-one trade off that allows for the rapid production of ATP. ONLY for use during short bouts of exercise. less that 10 seconds. Anaerobic glycolysis No oxygen required. NExt most immediate energy source. break down carbs (glucose or glycogen) into pyruvate. Used during medium-duration exercise. no more than about 90 seconds. Aerobic glycolysis (oxidative system) Oxygen dependent. As exercise intensity decreases allowing for longer duration activities, use of the oxidative system increases. (Krebs cycle and ETC). Produce ATP in the mitochondria of the cell-- requires oxygen. Lasts longer than 1-2 minutes. What is VO2? The volume of oxygen the body consumes. VO2 max is the highest volume of oxygen the body can consume.
Define Stroke Volume the volume of blood the heart ejects with each beat. How does SV increase with workload? Similar to HR, it increases as workload increases but only up to ~40% to 60% of VO2max. The percentages can be decreases in sedentary individuals and increased with training. What happens to resting HR as stroke volume increases? it decreases, as more blood being pumped per beat allows the heart to beat less often. What is cardiac output? a measure of blood pumped per minute. The product of stroke volume and heart rate. What does Diastolic Blood pressure do during exercise? Remains stable or decreases slightly. What is rate pressure product? serves as an estimate of myocardial oxygen demand. Product of HR and Systolic BP. HR X SBP What is the Fick equation used to determine VO2 max? VO2max = HRmax X SVmax X a-VO2 difference max (arteriovenous oxygen difference) What is the gold standard to measure Cardiorespiratory fitness? VO2 max during open circuit spirometry. How does a submaximal exercise test work? It estimates VO2 max from the HR response to submaximal single stage or graded exercise. absolute oxygen consumption vs. relative oxygen consumption absolute is the raw volume of O2 consumed by the body. Relative is the volume of O2 consumed relative to body weight. Useful to compare fitness levels between individuals. What is one of the largest components of PA-related energy expenditure? Occupational Physical Ativity 5 Health related physical fitness components
150 minutes Moderate PA per week (30 min or more most days of the week), 75 minutes of vigorous intensity Can most sedentary individuals safely begin a low-to moderate intensity PA Program without the need for baseline testing or medical clearance? Yes indeed Most common musculoskeletal injuries occur in what area of the body? lower body- particularly the knee or foot Who is most at risk for sudden cardiac death? Sedentary individuals performing infrequent exercise Light PA is defined as <3 MET's Moderate PA is defined as 3 to <6 MET's Vigorous PA is defined as >/=6 MET's What is 1 MET? Why do we use METs? 1 MET = the relative oxygen consumption at rest. or, 3.5 mL per kg per minute. It is an easy way for the general public to gauge their exercise intensity. Also used to calculate energy expenditure over time. What is a kilocalorie? what is it also known as? AKA: Calorie. estimate of energy cost that can be directly related to physical activity and exercise. Weight gain, loss and maintenance can be estimated remembering that 3,500kcal =1 lb of fat. Is the ACSM's weekly recommended PA sufficient to prevent weight gain in the typical american lifestyle? Hell na! They must go beyond these recommendations. Two types of pre-participation self-guided screenings
- PAR-Q (physical Activity Readiness Questionnaire) 2.Fitness Facility Pre-participation screening questionnaire
What is the PAR-Q? Limitation? A minimal standard for entry into Moderate-intensity exercise programs. allows individuals to gauge their own medical readiness to participate. does not screen well for those at low to moderate risk. What is a pre-participation screening questionnaire? Also useful for clients to assess their health readiness. More comprehensive and recognizes signs and symptoms of CVD and other risk-factor thresholds. What are the ACSM Coronary Artery Risk factors? Age (Men 45 and older women 55 and older), Family History (MI, coronary revascularization or sudden death before 55 in father and 65 in mother or first degree relative), Smoker (current or quit within the last 6 months), Sedentary (no PA in at least 30 minutes of MPA at least 3 days per week for the last 3 months), Obesity (BMI 30 or over, or waist girth >40in for men and >35in for women), Hypertension (SBP 140 or more and/or DBP 90 or more confirmed on 2 seperate occasions), Dyslipidemia (LDL 130 or more OR HDL <40. OR on lipid lowering meds), Prediabetes (Impaired FBG between 100 and 125.) What is the negative risk factor? HDL value of greater than or equal to 60. (this is reverse cholesterol transport and reduces the risk of CVD) Dyspnea Shortness of breath Orthopnea trouble breathing while lying down paroxysmal nocturnal dyspnea difficulty breathing while asleep What classifies as low, moderate, and high risk clients? Low: <2 risk factors and asymptomatic Moderate: 2 or more risk factors and Asymptomatic High: Symptomatic OR known CVD, CPD, renal or metabolic disease What is the exception to missing risk factor information? Prediabetes is counted as a positive risk factor ONLY if the person is 45 or older OR The BMI is 25 or more (and have additional risk factor for prediabetes) What is a contraindication
When a motor unit is stimulated by a single nerve impulse tetanus motor unit stimulated constantly summation motor unit has more than 1 stimulus What is the SAID principle? What is it dependent on? The specificity principle. Specific exercise elicits specific adaptations, creating specific training effects. (Specific Adaptations to Imposed Demands). Dependent on the TYPE and MODE of exercise. Example: a client wants to improve their time in an endurance run, you select training stimulus that is appropriate. (eg. endurance activities, not swimming. 7 ways of determining exercise intensity
- Heart rate reserve method.
