Welcome! ACE Personal Trainer Virtual Exam Review: Module 8 · 3 Hypertension • Affects over 50% of those over age 65 • Affects more men prior to age 50; more women after age

1

Welcome!ACE Personal Trainer

Virtual Exam Review: Module 8

(C) 2011 by Exercise ETC Inc. All rights reserved.

Laura Abbott, MS, LMT• Master’s Degree, Sports

Medicine • Licensed Massage Therapist • Undergraduate degree in

Exercise Science • Instructor of Kinesiology,

Georgia State University • ACE Certified Personal Trainer• Guest speaker at Atlanta area

massage schools and at the Georgia State University Physical Therapy department.

• Owner of Premier Performance, Atlanta, GA


What We’ll Cover :

• Chapters 12, 15, 16 & 17 of the ACE Personal Trainer Manual (3rd ed)

• Chapter 1, 14, 15, 16, 17 & 18 of the ACE Personal Trainer Manual (4th ed)


2

Module 8:Special Populations & Professional Issues


Modifications for Special Populations

Physician release/clearance

Longer warm up & cool down

Cardio: longer duration, lower intensity (May be discontinuous)


Modifications for Special Populations

Strength: Lower resistance, higher reps (15-20)

Observe symptoms & modify as needed

Document everything


3

Hypertension• Affects over 50% of

those over age 65

• Affects more men prior to age 50; more women after age 50

• Affects 3 main organsBrain-strokes

Kidneys-renal failure

Heart-congestive heart failure


Hypertension DefinitionsSource: JNC 7: May, 2003

Category Systolic DiastolicOptimal <120 <80Pre-hypertension >120 >80

Hypertension

Stage 1 140-159 90-99Stage 2 >160 >100


Exercise Guidelines for Clients with High Blood Pressure

• No exercise if client forgets to take their medications

• Be aware of effects of BP meds on heart rate (Beta Blockers)

• Take blood pressure before, during, after exercise

• Avoid isometrics, decline positions, arms higher than head

• Stop exercise if systolic goes above 250 or diastolic goes above 110


4

Lifestyle Modifications

• Body fat management• Increase physical

activity and/or exercise

• Stop smoking• Monitor alcohol intake• Avoid excess sodium• Reduce dietary intake

of saturated fat and cholesterol


Avoid These Situations – exposure to extreme heat

or cold

– a heavy meal 1 – 2 hours prior to exercise

– exercise if BP or HR are 20 pts/bpm above normal

– saunas, steam baths and hot tubs

– activities which increase thoracic blood pressures


Sample Hypertension Program

Cardio Strength Flex

Frequency 3-7X per wk, to burn up to 2000 kcals/wk

2-3X per week

3X per week

Intensity 40-70% VO2 16 – 20 reps, 50 –60% 1RM

Point of tension

Duration 30 – 60 minutes

1 – 3 sets 10 seconds

Mode Any type they enjoy

Circuit training

Active, static, tai chi


5

Diabetes Stats

• Affects >20 million Americans

• ~6 million undiagnosed

• >800K new cases each year

• Leading cause of blindness, amputation for older adults


Diabetes Mellitus“Sweet Honey Flowing”

• Type 1– “Juvenile Diabetes”

– Insulin Dependent Diabetes Mellitus (IDDM)

– Treatment: • Exogenous Insulin

(injected)

– 5% of all diabetics

• Type 2– “Adult Onset Diabetes”

– Non-Insulin Dependent Diabetes Mellitus (NIDDM)

– Treatment:• Diet

• Exercise

• Oral medication

– 95% of all diabetics


Exercise Adjustments

• Physician may need to adjust insulin dosage in Type 1 Diabetes to prevent hypoglycemia

• If exercise is unplanned or of long duration, encourage use of supplemental carbohydrate to support increased glucose needs

• Replace carbohydrate stores post-exercise (30 minutes)


6

Exercise & Diabetes

Avoid injecting into an exercising limb

Monitor blood glucose often

Work with physician to reduce insulin dosage

Keep exercise predictable & consistent


Exercise & Diabetes

Avoid exercise that involves trauma to the feet and large increases in blood pressure

Be alert for symptoms of hypoglycemia

Have quick acting glucose available


Exercise Adjustments

• Physician may need to adjust insulin dosage to prevent hypoglycemia

• If exercise is unplanned or of long duration, encourage use of supplemental carbohydrate to support increased glucose needs

• Replace carbohydrate stores post-exercise (30 minutes)


7

Blood Glucose Variations

• Hypoglycemia: low blood glucose– Results from

too much exercise, too much insulin or too little food


Symptoms of Hypoglycemia

• Defined as blood sugar levels <60 mg/dl

– Dizziness

– Light headedness

– Unsteady

– Confused irritable

– Nervous

– Unconscious


Blood Glucose Variations

• Delayed hypoglycemia biggest danger– Increased glucose

uptake following exercise can cause hypoglycemia 6-15 hours after exercise

– Insulin sensitivity increases following exercise


8

Sample Program: DiabetesCardio Strength Flex

Frequency 3-6X per wk 2- 3X per week 2-3 X per wk

Intensity 40 – 70% VO2 10 – 15 reps To the point of tension

Duration 20 - 60 minutes

1-3 sets 10 – 30 seconds

Mode Any Free Weights, Machines, Tubing, etc.

