CSEP CEP Practical Protocols

Resting HR

1) Ensure the client has abided by the preliminary instructions and does not present with any symptoms that warrant the postponement of the assessment.

2) Have the client rest in a seated position with feet flat on the floor and arms resting at heart level on the table in front of them for 5 minutes.

3) Ask permission to touch them and palpate the radial or coronary artery, or use a stethoscope over the sternum or second intercostal space.

4) Using a 15-second count, start timing simultaneously with the first beat, counting as zero. Multiply by 4 to get bpm.

5) If HR is above 100bpm, rest again for 5 minutes and repeat the procedure.

Resting BP

1) Ensure the client has abided by the preliminary instructions and does not present with any symptoms that warrant postponement of the assessment.

2) Have the client sit with their back against the chair, arm supported by the table at approximately heart level.

3) place cuff 2.5 cm above the antecubital fossa with the bladder of the cuff (index line) over the brachial artery. Make sure cuff is tight so no more than two fingers can slip under the cuff.

4) While taking radial pulse, rapidly inflate the cuff to 70mmhg, then continue to inflate by 10 mm increments until you no longer palpate the pulse. Inflate another 20-30mmHg then put stethoscope over brachial artery.

5) Release the cuff at a rate of 2mm per second and note the first and last Korotkoff sounds.

6) 160/90 would be the highest cut off for BP

Waist Circumference

1) ask client if they are comfortable clearing clothing and accessories from around their waist and give consent for the tape to touch the skin. Demonstrate on yourself where the tape will be placed.

2) Position the client's feet shoulder-width apart, arms crossed over the chest in a relaxed manner.

3) take measure at the edge of the iliac crest;, draw a horizontal line with a washable marker. The tape measure should go directly in line with the inferior edge of the measure touching the landmarked line.

4) Ensure the tape is level and even, then measure at the natural exhalation to the nearest 0.5 cm without causing indentation in the skin.

mCAFT Protocol

1) Explain that the test is measuring aerobic fitness to determine where the participant lands in the normative data and to inform the exercise prescription. Explain the full protocol and the termination criteria (asking to stop, reaches ceiling HR, physiologiingcal distress such as staggering, dizziness, chest pain, nausea, or facial pallor, cannot maintain cadence, or equipment fails).

2) Prior to starting the test, have the 85% HRmax → 0.85x[208-(0.7xage)]

3)Ensure the HR monitor is secured to the client according to the device and place a wall marker for the client to concentrate on during the test.

4) steping instructions: step not run and lead with the left or right foot as perferred. Lead foot can be switched at the end of each 3-minute stage. Both feet should placed on the top step with legs fully extended and back upright, and client is to stop steopping and remain motionless at the end of the music of each stage.

Treadmill Single Stage Walking Test

1) Explain the test protocol, purpose, and termination criteria (ask to stop, signs of physiological distress, meeting HR ceiling, or cannot maintain cadence).

2) Calculate 85% HR max (0.85 x {208x(0.7xage)}), also calculate 50% ad 70% HR max and record them on the data collection sheet.

3) Use a nmarker on the wall for the client to concentrate on and also use a HR monitor attached to the specifications of the manufacturer.

4) First 4 minutes of the test is 0% grade at a speed that will elicit 50-70% HRM. (3.4- 4.0 mph). If HR is not within range after 1 minute adjust the speed accordingly.

5) After the 4 minutes, increase the grade to 5% without changing the speed and continue the walk for 4 minutes.

6) Record the HR during the final 15 seconds of each minute. Continue until SSHR is achieved. (within 5 bmp from the last HR). Add 1 minute if not attained.

7) cool the participant down according to the data collection sheet and then calculate estimated vo2 max using speed and SSHR.

1 mile walk test

1) Explain purpose: submaximal test used to estimate Vo2 max. The client walks 1600m as quickly as possible. Suitable for sedentary or older clients. Emphasize the importance of collecting HR immediately after the cessation of the test.

2)Ask client to walk at a light to moderate pace for 3 minutes before commencing the test. After this, direct the client to begin walking the 1600m as quickly as possible while maintaining a consistent pace throughout.

3) record HR in the final minute of walking and time to complete the 1600m (4xaround 400m track). Use HR montior or maual radial pulse immediatley after walk is complete.

4) use time, BM, and HR to estimate VO2 max.

2)

Cycle Erg Test

1) Explain purpose, protocol, and termination criteria.

2) Fit client to the cycle, calculate 85% HRM, and place a marker on the wall for client to focus on.

3)First workload for all cleints is 150kpm.min (25 watts). Depending on the erg, it may need to montitored to keep at50 rpm or set a metronome to 50 bmp

3) record HR during the final 15 seconds of each minute SSHR is the average of the HR taken in the last 2 min of each workload. If HR differs by >5 bpm in min 2 and 3, extend the workload by 1 min.

4) the last HR from the last minute of the frist worload determines the next stage and so on. COntinue 3 minute workloads until there are 2 consecuative workloads where the SSHR stays between 110bpm and 85% HR max.

5) Scoring is dtermined based on the submaximal oxygen costy of the second last and last workloads. you will also need the average SSHR for second to last and last workloads.

Bruce Treadmill Test

1) Explain purpose, protocol, and termination criteria to the client. (this is a maximal test). Progressively increases in speed and/or grade in 3-minute stages. Total time in seconds is used to predict VO2max

2) HR is recorded every minute, BP and RPE at end of each stage, and time to failure in seconds.

3) Cool down should be a minimum of 3 minutes walking slowly on the treadmill. Monitor HR for 5 minutes post and follow up with appropriate cool down stretching.

Modified Bruce Protocol

`1) Used for sedentary individuals or elderly populations because it has two lower-intensity stages.

2) Stage 1 = 1.7 mph @ 0% grade; stage 2 = 1.7mph @ 5% grade then the thrid is the regular first stage of the Bruce.

Grip Strength

1) explain the test purpose: Measures isometirc strength of the forarm and is sued to predict functional limitations later in life.

