ACSM Personal Trainer Certification Exam Review Latest Update, Exams of Nursing

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ACSM Personal Trainer Certification Exam Review Latest Update. pretest considerations for healh appraisal - ANSWER-systematic approach in screening clients for: signs and symptoms, family history, risk factors for disease informed consent - ANSWER-an agreement to do or allow something to occur, made with an awareness of relevant facts, including: procedures, risks, benefits, limitations, and discomforts -legal and ethical document -often paired with release of liability form Par-Q - ANSWER-used for screening Physical Activity Readiness Questionnaire minimal standard for moderate intensity exercise 7 questions; if answered "yes" to any question, then require to get medical release form from healthcare provider physician referral - ANSWER-safeguard for high risk clients who may compromise health with exercise without medically trained staff -physician's name, stating diagnosis, and exercise perscription risk stratification - ANSWER-assigns individuals to low, medium, or high risk based on presence of conditions ACSM risk stratification matrix - ANSWER-makes recommendations based upon low, moderate, or high risk clients positive risk factors - ANSWER-family history of disease cigarette smoking hypertension hyercholesterolemia/dyslipidemia impaired fasting glucose obesity sedentary lifestyle family history of disease - ANSWER-myocardial infarction, coronary revascularization, or sudden death before age 55 in males and 65 females (1st degree relatives) cigarette smoking - ANSWER-currently smoking or quit withing 6 months, or exposed to 2nd hand smoke over 6 months ACSM Personal Trainer Certification Exam Review Latest Update. hypertension - ANSWER-clients currently taking antihypertensive medication and/or confirmed (2 separate occasions) 140/90 BP or higher hypercholesterolemia/dyslipdemia - ANSWER-clients currently taking lipid lowering medication and/or those with total serum cholesterol >200 mg/dL, or high density lipoprotein cholesterols of 0.35 mg/dL impaired fasting glucose - ANSWER-fasting blood glucose > or equal to 110 mg/dL (2 separate measurements) obesity - ANSWER-BMI > or equal mg/m^2 or waist girth exceeding approximately 39.4 inches sedentary lifestyle - ANSWER-those not meeting recommended amount of physical activity (at least 30 minutes of physical activity at a moderate intensity 40-60%, at least 3 days a week for at least 3 months) negative risk factors - ANSWER-high serum HDL cholesterol: >60 mg/dL emerging risk factors - ANSWER-inflammatory markers: reactive C protein (CRP) and fibrinogen low risk - ANSWER-men <45, women <55, asymptomatic, with 1 or less risk factors A) current medical examination and exercise testing prior participation- not necessary for moderate or vigorous exercise B) physician supervision of exercise tests- not necessary for submax or maximal tests moderate risk - ANSWER-men >45, women >55, or those who meet the threshold for 2 or more risk factors A) current medical examination and exercise testing prior participation- not necessary for moderate but recommended for vigorous exercise B) physician supervision of exercise tests- not necessary for submax but recommended for maximal tests high risk - ANSWER-1 or more signs and symptoms listed or a known cardiovascular, pulmonary, or metabolic disease A) current medical examination and exercise testing prior participation- recommended for moderate or vigorous exercise B) physician supervision of exercise tests- recommended for submax or maximal tests exercise testing steps - ANSWER- M.R.I.P.L. medical history risk factor assessment interpreting the data (cardio endurance, muscle strength/endurance, flexibility, body comp) ACSM Personal Trainer Certification Exam Review Latest Update. angina - ANSWER-heart pain -insufficient supply off blood *symptoms:* chest pain/discomfort, pain in neck shoulder back arms or jaw, nausea, fatigue, sweating, shortness of breath, anxiety, dizziness stable angina - ANSWER-most common type ACSM Personal Trainer Certification Exam Review Latest Update. occurring with exertion and going away with rest can be triggered by mental or emotional stress could feel like indigestion and spread to arms, back, or other areas unstable angina - ANSWER-*medical emergency* occurs even at rest and usually more severe and longer lasting (as long as 30 minutes) -may signal heart attack!!! arrhythmias - ANSWER-abnormal heart rhythm: -tachycardia -bradycardia -atrial fibrillation -ventricular ectopic beats (VEB tachycardia - ANSWER-very fast heart rate sinus: >100 bpm atrial: >100 bpm with narrow QRS complex, w/ P waves originating not from sinus node ventricular: potentially life threateing, >100 bpm, with at least 3 irregular heartbeats in a row (ventricular fibrillation, asystole, or death) bradycardia - ANSWER-unusually slow heart rate (less than 60 bpm) atrial fibrillation (A-fib) - ANSWER-irregular heart rhythm -continuous rapid firing of atrial foci -no P waves -does not completely depolariaze -series or erratic tiny spikes ventricular ectopic beats (VEB) - ANSWER-heartbeat arising from an abnormal focus. Called premature beats (before next schedule heart beat) or escape beats (later than next scheduled heart beat) dyspnea - ANSWER-shortness of breath (SOB). difficult or uncomfortable breathing experienced subjectively. can occur at rest or be cause by exertion exertion cause dyspnea - ANSWER-suggests presence of cariopulmonary disorders (especially left ventrifular dysfunction or chronic obstructive pulmonary disease) -tachypnea -hyperventilation ACSM Personal Trainer Certification Exam Review Latest Update. -hyperpnea tachypnea - ANSWER-increase in respiratory rate above normal ACSM Personal Trainer Certification Exam Review Latest Update. -acute myocardial infarction, unstable angina, uncontrolled cardiac arrhythmias, symptomatic severe aortic stenosis, symptomatic heart failure, acute pulmonary embolus, pulmonary infarction, acute myocarditis or pericarditis, acute dissection, dissection aneruysm, or acute system infection with fever body aches or swollen lymph glands relative contradictions - ANSWER-test may still be performed, sometimes with modifications -left main coronary stenosis, moderate stenotic valvular heart disease, electrolyte abnormalities, severe arterial hypertension, tachyarrhythmias or bradyarrhythmias, hypertropic cardiomyopathy, outflow tract obstruction, neuromuscular, musculoskeletal or rheumatoid disordors, ventricular aneurysm, uncontrolled metabolic disease, chronic infectious disease, mental or physical impairment, high degree atrioventricular block absolute indications - ANSWER-immediately stop if any seen: sings of heart attack onset of chest pain drop in systolic BP below resting pressure or with increasing workload signs of poor circulation extreme shortness of breath ataxia, vertigo, visual or gait problems, or confusion abnormal heart rhythms technical inability to monitor the ECG client's request to stop relative indications - ANSWER-do not call for immediate stop: increasing chest pain shortness of breath severe fatigue wheezing leg cramps/ intermittent claudication hypertensive response (260/115 mm Hg or higher) pronounced ECG changes from baseline bundle branch block supraventricular tachycardia or other less serious arrhythmias 5 components of fitness assessment - ANSWER-cardio endurance muscular strength muscular endurance flexibility body comp isotonic contraction - ANSWER-contraction wherein the muscle remains ACSM Personal Trainer Certification Exam Review Latest Update. unchanged, and the distance between the origin and insertion shortens ACSM Personal Trainer Certification Exam Review Latest Update. isometric - ANSWER-muscle contraction without shortening or changing distance between the origin and insertion isokinetic - ANSWER-concentric muscle or eccentric muscle in which the speed and tension are constant throughout the range of lengthening or contractin 1 RM testing - ANSWER-1. cover movement, then do light warm up 5-10 reps of light- moderate exertion 2. rest for 1 min, light stretching, then 3-5 reps of moderate-heavy exertion 3. add 5-10 pounds if successful lifting previous weight, rest 5-10 minutes before adding weight again 4. divide 1 RM by their body weight to get relative results BMI equation - ANSWER-703 * lbs/in^2 BMI categories - ANSWER-underweight: < 18 normal weight: 18.5-24.9 overweight: 25-29.9 obese > 30 normal BP - ANSWER-< 120/80 pre-hypertensive BP - ANSWER-120-139 / 80-89 stage 1 hypertension BP (HTN) - ANSWER-140-159 / 90-99 stage 2 hypertnsention BP - ANSWER-> 160/10 periodization - ANSWER-the process of varying a training program at regular time intervals to bring about optimal gains in physical performance -improves muscular endurance, strength, power, motor performance, and/or muscle hypertrophy variable resistant - ANSWER-a resistance that changes over ROM when an isotonic contraction is used to move a load plyometric exercise - ANSWER-"jump training" dynamic resistance exercises that rapidly stretch a muscle and then rapidly shorten it EX) jumping/hopping exercise recommendations for adults - ANSWER-150 min/week of moderate activity or 75 min/week of vigorous activity (use if want to improve fitness level) 5-7 days/week stretching 3-5 days/week cardio 2-3 days/week of resistance training for 45-60 min/day ACSM Personal Trainer Certification Exam Review Latest Update. -good for beginners/intermediate levels alternation periodization - ANSWER-altering between volume and intensity -god for more advanced clients EX) more weight with less reps, then less weight with more reps initial stage of condition - ANSWER-10-15 min warm up 15-30 min moderate activity (40-60% of heart rate reserve) 3-4 days/week improvement stage of conditioning - ANSWER-10-15 warm up 30 min of 50-85% intensity to start then increase duration by 10-20% every week increase intensity 5-10% every 2 weeks once goal met, maintain with other activities benefits of flexiblity - ANSWER-decrease occurrences of muscle imbalances, joint dysfunctions, and overuse injuries/ injury prevention -static, ballistic, and PNF static stretching - ANSWER-corrective measure passively stretch and hold 10- 30 sec -muscles relax due to autogenetic inhibition and elongation of muscle ballistic stretching - ANSWER-uncontrolled bouncing, jerking, bobbing, or pulsing to achieve greater range of motion NOT preferred stretch -possible risk of injury and soreness -causes muscles to contract, leading to muscle fibers tearing PNF stretching (proprioceptive neuromuscluar facilitation) - ANSWER- rehabilitation of clients stretching based on a contract-and-relax technique requiring the help of another person -facilitate muscle relaxation and fuller range of motion benefits of strength training - ANSWER-reduce body fat, create lean muscle mass, burn more overall calories throughout day decreases symptoms of many chronic diseases, help develop stronger bones, reduce risk of injury, help control weight, and assist in overall strength in daily activities superset - ANSWER-performing 2 exercises using same muscle groups back to ACSM Personal Trainer Certification Exam Review Latest Update. back circuit training - ANSWER-series of exercises back to back with little rest ACSM Personal Trainer Certification Exam Review Latest Update. horizontal loading - ANSWER-completing all sets of an exercise before moving on to the next exercise vertical loading - ANSWER-completing one set of all exercises before beginning the second set proper breathing - ANSWER-breath diaphragmatically during aerobic activity (through stomach) -if clients cannot switch to proper breathing pattern, refer them to a health care professional inhale concentric exhale eccentrically valsalva maneuver physiological response - ANSWER-initial pressure rise first 5-10 sec reduced venous return and 15-20 sec compensation 20-23 sec pressure relief 24 sec + return of cardiac output eccentric contraction - ANSWER-strongest of 3 muscle actions target heart rate zones - ANSWER-*zone 1:* recovery zone 40-60% *zone 2:* aerobic zone 65-85% *zone 3:* peak zone 85%+ exercise perscription components - ANSWER- mode intensity duration frequency progressio n target heart range for moderate activity - ANSWER-50-70% of max HR specificity principle - ANSWER-exercising a certain body part that develops primarily that part must perform exercise/skill to improve on exercise/skill overload principle - ANSWER-body easily adapts to increase or decreased physical demand, enabling people to develop muscle coordination and sports-specific skills adaption principle - ANSWER-greater stress than normal is required for adaption to occur to improve fitness/strength/endurance, then workload must increase accordingly ACSM Personal Trainer Certification Exam Review Latest Update. borg scale - ANSWER-walking or cycling = level 13 strength activities = levels 15-17 ACSM Personal Trainer Certification Exam Review Latest Update. challenging activities become easier over time acute adaptions - ANSWER-stroke volume and cardiac output stroke volume - ANSWER-how much blood is expelled with each heartbeat at rest ~72 bpm cardiac output - ANSWER-stroke volume and heart rate blood per min = HR * SV at rest ~5 L/min chronic adaptions to heart - ANSWER-decrease CVD, stroke, high blood pressure, and obesity with