NSCA-CPT: Client Consultation & Assessment

What components of personal training services should be assessed to determine compatibility?

- Detailed description of services available.

- Evaluate the level of exercise readiness.

- Assess suitability and appropriateness.

How can a personal trainer assess exercise readiness?

(Physical Activity Readiness Questionnaire (Par-Q))

- By assessing the motivation and commitment of the individual.

- Asking about past experience, appreciation for exercise, availability of support, time management and organizational skills, and potential obstacles.

- Paper test/ attitudinal assessment form.

What aspects of personal training should be discussed to determine suitability?

- Trainer's info: education, experience, certifications, expertise/specializations, mission statement, success rate, and unique features of program delivery system.

- Logistical info: time/location availability of services.

- Client info: Client's readiness/motivation

- Boundaries: agree to boundaries, roles, resources, expectations.

- Referral info: provide referral information if client/trainer are not compatible.

What factors might demonstrate the need for a personal trainer to refer a client to another personal trainer?

- They don't agree with their client's goals.

- Trainer is not specialized in the area client wants to improve.

Ex: yoga instructor not good for strength training.

- Personality differences clash.

What information should be discussed and agreed upon prior to the initial training session?

- Determining trainer-client compatibility.

- valuate the level of exercise readiness.

- the discussion of goals.

- suitability and appropriateness

- finalize trainer-client agreement.

- Services

- Price

- Timelines

- Policies/procedures

- Delivery process- "can pt help the client?", site of delivery.

What are the components of a client-personal trainer agreement? What is the purpose of each of these components?

- Components of a contract include written documentation describing the services, parties involved, expectations of those parties, timeline of delivery, cost structure, and payment process.

- The trainer should document and clarify questions and issues concerning the agreement b4 signing the contract.

- Cancellation policy, and termination of contract should also be discussed.

What is the purpose of a client-personal trainer agreement? What does it outline, when is it valid?

- In most cases this is legally driven. Outlining the process, services rendered, and payment plan.

- Contact becomes valid when signed by both parties.

- So, both the personal trainer and client have an understanding of what is going to take place in the training session.

- Lastly, so there are no disagreements between the trainer and client.

What is the purpose of an informed consent?

- Gives clients info about the content and process of the program delivery system.

- It includes the risks and benefits of the program and what the client is getting involved in.

What is the purpose of a liability waiver form?

- This is also called a Release/Assumption or Risk agreement.

- An agreement by the client b4 beginning participation, to give up or relinquish or waive the participants rights to legal remedy (damages) in the event of an injury, even when injury arises as a result of provider negligence.

What information should be contained within an informed consent?

- Gives clients info about the content and process of the program.

- Detailed description of program.

- Risk and benefits associated with participation.

- Confidentiality clause.

- Responsibilities with participation.

- Documentation of knowledge and acceptance of terms described in form.

When should the informed consent and liability forms be obtained?

- During the initial interview.

- Should be obtained prior to any testing or participation to ensure the participant knows and understands the risks and circumstances.

What is the purpose of assessing an attitude and readiness inventory?

- Assessment to find out the readiness of your potential client by asking about past experiences, appreciation for exercise, availability of support, and potential obstacles that might affect sessions.

- Also used as an gauge of attitudes, outlook, and perspective.

How does use of the attitude and readiness inventory aid both the client and personal trainer?

- So the client can have approval from a health care provider.

- So personal trainer is aware of the client's conditions and habits to help build an exercise program.

List and describe the stages of readiness for change:

• Precontemplation: Person is not increasing activity and is not thinking about it

• Contemplation: person is thinking about increasing activity but has not yet

• Preparation: Client accumulates 30 minutes of activity a week

• Action: Client accumulates 30+ minutes of activity a day 5 days a week for less than 6 months

• Maintenance: Client accumulates 30+ minutes of activity a day 5 days a week for more than 6 months

List and describe potential barriers for readiness for change. How might they be addressed?

- Physical: physical reasons for being unable (injury etc.)

- Emotional: Emotional reasons (depression, isolation, anxiety)

- Motivational: Unmotivated

- Time: Time management and scheduling issues

- Financial: no money or reasons to hold off due to needing money

- Logistical: issues with access to facilities or equipment

What are the objectives when conducting a medical history/health appraisal?

- For health appraisal is to screen participants for risk factors and symptoms of chronic cardiovascular, pulmonary, metabolic, and orthopedic diseases in order to optimize safety during exercise testing and participation.

- First step is to ask client to complete relevant forms.

- Health appraisal instruments are tools by which information is collected and evaluated to assess appropriateness for various levels of exercise and referral

What questions are commonly included on a medical history/health appraisal form?

