ACSM Certified Exercise Physiologist PDF

ACSM Certified Exercise Physiologist What is an exercise physiologist? “Fitness professionals with a minimum of a bachelor’s degree in exercise science qualified to pursue a career in university, corporate, commercial, hospital, and community settings.” “ACSM-EPs not only conduct comple...

ACSM Certified Exercise Physiologist What is an exercise physiologist? “Fitness professionals with a minimum of a bachelor’s degree in exercise science qualified to pursue a career in university, corporate, commercial, hospital, and community settings.” “ACSM-EPs not only conduct complete physical assessments – they also interpret the results in order to prescribe appropriate, personalized exercise programs.” “Works with apparently healthy clients and those with medically controlled diseases to establish safe and effective exercise and healthy lifestyle behaviors to optimize both health and quality of life.” Requirements Last semester or graduate of undergraduate degree in exercise science, or related CPR/AED certification $279 -- $349 for exam Exercise Physiologist vs. personal trainer Exercise physiologist is able to work with a wider variety of individuals Clinical Special populations Because of that, it is even more important for an exercise physiologist to assess individual’s health and ability to exercise prior to beginning What is the exam like? https://www.acsm.org/docs/ default-source/certification- documents/acsmep_examco ntentoutline_2017.pdf 225 minutes Consists of 150 items 125 items are scored and 25 are non-scored Pre-existing knowledge content Applied Exercise Physiology Acute and chronic adaptations to exercise Energy systems/metabolism Muscle physiology Muscular force Joint structure Lever systems Biomechanical basics Balance and stability Pre-activity screening (PAR-Q, medical history, etc.) Exercise Preparticipation Health Screening https://www.acsm.org/docs/default-source/default-document- library/read-research/acsm-risk-stratification- chart.pdf?sfvrsn=7b8b1dcd_6 ** really good info Pathophysiology of CVD CVD = cardiovascular disease Arteriosclerosis: loss of elasticity of the arteries that occurs throughout the lifespan Atherosclerosis: accumulation of plaque and lesions within the arterial wall Pathophysiology of CVD As plaque builds up in arteries, narrows the vessel and causes reduced blood flow When this occurs in the arteries around the heart (coronary arteries), causes reduced blood flow to muscles of the heart Pathophysiology of CVD Decreased blood flow to heart muscle causes pain and other issues Myocardial ischemia: oxygen supply to myocardial tissue is lower than demand Angina pectoris: discomfort/pain in chest, neck, cheeks, jaw, shoulder, upper back, and arms Acute myocardial infarction: [heart attack] prolonged ischemia leading to necrosis (death) of myocardial tissue Pathophysiology of CVD https://www.heart.org/en/health-topics/consumer-healthcare/what- is-cardiovascular-disease CVD can refer to many different conditions: Heart disease Heart attack Stroke (blood supply blocked to brain) Heart failure Arrhythmia Heart valve problems Pathophysiology of diabetes Type I vs Type II Type I = normally diagnosed in children/young adults Autoimmune disorder where insulin is no longer produced in the body Insulin dependent Type II = diagnosed in adults, usually due to lifestyle factors Insulin is still produced, but insulin resistance occurs Pathophysiology of Renal Disease Chronic kidney disease https://youtu.be/XqsnI_PBKRI https://www.mayoclinic.org/dis eases-conditions/chronic- kidney-disease/symptoms- causes/syc-20354521 Pathophysiology risk factors Many risk factors for diabetes and CVD are similar We can identify risk factors to determine potential risk of both diseases/disorders Important to determine prior to beginning exercise program due to contraindications Recommended Sequence of Evaluation Prior to engaging in physical activity or structured exercise programs Informed consent Exercise preparticipation health screening Health history Cardiovascular (CV) risk factor analysis Medical History & CV Risk Factor Analysis Medical history and CV risk factor analysis are not part of the preparticipation health screening procedures for the purpose of reducing acute risk. Insufficient evidence is available to suggest that the presence of CVD risk factors without underlying disease confers substantial risk of adverse exercise-related CV events. However, medical and CV screening provides valuable information for designing individualized exercise programs to lower or reduce known health risks. Medical and CV screening may also uncover a need for other health or medical referrals. Assessing Risk Factors Exercise Testing for Medical Clearance ACSM no longer recommends the inclusion of exercise testing for medical clearance. That decision is left to the qualified health care provider. This recommendation better aligns with evidence that exercise testing is a poor predictor