Static


ACOG Guidelines- Pregnancy• Must have physician approval

to exercise

• No supine positions after the 1st trimester

• Mild-moderate intensity

• Stop exercise & refer immediately if vaginal bleeding occurs

• Replace calories used during exercise

• Watch for joint laxity

• Encourage use of Kegels(C) 2011 by Exercise ETC Inc. All

rights reserved.

Youth Fitness• Treat children as you would

treat any special population group

• Avoid extreme exercise & maximal strength training

• Immature cardio-respiratory systems limit exercise capacity

• Have a strong “play” component – children do not have adult attention spans

• Hormone deficiencies limit major gains in strength or size(C) 2011 by Exercise ETC Inc. All

rights reserved.

9

Adolescent Fitness

• As the child matures they can transition into a more adult exercise program

• Children mature at very different rates: “late bloomers” vs “early bloomers.”

• By age 14 – 16 most teens can transition into an adult exercise program


Safety & Injury Prevention


Basic Injury Prevention

R: Rest the injury

I: Ice 20-30 min. at a time, not directly on tissue

C: Compress the injury to reduce swelling

E: Elevate above heart level to promote circulation and reduce swelling

REFER if status does not improve


10

Factors Associated with Injury

• Wet floors

• Obstacles on floors

• Unracked weights

• Poorly cushioned (or untied!) shoes

• Poor technique

• Poor form

• Excessive frequency or duration


Warning Signs Requiring Intervention

• Heat illnesses:

(Cramps, exhaustion, stroke)

• Chest pains

• Severe hypoglycemia

• Syncope

• Severe dyspnea

• Severe, traumatic injury


Responding to an Emergency

• Establish unresponsiveness

• Call 911

• Check A-B-C’s

• Begin CPR if necessary


11

Professional & Legal Issues


Legal Concepts

• Reporting & Confidentiality

• Acquiring, Recording, Securing Information

• Right to Privacy


SCOPE OF PRACTICE

Only providing the information and/or services covered by your certification.


12

NEGLIGENCE

• Not acting in a reasonable, safe, prudent manner.

• May be an act of Omission or Commission.

• 3 Criteria– Duty/Responsibility– Failure to perform– Injury/Damage

CoMparative=Client gets Money

CoNtributory=Client gets No money

A VERY bad idea.(C) 2011 by Exercise ETC Inc. All rights reserved.

Risk Management

• A means to eliminate or reduce potentially harmful situations BEFORE they occur.

•


Elements of a Risk Mgmt Plan

• Maintain CPR Certification• Know the RICE method of first aid• Have an emergency action plan. • Have accessible, well-stocked first aid kits

available.• Know the warning signs requiring

intervention.• Keep equipment maintained as per

manufacturer’s directions(C) 2011 by Exercise ETC Inc. All

rights reserved.

13

Insurance Needs

General liabilityCovers incidents, accidents

and property damage

Professional liabilityCovers negligence


CEC REQUIREMENTS

Earn 2.0 every 2 years

Each 1 hour spent in class or approved home study= .1 CEC

2.0 CECs = 20 hours spent in class or doing approved home study


For Discussion

Your new client is 3 months pregnantand has pregnancy induced hypertension. You must:

A. Lower the intensity and increasethe duration of her program

B. Receive physician approvalto exercise

C. Avoid isometric exerciseD. Monitor blood pressure


14

For Discussion

While working with your client in their home, you drop a weight which rolls across the room and down the stairs, damaging a priceless, antique vase as well as Fluffy, the family cat. What type of insurance will cover this?

A. DisabilityB. General liabilityC. Professional liabilityD. Your homeowner’s policy

“You’ll be hearing from my

attorney.”