- Is to identify known diseases and positive risk factors associated with coronary artery disease, assess lifestyle factors that may require special considerations, and identify individuals who may require medical referral before starting an exercise program.

- present / past history

- family history

- active history

What is the purpose of administering a lifestyle questionnaire? What are its benefits and limitations?

- Requires self-recall of observations and signs and symptoms experienced by the client as well as confirmation of the diagnosis by a physician.

- Cost effective, easy to administer, identifies individuals who require additional medical screening while not excluding those who would benefit from participation in low-intensity activity.

- Limitations: designed essentially to determine the safety of exercise and not necessarily the risk for coronary artery disease.

What questions are commonly included on a lifestyle questionnaire?

- Questions related to conditions or pain.

- Do you lose your balance because of dizziness?

- Do you have a bone or joint problem?

- Do you know of any reason of why you should not do physical activity?

Identify the process for determining a client's need for medical clearance prior to participating in an exercise program.

- It is the personal trainer's responsibility to encourage medical clearance as a reasonable and safe course of action.

- Recommendation to consult with physician prior to participation in an exercise should not be considered an abdication of responsibility by the personal trainer, but an effort to obtain valuable information and professional guidance to ensure safety and protection of individuals health.

Who should obtain a medical release prior to participation in an exercise program?

- Once medical clearance recommended, personal trainer should give the client a physician's referral form in order to obtain the necessary information about health status, physical limitations, and restrictions that would be required to make future fitness program recommendations.

Identify and discuss information found on a medical history/health appraisal form or lifestyle questionnaire that might require modifications to an exercise program?

- If present many symptoms on heath medical form exercises will need to be adjusted based on their present or past history.

- if say yes to any of the PAR-Q

Identify and discuss information found on a medical history/health appraisal form that might require referral to a healthcare professional.

- High Risk: Recommended that a current medical examination and exercise test be performed prior to moderate or vigorous exercise, and recommended that a physician supervise either a sub maximal or maximal exercise test.

What information should be included on a physician's referral form? When should it be given?

- Once medical clearance is recommended, the personal trainer should give the client a physician's referral form in order to obtain the necessary information about health status, physical limitations, and restrictions that would be required to make future fitness program recommendations.

Form includes:

- Assessment of an individual's functional capacity - classification of ability to participate based on the evaluation.

- Identification of preexisting conditions that may be worsened by exercise.

- Prescribed medications, and fitness program recommendations.

Identify the various individuals considered to be allied healthcare professionals that a personal trainer might interact with when training clients with medical concerns.

- Certified fitness professionals.

- Nurses, doctors, therapists.

- Family members.

Describe strategies to build and maintain networks with allied healthcare professionals.

- Interact with each other weekly to make sure you both are on the same page as the client.

- Make sure you both agree with what the plan is as far as increasing or decreasing the amount of exercise the client does.

- Always check up on the client weekly.

What is the purpose of a fitness evaluation?

- A fitness assessment identifies your current fitness levels and serves as a baseline or starting point of your body's fitness. You can use this fitness assessment to figure out your training needs and goals. You then compare your progress over time to the initial fitness assessment.

How can a personal trainer determine the reliability of a fitness test?

- Reliability = is the measure of repeatability or consistency of a test or observation.

- Must measure the same trait under the same conditions with no intervention.

- If results are same from one trial to another, test is reliable.

- Scores collected by different personal trainers on the same client without interventions should be compared in order to determine reliability or objectivity.

- If more than one personal trainer can get the same results, the test is objective rather than subjective.

- Not practical to test client multiples times a day or per week so personal trainer must look for assessments that were proven to have good reliability when they were developed.

- Personal trainer needs to take the time giving the assessment by performing it very strict and under standardized conditions.

What determines the validity of a fitness test?

- Indicates that a test measures what it is supposed to measure.

- Must also be relevant- In other words is the test score a "truthful score".

What is Face Validity?

- Face Validity = Means that the test appears to test what it is supposed to test.

*Ex: A 1 RM test is a valid measurement of muscular strength but not muscular endurance.

Identify and describe the factors that affect the validity and reliability of a test contributing to the selection of fitness tests.

- Health Status and Functional Capacity = Dictates which assessments are appropriate. Information gathered is used to identify physical limitations.

- Age = Depending on your age can influence testing performance based on maturity.

- Sex = Sex-specific biological factors can influence performance in a variety of activities or assessments such as push-up, chin-up, and bench press.

-Pretraining Status = May affect test selection when the skills required for the test and the relative level of exertion are considered. Caution should be emphasized in assessment of untrained, deconditioned individuals.

Identify and explain the actions a personal trainer should take when preparing to conduct fitness assessments.

- Requires advanced preparation and organization to ensure psychometrically sound results and safe outcomes.