of acute cardiac events in asymptomatic individuals. American College of Sports Medicine Preparticipation Screening Algorithm The ACSM preparticipation screening algorithm (Figure 2.2) is designed to identify individuals at risk for CV complications during or immediately after aerobic exercise. Although resistance training is growing in popularity, current evidence is insufficient regarding CV complications during resistance training to warrant formal prescreening recommendations. American College of Sports Medicine Preparticipation Screening Algorithm (cont.) Algorithm components Classifying individuals who do (Yes) or do not (No) currently participate in regular exercise Identifying individuals with known CV, metabolic, or renal diseases or those with signs or symptoms suggestive of cardiac, peripheral vascular, or cerebrovascular disease, Types 1 and 2 diabetes mellitus (DM), and renal disease Identifying desired exercise intensity ACSM Preparticipation Screening Algorithm ACSM Preparticipation Screening Algorithm ACSM Preparticipation Screening Algorithm Signs/symptoms If your client has any of the following, these are considered signs and symptoms of CVD, renal, pulmonary, or metabolic disease. Any of these automatically places your client in ”high risk” Chest discomfort with exertion Unreasonable breathlessness Dizziness, fainting, blackouts Ankle swelling Unpleasant awareness of a forceful, rapid or irregular heart rate Burning or cramping sensations in the lower legs when walking short distance Summary A preparticipation health screening is important to assess clients’ risk of exercise An informed consent should be used to ensure clients understand all factors of their involvement and participation Risk stratification is used to determine the level of risk in participation and can determine what steps should be taken prior to beginning exercise ACSM Certified Exercise Physiologist Part 2 Legal liability / program administration Negligence: failure to exercise appropriate and/or ethical ruled care expected to be exercised amongst specified circumstances Tort Law: include all negligence cases as well as intentional wrongs which result in harm Risk management Pre-exercise screening, consent forms, contracts, incident reports, emergency plans, insurance Program administration Facility requirements, budget, hiring, evaluations, promotional/marketing, procedures Strategies for behavior change Building self-efficacy: an individual's belief in his or her capacity to execute behaviors necessary to produce specific performance attainments Transtheoretical model Precontemplation Contemplation Preparation Action Maintenance Strategies for behavior change Precontemplation: no intention to be active in next 6 months Contemplation: intending to be regularly active in next 6 months Preparation: intending to be regularly active in next 30 days Action: regularly active 6 months Cognitive or behavioral changes? Cognitive = change in mindset Behavioral = change in actions Strategies for behavior change Precontemplation: cognitive (increase knowledge and awareness) Contemplation: cognitive & behavioral (identify barriers, motivation, small steps) Preparation: cognitive & behavioral (take the step, identify benefits) Action: behavioral (find support, identify alternatives to maintain adherence, accountability) Maintenance: behavioral (find additional support, maintain adherence, accountability) Contraindications to exercise Contraindication: condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient Absolute vs. relative Absolute – severe risk, you SHOULD NOT do exercise with this individual Relative – potentially able to exercise, BUT should see a physician first Assessing muscular fitness Absolute contraindications to resistance training/testing Unstable coronary heart disease Decompensated heart failure Uncontrolled arrhythmias Severe pulmonary hypertension Severe and symptomatic aortic stenosis Acute myocarditis, endocarditis, or pericarditis Uncontrolled hypertension (>180/110 mmHg) Aortic dissection Marfan syndrome High intensity RT in patients with active proliferative retinopathy or non- proliferative diabetic retinopathy Assessing muscular fitness Relative contraindications to resistance training/testing (talk to physician first) Major risk factors for CHD Diabetes at any age Uncontrolled hypertension (>160/100 mmHg) Low functional capacity Musculoskeletal limitations Implanted pacemakers or defibrillators Assessing muscular fitness Muscular strength: 1RM (standard), 3RM, 5RM, 10RM Muscular endurance: max reps over a period of time OR time a contraction is held Curl up (crunch) test Push up test Older adults Senior Fitness Test (SFT) 30 sec. chair stand test (endurance) Single arm curl (strength) Assessing flexibility Range of motion: goniometry Flexibility: Sit and reach test Functional movement: FMS Assessing body composition Body mass index (BMI) = body weight (kg) / height (m)2 OR can do (lbs/in2)*703 Underweight = 40.0 