2) Contraindications include injury or condition that revents safe pain free technique of the test.

3) Have the cleint stand and hold the dynamometer at the legel of the thigh. nether the hand or the dynamometer should tough the thigh.

4) have client exhale as they maximally squeeze. Measure each side twice and take the best max for each hand in the nearest kg. Combine the max score from each hand and record results and associated HBR.

Push Up Test

1) purpose: muscular endurance of the upper body. Termination criteria: pain or discomfrot, starining forcibly or unable to maintian proper technique over 2 consevutive reps, and do not include reps with improper technique.

2) have client practice proper technique in 1-2 reps.

3) Ask client to lie face down on the mat; women use knees as pivot and men use toes. Advise the client to exhale when pushing up or the upward phase of the movement to avoid breath holding

4) The body must be kept in a straight line, returning to the starting position of chin to the mat. Stomach and thighs do not touch the mat. Incorrect reps do not count. The cleint will perform as many consecutive pushups as they can do and there is no time limit.

Sit and Reach Test

1) Explain purpose: to measure flexibility of the hamstrings and lower back. contraindications include osteroporisis back pain or anything that would prevent pain free completion.

2) Warm up with 20 sec per side modified hurdeler.

3) without shoes, feet flat against flexomiter, legs fully extended, and ensure feet are 6” apart.

4) handover hand on the exhle have the partipant bend forward and push the marker as far as possible without bending the knees.

5) 2 trials are attempted and recorded to the nearest 0.5 cm

1 RM Prediction

1) Purpose: muscle-specific measure of strength through a full range of motion. Contrindications = injury or osteroporisis that prevent safe execution of pain-free ROM

2) Ensure you demonstrate and practice proper technique and give the client a 5 minute aerobic warm-up before beginning.

3) Review technique for each exercise and ensure it can be perfromed with no loss of form.

4) starting weight should be ` 6-10 reps without loss of form. If a second or third set it required, give at least 2 min rest. If you need more than 3 sets rest for 48 hours.

Vertical Jump

1) Purpose: measure peak power of the lower body and the ability to contract the leg muscles with speed and force in one explosive movement. Contraindications include injury or conditions such as lower back, foot and ankle problems or osteoporosis.

2) Client stands perpendicular to the measuring tape on the wall. Record standing reach height to the nearest 0.5cm

3) Have client step away from the wall swing arms behind hips and pause in a 1/2-1/4 squat and pause then jump as high as possible to touch the tape at the highest point.

4) Allow 3 trials with 10-15 seconds of rest between. Record each jump attempt to the nearest 0.5cm.

Back Extension Test

1) Explain protocol, purpose, termination crieteria and demo the technique.

2) have client lay face down on the mat with the iliac crest at the edge of the table with hips shoulder and head aligned.

3) once prepared to begin and client is secure to the table have them crss their arms over their body and concentrate on the floor while maintianing the horizontal body position. No rotaion or lateral shifting is allowed and a max of 3 minutes will be allowed.

4) test is terminated if: client experiences pain/discomfort/fatigue, torso drops below horizontal (1 warning for adjustment) or maximum time is met. Record time in 0.1 sec.

5) immediately after hav client lay on back with knees to chest to relax the back muscles for 1 min

Forearm Plank Test

1) Explain the purpose, protocol, and termination criteria. Demonstrate proper technique.

2) Have the client lie prone on the mat, feet narrow but not touching, elbows under shoulders and hands in front of elbows.

3) start timing when the client lifts their hips off the mat and assumes the rigid body position.

4) Termination criteria: volition, pain/discomfort/fatigue, and if form cannot be corrected after 2 consecutive cues.

5) record time to nearest 0.1 second. contraindications are any injury or condition that causes pain the the lower back, shoulders, or elbows.

One Leg Stance Test

1) explain test and protocol, including termination crieteria: arms move/become uncrossed, raised foot moves towards or away from the standing limb or touches the floor, weight bearing foot is moved, and max of 45 sec is achieved. (if doing eyes closed trial eyes opening will result in termination).

2) have client stand barefoot near a sturdy chair with hands crossed over the body on a flat floor surface. Have client focus on a marker on the wall and try to maintain balance for >45 sec.

3) Time commences when the foot is raised and ends when termination criteria is met. Time measured to nearest 0.1 sec and repeat on other leg. *If client loses their balance in first 3 sec of eyes closed, allow a re-trial to account for set up error.

Y Balance Test

1) Place 3 tape strips ~1m long with one forward strip and the others 135 degrees to the anterior piece.

2) when standing on left foot, the right leg reaches out along the tape in all 3 directions and is repeated on the other leg.

3) Explain test protocol and give client 4 practice trials in each of the 3 directions. Have them remove their shoes and have them stand with hands on hips and heel at the intersection of the 3 lines.

4) once practice is done 3 trials in each direction are completed with 10s rest in between attempts. Marking the most dital portion of the foot in each direction then complete the other side.

5) Termination criteria: unable to maintian stance (hands come off hips or heel moves), heavy contact on tapping limb, or unable to return to starting position in control.

6) take max score for each side measured to the nearest 0.5 cm and use limb length to normalize scores.

Welcome Package

Should be sent at least 48 hours prior to the appointment and should include:

• letter outlining the

• Informed consent

• PAR Q

• AAL-Q

• Other clearance documents like PAR-Q+, Healthcare provider consultation form for prenatal physical activity, or ~Physician guidance for PA(as appropriate).

Informed Consent

Clearly describes the nature of the assessment and/or exercise program and the responsibilities of the client for the safe and responsible admistration/execuition of fitness assessment or exercise. It does not waive any responsibility of the QEP.

Review the written form verbally and allow the client to ask any questions prior to signing. Ensure full comprehension. May need to consult primary caregiver if consent cannot be fully understood and given.

Get Active Questionnaire 

Used to identify clients who may need to speak with a healthcare provider before participating in exercise. It should be filled out by the client individually and reviewed by the QEP. If there is a yes to any of the questions, then the reference document needs to be filled out. Medical guidance is required for chest pain at rest or exertion, resting BP over 160/90(one or both values), dizziness or lightheadedness during PA, or recent concussion.

