CSSD Board Exam Study Guide

Pro-Style Nutrition Study Guide for the CSSD Board Exam

• Study guide designed for individuals preparing to take the Certified Specialist in Sports Dietetics (CSSD) Board Certification Exam.

• Includes a study outline based on the 2017 content outline provided by the Commission on Dietetics Registration.

• Includes suggested resources and references

• Includes preparation and study tips, including a 6-week study plan/schedule.

• Includes Quick Check Review Questions upon completion of each content area.

• Includes 20 practice questions in a similar format to the CSSD Exam.

• Includes references to separately available full practice mock examination of 150 multiple-choice questions, flash cards, slide decks, and recorded lectures.

• Disclaimer states the study guide assumes the user has a basic knowledge of sports nutrition and intends to serve as a review, not as a first-time teaching tool.

Suggested Resources and References

• The Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine released a position statement on Nutrition and Athletic Performance in 2016.
• The IOC released a consensus statement on relative energy deficiency in sport (RED-S) in 2018.
• The Academy of Nutrition and Dietetics released revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists.
• Vegan diets: practical advice for athletes and exercisers was published in 2017.
• A review and recommendation on exercise and sports nutrition was updated in 2018..
• The American College of Sports Medicine released an Exercise and Fluid Replacement position stand in 2007.
• The National Athletic Trainers' Association released a Position Statement: Evaluation of Dietary Supplements for Performance Nutrition in 2013.
• Karpinski C and Rosenbloom C wrote "Sports Nutrition: A Handbook for Professionals" in 2017, and the exam closely follows this book's content.
• Burke LM and Deakin V (eds) wrote "Clinical Sports Nutrition" in 2015, which is helpful for obtaining a clinical perspective.
• Quick Guide To Sports Nutrition was written by Dr. Melissa Brown and Kaneen Gomez-Hixson in 2019, which is helpful for consolidating information.

Preparation and Study Tips

• Preparation for the CSSD exam requires content knowledge and accruing required advanced practice hours.
• There’s distinction between a “Certificate" obtained online and “Board Certification” through CDR, so, advance planning for practice hours is crucial.
• First, one must be a Registered Dietitian/Registered Dietitian Nutritionist (RD/RDN).
• To be eligible, one needs 2,000 practice hours in sports nutrition within the past 5 years for initial certification and 1,500 hours for re-certification.
• It is highly recommended to review the entire CSSD Examination Handbook for Candidates early in the process.
• One can use an educational degree once for initial certification but not for re-certification.
• Education includes 300/400 hours for a completed masters/doctoral degree in sports nutrition, exercise science/physiology/kinesiology, or nutrition with sports emphasis.
• Professional activities completed within the previous five years may also be used for credit.
• This includes 20 hours of publication as primary author in a peer-reviewed scientific journal or 10 hours as a co-author.
• It also allows 100 hours for a published sports nutrition/dietetics textbook or manual, or 15 hours for a published chapter.
• Gaining 20 hours for sports research as the PI or 10 hours as a Co-I, or 75 hours for continuing education in sports-related topics.
• 500 hours may be granted for completing the International Olympic Committee Diploma in Sports Nutrition.
• The examination fee is $350.00 for those residing in the U.S. and $475.00 outside the U.S, and is due upon application submission.
• It is important to review the process for verifying eligibility early in the process.
• Appointments to take the exam can now be scheduled year-round, with immediate results provided.
• Pass/Fail statistics are updated regularly by the CSSD website.
• The CSSD exam consists of 150 multiple-choice questions with a three-hour completion time.
• Of the 150 questions, 125 count toward the score, while 25 are "test questions" pilot questions for content, clarity, and appropriateness testing.
• Candidates can enter feedback on any question deemed misleading or incorrect.
• Determining study time depends on individual learning styles.