prolonged exercise: -increase red blood cell's oxygen carrying capacity -increase size of heart (more blood produced) -lower blood pressure -reduced blood lipids pulmonary diffusion - ANSWER-ability of blood to extract oxygen from alveoli metabolic rate - ANSWER-accounts for up to 75% of calories burned by body each day to maintain normal body functions -heart, lungs, brain function heat exhaustion symptoms - ANSWER-heavy sweating cool/clammy skin fatigu e nause a faintin g heat stroke symptoms - ANSWER-MEDICAL EMERGENCY apply cool water to skin and seek medical help high fever, hot/dry skin w/o sweating, pounding pulse, dizziness, nausea/vomiting, confusion, unconsciousness -higher risk with heart disease or CVD (may cause damage to organs) patients with diuretics or beta blockers - ANSWER-ask doctor about safe levels of water in hot temps vs mild temps ACSM Personal Trainer Certification Exam Review Latest Update. cold temps and heart disease - ANSWER-exercising in cold temps makes heart work harder to maintain core temp -ask doctor safe levels of exposure to cold and which activities to avoid -always bundle up ACSM Personal Trainer Certification Exam Review Latest Update. *cons:* not mechanically supported so risk of injury is higher bioenergetics - ANSWER-process of transferring energy from foods throughout the body, supplying the contracting muscles with usable energy: ATP phosphagen system - ANSWER-uses immediate stored energy inside the muscle cell -ATP and phosphocreatine (PCR) EX) sprinting and weightlifting *no more than 30 sec* nonoxidative system (anaerobic) - ANSWER-AKA lactic acid or glycolytic system short term energy system ATP and phosphocretine to be re-synthesized at a rapid rate uses carbs (glucose and glycogen) for ATP production -byproduct: lactic acid produced when carbs breakdown w/o oxygen EX) running upstairs *30 sec - 3 min* high intensity effort oxidative system (aerobic) - ANSWER-long term energy system produces large amounts of ATP breaks downs carbs and fats -byproducts: water and carbon dioxide when broken down w/ oxygen EX) running marathon, hiking *>3 min* anaerobic/ lactate threshold - ANSWER-when working muscle demands more ATP than is being provided, the muscles will rely on the nonoxidative system for energy along with oxidative system erythrocytes - ANSWER-red blood cells -contains hemoglobin hematocrit - ANSWER-blood test to measure erythrocytes (RBC) within blood -slightly higher in men due to testosterone leukocytes - ANSWER-white blood cells -body's defense system hyperemia - ANSWER-increased amount of blood flow to working muscle of the body ^exercise = ^oxygen and nutrient delivery to muscles -increases waste removal (lactate and carbon dioxide) ACSM Personal Trainer Certification Exam Review Latest Update. cardiovascular drift - ANSWER-prolonged endurance exercise increases body temp plasma moved from blood to tissue to promote sweating -can cause increased HR, and decreased stroke volume and volume of blood ACSM Personal Trainer Certification Exam Review Latest Update. hemoconcentration - ANSWER-movement of plasma out of blood decrease of fluids within blood upper respiratory track - ANSWER- nose pharynx (throat) larynx (voice box) lower respiratory track - ANSWER-trachea (wind pipe) lungs bronchi bronchioles (passageway into alveoli) alveoli (air sacs) tricuspid valve - ANSWER-located between right atrium and right ventricle bicuspid valve (mitral valve) - ANSWER-located between the left atrium and left ventricle pulmonic valve (pulmonary semi-lunar valve) - ANSWER-located between the right ventricle and pulmonary artery aortic valve - ANSWER-located between the left ventricle and aorta pulmonary circulation - ANSWER-right atrium to heart w/o oxygen blood. Heart pumps blood into lungs to gain oxygen then to left atrium w/ oxygenate blood -works with lungs systemic ciculation - ANSWER-transports oxygenated blood away from heart and oxygen depleted blood back towards heart -circulated blood to all parts of body, except lungs blood flow of heart - ANSWER-right atrium tricuspid valve right ventricle pulmonic valve pulmonary artery lungs pulmonary veins left atrium mitral/bicuspid valve left ventricle aortic valve aorta (rest of body) ACSM Personal Trainer Certification Exam Review Latest Update. lordosis - ANSWER-inward curve on spine cervical and lumbar regions -develops after birth ACSM Personal Trainer Certification Exam Review Latest Update. te*nd*ons - ANSWER-*m*uscle to *b*one ligaments - ANSWER-bone to bone sliding filament theory - ANSWER-theory of muscle contraction; sarcomeres shorten when thick filaments pull on thin filaments length tension relationship - ANSWER-The resting length of a muscle and the tension the muscle can produce at this resting length. -produce greatest tension at resting length (how much contracted/lengthened dependent on force) type I muscle fibers - ANSWER-slow twitch most resistant to fatigue produce large amounts of ATP w/oxygen developed through training and genetics -marathon runners type IIA muscle fibers - ANSWER-fast twitch produce bursts of power fatigue quickly ATP produced w/o oxygen ATP broken down rapidly -sprinters type IIB muscle fibers - ANSWER-combo of Type I and Type II fibers ATP produced w/ and w/o oxygen produce fast.strong muscle contractions more prone to fatigue that type I -resistance training sagittal plane - ANSWER-divides body into left and right sides -flexion and extension -rotates around mediolateral axis (perpendicular) EX) walking or squatting transverse plane - ANSWER-divides body into superior and inferior portion -internal/external rotation, horizontal flexion/extension, and supination/pronation -rotates around longitudinal axis (perpendicular) EX) throwing baseball or golf swing ACSM Personal Trainer Certification Exam Review Latest Update. frontal (coronal) plan - ANSWER-divides body into anterior and posterior portions -abduction/adduction, side flexion, and inversion/eversion -rotates around anteroposterior axis (perpendicular) EX) side bending, and lateral arm lifts ACSM Personal Trainer Certification Exam Review Latest Update. mark sites measure for 4 seconds measure to nearest 1/2 - 1 mm 2 measurements of each site in rotational order and averaged (difference more than 1 mm = measure again) women skinfold sites - ANSWER- triceps suprailium thigh mens skinfold sites - ANSWER- chest ab thigh bioelectrical impedance analysis (BIA) - ANSWER-fluid is capable of electrical conduction, safe, low level current flows through body fluids to determine body comp -clients lies flat on table no limbs touching w/ electrodes on hands and feet -more lengthy and expensive than skinfold implications of BIA - ANSWER-*min reccomended level of total body fat:* men: 5% women: 15% *optimal health:* men: 10-25% women: 18-30% lower ranges for athletes ideal wait-hip ratios - ANSWER-women 18-59: <0.87 women 60+: <0.91 men 18-59: <0.96 men 60+: <1.04 positive health affects for women maintaining ideal WHR - ANSWER-optimal levels of estrogen lowered susceptibility to diabetes, cardio disorders, and ovarian cancer positive health affects for men maintaining ideal WHR - ANSWER-higher fertility lower susceptibility to prostate and testicular cancers 4 criteria for anorexia nervosa diagnosis - ANSWER-1. refuse to maintain body weight or body weight during growth period 15% lower than ACSM Personal Trainer Certification Exam Review Latest Update. anticipated 2. being underweight and strong fear of gaining weight/fat 3. denial and think their appearance is heavily influenced by body weight ACSM Personal Trainer Certification Exam Review Latest Update. 