Physician Guidance for Physical Activity Form

Used for clients deemed to need medical clearance before proceeding with assessment and programming. Page 1 and 2 are for the provider; pages 3 and 4 are outlining the skills and knowledge of the QP. Even with medical clearance, the QEP needs the skills and knowledge to work with the individual; otherwise they should refer to another QEP that has suvh.

Get Active questionnaire for Pregnancy

Tool used to help identify the minority of individuals who have pregnancy-related contraindications to prenatal exercise. Yes to one or more questions will require guidance from an obstetrician using the health care provider consultation form for prenatal physical activity.

Abilities for Active Living Questionnaire

Allows clients to voice any accomodations they may need at the assessment and throughout the programming. It also answers and clarifies the cleint’s ability to complete the assessment and what types of PA are appropriate and best suited for the client’s abilities.

Client Information Sheet

Summarizes all the information from the assessment (physical activity, lifestyle, etc). Includes details like contact information, demographics, emergency contact, health screening, and results from anthropometric, aerobic, and MSK assessments.

SOAP Charting Notes

Charting is the QEPs legal record of a session with a client. It is a standard requirement of practice. SOAP stands for subjective, objective, Assessment, and Plan and is a way of charting important cleint and session details.

Movement Counselling Tool

Helps guide the discussion between the QEP and Client as it relates to integrating the three core movement behaviour recommendations into their daily activity. “move more, reduce sedentary time, and sleep well).

Information gathering – Family history, lifestyle, healthy behaviours, etc.

1. Interview process

2. Develops rapport and a working relationship with the client

3. Develops a picture of the client’s personality, current health-related or performance-related fitness status, readiness to change, general goals, physical activity preferences, activity history, present physical activity participation, attitude, time restrictions, facility plus equipment accessibility, other potential barriers, etc.

4. Check for current medication use

5. Demonstrates knowledge of responses and/or conditions requiring medical follow-up

6. Demonstrates knowledge of other risk factors and risk cut-off values: smoking, hypertension, hyperlipidemia, diabetes, BMI, waist circumference, immediate family history of premature death < 55 years of age, age (men > 45 years, women > 55 years), physical inactivity (sedentary job and no regular exercise program)

7. Demonstrates knowledge of contraindications to both exercise testing and physical activity or exercise participation, based on discussion and selection of testing procedures

8. Uses appropriate counselling and communication skills

9. Gathers information about the client’s background and lifestyle behaviour

10. Gathers information regarding the client’s attitudes towards physical activity or exercise and current levels of activity 

11. Gathers information using appropriate tools, e.g. FANTASTIC, Stage of Change (verbal or written)

12. Determines and clarifies the reason(s) for the client for attending the session and rates or paraphrases and summarizes the client’s words to ensure understanding. 

13. “Uses questions such as, “What is the reason for your visit today?” or “What caused you to seek this assessment and/or undergo this exercise session?”

14. Has the client clearly state his or her goals in operational/behavioural terms. Uses questions such as, “What do you hope to achieve…?” or “What are your fitness goals?” Asks for clarification or clear restatement.

Client Screening - RHR and RBP measurement, observations, clearance forms

1. Reviews evidence-based screening tools, i.e. Get Active Questionnaire, and other relevant pre-screening documentation; demonstrates proper use of these documents; answers questions and confirms signatures. 

2. Checks for current medication use 

3. Demonstrates knowledge of the components of the informed consent document; answers questions; and confirms signatures. 

4. Describes conditions that warrant postponement of the appraisal (illness, medications, pregnancy, preliminary instructions not adhered to). 

5. Checks that all tools and instruments are available and operational. 

6. Ensures client has been comfortably seated for a minimum of 5 minutes with arms rested on the table so the middle of the arm is at heart level. 

7. Correctly positions the stethoscope via palpation or ECG properly set up; properly determines HR in beats/min. 

8. Correctly classifies pre-exercise HR (< 100 bpm) 

9. If necessary, repeats procedure following a 5-minute interval. 

10. Selects proper cuff size, properly positions the cuff and the bell of the stethoscope to accurately read BP within 2- 4 mmHg. 

11. Deflates cuff after measurement 

12. Correctly classifies Pre-Exercise BP measurement 

13. If necessary, repeats after a 5-minute interval. 

1. Clinical Assessment - Exercising HR and BP, ECG or Spirometry or pulse oximeter, risk factor assessment or mobility/posture

1. Obtains accurate exercise HR and BP

2. Demonstrates correct use of ECG, spirometry or pulse oximeter

3. Provides client with clear instructions throughout the test procedure

4. Initiates recovery once client has reached clinical cut-offs

5. Ensures the client understands what was measured, what are the implications of the outcomes, and relevance to the client’s lifestyle habits, current physical activity patterns, etc.

Fitness Assessment - Body Composition assessment/feedback

1. “Based on information gathered from the client, selects appropriate test items and test procedures for the scenario being examined

2. Focuses on the appropriate health-related fitness or performance-related fitness

3. If using circumference measurements

   1. :Explains purpose of the test

   2. Explains test procedures correctly

   3. Uses correct testing procedures

   4. Correctly identifies site(s)

   5. Measures correct side of the body

   6. Positions tape correctly

   7. Pulls tape without pinching

   8. Correctly interprets results and, where applicable, uses appropriate normative data

   2. “If using skinfold measurements:

      1. Explains purpose of the test

      2. Explains test procedures correctly

      3. Uses correct testing procedures

      4. Correctly identifies sites

      5. Measures on the correct side of the body

      6. Lifts folds and places callipers properly

      7. Measures after 1 to 2 seconds

      8. Administers trials within 0.4 mm

      9. Measures skinfolds in rotational order

      10. Calculates or scores body composition (percentage body fat) correctly for skinfolds measured

      11. Correctly interprets results and, where 

Fitness Assessment - MSK assessment and feedback

1. Correctly selects appropriate test(s)

2. Overviews scenario-relevant test items and test procedures to the client. 

3. Explains the purpose and benefits of the test items and procedures to the client 

4. Properly positions the client before administering the scenario-relevant test items and procedures

5. Knows the test protocols and procedures for the fitness component being assessed. 

6. Correctly identifies the endpoint of the test

7. Correctly measures the outcome

8. Correctly interprets the test outcomes and, where applicable, uses normative data

9. Ensures client understands what is being measured, the implications of the outcomes, and relevance to the client’s lifestyle habits, current PA patterns, etc. 