Study Methods

• One can adjust the schedule to fit individual needs.
• Determine if visual, audio, or a combination learning styles work best to determine how to study.
• Consider making your own notes, watching PowerPoint lectures, completing practice questions, and case studies.
• Flashcards can be either self-made or purchased.
• Selecting 1-3 resources can be less overwhelming.
• Schedule the exam date and create a study plan.
• Studying should start at least 6 weeks before the exam so that the time to complete a study plan is adequate to review the information, and to practice calculations.
• A timeline and study grid should outline plans for each week.
• The CSSD exam is heavily based on application, emphasizing athlete nutrient needs, current intakes, and potential deficiency calculations.
• Practice selecting the "best" or "most appropriate" answer.
• One strategy is to take a practice exam before starting the study process, highlighting areas of strength and weakness.
• Highlight areas of study materials that need review, eventually consolidating them into a "cheat sheet."
• Find study buddies to brainstorm ideas.
• Locate and drive to the test center before exam day, which helps budget time, locate building, parking and get familiar with the logistics.
• Simulate test day, scheduling a day and time and running through a mock exam under realistic conditions.
• The day before the exam should involve relaxing, exercising, eating well, and getting adequate sleep.
• On exam day, fuel up with familiar foods and hydrate.
• Bring a backup calculator.
• Arrive at the testing center 20 minutes early while reminding yourself you are are prepared.
• Use the restrooms before starting the exam.
• Ensure to take the practice tutorial beforehand.
• Read each question and answer choice completely to ensure no misunderstanding what is bing asked.

Example schedule includes

• A full mock exam to find strengths and weaknesses for the various areas.
• #1 area is 1A, Energy Metabolism
• #2 area is 1B, Fueling for Training and Competition
• #3 area is 1C, Fluid and Electrolyte Balance
• #4 area is 1D, Sports Foods and Supplements
• #5 area is 2A, Energy Balance and Availability. 2B Weight Management. 2C Special Populations.
• #6 area is 2D, Disordered Eating. 3A Food and Beverage Management. 3B Nutrition Administration
• Additional areas provided in 98-103, with identified weak areas, flash cards, re-read position and do practice questions and consensus statements.
• Repeat the mock exam, focusing on large question-quantity areas of the CSSD exam.
• Content area #1 represents 75 questions total and should be spent the most time on.
• One should ensure that they understand content area 1A Energy Metabolism before reviewing the rest of the content areas.
• Content area 1B should be next as one needs to adjust recommendations based on special populations and clinical conditions.
• Weekly assignments may not work for everyone, so if one takes a mock exam and the information seems too familiar skip the first content area.

Content Area 1: Exercise and Sports Nutrition

• There are 75 questions on the CSSD Board Exam.
• Area 1A, Energy Metabolism has 26 questions.
• Area 1B, Fueling for Training and Competition has 26 questions.
• Area 1C, Fluid and Electrolyte Balance has 13 questions.
• Area 1D, Sports Foods and Supplements has 10 questions.

Content Area 1A: Energy Metabolism Topics

• Analyze and interpret data for performance enhancement and health.
• Design nutrition strategies for active individuals applying energy metabolism.
• Explain energy storage in skeletal muscle and tissues.
• Describe oxygen transport in exercise and training.
• Evaluate factors influencing substrate use and exercise metabolism data.
• Evaluate factors contributing to exercise-induced fatigue.
• Describe nutrition and exercise effects on health and performance.
• Explain carbohydrate, fat, and protein/amino acid use during exercise/training/competition/recovery.
• Describe vitamin/mineral requirements for training/exercise and the potential risks of excessive supplementation.
• Describe antioxidant function in relation to exercise/recovery/long-term training adaptations.

Energy Systems

• Adenosine Triphosphate [ATP] is the energy currency of the cell: nitrogenous purine base, pentose sugar and three phosphates.
• ATP is the fuel for all energy-requiring cell processes and generates power for “work” by releasing energy and activating muscle contraction
• Resynthesis of ATP can occur from CP or creatine phosphate via the phosphagen system, anaerobic glycolysis, and aerobic metabolism.
• Every muscle contraction requires ATP. , and all metabolic systems work concurrently where each contribution depends on oxygen availability and demand.
• Factors determining fuel source include: exercise duration and intensity, training level, and diet composition.
• Four Major Fuel Sources: glycogen, plasma glucose, intramuscular triglycerides and plasma free fatty acids.
• Amino acids are used, but conserved, at all costs.