* Preparation to evaluate someone's level of fitness requires the personal trainer:

- To execute preassessment screening procedures-review safety considerations, select appropriate assessments.

- Select facilities and verify accuracy of equipment.

Describe the procedures for measuring heart rate.

- Heart Rate:

1. Palpation Procedure = Use tips of index and middle finger to palpate the pulse. Avoid using thumb because its inherent pulse can be confusing.

2. Auscultation Procedure = Requires use of stethoscope, bell of stethoscope placed directly under skin on third intercostal space just left of sternum. Sounds heard from heart beating should be counted for either 30 or 60 seconds.

3. Heart Rate Monitor Procedure = Digital display.

What factors might affect the assessment of the heart rate?

Heart Rate:

- Smoking and tobacco products

- Caffeine

- Environmental temperature extremes

- Altitude

- Stress

-Food digestion

-Time of day

- Medications and supplements

- Time of day

Identify common errors and potential issues that occur when measuring heart rate.

Heart Rate:

- Assuming low reading always bad.

- Client not sitting in good position to take it.

- Not directly on client's pulse to get accurate reading.

Describe the procedure for measuring height.

1. Ask client to remove all footwear.

2. Instruct client to stand as erect as possible with feet flat on floor and heels together facing away from wall.

3. Instruct client to horizontally align the lowest point of the orbit of the eye with the opening of the ear.

4. Before taking measurement, instruct client to take deep breath and hold until measurement has been taken.

5. Rest anthropometer arm or measurement angle gently on crown of client's head.

6. Mark the wall or stabilize the anthropometer and record measurement to nearest centimeter.

Describe the procedure for measuring weight.

1. Ask client to remove as much clothing and jewelry off them.

2. Instruct client to step on scale gently and remain as still as possible throughout the measurement.

3. Record weight nearest 1/4 pound.

4. Convert measurement into pounds to kilograms.

What are skinfold calipers used for? How are they used? What does it help understand.

Skinfold Calipers = Skinfold measurements. A skinfold caliper is used to assess the skinfold thickness, so that a prediction of the total amount of body fat can be made. This method is based on the hypothesis that the body fat is equally distributed over the body and that the thickness of the skinfold is a measure for subcutaneous fat.

Identify and demonstrate the method for determining body mass index.

- Necessary to have clients height and weight.

*BMI (kg/m^2) = Body weight (kg) / Height^2 (m^2)

Describe the procedure for assessing body composition with calipers.

- Take all measurements on right side of body.

- When clients skin is dry and free of lotion.

- Identify and measure and mark skin fold sites.

- Grasp between thumb and finger, placement 1 cm apart

- Lift the fold by placing thumb and finger 8 cm apart

- Keep fold elevated

- Place jaws of caliper perpendicular to fold- Record skin fold measurement.

- Take minimum of 2 measurements, if values vary by more than 2mm or 10% than take an additional one.

*A three-site skinfold is commonly done and includes the chest, abdomen, and thigh on men and triceps, suprailiac, and thigh on women

Identify considerations for assessing body composition with calipers specific to sex, age, etc. What has been made to remedy it?

- There are some issues using skinfolds to estimate % body fat for a number of reasons, including distribution of body fat varies with age, sex, race, and athletic activity. Reasonably accurate prediction of % body fat from skinfolds therefore requires that the equation used for a given person to have been developed using a similar subject population.

Jackson-Pollock 3-Site Skinfold Formula has provided generalized equations that have been validated for various age groups and both athletic and non-athletic populations.

*These equations are:

- Men: D=1.1125025-0.0013125(x) + 0.0000055(x2 ) - 0.000244(y)

- Women: D=1.089733-0.0009245(x) + 0.0000025(x2 ) - 0.0000979(y)

*Where x=sum of triceps, chest, and subscapular skinfolds (in mm) for men, and the sum of triceps, suprailium, and abdominal skinfolds for women, and y =age in years.

Identify common errors and potential issues when assessing body composition using calipers.

- Human error.

*Example: incorrect pinching technique by to person performing the assessment could result in a larger than actual measurement, if muscle is pinched with the fat.

Describe the procedure for measuring and determining waist-to-hip girth ratio.

1. Place tape measure around girth of waist and hip.

2. Hold zero end of tape in one hand, positioned below the other part of tape, which is held in the other hand.

3. Apply tension to the tape so that it fits around the body part but does not indent the skin or compress the subcutaneous tissue.

4. Align the tape in a horizontal plane, parallel to the floor.

5. To determine the waist-to-hip ratio, divide the waist circumference by the hip circumference.

What methods can be used to determine muscular strength?

- 1 rep max (RM) bench press

- 1 rep max (RM) leg press

Describe the procedures for conducting 1RM maximal testing.