4. amenorrhea (3 consecutive cycles+) potential complications with anorexia - ANSWER-anemia, kidney problems, and/or death heart issues bone density loss amenorrhea, decreased testosterone gastrointestinal issues electrolyte abnormalities mental health issues and disorders bulimia nervosa criteria - ANSWER-binging at least twice weekly for at least 3 months behaviors different than anorexia self evaluation focused on body shape/weight (vomiting, laxatives, diuretics, enemas, fasting, exercising excessively) complications of bulimia - ANSWER-dehydration (kidney failure) heart issues tooth decay, gum disease amenorrhea digestive problems (dependence on laxatives) anxiety/depression drug/alcohol abuse binge eating disorder (BED) criteria - ANSWER-recurrent bingeing episodes twice weekly for at least 6 months with at least 3 of the following: -eating until uncomfortable -eating when not physically hungry -eating rapidly -eating alone for fear of being embarrassed by how much food is being consumed -feeling disgusted, depressed or guilty after the episode of overeating complications with binge eating disorder - ANSWER- depression suicidal thoughts insomni a obesity high BP type II diabetes high cholesterol heart disease gallbladder disease and other digestive ACSM Personal Trainer Certification Exam Review Latest Update. legal and ethical considerations - ANSWER-never try to diagnose a client -look for underlying health issues ACSM Personal Trainer Certification Exam Review Latest Update. provide them with a written statement of the facilities standards of care, and provide confidentiality written statement of standard of care health risk assessment - ANSWER-before exercising with any client! -identify health risk factors -control health care costs -predict employee absenteeism -encourage clients to be proactive Health Insurance Portability and Accountability Act (HIPPA) - ANSWER-set of federal regulations adopted to protect the confidentiality of patient information and the ability to retain health insurance coverage tort laws - ANSWER-State legislation that applies to civil cases dealing with wrongful conduct or injuries, negligence tort action factors - ANSWER-1. the defendant owed the claimant a duty of care 2. the defendant bread that duty of care 3. reasonably foreseeable damage was caused by the breach of duty 4 basic duties - ANSWER- inform instruct monitor supervis e waivers - ANSWER-suggested for every client to lower risk of liability in cases of negligence program development - ANSWER-systematic process that involves ongoing and structured planning to successfully achieve goals overuse injuries - ANSWER-muscle pulls sprains strains over-extension - ANSWER-similar to overuse injuries, but overexertion may result in exhaustion, shortness of breath, dizziness, and other dangerous conditions type I diabetes - ANSWER-insulin dependent typically under age 40 and chronic condition type II diabetes - ANSWER-insulin resistant ACSM Personal Trainer Certification Exam Review Latest Update. -resistant to effects or fails to produce enough insulin -more common ACSM Personal Trainer Certification Exam Review Latest Update. -increased metabolism -stress and anxiety reduction -better sleep long term effects of exercise - ANSWER--weight loss -mobility ACSM Personal Trainer Certification Exam Review Latest Update. -disease prevention learning theories of human behavior - ANSWER- behaviorism cognitivism constructionsi m humanism behaviorism - ANSWER-views learners as observers who develop or learn their behavior based on the type of outside feedback they receive operant conditioning - ANSWER-the learner is viewed as passive, until acted upon by environmental stimuli cognitivism - ANSWER-a person's learning process is affected by their own unique thinking, memory, and problem-solving abilities -mind being a computer (info comes in, processed, then outcomes) constructionism - ANSWER-people have unique sequences of learning experiences, and holds these past experiences affect the way people process new info -learner is active, constructive process -link info to prior knowledge humanism - ANSWER-most complex theory learners must be evaluated entirely in order to understand, interpret, and predict their reactions to new info -each unique and personal to own self learning phases - ANSWER- cognitive associative automatic cognitive phase - ANSWER-learning basics of exercise/skill -mostly thinking before executing -attention on instruction and guidance associative phase - ANSWER-muscle memory begins -more comfortable with exercise/skill -corrections on form or technique -give constructive criticism automatic phase - ANSWER-perform exercise efficiently without much thought to proper form or technique -muscle memory automatically makes corrections -positive feedback and further instruction necessary ACSM Personal Trainer Certification Exam Review Latest Update. health belief model - ANSWER-psychological reasons for a person's inactivity by evaluating their current attitudes and beliefs as a set of variables, dependent on individual perceptions, modifying factors, and the likelihood of action health belief model diagram - ANSWER- trans-theoretical model of change in behavior (TMC) - ANSWER-6 stages of change that people go through when developing new patterns of behavior: precontemplation, contemplation, preparation, action, maintenance, (relapse/termination) processes of behavioral change - ANSWER-within trans-theoretical model 10 processes of behavioral change -5 cognitive (best when in initial stages of chage) -5 behavioral (during action and maintenance stages) 5 cognitive processes - ANSWER-1. conscious raising 2. dramatic relief 3. environmental reevaluation 4. self-reevaluation 5. social liberation 5 behavioral processes - ANSWER-1. counter- conditioning 