Fitness Assessment - Aerobic assessment/feedback

1. “Based on information gathered from the client, selects appropriate test items and test procedures for the scenario being examined

2. Focuses on the appropriate health-related fitness or performance-related fitness

3. Determines endpoint (e.g. 70% HRR or 85% HRmax)

4. Provides client with clear instructions throughout the test procedure

5. Properly initiates test protocol

6. Knows physiological measurements to be taken (HR, BP, RPE)

7. Demonstrates the correct timing of measurements

8. Obtains accurate exercise HR and BP

9. Increases work rate properly throughout the stages of the test

10. Ensures work rate is maintained (e.g. mechanically braked cycle ergometer: monitors revolutions/min, checks resistance)

11. Checks for steady-state HR (within 6 beats/min) before increasing work rate

12. Initiates termination of test if conditions warrant (e.g. abnormal HR and/or BP responses)

13. Monitors client’s physical appearance

14. Initiates recovery once client has reached pre-determined endpoint

15. Knows when to have active or passive recovery

16. Monitors HR each minute and BP every 2 minutes during recovery

17. Continues with recovery monitoring for at least 4 minutes or until HR and BP are near pre-exercise conditions

18. Provides client with clear instruction regarding the completion of the test and directs the client to carry out ROM exercises for the primary muscle groups used during CVR assessment, as well as opposing muscle groups

19. Correctly calculates test results

20. Correctly interprets test results and, where applicable, uses appropriate normative data

21. Ensures the client understands what was measured, what are the implications of the outcomes, and relevance to the client’s lifestyle habits, current physical activity patterns, etc.

Exercise Prescription - MSK Program

1. Assimilates the information for appropriate implementation of the established training guidelines for any of the fitness components, selects appropriate physical activity/exercise program

2. Integrates all components of fitness: aerobic, muscular strength, muscular endurance, muscular power, flexibility.

3. Ensures the client understands the prescription with respect to mode, intensity, frequency, duration, and progression 

4. Outlines benefits of participating in regular activity/exercise

5. Addresses issues related to motivation, exercise adherence, and behaviour modification 

6. Explain/demonstrate the resistance training exercises for a specific muscle group. 

7. Correctly explains exercise/muscle groups used 

8. Demonstrates proper lifting techniques 

9. Correctly applies biomechanical principles to the exercise technique 

10. Detects and corrects performance/excecution errors. 

11. Explains and instructs the client on an exercise equipment setup, use, and safety. 

12. Explains and instructs the client on methods to determine exercise intensities and workloads

Exercise Prescription - Aerobic program

1. “Explains and instructs the client in the principles and techniques of aerobic conditioning

2. Explains the physical activity or exercise prescription with respect to health-related fitness or performance-related fitness

3. Explains and instructs the client on the concepts, principles, and techniques related to aerobic conditioning, including mode, overload, specificity, reversibility, progression, frequency, duration, and adaptations

4. Explains and instructs the client on exercise equipment set-up, use, and safety

5. Explains and instructs the client on proper form and techniques for a variety of activities, including walking, jogging, running, continuous versus intermittent activity, and circuit training

6. Explains and instructs the client on methods to determine appropriate exercise intensities and workloads

Client Education - Exercise prescription implementation and nutritional and lifestyle changes: 

1. Provides information at an appropriate level with regard to the client’s goals and stage of change, either in verbal or written form

2. References guidelines and strategies to achieve client goals

3. Develops suitable exercise and training prescription strategies

4. Helps the client with their program and specific exercises. Remember that, for any demonstration, the CSEP-CEP candidate must establish background and purpose beforehand and provide a personal follow-up afterwards. Any modifications should be re-demonstrated. Careful observations and safety are critical during exercise monitoring.

5. Applies pertinent underlying and important theoretical concepts (e.g. adaptation principle). Explains the use or lack of use of normative data in explaining the client’s level of health-related or performance-related fitness.

6. Makes appropriate referrals, either for counselling intervention or more advanced exercise prescription (e.g. specialized strength training).

Client Education - Medication

1. Checks for medication use 

2. Checks for client’s knowledge of medication 

3. Educates client on medication and its use

Client Counselling - Behaviour Modification

1. Uses appropriate tools as a part of the action phase, including goal-setting tools, first step planners etc. 

2. Uses an intervention approach consistent with the client’s stage of change or intentionality and consistent with the client’s overall goals

3. Facilitates a shift in decision-balance towards a positive attitude toward exercise for the inactive or low-fit individual 

4. Facilitates increased self-efficacy about adoption of regular PA or to achieve a particular goal; eg) using previous successes as a springboard for developing confidence in future success. 

5. Identifies and discusses strategies for overcoming barriers to PA and/or exercise. 

6. Applies goal-setting strategies

7. Utilizes the basic problem-solving sequence 

8. Recognizes level of intention (stage of change) and uses appropriate interventions 

9. Modelling - demonstrates own strategies for success

10. Enhcnaces client’s self confidence by highlighting personal strengths and previous achiovements 

11. Explains the positive impact of behaviour change and facilitates development of positive attitudes 

12. Helps client recognize the “cons” of not making changes 

13. Works to establish key support structures to facilitate behaviour

14. Demonstrates facilitation of development of specific, measurable, adjustable/attainibale, relevant, and time-orineted/time-based goals.

Professionalism - Communication

1. Active listening skills

   1. Attending - make eye contact, pay attention, and maintain an open body position 

   2. Paraphrasing - restate and review the client’s words in a meaningful manner to facilitate progress and ensure understanding. 