1. Instruct client to warm up with light resistance that easily allows 5-10 reps of 40-60% of his or her estimated 1 RM.

2. Provide a 1-minute rest period.

3. Warm-up load allow client to do 3-5 reps.

4. 2-minute rest period.

5. A near maximum load that allows the client to do 2-3 reps.

6. 2-4-minute rest period.

7. Make a load increase.

8. Instruct client to attempt 1 RM.

9. If successful provide 2-4-minute rest and back to step 7, if failed 2-4-minute rest and decrease the load.

10. Continue increasing or decreasing load.

11. Record 1 RM.

Identify how to determine relative strength.

- Usually expressed relative to body weight.

- Amount of strength to body size.

- Absolute strength / Body Weight

Describe how to estimate 1RM from a submaximal resistance.

- Have client perform as many reps as possible w/ submaximal performance.

Rep - %

1-100

2-95

3-93

4-90

5-87

6-85

7-83

8-80

9-77

10-75

11-70

12-67

15-65

Describe the procedures for YMCA bench press. What does it measure?

- YMCA Bench Press:

1. Spot client closely and observe technique.

2. Set resistance at 80 pounds for male clients, 35 pounds for female clients.

3. Proper bench technique.

4. Set metronome cadence at 60 beats per minute to establish rate of 30 reps per minute.

5. Have client begin with arms extended and shoulder width grip, lower the weight to the chest.

6. Terminate test when client can no longer lift.

Measures Upper Body Muscular Endurance

Identify common errors and potential issues when conducting muscular endurance tests.

- Poor explanation of test procedures and performance criteria used for scoring.

- The cadence not correlating when lifting the weights.

- Doing the exercise to fast or slow.

- Lack of client neuromuscular proficiency, or familiarity (too weak, or not used to the load).

- Loose scoring guidelines used by the tester.

Identify the purpose of for conducting assessments that measure speed, agility, and power.

- Tests the ability to turn in different directions and at different angles.

- The aim of the test is to complete the running course in the shortest possible time.

- Training programs that target muscular power have great potential to improve sport performance.

- It has been shown that improvements in speed and jumping ability are greater when a program targeting muscular strength is performed for a period of time prior to a program targeting muscular power.

- Evidence indicates that older adults who engage in power training experience improvements in their ability to engage in activities of daily living and in functional performance.

Identify and describe various methods for assessing speed, agility, or power.

1. 40 Yard Sprint Test.: This is the most common test to measure speed.

2. T-Test: The T-Test is a common field test of agility that is normally performed on the athlete's regular playing surface.

3. Arrowhead Test.: This is an agility test that utilizes speed and quick changes in direction.

*Vertical Jump

Discuss the differences between a submaximal and maximal cardiovascular endurance test.

Submaximal: Used most often because of high equipment expenses, the personnel needed, and increased risks associated with maximal tests.

- Concept behind submax test is to monitor HR, BP, or RPE or some combination of these during exercise until a predetermined percentage of the clients predicted maximal HR is achieved.

Maximal:

- To get true measure of clients cardiovascular endurance one would need to conduct maximal test Are not safe or necessary for clients and sometimes cannot be conducted without physician supervision.

Identify the basic assumptions when conducting a submaximal cardiovascular endurance test. What are solutions for these in practical settings?

- Provide valid, reliable, specific and sensitive estimation of Vo2 max.

1. Assumption 1: Heart rate measurements must be steady state.

*Solution: HR can fluctuate dramatically with sudden changes in work rate. To ensure HR has achieved steady state, personal trainers should record HR values at end of constant work rate stage or after 2-3 minutes of exercise.

2. Assumption 2: True maximal HR for a given age must be the same for all clients.

*Solution: Any given age, maximal HR can vary as much to 10-12 beats a min across individuals.

3. Assumption 3: The relationship between HR and work rate must be strong, positive, and linear.

*Solution: The positive relationship between HR and workload is most linear between 50% and 90% of maximal HR.

4. Assumption 4: Mechanical efficiency (VO2 at a given work rate) is the same for all clients.

*Solution: Personal trainers should choose a test that is specific to the client's existing cardiovascular exercise models, daily activities or both.

Identify and explain the different methods for assessing cardiovascular endurance.

1. Cycle Ergometer Testing = A bicycle ergometer is used to evaluate the fitness level of an individual or athlete. The test subject rides the bicycle while connected to monitoring equipment. This equipment measures heart rate, pulse, metabolic changes and respiratory effects of exercise.

2. YMCA Cycle Ergometer Test = This test is a nationally used submaximal test that measures heart rate response to an increasing exercise workload. Two exercise heart rates are used to estimate maximal physical working capacity. A workload guide was established to make testing more efficient.