Assessing body composition Circumference measurements Waist (narrowest part of torso, above umbilicus and below xiphoid process) Hips (maximal circumference of buttocks, above gluteal fold) Waist to hip ratio (WHR): waist circumference / hip circumference Assessing body composition Skinfold measurements Estimates body fat percentage Common sites Abdominal (Male 3 site) (7 site) Biceps (not used often, 9 site) Calf (not used often, 9 site) Chest/pectoral (Male 3 site) (7 site) Midaxillary (7 site) Subscapular (7 site) Suprailiac (Female 3 site) (7 site) Thigh (Male and female 3 sites) (7 site) Triceps (Female 3 site) (7 site) Assessing body composition Clinical and laboratory techniques Bioelectrical impedance analysis (BIA, InBody) Hydrostatic weighing Air displacement plethysmography (BodPod) Dual x-ray absorptiometry (DEXA) Magnetic resonance imaging (MRI) Weight management Estimating desired body Fat mass (FM) = TBM x current composition BF% FM = 213 x 0.31 = 66.03 lbs of fat Given: Current BF% = 31%, desired BF% = Fat free mass (FFM) = TBM – FM 25% FFM = 213 – 66.03 = 146.97 lbs of fat Current body mass (TBM) = 213 lbs free mass Estimate target weight Desired weight = FFM / (1 – desired BF%) Desired weight = 146.97 / (1 – 0.25) = ~196 lbs 213 – 196 = ~17 lbs weight loss to reach desired body composition Weight management Promote 5-10% weight reduction over 3-6 months Weight loss rate should be around 1-2 lbs / week Weigh-ins should be done at the same time each day to avoid error Use a combination of diet and exercise for weight loss Focus on getting at least 30 min/day moderate – vigorous activity Assessing cardiorespiratory fitness Things to consider before choosing tests Client needs, contraindications, abilities Maximal vs. submaximal intensity Clinical vs. field tests Modality Protocols to know: Astrand-Ryhming and YMCA (cycle ergometer) VO2max protocols such as Costil Fox (treadmill) Field tests: 1.5 mile walk/run, 12 min walk/run, Rockport One-Mile Fitness Walking Test Assessing cardiorespiratory fitness HRmax = maximal heart rate RHR = resting heart rate HRR = heart rate reserve HRmax = 220 – age HRR = HRmax – RHR Assessing cardiorespiratory fitness Signs of exercise intolerance HR response higher than expected SBP accelerated or doesn’t rise DBP changes Hyperventilation Muscle fatigue Dizziness, lightheadedness, incoherence Volitional fatigue Cyanosis, pallor Nausea Inability to maintain protocol, workload Assessing cardiorespiratory fitness Test termination criteria Onset of angina (Chest Pain) Drop in SBP with increase in work rate OR SBP drops below resting value Excessive rise in SBP >250 or DBP >115 mmHg Shortness of breath, wheezing, claudication Failure of HR to rise with increased work load Changes in heart rhythm Subject asks to stop Severe fatigue Failure of equipment Exercise programming ACSM utilizes FITT-VP for exercise programming F – frequency I – intensity T – time T – type V – volume P – progression Aerobic ExRx Frequency At least 5 days/week moderate intensity Or 3 days/week vigorous intensity (combination of both is recommended) Intensity Moderate = 40-60% HRR (64-76% HRmax) Vigorous = 60-60% HRR (76-96% HRmax) Can also use METs, RPE, and talk test (can they hold a conversation?) to determine intensity Aerobic ExRx Time (duration) At least 30-60 min/day of moderate intensity 5 days/week OR 20-60 min/day of vigorous intensity 3 days/week OR combination of both Bouts of 10 minutes can add up to recommended daily amount Type (mode) Aerobic, uses large muscle groups, continuous, rhythmic Aerobic ExRx Volume (quantity) Target around 1000 kcal/week (500-1000 MET/min/wk) from moderate intensity exercise ~150 min/week ~5,400 – 7,900 steps/day Progression (rate of) Gradual increase in exercise volume by adjusting exercise frequency and/or intensity Resistance ExRx Type Free weights, machines, stability balls, resistance bands, body weight Multi-joint or compound exercise, core training, isolated exercises Total body training vs. split Volume Repetitions x sets 2-4 sets x 8-12 reps, rest 2-3 minutes Untrained = 1-2 sets x 10-15 reps Progression Gradual progression of greater resistance/can add reps per set Programming definitions Overload: must exercise at a level greater than accustomed to induce adaptation Specificity: distinct adaptations occur as a result of a training program SAID = specific adaptations to imposed demands Reversibility: “use it or lose it” If activity stops, adaptations will reverse and decrease. Body will readjust to reduced demands Individual variability: everyone is different and all individuals will not respond similarly to a given training stimulus Flexibility ExRx F – 2-3 days/week at least I – stretch to point of slight discomfort T – hold stretch 10-30 secs T – static (passive, active), dynamic, ballistic, PNF V – 60 seconds total per major muscle-tendon, 2-4 times per stretch P – as flexibility increases, continue stretching to slight discomfort Special populations