2. helping relationships 3. reinforcement management 4. self-liberation 5. stimulus control decisional balance - ANSWER-part of trans-theoretical model of change how people view pros and cons of healthy lifestyle as going through stages of change -beginning cons outweigh pros, the in time they reverse self-efficacy - ANSWER-self-confidence social cognitive theory (SCT) - ANSWER-interaction of behavioral, personal, and environmental influences interaction creates unique behavior patterns -people influence and are influenced by their environments social cognitive theory dynamic model - ANSWER-personal: feelings/thoughts behavioral: demeanor/personality environmental: external events/other people ACSM Personal Trainer Certification Exam Review Latest Update. PR interval equal? between 0.12-2.0 sec? QRS complex look alike? R-R intervals <0.12 sec? types of arrhythmias - ANSWER-atrial fibrillation ventricular fibrillation (v-Fib) ACSM Personal Trainer Certification Exam Review Latest Update. atrial flutter multifocal atrial tachycardia (MAT) paroxysmal junctional tachycardia premature atrial complexes (PACs) premature ventricular complexes (PVCs) ventricular tachycardia (V Tach) supraventricular tachycardia (SVT) asystole *ventricular rhythms are life threatening!!!* ventricular fibrillation (v-Fib) - ANSWER-type of cardiac arrest no pumping action immediate CPR and defibrillation!!! rapid discharges from ventricular foci no identifiable waves (if any sort of pattern repetition, then not this case) atrial flutter - ANSWER-rapid series of atrial depolarization resembles teeth of saw multifocal atrial tachycardia (MAT) - ANSWER-various P wave shapes -sometimes associated with digitalis toxicity in clients with heart disease paroxysmal junctional tachycardia - ANSWER-Caused by sudden rapid pacing (150- 250bpm) of irritable automaticity focus in AV Junction. Can cause left ventricle to depolarize before right causing widened QRS complex. premature atrial complexes (PACs) - ANSWER-not life threatening, occur often in exercise when atrial site other than sinus node depolarizes prematurely narrow QRS complex ventricular tachycardia (V Tach) - ANSWER-150- 250 bpm pattern of huge, consecutive PVC-like complexes SA node continues to pace the atria only sporatic atrial depolarization *coronary ischemia or cardiac hypoxia* treat quickly! premature ventricular complexes (PVCs) - ANSWER-not life threatening, occur often in exercise ACSM Personal Trainer Certification Exam Review Latest Update. site in ventricles fires before next wave p waves not present or hidden wide QRS complex chagnge from beat to beat ACSM Personal Trainer Certification Exam Review Latest Update. -irregular rhythm; more P waves than QRS complexes 2nd degree AV block (Mobitz) - ANSWER-punctual P wave is not followed by QRS response NO progressive lengthening of PR interval or premature P wave ACSM Personal Trainer Certification Exam Review Latest Update. 3rd degree AV block - ANSWER-complete AV block none of the atrial depolarizations conduct to ventricles -automaticity focus below the blocks escapes overdrive suppression to pace the ventricles at its inherent rate -ventricular rate may be so low that insufficient blood flow to brain occurs bundle branch blocks (BBB) - ANSWER-block in conduction within the right or left bundle branch -wide QRS complex (>120 ms) --disease of bundle branches or ventricular abnormalities, drugs, electrolyte, or metabolic disorders may cause 2 classifications: left and right (RBBB & LBBB) RBBB - ANSWER-activation of the left ventricle occurs before the right ventricle -triphasic complex trigger screening for conditions affecting right side of heart or lungs (pulmonary emboli, COPD, and cardiomyopathy) LBBB - ANSWER-initial ARS deflection is altered due to initial impulse traveling across the septum from the right to left -initial negative deflection V1 and initial upright deflection in V6 (wide notched appearance) -followed by imaging study: underlying cardiac pathology (dialated/hypertropic cardiomyopathy, hypertension, aortic valve disease, cardio disease) myocardial ischemia - ANSWER-partial or complete blockage of blood to the heart muscle moderate-high risk for disease need to identify -evidenced in ST segment as depression >1mm below baseline myocardial infarction (MI) - ANSWER-near-total or complete blockage to artery which blocks blood flow to an area of the heart *MI triad:* ichemia, injury, and necrosis (initial lack of oxygen, ischemia 20-40 min, then death of tissue) -time span of 2-12 hours abnormal Q waves, ST segment depression, ST segment elevation, T wave inversion (scan ALL leads) chamber enlargement - ANSWER-Involves the atria, the ventricles or both. It implies either dilation or hypertrophy of the chamber walls. ACSM Personal Trainer Certification Exam Review Latest Update. right atrial enlargement - ANSWER-biphasic P wave, initial component is larger leads V1 and V2 tall, peaked P waves ACSM Personal Trainer Certification Exam Review Latest Update. identify any compromised artery opening as well as the presence of atherosclerosis cardiac cathererization - ANSWER-interventional treatment purposes minimally invasive identify cardiac pathologies (blockages, stenosis, thrombosis, etc) angioplasty: placement of stents (expandable stainless steel mesh tubes placed in vessels via balloon catheter to expand a blocked stenotic artery) -allows blood flow coronary bypass surgery - ANSWER-treats heart disease (revascularization surgery), due to extensive atherosclerosis or blockage restores blood flow by rerouting around blocked artery (healthy blood vessel removed else where is connected to artery) -done to single or multiple arteries -improves symptoms of angnia and shortness of breath pharmacologic agets for cardiac pathologies - ANSWER-*beta blockers:* decrease HR and cardiac output -hypertension, angina, arrhythmias, MI, and hear failure *ace inhibitors:* expand blood vessels and lower resistance by lowering angiotensin II levels -hypertension and chronic heart failure *nitrates:* relax blood vessels and increase blood and oxygen supply to heart -angina and chronic heart failure *anti-arrhythmics:* suppressing activity of tissue initiating electrical impulses too quickly in SA node OR slowing and regulating fast electrical impulses in heart -atrial fibrillation; normal sinus rhythm; ventricular arrhythmias; slow ventricular response in atrial fibrillation *anti-coagulants:* decrease the clotting ability of the blood -atrial fibrillation which of the waveforms on the ECG will yield info about atrial enlargement? what should you look for? - ANSWER-P waves yield info about atrial enlargement look for tall, peaked P waves