   3. Clarifying - Ask questions to clarify or explain the meaning of information.  

   4. Fact-checking - checks personal interpretations of the meaning of the client’s statements, using statements such as “Let me check if I have this right...”

2. Leading skills: 

   1. Questioning with open-ended questions; using what, how instead of why. 

   2. Direct leading through asking the client to stay within certain directions, ideas, topics, and themes during discussion 

3. Focusing

   1. Has the client focus on areas of particular relevance as they arise during counselling 

4. Challenging 

   1. Confront inconsistencies in client goals and data; helps the client recognize and challenge ambivalence 

5. Interpreting 

   1. Helps client interpret their own profile and recognize their new solutions 

6. Informing 

   1. Provides appropriate information to the client consistent with their goals and motivations 

7. Summarizing

   1. Reviews information and establishes meaning of health-related fitness or performance-related profiles 

8. Provides a clear explanation of assessment tools and procedures and their purpose; explains all procedures during their fitness assessment. 

9. IS aware of and sensitive to personal boundaries - asks permission to touch skin 

10. Field questions regarding protocols and/or other fitness related type of questions during the assessment. 

11. Follow-up/closure strategy: will meet with client to ensure they are properly performing their program. A follow-up is booked 6 weeks after the initial assessment to change the initial prescription. 

1. Professionalism - Documentation 

1. Reviews evidence-based screening tool, ig) GEt active questionnaire; demonstrates proper use of other relevant pre-screening documentation; demonstrates proper use of these documents, answers questions, and confirms signatures. 

2. Demonstrates knowledge of the components and parts of informed consent; answers questions, and confirms signatures

3. Uses proper data sheets to record assessment results 

4. Uses proper normative data, explanation sheets, prescription templates, and educational material appropriate for the scenario. 

Describe the Bruce Protocol

3 minute stages that increase in grade and speed; goal is to achieve steady state HR
- Completed when stopping criteria is met
Measure - HR / RPE every minute
BP at end of each stage
Scored - minutes of completion

Give examples of power tests

Vertical jump
1RM power clean
Standing long jump

Provide examples of muscular endurance tests

Push ups
Chin ups
Plank
Single leg stance

1/3 RM protocol

Warm up at 50%; add weight and lift 1/3 reps
If it can be done; add 10-120lbs until client can no longer lift
Scoring - Highest weight lifted
* Not to be done with novice lifters

In what order should a workout be planned?

1.Release - Foam rolling and SMR
2.Reset - Prehab and breathing exercises
3.Readiness - RAMP warm-up
4.Reactive - Speed and power work
5.Resistance - Strength work
6.Resiliency - Energy systems development
7.Recovery - Foam rolling, mobility, flexibility and breathing

What are some considerations when working with cancer patients?

Avoid dislodging PICC lines or catheters
May experience muscle weakness
Vestibular issues
Limited ROM due to surgeries
No exercise if chemo was received in past 24 hours
Radiation may impact cardiac function (reduced diastolic volume)
Radiation increases stiffness
Increased risk of fracture with advanced disease
Exercise tolerance will vary from session to session

Name some contraindications when working with cancer patients

Monitor hematologic abnormalities (low platelets, hemoglobin level)
MSK disorders (recent bone/back/neck pain; muscular weakness; extreme fatigue)
GI disorders (severe nausea, vomiting/diarrhea)
CV disorders (chest pain, elevated resting HR, elevated BP, irregular heartbeat, lymphedema)
Pulmonary disorders (severe difficulty breathing, coughing/wheezing)
Neurological disorders (decline in cognitive status, dizziness, disorientation, blurred vision)

What is FEV1 in restrictive and obstructive diseases?

Obstructive: reduced
Restrictive: slightly reduced

If FEV1/FVC is greater than 0.8 and FVC is less than 0.8...

Restrictive disease

If FEV1/FVC is less than 0.8...

Obstructive disease

What are some considerations when working with individuals with cystic fibrosis?

Reduced mitochondrial efficiency - reduced exercise capacity
Lower respiration due to deadspace in lungs
Reduced muscular strength and capacity

What are the absolute contraindications to exercise during pregnancy?

Ruptured membrane; premature labour; unexplained persistent vaginal bleeding; placenta praevia after 28 weeks; pre-eclampsia; incompetent cervix; intrauterine growth restriction; high-order multiple pregnancy (triplets); uncontrolled type I diabetes, hypertension or thyroid disease; other serious cardiovascular, respiratory or systemic disorder

What are the relative contraindications to exercise during pregnancy?

Recurrent pregnancy loss; history of spontaneous preterm birth; gestational hypertension; symptomatic anaemia; malnutrition; eating disorder; twin pregnancy after the 28th week; mild/moderate cardiovascular or respiratory disease; other significant medical conditions.

“Information gathering – Family history, lifestyle, healthy behaviours, etc.

1. Interview process

2. Develops rapport and a working relationship with the client

3. Develops a picture of the client’s personality, current health-related or performance-related fitness status, readiness to change, general goals, physical activity preferences, activity history, present physical activity participation, attitude, time restrictions, facility plus equipment accessibility, other potential barriers, etc.

4. Check for current medication use

5. Demonstrates knowledge of responses and/or conditions requiring medical follow-up

6. Demonstrates knowledge of other risk factors and risk cut-off values: smoking, hypertension, hyperlipidemia, diabetes, BMI, waist circumference, immediate family history of premature death < 55 years of age, age (men > 45 years, women > 55 years), physical inactivity (sedentary job and no regular exercise program)

7. Demonstrates knowledge of contraindications to both exercise testing and physical activity or exercise participation, based on discussion and selection of testing procedures

8. Uses appropriate counselling and communication skills

9. Gathers information about the client’s background and lifestyle behaviour

10. Gathers information regarding the client’s attitudes towards physical activity or exercise and current levels of activity 

11. Gathers information using appropriate tools, e.g. FANTASTIC, Stage of Change (verbal or written)

12. Determines and clarifies the reason(s) for the client for attending the session and rates or paraphrases and summarizes the client’s words to ensure understanding. 