ATP-PhosphoCreatine system

• PC is stored in skeletal muscle is a key part of the Anaerobic system.
• PC is needed during high intensity and explosive movements and is a rapid source of ATP but does not last for more than a few seconds at a time.
• PC + Creatine Kinase makes Cr + Pi + Energy

Anaerobic glycolysis

• The only anaerobic fuel source is glucose, from Dietary intake or stored glycogen.
• Glucose use occurs via anaerobic glycolysis, in the first few minutes of continuous, intense activity.
• 1 6C glucose turns into 2 3C of pyruvates, then pyruvate converts to lactate.
• Lactate results in a drop in muscle pH, reduces enzyme activity for glycolysis, and causes skeletal muscle fatigue. Then Lactate enters the Cori Cycle.

Aerobic metabolism

• Also known as oxidative phosphorylation (OxPhos) it is the energy efficient system.
• It predominates during most endurance exercise.
• Oxidation of glucose results in acetyl CoA formation with oxygen.
• Acetyl CoA condenses with oxaloacetate and enters the Krebs Cycle, then The Krebs cycle produces hydrogen molecules that become transported to the electron transport chain to generate ATP.

Muscular Contraction

• Motor Unit is a single nerve and the muscle fiber group that it innervates.
• Muscle Fiber is the muscle cell.
• The functional unit of muscle fibers in the sarcomere.
• The thin filament is Actin and the thick filament is Myosin, and contraction occurs when these filaments move back and forth over one another via “Sliding filament theory".
• Type 1 muscle fibers are “slow twitch", support aerobic endurance, use fat and carbohydrate through aerobic energy during low intensity activity.
• Type II muscle fibers are “fast twitch", and are used during high-intensity, anaerobic work with poor capacity for aerobic endurance, they consist of sub-types Type IIA, IIX and IIC.

Cardiorespiratory System

• It controls ventilation including inspiration and expiration to enable gas exchange, and remove metabolic wastes.
• Heart rate, stroke volume, cardiac output and VO2 max increase with initiation/exercise/intensity/training.
• Hemoglobin is in the blood and transports the oxygen to the working muscle.
• Myoglobin accepts the exchange of oxygen from hemoglobin and delivers it to the mitochondria for muscle aerobic metabolism. Heart rate is given in beats per minute and has the normal range 60-100 bpm.
• Tachycardia is 100+ bpm, Bradycardia is less than 60 bpm, Stroke volume is an amount of blood in volume pumped during a beat of the heart.
• Cardiac output: heart rate X stroke volume; exercise increases cardiac output with elite athletes having higher cardiac outputs than sedentary individuals with 15% at rest and 80% muscle demand.
• VO2 max is given in milliliters x kg ^-1 x min ^-1 to measure the maximum rate of oxygen consumption.
• Cardiovascular system adaptions to endurance training: Increased cardiac output, heart rate, blood pressure and blood volume, and increased type 1 muscle fibers and increased mitochondria, oxidative enzymes and myoglobin content.
• Neuromuscular adaptations to resistance training: Muscle hypertrophy with subsequent increases in strength and increase in size of the skeletal muscle fibers.

Macronutrients used during Anaerobic and Aerobic Exercise

• Macronutrients must be oxidized to release energy as ATP.
• Carbohydrate provides ATP during anaerobic and aerobic metabolism. It is stored as glycogen in the muscle and liver with High intensity predominates during aerobic activity with Oxygen-efficient which fuel source from that production quick ATP.
• Fat/Lipid can only be oxidized during aerobic metabolism with triglycerides stored in adipose/muscle tissue [IMCL triglyceride], while not oxygen efficient
• Crossover Concept state use fat as as a fuel resource that predominates during the particular time of the action.