in 3rd degree AV block, how many impulses from the SA node penetrate the AV nod to depolarize the ventricles? is the rhythm regular or irregular? - ANSWER-3rd degree is a total block, NO impulses from the SA node penetrating the AV node regular rhythm which leads do you look for RBBB in? LBBB? - ANSWER-RBB leads V1 and V2 LBBB leads V5 and V6 ACSM Personal Trainer Certification Exam Review Latest Update. what are the characteristic ECG changes that yield info about ischemia? - ANSWER- ECG changes such as *inverted T waves and/or ST segment depression* yield info about ischemia ACSM Personal Trainer Certification Exam Review Latest Update. what criteria need to be met for ST segment elevation to be considered abnormal on an ECG? ST segment depression? - ANSWER-abnormal is ST segrment > 1mm above or below baseline in 2 or more continuous leads which part of the ECG will yield info about the AV node? - ANSWER-the PR interval yield info about the AV node tells you the relationship between the atrial and ventricles true/false: sinus tachycardia is a regular rhythm - ANSWER-true what rhythm produces a straight line on the ECG, suggesting that there is no electrical activity left in the heart? - ANSWER-asystole: a rhythm which produces a straight line on the ECG, suggestion no electrical activity in the heart cardiac muscle cells are unique in that they are able to generate their own electrical impulse. what is the ability called? - ANSWER-automaticity: the ability in cardiac muscle cells to generate their own electrical imulse leads V3 and V4 view which area of the heart? - ANSWER-leads V3 and V4 view the *anterior left ventricle* of the heart on an ECG, what does the P wave represent? - ANSWER-the P wave represents atrial depolarization on an ECG age groups - ANSWER-*infant:* 3 weeks - 1 year *child:* 1-10 years *juvenile:* 10-16 years *adolescence:* 16 - early 20s *adulthood:* early 20s - 64 years *senescence:* 65-100+ years exercise for children - ANSWER-educate importance of staying active physiological considerations for children - ANSWER-1. higher VO2 (^ oxygen delivery). Coresponds with growth spurts = hypertrohpy of heart and stimulation of RBC and hemoglobin 2. higher resting/exercise HR 3. lower resting/exercising BP 4. hormonal changes 5. thermoregulatory differences (less sweat rate, ^ heat production and sensitivity to excessive heat/cold) 6. musculoskeletal and bone ACSM Personal Trainer Certification Exam Review Latest Update. until 12-15 reps) submax and using full range of motion *flexibility:* 5-7 day/week light-moderate (12/13 RPE) ACSM Personal Trainer Certification Exam Review Latest Update. hold 15-30 sec 2-4 static stretches for each muscle group exercise for older adults - ANSWER-pre-exercise evaluation in clinical setting recommended (medical history, physical exam, and lab tests) physiological considerations for older adults - ANSWER-1. lower VO2, reduced max HR and CO 2. higher resting/exercise BP 3. decreased immune function 4. decrease sensitivity in thermoregulation (reduced total body water and capacity for sweating) 5. increased risk factors such as: -hypertension, hyperlipedemia, diabetes, coronary artery disease physical considerations for older adults - ANSWER-1. decrease in bone and muscle mass 2. decreased balance and coordination 3. increase in obesity; higher % of fat mass 4. osteoarthritis 5. orthopedic injuries psychological considerations for older adults - ANSWER-1. self-efficacy (improve perception to perform task) 2. self-concept 3. cognitive functioning 4. life satisfaction exercise prescription for older adults - ANSWER-*aerobic activity: 5-7 days/week light-moderate (50-80% max HR) 30-60 min a day (can be 10-15 min intervals) walking, stationary bike, low orthopedic stress *resistance training:* 2 days/week 1 set of 8-10 reps for each muscle group (RPE 12-13) 20-30 min sessions (Gradually add weight as tolerated) weight training machines, tubing and bands (with assistance) *flexibility:* 5-7 days/week light-moderate (12-13 RPE) hold 15-30 sec ACSM Personal Trainer Certification Exam Review Latest Update. 2-4 static stretches for each muscle group COPD and restrictive lung disease tests for diagnosis - ANSWER-chest x-ray computerized temography (CT) ACSM Personal Trainer Certification Exam Review Latest Update. medications to block prior exercise (beta-agonist bronchodialator) effects of exercise on metabolic syndrome - ANSWER-acute and chronic activity have substantial impact on: 1. hypertension 2. dyslipidemia 3. glucose intolerance/insulin insensitivity 4. obesity effects of exercise on diabetes - ANSWER-type I: control blood sugar levels, similar to insulin; eventually can lower insulin injections needed type II: helps clean glucose from circulation 12-28 hours post exercise, decreases hyperglycemic episodes, eventually increased glucose storage capacity because muscles will require more glucose with exercise effects of exercise on coronary artery disease (CAD) - ANSWER-1. effects on risk factors: decrease resting/exercise BP, decrease in total cholesterol (LDL and triglyceride), increase in HDL, improved glucose tolerance and insulin sensitivity, decrease in body fat percentage and waist circumference 2. reduces cardiac oxyge demand at rest/submax (increased ischemic/angina thresholds) 3. reduces platelet aggregation 4. improved endothelial function and tone medications: ACE inhibitors, beta blockers, calcium channel antagonists, nitrates, digitalis, diuretics claudication - ANSWER-to limp; pain/tension in legs while walking that subsides after rest; caused by inadequate blood supply common symptom of peripheral artery disease (PAD) embolism - ANSWER-blockage in a blood vessel from a blood clot or other foreign matter that gets trapped when traveling through the bloodstream stenosis - ANSWER-abnormal narrowing or contraction of a valve or artery ECG changes in CAD - ANSWER-horizontal or downward sloping ST depression of 1 mm in 2 leads T-wave abnormalities ECG changes in pulmonary disease - ANSWER-low voltage QRS complex poor R wave progression ECG changes in hypertensive heart disease - ANSWER-left ventricular hypertrophy and left atrial enlargement are common LBBB and atrial fibrillation can occur ACSM Personal Trainer Certification Exam Review Latest Update. ECG changes in myocardial ischemia and infarction (MI) - ANSWER-severe or prolonged ischemia ST elevation upright T waves or inverted ECG changes in atrial enlargement - ANSWER-P wave >0.12 sec (mitral valve disease) tall P wave >2.5 mm (pulmonary disease) P wave notched or biphasic ECG changes in ventricular hypertrophy - ANSWER-high voltage criteria in leads over hypertophied areas left ventricular hypertrophy (LVH): tall R