Pregnancy, children and adolescents, older adults Need to know what they can and can’t do Exercise should be beneficial, not harmful Exercise in pregnancy Exercise is encouraged in healthy pregnant women Provides health/fitness benefits to mother and child May reduce risk of developing pregnancy induced hypertension and gestational diabetes mellitus Important to consider all absolute and relative contraindications prior to beginning and/or resuming exercise Pregnancy ExRx F – 3-4 days/week I – moderate intensity for low risk pregnancies and women with pre- pregnancy BMI 60 mins/day fatigue T – enjoyable and T – as part of 60 mins/day developmentally appropriate, T – playground play, climbing, tug- walking, games, dance, sports of-war, lifting weights, running, jumping rope, sports, hopscotch Older adults ExRx Aerobic F – 5 day/week of moderate or 3 day/week of vigorous, or combination I – should use RPE for intensity; 5-6 for moderate, 7-8 for vigorous T – at least 30 min/day; can use bouts of 10 mins to total 150 mins/week for moderate (75-100 mins/week of vigorous) T – any modality that doesn’t impose excessive orthopedic stress (walk, aquatic, cycle) Older adults ExRx Resistance F – at least 2 day/week I – between moderate (5-6) and vigorous (7-8) T – NA T – weight training or calisthenics involving major muscle groups (stair climbing, etc) V – 8-10 exercises, 10-15 reps Should also focus on flexibility and neuromotor (balance) training Exercise in controlled chronic diseases What are the contraindications to exercise? What has their doctor cleared them to do? What types of exercise needs to be included? What are the limitations? Exercise in CVD Pre-exercise assessment at each session ECG Blood pressure Body weight Heart rate Symptoms Medication compliance CVD ExRx F – 3-4 days/week I – light to moderate intensity T – warm up and cool down, 20-60 mins of exercise; can do 1-10 minute bouts if better tolerated T – aerobic, rhythmic, large muscle groups, whole body fitness P – slow, gradual increases Should include both aerobic and resistance training Exercise for arthritis F – 3-5 days/week (aerobic), 2-3 days/week (resistance), daily for flexibility I – general recommendations (for healthy individuals) except monitor and adjust as pain allows T -- 5-10 minutes to accumulate 20-30 mins/day, resistance follows general guidelines T – low joint stress activity (aerobic), start with isometric resistance training in affected joints and then move to dynamic (resistance) Exercise for diabetes Special considerations: Monitor blood glucose levels Exercise with someone else (not alone) Avoid resistance exercise in some individuals (retinopathy) Use caution in extreme temperatures Wear proper, comfortable shoes to avoid foot injuries Carry source of carbohydrates/sugar Hydrated Use a cool down Diabetes ExRx F – 3-7 days/week I – light to moderate intensity T – 20-60 mins/day; at least 10 min bouts to reach 150 mins/week Aim for 300 mins/week eventually T – large muscle groups, rhythmic, continuous Enjoyment for adherence P – caloric expenditure is a focus; increase progressively Dyslipidemia ExRx F – at least 5 days/week to maximize caloric expenditure I – 40-75% HRR T – 30-60 mins/day; 50-60 mins/day recommended; 10 min bouts can be used T – aerobic physical activity that involve large muscle groups, resistance training guidelines for healthy adults Hypertension ExRx F – aerobic exercise on most, or all, days of the week; resistance training 2-3 days/week I – moderate intensity aerobic and resistance training (40-60% HRR, 60-80% 1RM) T – 30-60 min/day of aerobic; 1 set x 8-12 reps resistance training T – aerobic activities, resistance training using machines or free weights (8-10 exercises on major muscle groups) P – gradual with avoidance of large increases in intensity Exercise for osteoporosis Follow general guidelines for healthy adults for aerobic and resistance exercise Focus attention of weight-bearing exercise and resistance training to increase bone density Exercise for overweight / obesity F – at least 5 days/week to increase caloric expenditure I – moderate initially and progress to more vigorous T – 30 min/day and progress to 60 min/day T – aerobic is focus, use resistance training to supplement Exercise for asthma F – 2-3 days/week I – 60% VO2peak or 80% of maximal walking speed (from 6-min walk test) T – at least 20-30 min/day T – aerobic using large muscle groups (if swimming, preferable in non- chlorinated pool) P – increase intensity to 70% Vo2peak, and 40 min/day and 5 days/week if tolerated Use general guidelines for healthy adult for resistance training Exercise for COPD F – at least 3-5 days/week I – as tolerated based on dyspnea T – intermittent short exercise bouts as tolerated T – aerobic and resistance training as tolerated Summary ACSM Exercise Physiologists evaluate and program exercise for both healthy individuals and special populations Different special considerations have to be given for each population