13. “Uses questions such as, “What is the reason for your visit today?” or “What caused you to seek this assessment and/or undergo this exercise session?”

14. Has the client clearly state his or her goals in operational/behavioural terms. Uses questions such as, “What do you hope to achieve…?” or “What are your fitness goals?” Asks for clarification or clear restatement.

Client Screening - RHR and RBP measurement, observations, clearance forms:

1. Reviews evidence-based screening tools, i.e. Get Active Questionnaire, and other relevant pre-screening documentation; demonstrates proper use of these documents; answers questions and confirms signatures. 

2. Checks for current medication use 

3. Demonstrates knowledge of the components of the informed consent document; answers questions; and confirms signatures. 

4. Describes conditions that warrant postponement of the appraisal (illness, medications, pregnancy, preliminary instructions not adhered to). 

5. Checks that all tools and instruments are available and operational. 

6. Ensures client has been comfortably seated for a minimum of 5 minutes with arms rested on the table so the middle of the arm is at heart level. 

7. Correctly positions the stethoscope via palpation or ECG properly set up; properly determines HR in beats/min. 

8. Correctly classifies pre-exercise HR (< 100 bpm) 

9. If necessary, repeats procedure following a 5-minute interval. 

10. Selects proper cuff size, properly positions the cuff and the bell of the stethoscope to accurately read BP within 2- 4 mmHg. 

11. Deflates cuff after measurement 

12. Correctly classifies Pre-Exercise BP measurement 

13. If necessary, repeats after a 5-minute interval. 

Clinical Assessment - Exercising HR and BP, ECG or Spirometry or pulse oximeter, risk factor assessment or mobility/posture

1. Obtains accurate exercise HR and BP

2. Demonstrates correct use of ECG, spirometry or pulse oximeter

3. Provides client with clear instructions throughout the test procedure

4. Initiates recovery once client has reached clinical cut-offs

5. Ensures the client understands what was measured, what are the implications of the outcomes, and relevance to the client’s lifestyle habits, current physical activity patterns, etc.

Fitness Assessment - Body Composition assessment/feedback

1. “Based on information gathered from the client, selects appropriate test items and test procedures for the scenario being examined

2. Focuses on the appropriate health-related fitness or performance-related fitness

3. If using circumference measurements

   1. :Explains purpose of the test

   2. Explains test procedures correctly

   3. Uses correct testing procedures

   4. Correctly identifies site(s)

   5. Measures correct side of the body

   6. Positions tape correctly

   7. Pulls tape without pinching

   8. Correctly interprets results and, where applicable, uses appropriate normative data

4. “If using skinfold measurements:

   1. Explains purpose of the test

   2. Explains test procedures correctly

   3. Uses correct testing procedures

   4. Correctly identifies sites

   5. Measures on the correct side of the body

   6. Lifts folds and places callipers properly

   7. Measures after 1 to 2 seconds

   8. Administers trials within 0.4 mm

   9. Measures skinfolds in rotational order

   10. Calculates or scores body composition (percentage body fat) correctly for skinfolds measured

   11. Correctly interprets results and, where

Fitness Assessment - MSK assessment and feedback

1. Correctly selects appropriate test(s)

2. Overviews scenario-relevant test items and test procedures to the client. 

3. Explains the purpose and benefits of the test items and procedures to the client 

4. Properly positions the client before administering the scenario-relevant test items and procedures

5. Knows the test protocols and procedures for the fitness component being assessed. 

6. Correctly identifies the endpoint of the test

7. Correctly measures the outcome

8. Correctly interprets the test outcomes and, where applicable, uses normative data

9. Ensures client understands what is being measured, the implications of the outcomes, and relevance to the client’s lifestyle habits, current PA patterns, etc. 

Fitness Assessment - Aerobic assessment/feedback

1. “Based on information gathered from the client, selects appropriate test items and test procedures for the scenario being examined

2. Focuses on the appropriate health-related fitness or performance-related fitness

3. Determines endpoint (e.g. 70% HRR or 85% HRmax)

4. Provides client with clear instructions throughout the test procedure

5. Properly initiates test protocol

6. Knows physiological measurements to be taken (HR, BP, RPE)

7. Demonstrates the correct timing of measurements

8. Obtains accurate exercise HR and BP

9. Increases work rate properly throughout the stages of the test

10. Ensures work rate is maintained (e.g. mechanically braked cycle ergometer: monitors revolutions/min, checks resistance)

11. Checks for steady-state HR (within 6 beats/min) before increasing work rate

12. Initiates termination of test if conditions warrant (e.g. abnormal HR and/or BP responses)

13. Monitors client’s physical appearance

14. Initiates recovery once client has reached pre-determined endpoint

15. Knows when to have active or passive recovery

16. Monitors HR each minute and BP every 2 minutes during recovery

17. Continues with recovery monitoring for at least 4 minutes or until HR and BP are near pre-exercise conditions

18. Provides client with clear instruction regarding the completion of the test and directs the client to carry out ROM exercises for the primary muscle groups used during CVR assessment, as well as opposing muscle groups

19. Correctly calculates test results

20. Correctly interprets test results and, where applicable, uses appropriate normative data

21. Ensures the client understands what was measured, what are the implications of the outcomes, and relevance to the client’s lifestyle habits, current physical activity patterns, etc.

