1. Exam # 1
February 15
Exam 1 will consist of: 55 multiple choice, matching
and fill-in-the-blank type questions (2 points each)
and 10 short answer questions (4 points each)
In addition to this power point you will also be
questions pertaining to proper patient
positioning, protocols and evaluation of results as
outlined in “Recommendations for Blood Pressure
Measurement in Humans and Experimental Animals”
article

2. Medical Documentation
• SOAP notes
– Not used widely in exercise prescription
– Used primarily in the medical and health care fields
– What does it stand for?
– If working with specific populations in specific facility may
be required to use this form of documentation (i.e. Cardiac
Rehab Facility)
• Most reputable facilities require at LEAST some
medical history questions prior to beginning a work-
out program within the facility
• American College of Sports Medicine (ACSM)suggests
certain documentation be completed prior to exercise

3. Medical History Form
• Longer version of the health screening form
• A great place to start!
• Can be filled out by the individual themselves
or exercise professional can ask the questions
– Use judgment
– If your facilities form has sensitive material on
it, let them fill it out
– If working with an elderly client ask if they would
like assistance

4. Health Screening Form
• Shorter version of the medical history form
• Still effective at measuring an overall profile of
an individual
• NOT to be used with high risk population or
for something with a prescription from a
doctor for exercise
– More extensive form is needed

5. Informed Consent
• Seven items that should be included on all
informed consent documents:
1. Purpose and explanation of the test
2. Clients risks and discomforts
3. Responsibilities of the client
4. Benefits to be expected
5. Inquiries
6. Use of medical records
7. Freedom of consent

6. Physicians Release Form
• Not needed with all clients
– Individuals who fall into the “healthy population”
category may not need physician clearance
– The reason that we need these evaluations is to
find out
• When would you attempt to obtain physician
release form?

7. Risk Stratification
• ACSM has three risk categories that place
people at differing levels of risk:
– Low Risk: Asymptomatic men and women who
have < 1 CVD (cardiovascular disease) risk factor
– Moderate Risk: Asymptomatic men and women
who have > 2 risk factors
– High Risk: Individuals who have known
cardiovascular, pulmonary, or metabolic disease or
one or more signs and symptoms from the
following: See next slide

8. Major S/S or Symptoms Suggestive of
• CV, in the
Pain Pulmonary, or Metabolic Disease
• Ankle edema
neck, jaw, arms, or other • Palpitations or
areas that may result in tachycardia
ischemia • Intermittent claudication:
• Shortness of breath at pain in muscle areas with
rest or with mild exertion inadequate blood supply
• Dizziness or syncope (usually from
• Orthopnea or paroxysmal atherosclerosis)
nocturnal dyspnea: • Known heart murmur
shortness of breath in • Unusual fatigue or
recumbent position or shortness of breath with
when asleep usual activities

9. Fitness Assessment Form
• More to come on this later
– When we complete exercise testing
• Essentially a recording form that allows professional to
record items such as VO2 max, 1RM, musculoskeletal
flexibility assessments made, etc.
• Some facilities like to list guidelines for enhancing
those listed assessments
– i.e. To increase muscular fitness you should have a
mode, frequency, intensity, duration and a number of
repetitions specific to your client that would enhance the
items measured….a lot more to come later!

10. Exercise Prescription Interview Form
• All forms and questions are different
• Attempt to ask questions in the simplest manner
possible
– i.e. Not all people understand what “mode” of exercise
is, use “type” of exercise instead
• Needs to be filled out together with professional and
client
• If you are going to ask the questions, be prepared to be
able to produce the materials should they want them
– i.e. don’t ask if they would like a consult from a
nutritionist, if you do not have that ability, etc.