3. Astrand-Rhyming Cycle Ergometer Test = Is one of the most commonly administered submaximal tests to determine aerobic capacity. Additional research has also found that the ARCET shows a 15% standard deviation from directly measured maximal aerobic capacity.

4. YMCA Step Test = Measures the cardiovascular endurance. To acknowledge how the heart rate quickly returns to normal after exercise.

5. The Cooper 12 Minute Run/Walk = A popular maximal test of aerobic fitness, in which participants try and cover as much distance as they can in 12 minutes. There are several other variations of running/walking tests, including the Cooper 1.5 mile run test, and also a swimming version.

6. Rockport Walking Testing = This test is a science-based measurement that's designed to assess your cardiac fitness level. The test was developed back in 1987 by Kline et al. in order to predict someone's VO2max. The original study focused on an adult population for adults between 40 and 69 years of age.

Describe the procedures for the various laboratory methods of assessing cardiovascular endurance.

YMCA Cycle Ergometer Test:

1. Instruct client to begin pedaling at 50 rpm and maintain cadence throughout test

2. Set work rate for 1st three-minute stage at 150kg

3. Measure clients HR during final 15-30 seconds of the second and third minute of the 1st stage

4. Set the work rate

5. Measure clients HR during final 15-30 seconds

6. Set the 3rd and 4th three-minute stages

7. Terminate test when client reaches 85% of his or her age predicted maximal HR

YMCA Step Test:

1. Client listen to cadence

2. Instruct client to step up and down to cadence of 96 beats per minute

3. Client steps for 3 min

4. After final step have client sit down and within 5 seconds measure HR

5. Compare 1 minute recovery HR to normative values

Describe the procedures for the various field methods of assessing cardiovascular endurance.

12 Minute Run/Walk:

1. Instruct client to run as far as possible during 12-minute duration

2. Record total distance completed in meters

3. Use equation to calculate VO2 max

1.5 Mile Run:

1. Instruct client to cover 1.5 mile

2. Call out or record elapsed time

3. Convert seconds to minutes by dividing seconds by 60

Identify common errors and potential issues when conducting submaximal cardiovascular endurance tests.

-Cadence is not the same as person pedaling

- Going too fast or slow

- Not starting timer on time

Describe the procedure for assessing flexibility using the sit-and-reach test.

1. Have client warm up and perform some moderate stretching prior to test.

2. Place yardstick on floor and place tape across yardstick at right angle to the 15 inches

.

3. Have client reach forward slowly with both hands as far as possible and holding the terminal position.

4. The score is the most distant point reached

Discuss options for assessing postural alignment and determining muscle balance.

- Prone Double Straight Leg Raise Test.

- Sit and Reach Test

- Flexibility

Identify and discuss methods for assessing movement and their implications (e.g., Functional Movement Screen, overhead squat).

- Screening assessment used to obtain a general indication of dynamic posture. The test identifies compensatory movements and considers muscles which could potentially be overactive or underactive with the intention of addressing these muscle imbalances.

What is the purpose of reevaluation?

- Purposes of assessment are to gather baseline data and to provide a basis for developing goals and effective exercise programs.

- Gathering and evaluating the various pieces of information give the personal trainer a broader perspective of the client.

When should a reassessment be conducted?

- Once the assessments are complete and the personal trainer has reviewed the results with the client than the program is designed and implemented based on the client's goals.

What factors should be considered when discussing fitness test results with a client?

1. Do you have diabetes?

2. Is body composition interfering with the performance of the simple of daily tasks? (i.e. clinically obese?)

3. Do you have a history of high blood pressure?

4. Do you have a family history of coronary disease prior to age 50?

Have you ever had:

- a heart attack

- cardiac surgery

- extreme chest discomfort

- high blood pressure (over 140/90)

- heart murmurs

- ankle swelling

- any vascular disease

- unusual shortness of breath

- fainting spells

- asthma, emphysema, or bronchitis

Do you:

- smoke (and over the age of 35)

- drink excessively (more than 1-2/day)

- have poor sleeping habits (less than 8 hrs/night regularly)

Explain the difference between a norm-referenced and criterion-referenced standard.

Norm-referenced = measure the acquisition of skills and knowledge from multiple sources such as notes, texts and syllabi.

Criterion-referenced = tests measure performance on specific concepts and are often used in a pre-test / post-test format.

Identify and discuss fitness test results that might require referral to a healthcare professional.

- Abnormal Vital signs

- Displays risk factors or symptoms of CAD

- High risk and would have to alternate fitness program (such as high body composition).

What information should be included on a physician's referral form?

- Member name

- ID number

- Provider name

- Diagnosis

- Reason for referral

What is the personal trainer's role and scope of practice regarding nutritional recommendations?