Exercise Prescription - MSK Program

1. Assimilates the information for appropriate implementation of the established training guidelines for any of the fitness components, selects appropriate physical activity/exercise program

2. Integrates all components of fitness: aerobic, muscular strength, muscular endurance, muscular power, flexibility.

3. Ensures the client understands the prescription with respect to mode, intensity, frequency, duration, and progression 

4. Outlines benefits of participating in regular activity/exercise

5. Addresses issues related to motivation, exercise adherence, and behaviour modification 

6. Explain/demonstrate the resistance training exercises for a specific muscle group. 

7. Correctly explains exercise/muscle groups used 

8. Demonstrates proper lifting techniques 

9. Correctly applies biomechanical principles to the exercise technique 

10. Detects and corrects performance/excecution errors. 

11. Explains and instructs the client on an exercise equipment setup, use, and safety. 

12. Explains and instructs the client on methods to determine exercise intensities and workloads

Exercise Prescription - Aerobic program

1. “Explains and instructs the client in the principles and techniques of aerobic conditioning

2. Explains the physical activity or exercise prescription with respect to health-related fitness or performance-related fitness

3. Explains and instructs the client on the concepts, principles, and techniques related to aerobic conditioning, including mode, overload, specificity, reversibility, progression, frequency, duration, and adaptations

4. Explains and instructs the client on exercise equipment set-up, use, and safety

5. Explains and instructs the client on proper form and techniques for a variety of activities, including walking, jogging, running, continuous versus intermittent activity, and circuit training

6. Explains and instructs the client on methods to determine appropriate exercise intensities and workloads

Client Education - Exercise prescription implementation and nutritional and lifestyle changes

1. Provides information at an appropriate level with regard to the client’s goals and stage of change, either in verbal or written form

2. References guidelines and strategies to achieve client goals

3. Develops suitable exercise and training prescription strategies

4. Helps the client with their program and specific exercises. Remember that, for any demonstration, the CSEP-CEP candidate must establish background and purpose beforehand and provide a personal follow-up afterwards. Any modifications should be re-demonstrated. Careful observations and safety are critical during exercise monitoring.

5. Applies pertinent underlying and important theoretical concepts (e.g. adaptation principle). Explains the use or lack of use of normative data in explaining the client’s level of health-related or performance-related fitness.

6. Makes appropriate referrals, either for counselling intervention or more advanced exercise prescription (e.g. specialized strength training).

Client Counselling - Behaviour Modification

1. Uses appropriate tools as a part of the action phase, including goal-setting tools, first step planners etc. 

2. Uses an intervention approach consistent with the client’s stage of change or intentionality and consistent with the client’s overall goals

3. Facilitates a shift in decision-balance towards a positive attitude toward exercise for the inactive or low-fit individual 

4. Facilitates increased self-efficacy about adoption of regular PA or to achieve a particular goal; eg) using previous successes as a springboard for developing confidence in future success. 

5. Identifies and discusses strategies for overcoming barriers to PA and/or exercise. 

6. Applies goal-setting strategies

7. Utilizes the basic problem-solving sequence 

8. Recognizes level of intention (stage of change) and uses appropriate interventions 

9. Modelling - demonstrates own strategies for success

10. Enhcnaces client’s self confidence by highlighting personal strengths and previous achiovements 

11. Explains the positive impact of behaviour change and facilitates development of positive attitudes 

12. Helps client recognize the “cons” of not making changes 

13. Works to establish key support structures to facilitate behaviour

14. Demonstrates facilitation of development of specific, measurable, adjustable/attainibale, relevant, and time-orineted/time-based goals. 

Professionalism - Communication

1. Active listening skills

   1. Attending - make eye contact, pay attention, and maintain an open body position 

   2. Paraphrasing - restate and review the client’s words in a meaningful manner to facilitate progress and ensure understanding. 

   3. Clarifying - Ask questions to clarify or explain the meaning of information.  

   4. Fact-checking - checks personal interpretations of the meaning of the client’s statements, using statements such as “Let me check if I have this right...”

2. Leading skills: 

   1. Questioning with open-ended questions; using what, how instead of why. 

   2. Direct leading through asking the client to stay within certain directions, ideas, topics, and themes during discussion 

3. Focusing

   1. Has the client focus on areas of particular relevance as they arise during counselling 

4. Challenging 

   1. Confront inconsistencies in client goals and data; helps the client recognize and challenge ambivalence 

5. Interpreting 

   1. Helps client interpret their own profile and recognize their new solutions 

6. Informing 

   1. Provides appropriate information to the client consistent with their goals and motivations 

7. Summarizing

   1. Reviews information and establishes meaning of health-related fitness or performance-related profiles 

8. Provides a clear explanation of assessment tools and procedures and their purpose; explains all procedures during their fitness assessment. 

9. IS aware of and sensitive to personal boundaries - asks permission to touch skin 

10. Field questions regarding protocols and/or other fitness related type of questions during the assessment. 

11. Follow-up/closure strategy: will meet with client to ensure they are properly performing their program. A follow-up is booked 6 weeks after the initial assessment to change the initial prescription. 

Professionalism - Documentation

1. Reviews evidence-based screening tool, ig) GEt active questionnaire; demonstrates proper use of other relevant pre-screening documentation; demonstrates proper use of these documents, answers questions, and confirms signatures. 

2. Demonstrates knowledge of the components and parts of informed consent; answers questions, and confirms signatures

3. Uses proper data sheets to record assessment results 

4. Uses proper normative data, explanation sheets, prescription templates, and educational material appropriate for the scenario. 

Young, Healthy adult Aerobic Assessments

mCAFT, YMCA, and 1 Mile walk (Bruce if very fit)

Young, Healthy Adults MSK Assessment

Push-ups, sit ups, plank, sit and reach, back extension, and vertical jump

Older Adult Aerobic Assessments

Ebbeling, 6MWT, or ISWT

Older Adult MSK Assessment

30 sec sit 2 stand, grip strength, 1 leg stance, TUG, gait speed, or 4 stage balance

Obese Aerobic Assessment

YMCA, Ebbeling, or 6MWT

Obese MSK Assessment

Grip strength, sit-to-stand, maybe a modified push up if there are no other contraindications.

Hypertension

Monitor BP! Submaximal: YMCA, Ebbling, Balke, or 6MWT

Hypertension MSK Assessments

Avoid Valsalva with proper direction on breathing for maximal isometrics.