- Peak HR method
- Peak VO2. method
- Peak METs method
- VO2 reserve method
- Talk test method
- RPE method (HRR) Heart rate reserve method KARVONEN FORMULA The difference between max HR and resting HR. Target HR = [(max HR -resting HR) X %intensity desired] + Resting HR. Peak HR method 220-age = max HR. (SD of 12-15 BPM) Target HR = max HR X % intensity desired Peak VO2 method must have measured or estimated VO2max. Target VO2 = VO2max X intensity desired Peak METs method Target METs = (%intensity desired)(VO2max in METS -1) + VO2 reserve method What is VO2 reserve?
VO2 reserve is the difference between VO2 max and VO2 rest. (determined in a lab setting) Target VO2 reserve = [(VO2max - VO2 rest) x %intensity desired] + VO2rest Talk test method differentiates between moderate and vigorous activity. If they can talk, but not sing it is moderate. If they are unable to say more than a few words without pausing for a breath it is vigourous. Borg's RPE scale. What level is recommended to improve cardiorespiratory fitness? ranges from 6 to 20. from no exertion at all to maximal exertion. 11 to 16 to improve CRF. What is the CR-10 scale of exertion? (Borg's category ratio scale) scale of 0 to 10. in which 0 is sitting and 10 is max effort possible. 5-6 is mod. 7-8 is vig. Symptoms identified during an exercise test in which the test should be stopped. Drop in SBP 10 or below. Rise in BP above 250 and/or 115. Failure of HR to increase failure of test equipment Do individuals with cardiac, respiratory, metabolic, or musculoskeletal disorders need to be supervised by trained personnel? Yes, when beginning an exercise program What is target heart rate? How do you determine it? Must consider the habitual PA, exercise level, and goals to determine the % intensity desired. Common musculoskeletal injuries signs and symptoms. Point tenderness Pain when body part is at rest Joint pain Pain that continues after warming up. Swelling or discoloration Increased pain with weight bearing activities changes in normal bodily functions Intrinsic risk factors to injury History of previous injury Inadequate fitness/conditioning Body composition Bony alignment abnormalities Flexibility/strength imbalances
Smallest contractile unit of a muscle Sarcomere Type I fibers Slow twitch fibers. Lower contractile force. better for endurance activities Type II fibers Fast twitch fibers. Higher contractile force. better for strength and power activities. Which type of muscle fibers are recruited first? Type I then Type II. as force production increases. initial simple assessment of muscular strength and change in muscular strength between clients (calculation) (kg) weight lifted / (kg) body weight What is a 1RM? Multiple RM? What equipment should be used? 1RM is the heaviest weight that can be lifted in 1 rep. using proper form and technique. STANDARD muscular strength assessment. multiple RM can provide an index of change over time. Performance is significantly greater on weight machines than free weights. Allow 3 to 5 minutes between trials. Obtain 1RM within 4 sets. Muscular endurance assessments. How do you determine which test to use based on each client? Curl-up and push up test. Based on the needs of the client. (poor ab strength is thought to contribute to low back pain. What are the PROS principle of designing a resistance training program? What do they mean? Progression- Regularity Overload Specificity Progression demands placed on the body must be continually and progressively increased over time. Increase at 5% to 10% per week and decrease the reps by 2 to 4 when a given load can be performed for the desired number of reps. Frequency
Resistance training must be performed on a regular basis several times per week to make gains. 2-3 per week. Overload to enhance muscular fitness, the body must exercise at a level beyond that at which it is normally stressed. Manipulated by changing the INTENSITY, DURATION, or FREQUENCY Specificity SAID principle. Specific adaptations to Imposed demands. Distinct adaptations that take place as a result of the training program. Must mimics demands of their sport or desired goals. Types of resistance training (3). Explain each. DCER(isotonic)- most common. weight lifted does not change through the lifting and lowering phase of an exercise. the heaviest weight that can be lifted is limited by the strength of a muscle at the weakest joint angle. Isokinetics- muscle