waves, deep S waves, ST changes w/ T wave inversion -aortic stenosis and hypertensive heart disease right ventricular hypertrophy (RVH): R wave greater than S wave, ST changes with T wave inversion ECG changes in pericarditis - ANSWER-ST segment elevation T wave inversion ECG changes in electrolyte abnormalities - ANSWER-hypokalemia: ST depression, flattened T waves hyperkalemia: narrow peaked T wave, prolonged PR interval, small P wave, wide QRS complex and asystole hypocalcemia: prolonged QT intervals 0.48 sec hypercalcemia: shortened QT interval 0.26 sec health behavior adherence - ANSWER-1. assess clients education needs 2. identify clients self management goals 3. plan process of teaching-learning and behavioral change 4. help client achieve self management goals by implementing educational and behavioral intervention 5. evaluate the client has attained self management goals model of participation centered education/counseling - ANSWER-1. info gathering by health professional 2. develop a helping relationship by establishing support 3. earlier stages of change benefit most from cognitive strategies, but later stages depend more on behavioral techniques whole body plethysmography - ANSWER-used primarily for COPD and emphysema technique for measuring the volume of gas in the lungs, including air trapped in poorly communicating air spaces ACSM Personal Trainer Certification Exam Review Latest Update. impedance plethysmography - ANSWER-venous impedance plethysmography a technique using cuff occlusion of the venous flow from a limb in which the change in limb volume is used to diagnose acute venous obstruction or vascular insufficiency of an extremity diagnostic tests for coronary artery disease - ANSWER-monitor: ECG, hemodynamic, and symptomatic responses frequently used for potential CVD clients -treadmill and bike exercise tests -stress tests with myocardial perfusion imaging -stress echocardiography -cardiac catheterization treadmill and bike exercise tests - ANSWER-workload changes every 3 min -^ speed and incline on treadmill or resistance on bike exercise until fatigued, develop symptoms, reach >85% of age predicted HR, or symptoms occur *symptoms to terminate:* -moderately sever chest discomfort -marked shortness of breath -dizziness -drop in systolic BP >10mmHg from baseline w/ increasing workload, accompanied with ischemia -signs of poor perfusion -sustained ventricular tachycardia -ST elevation (1mm) in lead w/o diagnostic Q waves (other than V1 or Vr) -clients request to stop stress tests with myocardial perfusion imaging (MPI) - ANSWER-nucelar medicine procedure where radionuclide used to examine cardiac tissue and evaluate heart's function and blood flow -will absorb and show where damaged tissue is (bad BF) *exercise:* -start at warm up speed on teadmill -speed up and increase incline every 3 min -exceed 85% age target HR -cool down -stop if develop sings/symptoms -inject radionuclide into vein during exercise -once circulated gamma camera takes pics of heart with client laying still on table prior to exercise (15-30 min) *pharmacologic:* -when medical conditions prevents treadmill use -given medication to dilate arteries -resting images prior to medication ACSM Personal Trainer Certification Exam Review Latest Update. -restenosis rate of 30-50% in 6 months vs more advanced procedures percutaneous transluminal coronary angioplasty with stent(s) - ANSWER-mesh or metal stent acts to hold open walls of arter after PTCA performed -stent on tip of balloon catheter and placed on blockage site -restenosis rate much lower, 10-15% in 6 months (drug eluting stents with an immunosuppressant coating to show even lower restenosis rates of <5%) laser angioplasty - ANSWER-similar to PTCA beneficial when blockage cannot be passed through due to size and calcification of blockage -end of catheter has laser beam that breaks appart plaque build up -often used with stent placement due to lower restenosis rates coronary artery bypass grafting (CABG) - ANSWER-clients with extensive multivessel disease and failed PTCA procedures, medication resistant, or at high risk for future disease development -left or right mammary artery or savenous vein removed then attached to base of aorta below blockage -arterial and mammary more resistant than savenous vein grafts antianginals - ANSWER-can cause depression, fatigue, and dizziness HR and BP lowered use RPE scale to monitor intensity instead 1. beta adrenergic blockers 2. nitrates beta adrenergic blockers - ANSWER-treat hypertension, left ventricular dysfunction, and angina reduce ischemia, decreases oxygen demand controls ventricular dysrhythmias and reduce resting and exercise HR and BP nitrates - ANSWER-treat angina as a vasodilator in heart failure reduce ischemia by decreasing oxygen demand and allows small increase in oxygen supply short and long lasting doses decreases resting and exercising BP antihypertensives - ANSWER-postural hypotension: drop in systolic and/or diastolic BP -dizziness, light-headedness, or loss of consciousness; can result in fall (more frequent with diuretics added) proper hydration is key role diuretics cause weakness and fatigue due to low potassium levels ACSM Personal Trainer Certification Exam Review Latest Update. -if levels too low then risk of lethal arrhythmias (VT and VF) at rest or with exercise 1. angiotension-converting enzyme (ACE) inhibitors ACSM Personal Trainer Certification Exam Review Latest Update. 2. calcium channel antagonists 3. diuretics angiotension-converting enzyme (ACE) inhibitors - ANSWER-treat hypertension reduce myocardial oxygen demand, reduces vascular resistance and resting/exercise BP may increase exercise tolerance with left ventricular dysfunction calcium channel antagonists - ANSWER-treat hypertension, angina, atrial fibrillation, and supraventricular tachycardia reduce ischemia by altering determinants of oxygen supply and demand reduces resting/exercise BP (sometimes HR) diuretics - ANSWER-for mild hypertension reduce BP by increasing renal secretion of sodium and potassium loss of water in urine mildly affects resting/exercise BP may increase exercise tolerance in clients with congestive heart failure antiarrhythmics - ANSWER-can cause dizziness, dry mouth, and low blood sugar fluid intake and blood sugar check performed routinely may need to modify intensities when appropriate 1. digitalis 2. amiodarone 3. adenosine 4. lidocaine 5. procainamide 6. atropine digitalis - ANSWER-treat congestive heart failure enhances myocardial contractility, increase stroke volume SA and AV node conduction, reducing resting.exercise HR w. tachycardia and atrial fibrillation amiodarone - ANSWER-treat tachycardia, ventricular fibrillation, and