- Credible source for nutrition info

- Address misinformation

- Give general information

- Refer to professional for people w/ disease state

What nutritional information can the person trainer provide to healthy clients?

- To address misinformation and to give general advice related to nutrition for physical performance, disease prevention, weight loss, and weight gain.

When should a personal trainer refer a client to a nutrition professional?

- When the client has a disease state (diabetes, heart disease, gastrointestinal disease, eating disorder, osteoporosis, elevated cholesterol.

- When the complexity of the nutrition issue is beyond competence of the personal trainer, which will vary.

Discuss the different types of regulations that exist for the provision of nutritional information.

- Licensing: Statues include an explicitly defined scope of practice, and performance of the profession is illegal unless a license has been obtained from the state.

- Statutory Certification: Limits use of particular titles to persons meeting predetermined requirements, while persons not certified can still practice the occupation or profession.

- Registration: This is the least restrictive form of state regulation. As with certification, unregistered persons are permitted to practice the profession. Typically, exams are not given and enforcement of the registration requirement is minimal.

What is the purpose of performing a dietary assessment?

- If a client wants to seek nutrition information within the personal trainer's scope of practice, then the personal trainer would want to assess the client's diet.

- Includes dietary data, anthropometric data, biochemical data, and a clinical examination.

- Personal trainers may want to be familiar with individual components of a comprehensive dietary assessment so they can work with dietitian to provide the client the best service possible.

Describe methods that can be used to evaluate a client's dietary habits that are within a personal trainer's scope of practice.

- To compare a client's data to the recommendations given in the country's general dietary guidelines.

- MyPlate: Client's interests in nutrition, a more detailed analysis of the diet using diet analysis software

- How much someone should consume including balancing calories, foods to increase, foods to reduce.

-Computerized Diet Analysis: Provide snapshot of a client's diet, including vitamin and mineral intake

What methods can be used to evaluate a client's dietary intake?

- Diet Recall: Clients recall what they have eaten in the past 24 hours.

- Diet History: Clients answer questions about usual eating habits, likes and dislikes, eating schedule, medical history, weight history and so forth

*Diet Record: Typically, a log filled out for three days in which the client records everything consumed (foods, beverages, and supplements).

- The three-day diet record is considered the most valid of the three methods for assessing the diet of an individual.

Identify and explain the factors that determine an adult's energy requirements.

- Resting metabolic rate: largest contributor to total energy requirement, accounting for approximately 60% to 75% of daily energy expenditure. It is the measure of the calories required for maintaining normal body functions such as respiration, cardiac function, and thermoregulation.

Factors that increase it include:

- Gaining lean body tissue

- Young Age-Growth

- Abnormal body temperature

- Menstrual cycle

- Hyperthyroidism

Factors that decrease it include:

- Low caloric intake

- Loss of lean tissue

- Hyperthyroidism

- Physical Activity: The amount of energy needed for physical activity depends on the intensity duration, and frequency of training. Also depends on environmental conditions such as extreme heat or cold increases calorie expenditure.

*Personal trainer needs to remember to ascertain how physically active the client is aside from structured exercise.

- Thermic Effect of food: Increase in energy expenditure above the RMR that can be measured for several hours following a meal.

*The thermic effect of food is the energy needed to digest and assimilate foods, approximately 7% to 10% of a person's total energy requirement

List and describe the roles of the six nutrients required by the body.

1. Protein = Main nutrient of interest especially among body builders, weightlifters, and others who engage in resistance training.

- Two key factors include energy intake and source of protein

- Protein may be used for energy when fewer calories are consumed than expended.

2. Carbohydrate = Is required for the complete metabolism of fatty acids. To provide fuel for energy to why the amount depends on total energy requirement.

3. Fat = Prevent true deficiency. Can decrease testosterone production with low fat affecting metabolism and muscle development.

- Very low-fat diets can also impair the absorption of fat-soluble vitamins.

4. Vitamins = Considered essential nutrients. Help up shore up the bones, heal wounds, and bolster your immune system. Also convert food into energy and repair cellular damage.

5. Minerals = Water: To keep the body hydrated at all times and to avoid dehydration and maintain fluid balance.

Identify the recommended intakes for carbohydrate, protein, and fat.

1. Carbohydrates: 60-70% of total calories for physically active individuals.

- If client aerobic endurance athlete, he or she should replenish 7-10 g/kg body weight per day.

2. Protein: For healthy sedentary adults is 0.8 g/kg of body weight for both men and women.

- World Health Organization states a safe intake for 97.5% of population is 0.83 g/kg.

- Recommendation for athletes are 1.2-2.0 g/kg per day depending on sport, training, intensity and total calorie intake.