actions performed at a constant angular limb velocity. Plyometric training- enhances neuromuscular performance. quick, powerful movements that involve a rapid stretch of a muscle (eccentric) followed by a rapic shortening (concentric). What is the amortization phase? in plyometrics it is the amount of time it takes to change direction from eccentric to concentric. Should be as short as possible. (<0.1s) to maximize training adaptations. Resistance training program variables. Choice of exercise- promote balance across joints and between opposing muscle groups. Order of exercise- Total body (perform more challenging first and large muscle groups first) Resistance Load Used- Most important variables. Performed to muscle fatigue but not exhaustion. Training Volume- number of exercises performed per session, reps performed per set, number of sets performed per exercise all influence training volume. Rest intervals between sets- muscular strength (rest 2-3min) muscular endurance (rest <1min) repetition velocity-as individuals gain experience they may perform higher-velocity movements. Training Frequency- 2-3 x per week. Periodization- regularly changing the training stimulus to keep it effective. 4 types of flexibility training
- Static- most common. slow constant motion held to the point of mild discomfort.
- Ballistic- rapid bouncing movements. Used by coaches for athletes to increase blood flow before competition. Contraindicated.
- PNF (proprioceptive neuromuscular facilitation)- combining passive stretching combined with concentric and isometric. need partner. GTO plays an important role.
- Dynamic flexibility- slow controlled movements, sport specific that increase core temperature- relate to type of activity.
WHR
How to calculate BMI. Limitations of BMI? divide weight (kg) by height (meters squared). 1kg = 2.2 lbs 1in = 2.54cm 1m = 100cm Does not differentiate between fat and fat free mass. Not a true measure of body fatness. what is BMI classifications of: Underweight Normal Overweight Obesity class I Obesity class II Obesity class III Underweight <18. Normal 18.5-24. Overweight 25-29. Obesity class I 30-34. Obesity class II 35-39. Obesity class II 40+ Central obesity versus gynoid central (apple, or abdominal) vs. pear shaped (hips and thighs) Waist to hip ratio identify people with more central abdominal fat. Divide the circumference of the waist by the circumference of the hips (buttocks/hips) in inches. Using waist circumference alone describes abdominal fat measurement. health risks are higher when measurement is 35+ in for women and 40+ for men. risk category for waist circumference in male and female adults. (very low, low, high, very high) Women: very low <70cm Low 70-89cm High 90-110cm Very high > Men very low <80cm
Low 80-9cm High 100-120cm Very high > standard circumference sites Abdomen Arm *Buttox/hip Calf Forearm Hips/thigh Mid-thigh *Waist % body fat methods. What is the % for men and women that is considered satisfactory for health? Skinfold measurements Bioelectrical Impedance Lab methods for measuring body composition Hydrostatic weighing- calculates body density from body volume Air displacement plethysmography- measures body volume. DEXA- x- ray to measure bone mineral content, body fat, and lean soft tissue. what does hydrostatic weighing assume standard densities for muscle bone and fat 9 skinfold measurements. Principle behind skinfold measurements +- 3.5% error Tension set at ~12 g/mm- Abdominal Triceps Biceps Chest/pectoral Medial calf Midaxillary Subscapular Suprailiac Thigh *the amount of subcutaneous fat is proportional to the total amount of body fat. diagonal skinfolds
define Resting energy expenditure what influences it the most? resting metabolism! energy required to maintain normal regulatory balance and body functions at rest. Also called basal energy expenditure. The amount of calories a person uses if they want to do no activity throughout the day. lean body mass influences it because it is more metabolically active than fat. define thermic effect of food energy required to eat and digest food. The more physically active, the more active their metabolism TEE recommended 1-2lbs/week weight loss in calories 1lb of weight loss is a calorie deficit of 3,500 calories. or 500 calories per day. nor recommended for an individual to consume less than ____ calories per day 1,200 calories ACSM postion stand indicates that engaging in _____ minutes per week of MVPA would result in better weight management 250 min/week. demonstration of exercise is especially important in _____ populations overweight or obese Behavioral strategies for weight loss Self monitoring goal setting stimulus control problem solving How many calories in 1 gram of: carb protein fat alcohol 1 g carbs- 4 calories 1 g protein- 4 calories 1g fat- 9 calories 1g alcohol- 7 calories