For Discussion

Your client asks you to do a detailed dietary analysis and formulate a regimented nutritional plan and provide a prescription for supplementation.You explain that you cannot do this because it doesnot follow our industry’s:A. Standard of CareB. Scope of PracticeC. Legal limitationsD. Professional standards


For Discussion

Your client is beginning to experience the symptoms of hypoglycemia during exercise. You recommend that they consume:

A. Diet Coke

B. Hard boiled egg

C. Orange juice

D. Tuna fish


15

For Discussion

Exercises to strengthen the pelvic

floor during and following pregnancy

are called:

A. Pelvic crunches

B. Kegel exercises

C. Pelvic thrusts

D. Biofeedback


For Discussion

When a client plays some role in their

own injury this is referred to as:A. Comparative riskB. Contributory negligenceC. Comparative liabilityD. Contributory risk


For Discussion

Your postpartum client wants to return to exercise following a C-section.You advise her to:

A. Wait 4-6 weeksB. Begin walking at homeC. Begin doing pelvic tilts

and walkingD. Obtain a medical release


16

For Discussion

Which of the following would be the

MOST appropriate snack for a diabetic

client 30 minutes prior to exercise?

A. Some whole wheat crackers

B. A diet soda

C. A “Milky Way” candy bar

D. Carbonated water


For Discussion

A combination of forceful plantar flexion

and inversion of the ankle is referred to as:

A. Ankle strain

B. Ankle sprain

C. Impingement

D. Dislocation


For Discussion

During treadmill walking your client experiences a squeezing pain in her chest that radiates down the left arm. Your FIRST response would be to:A. Gradually reduce the intensity

of the treadmill speedB. Observe the client carefullyC. Refer the client to a physicianD. Activate the EMS


17

For Discussion

While walking on the treadmill your client, who is in the third trimester of pregnancy, says that her RPE is 13. What does this indicate?

A. She is working too hardB. She is not working hard enoughC. She is working out appropriatelyD. She is at an unacceptable level of

intensity


For DiscussionYour 60 year old client experiences pain in her jaw and up and down her left arm while on the treadmill. What would you do?

A. Reduce the intensity of the exercise & observe her closely

B. Stop the exercise and monitor for discomfort

C. Stop the exercise and send her home to rest

D. Stop the exercise, call 911 and monitor her symptoms


For DiscussionYour new client is 45 years old, a smoker, and

moderately overweight. She is highly motivated and has adhered to her exercise program for almost 6 months now. However, she flatly refuses to give up smoking because she is afraid she’ll “pack on the pounds.” What should you do?

A. Refuse to work with her until she stops smoking

B. Document her comments and keep working with her

C. Send her back to her physician for another evaluation

D. Refer her to a smoking cessation specialist(C) 2011 by Exercise ETC Inc. All rights reserved.

18

For Discussion

When should a pregnant woman NOTexercise?

A. If she is in the third trimester

B. If her heart rate goes above 140 bpm

C. If she experiences light vaginal bleeding

D. If she had morning sickness that morning


For Discussion

Which of the following is NOT a common method of risk management for a certified personal trainer?A. Attending educational workshopsB. Having sufficient funds to fix or

purchase equipmentC. Limiting your nutritional advice

to writing dietary plansD. Advising your clients to perform

the lat pull down in front


For Discussion

You find your client

unconscious in the

weight room. After you

call 911, what is your

next step?

A. “Are you OK, Are you OK?”

B. Begin chest compressions

C. Check breathing and circulation

D. Open airway (C) 2011 by Exercise ETC Inc. All rights reserved.

19

For Discussion

Failure to act as a reasonable and

prudent person would under similar

circumstances in known as:

A. Liability

B. Neglect

C. Negligence

D. Breach of duty


For Discussion

Your client is lunging onto a step. Which

of the following joint angles would place the

greatest amount of stress on the knee of your

client’s front leg?

A. 60 degrees of knee flexion

B. 50 degrees of knee flexion

C. 90 degrees of knee flexion

D. 125 degrees of knee flexion


For Discussion

Your hypertensive client should NOT do

which of these exercises?

A. Bicep curl

B. Standing overhead press

C. Squats

D. Tricep push downs


20

For Discussion

A tear in a muscle or its tendon is known as a:

A. Sprain

B. Tear

C. Strain

D. Bursitis


For Discussion

A non-healthy lifestyle has been linked to all of these diseases EXCEPT:

A. Diabetes

B. Cancer

C. Congenital heart disease

D. Coronary artery disease (CAD)


For Discussion

Which of the following is trueregarding a client who is pregnantand beginning an exercise

program?A. She may safely begin a low

to moderate program anytimeB. She should first consult her

physicianC. She should not exercise until

after the birthD. She may only exercise the

first 6 months of pregnancy(C) 2011 by Exercise ETC Inc. All

rights reserved.

21

For Discussion

Which of the following are NOT

appropriate exercise goals for a Type 2

diabetic?

A. Regulation of blood sugar

B. Facilitation of fat loss

C. Reduce their dosage of medication

D. Increase insulin resistance


Documents

Welcome! ACE Personal Trainer Virtual Exam Review: Module 8 · 3 Hypertension • Affects over 50% of those over age 65 • Affects more men prior to age 50; more women after age