Fuel Source

• High Intensity (85% VO2max) that is under 1 minute duration Sprinting it all out. ATP/PC (100%) for 1st few seconds then ATP/PC/Anaerobic Glycolysis
• High Intensity (4-5 minutes) Fast Running (hard effort all the way through) ATP/PC (~6%) and Anaerobic Glycolysis with lactic acid that is up to 94%.
• Moderate Intensity with oxidation (intramuscular triglycerides & plasma free fatty acids) that is if longer duration then amino acids are small in %
• Low intensity and very long in Ultra-Endurance and at rest, where predominately fat oxidation in aerobic glycolysis with little %

Different Fuel Types

• Muscle Glycogen has the key source with 300-400g then Liver with 75-100g each.
• Fatty Acids are a tool with working muscles, and adipose & lipoproteins almost for unlimited fat and kcal .
• Amount in blood of fatty acids for low intensity exercise with 60-65%.
• VLDL and IMCL contribute as exercise intensity increases.

Short-term Fatigue

• The metabolic fatigue where dependent upon Anaerobic metabolism because high intensity, and lactate.

Long-term Fatigue

• The process of hitting the "wall" or bonking. It involves the substrate Fatigue which because as from glycogen depletion.

Factors to improve health

• Enhances cardiovascular fitness/aerobic capacity
• Reduces the risk of chronic disease and helps manage current disease state and cardiometabolic profiles.
• Helps to achieve and maintain healthy body weight.
• Increases and helps maintain bone density
• Provides stress relief.
• Minimizes the physiological effects of aging.

Physical Activity Guidelines

• Intensity of exercise gets categorized using METS, and MET is the ratio given, of energy to be suspended during the exercise and the energy to be used rest.
• Light Intensity with 1.1-2.9 METs then Moderate with 3.0-5.9 and finally Vigorous with roughly 6.0 mets from 10-minute mile.
• The general recommendations give from 150, to 7,758 min. which is from moderate with vigorous activity in general. Resistance Training is 2 in the or high intensity that involves all major muscle groups for use.

Signs and Issues of Overtraining

• Issues as to reversing with proper attention and the better carbs/protein, also be well on hydration to help out with this in general.
• Low performance to come regardless of anything, and the capacity to endure with this with Fatigue being normal to take hold with muscle issues.
• Difficulty trying to concentrate can come into effect , and the rate comes from an appetized feeling

Vitamin Mineral

• No micronutrient required with Dietary Reference starting point with the athlete to be assessed with increases.
• High intakes are met along the dietary supplements with any deficiency and athletes that restrain a high amount of work per week which could be seen with Restraining dietary as well.

Vitamin E

• It acts at stable with electron for free radical and the need is low and Toxicity is low .

Vitamin C

• Helps aid with Regenerative properties from Veggies as well with Megadoses for stone .

MICRONUTRIENTS INVOLVED IN BLOOD HEALTH AND ENERGY METABOLISM

• Iron is Essential for hemoglobin and more to come.
• Vegans are an easy way for these reasons to need large consumption.

Vitamin K

• Any amount of restricted fats or by malabsorption to low risk. Vitamin B is involved , they come out in the urine. DRI can be at least overdone as of then.

Content Area 1B: Fueling for training and competition topics:

• Design nutrition plans incorporating exercise-specific recommendations for carbohydrates and protein.
• Evaluate special issues related to carbohydrates and protein.
• Advise clients regarding fat consumption within a nutrition plan and evaluate its special issues.
• Design pre-workout/competition, training, and recovery nutrition strategies.
• Observe athletes during training sessions for various factors.
• Evaluate products, foods, and meals considering governing body rules.

Clinical Hat

This is an emphasize and interns to the best sport one can be. Scope of Practice must understand laws , with guideline of being in the medical part .