atrial fibrillation acts like beta-blocker and potassium channel blocker on SA and AV nodes increases refractory period via sodium and potassium channel effects slowing intra cardiac conduction adenosine - ANSWER-treat supraventricular tachycardia, AV reentrant tachycardia, and AV nodal reentrant tachycardia transient heart block in AV node cell hyperpolarization increasing outward potassium flux when used to cardiovert abnormal heart rhythm, enters ventricular asystole ACSM Personal Trainer Certification Exam Review Latest Update. leukotriene antagonists and formation inhibitors (American association of family physicians) - ANSWER-potent inflammatory mediators inducing bronchoconstriction and enhancing airway hyperresponsiveness -stimulate smooth muscle hypertrophy, muscle hypersecretion, and influx of eosinophils into airway tissues xanthine derivatives - ANSWER-stimulate central nervous system, produce diuresis, and relax smooth muscles help relax smooth muscles in bronchial tree -may result in premature ventricular contractions at rest and exercise HR and BP mast cell stabilizers - ANSWER-prevent/control some allergic disorders, block calcium channel essential for cell degranulation, stabilizing cell and preventing release of histamine related mediators -used in inhalers to treat asthma, nasal sprays for fever, and eye drops for allergic conjunctives antidiabetic agents - ANSWER-if on insulin must coordinate injections and food intake with exercise program or diagnostic test *concerns:* foot ulcers and hypoglycemia -intensity, frequency, and duration depends on severity and fitness level -check blood glucose before and after exercise (must be at 100 before and after exercise!!!) 1. biguanides 2. glucosidase inhibitors 3. meglitinides 4. sulfonylureas 5. thiazolidinediones 6. insulin bigaunides - ANSWER-decrease hepatic glucose production and intestinal glucose absorption no effect on rest/exercise HR and BP glucosidase inhibitors - ANSWER-inhibit glucose absorption and have no effect on resting/exercise HR and BP meglitinides and sulfonylureas - ANSWER-stimulate pancreatic islet beta cells no effect on resting/exercise HR and BP thiazolidinediones - ANSWER-increase insulin sensitivity no effect on rest/exercise HR and BP insulin - ANSWER-caries how acts base on type -no effect on resting/exercise HR and BP ACSM Personal Trainer Certification Exam Review Latest Update. *1. rapid acting (mealtime insulin):* onset occurring 5-15 minutes, peak at 45-90 minutes, overall duration of 3-4 hours *2. intermediate acting:* covers need for half day or overnight, typically combined with rapid. onset at 1-2.5 hours, peak at 3-12 hours, overall duration 18-24 hours *3. long lasting:* covers needs for full day, typically combined when necessary with rapid or intermediate. onset at 30min-3 hours, peak at 6-20 hours, overall duration 24- 36 hours psychotropics - ANSWER-help with depression and anxiety can increase drowsiness and dizziness -don't exercise too soon after injection! -adequate fluids 1. monoamine oxidase inhibitors (MAOIs) 2. tricyclic antidepressants (TCAs) 3. selective serotonin reuptake inhibitors (SSRIs) monoamine oxidase inhibitors (MAOIs) - ANSWER-prevents breakdown of monamine neurotransmitters and increasing availability for depression, last choice treatment option due to require diet restrictions -cause dangerously high BP when w/certain foods tricyclic antidepressants (TCAs) - ANSWER-act as serotonin-norepinephrine reuptake inhibitors (ANRIs) that block the transporters (SERT and NET) -major depression disorders, generalized anxiety, obsessive compulsive disorder, and post-traumatic stress disorder -significantly high rate of serious cardio diseases *side effects:* tachycardia, increased BP, slight prolongation of intraventricular conduction time (arrhythmias risk) selective serotonin reuptake inhibitors (SSRIs) - ANSWER-antidepressants to treat depression, anxiety, and some personality disorders increase serotonin *side effects:* mild bradycardia, orthostatic hypotension, and prolongation in intraventricular conduction time -may demonstrate QRS lengthening or prolonged QT intervals vasodilators - ANSWER-treat recurrent angina coronary artery disease reduce exertion if symptoms become present, avoid extreme heat/cold, reduce emotional stress, and avoid large meals prior to exercise higher risk of hypotensive episodes with postural changes w/exercise, RPE scale to monitor exercise! 1. nitrate and nitroglycerin 2. direct peripheral vasodilators ACSM Personal Trainer Certification Exam Review Latest Update. nitrates and nitoglycerin - ANSWER-widen blood vessels -decrease in vascular resistance and increase in BF ACSM Personal Trainer Certification Exam Review Latest Update. -slows breakdown of muscle glycogen increasing amount of FFA in blood (enhances exercise endurance) -reduced adenosine in muscles (increases muscular contractions) -enhanced mood, alertness, and fine motor coordination nicotine - ANSWER-biphasic effect increased energy while stimulating relaxation -most common is through inhalation -flows almost immediately to brain when in blood effects on brain: positive feelings and irritability when quitting half life is 60 min quick release of adrenaline leads to: -increase HR and BP -increased respiratory rates -increased muscular endurance due to higher blood sugar levels -increased of arrhythmias at rest/exercise long term effects outweigh short term benefits alcohol - ANSWER-if in system before or after exercising have several negative effects: -slower recovery time -increasing body fat percentage -disrupted sleep -depletion of water and nutrients diet pills - ANSWER-usually unsafe ephedrine and country mallow banned by FDA effects: -blocking or decreasing amount of fat absorbed from food -decreasing you appetite -increasing the amount of calories individuals burn use for extended periods of time have serious consequences: -pulmonary hypertension (may need lung transplant), heart palpitations, stroke, and elevated BP antihistamines - ANSWER-when body affected by outside substance (such as pollen) and reacts by producing histamines side effects of histamines: watery eyes, sneezing, coughing, and extreme cases cause shortness of breath and asthma *common side effects of :* drowsiness, dizziness and blurred vision, restlessness and nervousness, upset stomach, dry mouth/nose, irritability, and difficulty urinating ACSM Personal Trainer Certification Exam Review Latest Update. cold medications - ANSWER-can cause side effects with exercise may contain caffeine that can increase HR side effects that could occur: increased rest.exercise HR and BP, increased atrial and/or ventricular ectopic beats, irritability and anxiety