11. Fitness Goals and Exercise Prescription
Form
• Write the population you are working with
someplace on the form, even if there is not a
place for it
– I.e. if you are working with a weight loss client,
indicate that
• Keep fitness goals limited to start out with
• Rate their commitment, importance and
confidence on a “likert scale”
– Likert scale: Rate the importance for you of your goal
for weight loss
1 2 3 4 5

12. Fitness Contract
• Not a binding contract, but let them know that
they will be held accountable for the plan you
have set forth for them
• Most people will sign without an issue
• Be cautious and answer any questions they
might have when you get to this part
• Remember that they signed an informed
consent form, which holds the legal rights
• This is more of a commitment form

13. Defining Activity
• Physical activity: defined as any bodily
movement produced by the contraction of
skeletal muscles that results in a substantial
increase in energy expenditure
• Exercise: type of physical activity that
planned, structured, and repetitive done to
improve or maintain one or more components
of physical fitness

14. Defining Activity
• Physical fitness: set of attributes or
characteristics that people have or achieve
that relates to the ability to perform physical
activity
– Usually broken down into health-related or skill
related components

15. Physical Fitness Components
Health-related Skill-Related
• Cardiovascular endurance • Agility
• Power
• Body composition
• Coordination
• Muscular strength
• Balance
• Muscular endurance
• Reaction time
• Flexibility • Speed

16. Exercise Intensity Measures
• VO2max: maximal oxygen consumption
• VO2R: oxygen consumption reserve
• HRR: heart rate reserve
• HRmax: maximal heart rate
• METs: metabolic equivalents

17. 2007 AHA and ACSM Update
• Overview:
– All healthy individuals 18-65 need moderate-
intensity aerobic physical activity for a minimum
of 30 minutes five days a week or vigorous activity
for a minimum of 20 minutes three days per week
• Combinations of this can be used
– Every adult should perform activities that
maintain or increase muscular strength and
endurance a minimum of two days each week

18. Benefits of Exercise
Area Benefit
Cardiovascular/Respiratory Function •Increased maximal oxygen uptake
•Decreased heart rate and blood pressure
at a given submaximal intensity
•Increased capillary density in skeletal
muscles
•Increased exercise threshold for the
accumulation of lactate in the blood
CAD Risk Factors •Reduced resting systolic/diastolic
pressures
•Reduced total body fat, reduced intra-
abdominal fat
•Reduced insulin needs
Decreased Morbidity/Mortality •Primary prevention (prevent initial
occurrence)
•Secondary prevention (intervention after
cardiac event)

19. Goal Setting
• Most important: include the client in the
decision making
– Although you may know a lot about the individual
(i.e. blood pressure, EKG readings, etc.) if you tell
them what their goals are they are much less apt
to follow them
• Always maintain a positive attitude and be
open-minded when clients are interested or
disinterested in goals you think are important

20. Goal Setting
• Suggest appropriate and attainable goals and
follow these four guidelines:
1. Goals should be attainable but challenging
2. Set long term and short term goals
3. Goals should be highly specific and practical
4. Clients should enlist social support to help
them reach their goals

21. Goals
• Help clients to break down long-term goals into
short-term manageable goals
• Clients need goals associated with adopting new
life behaviors, not just goals associated with
exercise prescription
• Helping the client to develop social networks that
will help them to stay on track is very helpful

22. Aerobic Demands of Exercise
• Certain demands are placed on the body anytime
an individual participated in physical activity
– Demands increase or decrease depending on
intensity, duration and physical fitness level of the
individual
• Exercise can:
– Aerobic activity can increase the metabolic demands
placed on the heart and increase sympathetic nervous
activity increasing likeliness a heart attack
could happen in people with pre-existing coronary
heart disease

23. Anaerobic Demands of Exercise
• Anaerobic activity can also have detrimental
effects seen even in healthy populations:
– Valsalva maneuver: possibly provoking coronary
ischemia in heart patients
– Extreme amounts of eccentric activity can release
lethal amount of potassium into the bloodstream and
cause the heart to stop
– Rhabdomyolysis: break down of skeletal muscles
causing the release of myoglobin into the blood
stream, eventually causes kidney failure and death
(DOMS)

24. Left Ventricular Hypertrophy
• Also called “Athlete’s Heart”
• Most common cause of sudden death in athletics
• Thickening of the cardiac muscle as a result of
training/stress, to the point that strength/size of heart can
impede blood flow
• Different from Hypertrophic Cardiomyopathy (HCM)

25. Absolute-Risk (Children-Young Adults)
(ACSM)
• High school and college athletes:
– Men: 1 in 133,000
– Women: 1 in 769,000
• Out of 136 total deaths that have been reported:
– 100 were caused from congenital and hereditary
abnormalities leading to the heart malfunctioning
including:
• HCM
• Coronary artery abnormalities
• Aortic stenosis (?)