energy intake for carbs, protein and fat 45 - 65% of daily energy intake; 70% for athletes; 4 cal/gram 10-15% of daily intake; .8 g/kg of body wt.; athletes may need 1.2 - 1.4 for endurance and 1.6-1.7 for strength; 4 cal/gram 3 abnormal curves of the spine hyperkyphosis, hyperlordosis, scoliosis Pregnant women need an additional ____ calories per day 150 cal per day then 300cal in the 3rd trimester avoid exercising in the ______ position after week _____ Supine position after week 16 pregnant women need as increase dietary need for.... folic acid (B vitamin to prevent serious birth defects) and iron. Vitamin D intake have increased for? what are the levels? all populations but particularly children and older adults (65+). children and adolescents 1-18 600 IU Older adults 800IU Coronary Artery disease accounts for the most cardiovascular deaths. The most prevalent types of CVD. Define athlerosclerosis process where fatty streaks develop, causing the artery wall the thicken while reducing the luminal diameter. begins with a focal injury to the lining of the artery and eventually causes damage to the endothelium. The endothelium then becomes more permeable to lipids , allowing LDL's to move easily through where they are oxidized by macrophages. creating fatty streaks and plaque formation begins. Define myocardial ischemia partial impairment of coronary artery artery blood flow reduces oxygen to cardiac tissue. Define myocardial infarction hEART ATTACK. results in heart tissue death.
permanent enlargement of airspaces along with necrosis of alveolar walls define CRPD Chronic restrictive pulmonary disease. (interstitial lung disease) resulting is desrease dlung volume and lung tissue necrosis. endurance exercise lowers resting SBP and DBP by____ 5 -7 mm Hg Scope of practice for pulmonary disease patients for EP-C prepared to work with a well-controlled asthma client but refer COPD and CRRD clients. NSAID's Nonsteroidal anti-inflammatory drugs. Ibuprofen, naproxen. increase risk of hypoglycemia Strain definition, signs and symptoms. most common sites, treatment injury to a muscle or tendon acute pain, muscle pain and dysfunction usually becomes more apparent 1-2 days after the the injury because of DOMS. most common in the calf and thigh (quads and hamstrings) rates I to III. III is the worst RICE Sprian definition, signs and symptoms. most common sites, treatment injury to a ligament. most common is ankle due to inversion. RICE contusion soft-tissue hemorrhage and/or hematoma that occurs after the disruption of the muscle fibers. PRICE Protection Rest Ice Compression Elevation Phases of tissue healing inflammatory phase (2-3 days) (edema)-fluid in surrounding tissues that act as a brace. repair- 3-5 days after lasting up to 2 months. Exercise during this phase remodeling-weakened repaired tissue.
Overuse injuries Tendinopathy (tendinitis-acute inflammatory,tendinosis-degenerative changes in the absence of inflammation) Plantar Fasciitis Low back pain Plantar fasciitis repeated trauma of the plantar fascia. common in running athletes. Stretching is incorporated Low back pain *drawing in maneuver endurance of core musculature is more critical than strength focus on bracing Arthritis. 2 types. inflammation of a joint. Rheumatoid autoimmune chronic inflammatory disease affecting the synovial lining of joints and other connective tissue. Slow progressive disease. osteoarthritis more prevalent with age. bone remodeling at the joint and overgrowth occurs. Thought to be the result of mechanical injury due to excessive loading or repeated low-force stressors. osteoporosis "silent disease". low bone density or bone mass. increases risk of fracture. largely preventable. Women are 3x more likely to develop it. osteopenia between normal and osteoporosis. describes those at risk for osteoporosis. The female athlete triad. disordered eating amenorrhea osteoporosis age difference between children, adolescents, and older adults children: younger than 13