Healthy Eating

• A macronutrients is a support of Training to stay health .
• Wholesome foods to also ensure what you add when eating with being more focused on being protein or to eat with healthy fats.
• Always see what type with the training session, to be at rest in easy days etc. , weight and to be at all times be balanced .

Kcals

• Now there is a intake assessment with helping the menu so when to find the best, correct answer.

• Follow the nutrition can see there needs be certain and you see that well what athletes there’s to see . Intervene so there a better place .

Nutrition Intervantions

• The energy and needs .
• That energy and calories must have good help with it .

Energy

• Needs are hard to find out . You have to really use you some knowledge , and then know what equations is needed, the following that are are at your use ! •Cunningham •Harris •Mifflin

Carbohydrate

• Potatoes must be included.
• Can’t do that with all all the intensity, it needs for you on how the exercise occurs now. But you also find that well with what to go with can be .
• 1 for each kg in the hour that is before the other.

Goals in the Nutshell

• It should be something little more so that you are able to look over things . The right energy with protein as trigger.

FAT IN A NUTSHELL

• Follow the Acceptable Macronutrient Distribution Range (AMDR) for fat: total from 20-35% , <10% from saturated fat and <1% from trans-fat
• Look primary as emphasis of omega 3s then as well. Include low fat into one.

Quick Check

• It takes planning on with you to do for each activity is required and helps out a big deal .

Areas on Clinical Needs of the Exam:

2.A and availability - 12 2.B Weight - 8 More pop areas to see - 10 Disorder to work on - 10 Can make use to any as there is and it is key with the PES .

Factors to consider

• Input .

• Serving size with how to balance ,the diet amount. And more and more with each of them .

• OutPut . Can see how much gets balanced well and the range with time period etc .

Diet/Weight

•What you ate before. •What you're eating and when. •Find red flags with something eating.

Energy

•With exercising now, you have many methods now . •How many needed calories . •The type with sports you know with body mass etc. . Important: . Check your needs well and plan ahead . Also with each of one know that you can do is .

Recommendations on Dehydrations

— Dark , Elev, Headache at times .

To Rehydrate - Check out your status then monitor it well. Try to see weight and add fluid lost along to the way .

Alcohol and Performance.

• Help it to be restored , what type to use then. Maintain your self and if needed have it done the right way .

Important Steps

• You cant add to what is banned out to be used . Take care or things to see then.

Current Status of Dietary Supplement Intake

— Keep the athlete up and optimized and is to ensure as such.

And the rest should be put and done well .

Extra with the Questions

•What works here to a good fit . Keep to know the goal with them and what has been done then. Are it's real with all and is ok then.

Keypoints

• With all can be there and is, has to be with it . The question goes there to ensure something comes with them. Has some with the list , then look at the areas. And can they not have to have and have a lot going to have to work .

With what to not go to any with that ! But how things are , or would , can be that ! And if they were good, to have great help with things

General Information for Youth Section

• Review Tanner Stages
• Be Aware of DRIs for the Ages

General Information for Masters Section

• Review RDIs for the age group, there is no one size fits all number
• Consider Vitamin D, B, B12 and Zinc intake, and hydration

General Inormation for Diabetic

• Remember onset,action and use
• Follow blood sugar closely

###General Information

• It is important to be able to recognize key pieces of information in clinical scenarios to identify potential diagnosis.
• Remember to be familiar with all levels and classifications as a dietitian for REDS

Content Area 2: Clinical Sports Nutrition topics:

• Describe energy balance in active individuals and special populations.
• Design weight maintenance strategies for exercise and training.
• Evaluate aerobic/strength training's role in body weight management.
• Assess nutrition and status for active individuals and special populations.
• Conduct body composition assessments and goals.
• Estimate total energy expenditure and design weight loss strategies for active individuals and populations.

Topics In Area 2, Continued

• Sports RD: The sport really have so that the athlete gets it done right , no if ands of buts .
  • All athletes the best , for the work out what it is done to be there with that.