3. Fats: Consume at least 3% of energy from omega-6 fatty acids and 0.5% to 1% from omega-3 fatty acids to prevent true deficiency.

- Recommendation is that fats should contribute 30% or less of the total calories consumed.

- Recommended 20% of the total calories come from monounsaturated or polyunsaturated sources, less than 10% come from saturated fats.

Identify and discuss the guidelines for fluid intake on a daily basis, before exercise, during exercise, and after.

Daily Basis: Anywhere from 64 ounces per day to 2 gallons. Water requirements change based on variety of factors including environment, sweating, body surface area, calorie intake, body size and lean muscle tissue. Avoid dehydration is a goal and to maintain fluid balance.

1. Before Exercise: Approx. 5-7 ml of fluid per kilogram body weight should be consumed at least 4 hours prior to exercise.

- Additional fluid should be consumed 2 hours prior to exercise, approx. 3-5 ml/kg body weight if urine is dark and scant.

2. During Exercise: Hydrate constantly during exercise to avoid dehydration and sweat loss.

3. After Exercise: Main goal is to replace any folioed and electrolyte losses.

- Clients should drink 20-24 ounces of fluids for every pound loss.

- Sodium rich food or a sport drink should be used to stimulate thirst, replace lost electrolytes, and enhance rehydration.

What are the primary recommendations for healthy weight gain?

- To increase calorie intake and to increase protein intake or maintain at an adequate level.

What are the primary recommendations for healthy weight loss?

- Help clients achieve a negative energy balance.

- Ability to achieve and maintain minimal body fat.

- Diet should be composed of food low in energy density.

- Diet should be nutritionally balanced and should provide a variety of foods.

Discuss common types, uses of, and recommendations for dietary supplements.

- Vitamin and mineral supplements remain the most commonly used.

- When evaluating clients supplement regiment, it is important to evaluate all sources of the nutrient.

- Excessive intakes such as iron, calcium, zinc, magnesium, niacin, B6 and vitamin A, should be corrected through changes in the supplement regimen.

- Helping client adjust food and supplement choices to optimize the vitamin and mineral intake is a useful function of diet analysis.

- Evaluation of each supplement depends on individual's goals and situation.

- Meal replacement drinks and bars can be excellent for busy people.

- Protein supplements can help needs for protein for people who don't eat enough.

- Important to know some supplements contain banned substances that could lead to a positive drug test.

What is the difference between eating disorders and disordered eating?

1. Eating Disorder: Engage in multiple behaviors such as thinking about food, body image or mood. The individual thinks about calories, taste, food avoidance, or where to buy food. They are not able to function the same way.

2. Disordered Eating: Is when one mindfully consumes food when hungry and is able to stop when full. They incorporate variety in their diet.

- Range of irregular eating behaviors that may or may not warrant a diagnosis of a specific eating disorder.

- Many individuals with disordered eating symptoms are diagnosed with Eating Disorder Not Otherwise Specified.

*The most significant difference between an eating disorder and disordered eating is whether or not a person's symptoms and experiences align with the criteria defined by the American Psychiatric Association.

Anorexia Signs and Symptoms?

1. Anorexia:

- Low body weight

- May have dramatic weight loss

- Feels as though he or she is overweight, even when that is clearly not the case.

- Denial of hunger

- Preoccupation with body weight and shape (frequent weighing and comments regarding weight and shape).

- Obsession with food and its nutrients (calories, fat, carbohydrates, etc.)

- Food rituals (cutting into very small pieces, excessive chewing, etc.)

- Excessive exercise and dieting.

- Anxiety regarding weight, mealtime, and social activities or gatherings

- Frequent fatigue and overall weakness

- Dry, thinning, or loss of hair-Dry skin and brittle nails.

What reasons or situation may require a client to be referred to a recognized nutrition professional or healthcare professional?

- When client has disease state such as diabetes, heart disease, gastrointestinal disease, eating disorder, osteoporosis, elevated cholesterol.

- Also indicated when complexity of nutrition issue is beyond the competence of the personal trainer.

Things to think about when determining stage of readiness for change.

*They will present and showcase, to differing degrees, a range of barriers that can get in the way of their ability to complete physical activity. It's up to you to spot, identify and tackle these reasons. Once you've done this it's time to get inventive and come up with practical solutions or workarounds that support keeping your client on track as much as possible.

*Barriers to exercise are not static and are constantly changing depending on many other elements that contribute to your client's overall lifestyle. For this very reason it's important to not only help tackle and overcome any barriers you encounter, but also remember to check in regularly with your client and be on the lookout for new barriers as they crop up.