26. Absolute-Risk (Adults) (ACSM)
• Higher prevalence of cardiovascular disease in
this portion of the population
• During vigorous physical activity-estimated at 1
per year for every 15,000-18,000 people
• Increased risk of sudden cardiac death and acute
myocardial infarction (MI) with vigorous exercise
in this population
• Active adults have between ¼ to ½ the risk of
developing CVD if they are physically active as
recommended by the ACSM

27. Recommendations for Prevention
1. Healthcare professionals knowing the conditions
associated with risk so that clients can be evaluated
appropriately
2. High school and college athletes undergo pre-
participation screening by qualified professionals
3. Athletes or individuals with known cardiac conditions
be evaluated for competition using published
guidelines
4. Active individuals should modify their activity based
on: exercise capacity, habitual activity, and
environment

28. Overview of Process
• Individuals are placed in one of the three
categories (low, moderate, high) based on the
following:
– Presence or absence of known
cardiovascular, pulmonary, and/or metabolic
disease
– Presence or absence of signs or symptoms
suggestive of CVD, pulmonary and/or metabolic
disease
– Presence or absence of CVD risk factors

29. Risk Factor Explanation/Qualification
Family History Parents, brothers, or sisters having heart
attack, bypass surgery, angioplasty, or
sudden cardiac death (male under 55,
female under 65) (If yes=risk factor)
Smoking Client smoked in the last 6 months (If
yes=risk factor)
Blood Pressure ≥140/90=risk factor, takes BP meds=risk
factor (1 total)
Cholesterol LDL >130 and/or HDL <40=risk factor;
HDL >60= (neg.) risk factor; total
cholesterol >200=risk factor
Fasting Glucose ≥100=risk factor
Height and Weight BMI ≥30=risk factor; waist girth >40 (for
men)=risk factor, >34.6 (for
women)=risk factor
Exercise 30 mins. Of moderate physical activity
on most days of week, no? (risk factor)

30. Symptoms (“Yes” places person at
High Risk)
• Pain or discomfort in your • Do you ever experience
chest or surrounding areas? painful burning or cramping
• Do you feel faint or dizzy in the muscles in your legs?
under normal
circumstances? • Has a physician ever said
• Do you find it difficult to that you have a heart
breathe when lying down or murmur?
sleeping?
• Do your ankles ever become • Do you feel unusually
swollen under normal fatigues or find it difficult to
circumstances? breathe with usual
• Do you have hear activities?
palpitations or rapid heart
beat?

31. Other Questions
Question/Category Risk
Men ≥45 and Women ≥55 Moderate risk
Heart disease, PAD, cerebrovascular Yes to any=High risk
disease, COPD, asthma, interstitial lung
disease, cystic fibrosis, diabetes
mellitus, thyroid disorder, renal disease,
or liver disease
Bone or joint problems that may Yes=exercise testing may need to be
exacerbated exercise? delayed or modified
Do you have a cold, flu or any other Yes=exercise testing must be delayed
infection
Are you pregnant? Yes=exercise testing postponed or
modified
Any other problem that may make it Yes= JUDGEMENT
difficult for you to exercise?

32. Low Risk
• Young (45 or younger for men, 55 or younger for
women) with no more than one coronary disease
risk factor and without symptoms or known
disease
• Risk of acute CV event is low and an exercise
program may be pursued safely without medical
exam or clearance
• Can offer low risk clients a submaximal or
maximal exercise test without physician
supervision

33. Moderate Risk
• Older (45 or older for men, 55 or older for
women) or with two or more coronary disease
risk factors
• Advisable to have a medical examination and
exercise test before participation in vigorous
exercise
• Can do submaximal testing or enter a moderate
exercise program
• Do not test these individuals in a fitness facility
without a doctor

34. High Risk
• With one or more symptoms or known
cardiopulmonary, cardiovascular, metabolic, or
pulmonary disease
• Should not be tested without a physician present
• Should not begin an exercise program without
medical evaluation/clearance
• Risk of acute MI for this population is very high
• “Ticking time-bomb….”

35. Recommendations for Exercise Testing
and Participation
• Once risk category has been established the
following can be decided upon:
– Necessity for medical exam/clearance
– Changing the FITT (frequency, intensity, time, and
type--more to come later) framework of an existing
exercise program
– Necessity for an exercise test
– Necessity for physician supervision for a maximal or
submaximal test