Steps of Client Consultation and Health Appraisal

1. Schedule interview appointment

2. Conduct interview

3. Implement and complete health appraisal forms

4. Evaluate for coronary risk factors, diagnosed disease, and lifestyle.

5. Assess and interpret results

6. Refer to an allied health professional when necessary.

7. Obtain medical clearance and program recommendations.

Describe Procedure for Measuring BP.

- Blood Pressure:

1. Instruct client to refrain from smoking or caffeine at least 30 minutes prior to BP measurements.

2. Client sit upright in chair.

3. Appropriate cuff size.

4. Begin BP measurements.

5. Place cuff on arm so air bladder directly over brachial artery.

6. Place stethoscope firmly with client's palm facing up.

7. Position the sphygmomanometer so that center of mercery column is at eye level.

8. Quickly inflate air bladder once everything in place.

9. Record both systolic and diastolic BP.

10. Carefully observe manometer for additional 10-20 mmhm Hg of deflation.

11. After minimum of 2 minutes of rest, measure BP again.

12. Once client's BP determined can be classified.

Identify common errors in procedure when measuring BP.

Blood Pressure:

- Stethoscope is on backward.

- Stethoscope bell is under the cuff.

- The dial is not at the tester's eye level.

- The blood pressure cuff is positioned too close to the antecubital space.

Things that might affect blood pressure reading results?

Blood Pressure:

- Smoking and tobacco products

- Caffeine

- Stress

- Body Position

- Time of day

What does the partial curl up test measure and how is it done?

- Partial Curl Up:

1. Direct client to assume supine position on mat with knees at 90 degrees.

2. Set metronome to 50 beats per minute and have individual do slow controlled curl ups.

3. Direct client to perform as many curl ups as possible without pausing, up to maximum of 25.

Measures Abdominal Muscular Endurance

Explain the procedures for the Prone Double Straight Leg Raise Test. What does it measure?

- Prone Double Straight Leg Raise Test:

1. Prone position with legs extended and hands underneath forehead and forearms perpendicular to the body.

2. Instruct client to raise both legs to point of knee clearance from table.

3. Can monitor test by sliding one hand under the thighs.

4. Record test duration in seconds.

5. Terminate test when client can no longer maintain knee clearance from the table.

Measures hip extensor and back extensor muscular endurance.

Bulimia symptoms and signs?

2. Bulimia:

- Frequent fluctuations in body weight

- Frequent episodes of bingeing (consuming large amounts of food) followed by purging (compensatory behaviors including self-induced vomiting, misuse of diuretics, laxatives, or enemas).

- Hiding food to eat in private

- Feeling of loss of control during binge episodes

- Feelings of shame and guilt when eating

- Preoccupied with body weight and shape

- Preoccupied with exercise and dieting

Binge Eating disorder signs and symptoms

3. Binge Eating Disorder:

- Frequent episodes of bingeing (consuming large amounts of food)

- Feeling of loss of control during binge episodes

- Hiding food to eat in private

- Feelings of shame and guilt when eating

- Eating when not physically hungry

- Eating past the point of discomfort

- Eating alone

Diabulimia symtoms and signs

4. Diabulimia:

- May have extreme weight loss

- Disordered eating behaviors including restriction or bingeing

- Secrecy around insulin administration

- Frequent episodes of hypoglycemia

- Nausea and vomiting

- Increase of thirst and urination

- Diabetic ketoacidosis, DKA

- Yeast infection, bladder infection

- Liver disease

What is Test-Retest?

- Test-Retest = when a test is repeated with the same individual or group within one to three days and sometimes up to one week.

What is content Validity

- Content Validity = Indicates an expert has determined the test covers all topics or abilities that it should.

*Ex: A volleyball athlete should be tested on more than just jumping ability in order to cover all skills perfumed in that sport.

What is construct Validity?

- Construct Validity = A theoretical concept meaning that a test is able to differentiate between performance abilities.

*Ex: If test is sport skill related test than those with the given sport skills should score better on the test than those who take test without having acquired those skills.

What is Criterion Related Validity?

- Criterion Related Validity = Allows personal trainers to use tests in the field or in the fitness center, instead of tests that can be performed only in a laboratory setting or with expensive equipment.

What is bioelectrical Impedance Analysis?

- Bioelectrical Impedance Analysis (BIA) = Measurement of the amount of impedance or resistance to a small, painless electrical current passed through the body between two electrodes, which are often placed on wrist and ankle.

What is hydrostatic weighing and what does it measure and how is it performed? What does it assume?

Hydrostatic Weighing (underwater weighing) = A method of measuring body composition whereby the subject is submerged into a tank of water and body composition is determined based on total body density using Archimedes' principle of displacement (the weight of displaced fluid can be found mathematically). Underwater weighing assumes that the densities of fat mass and fat-free mass are constant, lean tissue is denser than water, and fat tissue is less dense than water.