T2DM Aerobic Assessments

mCAFT, walking tests - check foot health and foot care

T2DM MSK Assessment

Grip strength, sit 2 stand, balance

Stable Cardiac Conditions Aerobic Assessment

6MWT, 1SWT, submaximal Bruce or Balke or Ebbling with ECG and RPE monitoring measures.

Stable Cardiac Conditions MSK Assessment

Grip strength, light multi-rep tests, balance, sit 2 stand, and gait speed.

COPD Aerobic Assessment

6MWT, Ebbling, ISWT, or YMCA - use dypsena scale and SP02 Monitoring.

COPD MSK Assessment

Sit 2 stand, grip strength, 30 sec arm curl.

Pregnacy Aerobic Assessment

Submaximal, RPE Guided since HR is increased ~ 10 BPM.

Pregnancy MSK Assessments

Avoid supine tests in later terms, avoid maximal tests - 10 RM or 30 sec arm curl.

NSLBP Aerobic Assessment

Walking or cycling depending on symptoms and aggitators

NSLBP MSK Assessment

If tolerated, it may be beneficial to test back extension or plank. Avoid 1 RM or max isometric exercises like mid-thigh pull.

Aerobic Rx for average healthy Individuals

F - 3-5 days per week

I - Beginners start at 30-59% HRR (9-11); Intermediate-Advanced aim 40-100% HRR (12-19 RPE)

T - <20 min is approproate for inactive clients just starting out, but 20-60 minutes per session is appropriate for those seeking to improve aerobic fitness. *Near-daily activity should be an aim for sedentary individuals.

T - Continuous Rhythmic, interval, or circuit training can be used in a mix to incorporate variability into training - use client preference.

V - Add ~ 10% each week when starting out.

P - Cosnider use of HIIT with more advanced clients, but when in doubt, add duration or days per week.

Aerobic Rx for CVD

F - 3-5 days per week to aim for 150 min/week

I - 20-40% HRR or 8-12 RPE when starting, progress to 40-60% HRR (13-16 RPE); if client has a pace maker, stay 10 BPM below device’s threshold or 10 BMP below ischemic changes. If you do not know stay 20 BPM + RHR to be conservative.

T - 20-45 minutes per day as tolerated beginning with as little as <10 minutes

T - All modalities as tolerated; low impact may be beneficial for overweight clients

Aerobic Rx for Diabetics

• Frequency - 4-7 days per week aiming to accumulate 150 minutes per week with no more than 2 consecutive days without exercise. 

• Intensity = Moderate to vigorous effort is recommended with vigorous being most appropriate for experienced exercisers and those with well-controlled diabetes 

• Time = 20-60 minutes per session or even as short as 10 min 

• Type = Rhythmic continuous activity that includes major muscles groups

Aerobic Rx for Dementia/Cognitive Impairment

• Frequency = 2-5 days per week - 150 min / week 

• Intensity = 40-60% HRR (moderate) and maybe 60-90% HRR for the more fit or more experienced 

• Time = 10-60 minutes per session depending on performance and tolerance. 

• Type = Carefully monitor and instruct how exercise is to be performed. For those with dementia, using familiar and meaningful activities. Consider the impact of social exercise to the individual’s social and mental well-being.

Aerobic Rx for Osteoporosis

• Frequency = most days of the week ~ 5 days per week 

• Intensity = moderate to vigorous (40-60% HRR or 12-13 RPE)

• Time 30 minutes per session 5 days per week to accumulate the recommended 150 min per week. 

• Type = low impact: walking, swimming, cycling, aquatic exercise etc. 

Aerobic Rx for Mental Illness

• Frequency = 3-7 days per week to aim for 150 min/week 

• Intensity = 40-60% or 60-90% HRR 

• Time = 20-60 minutes per session 

• Type = Anything appropriate for the client and co-morbidies. Enjoyment is a primary consideration for those living with depression to improve well-being. 

Aerobic Rx for Respiratory Conditions

• Frequency = 3-5 days per week to accumulate the 150 minutes per week 

• Intensity = Low to moderate intensity is recommended for patients with COPD. For asthmatics start with 40-59% HRR and if tolerated well, progress to 60-70% HRR. For COPD exercise can be performed at 60=80% HRR or 4-6 dyspnea scale rating. 

• Time = 20-60 minutes per day 

• Type  = Rhythmic activities that involve major muscles groups.

RT Rx for Healthy Populations

• Frequency = depends on routine, but each muscle group needs to be trained 2 x per week. So a 2-3 day per week program is more suited to the full body split whereas the upper/lowerroutine is better for those who have 4+ days to RT in a week. Alternating splits is more muscle group specific and is popular for those looking to build mass. 

• Intensity = percent of predicted 1 RM. Hypertrophy is 8-12 reps at a 60-85% 1 RMendurance is <50% 1RM but for more than 12 reps. Sets should be 2-4 and rest should be 2-3 minutes in between sets with 48-72 hours between sessions. 

• Time = depends on session style and sets and reps schemes. 63

• Type - machines, free weights, plyometrics, or BW

RT Rx for CVD

• Frequency = 2-3 days per week with sessions that train the same muscles groups and 48  hours of rest between sessions

• Intensity = 30-60% 1 RM with progression to 60-80% of low risk and tolerating exercise well. 

• Time = 1-3 sets of 8-12 reps 

• Type: BW, free weight or machines. 

RT Rx for Diabetics

• 2x per week min

• Moderate to vigorous intensity (30-40% 1RM to start) then progress to 60-80% 1RM. 

• Best glycemic control has been found with 3 sets of 8 reps, 3 days per week. 

RT Rx for Dementia/CI

• 2+ days per week with the exception of core exercises which can be performed daily along with flexibility and balance. 

• Start by establishing good technique with lighter loads then progress to 8-15 reps under the direct supervision of a QEP.

• Functional exercises with body weight, machines, bands, or free weights. 

• People with dementia tend to be more successful with familiar exercises.

RT Rx for Mental Illness

• 2-3 sessions per week 

• 40-80% 1RM (moderate to vigorous intensity). Start light so that exercise can be an enjoyable activity to lay the foundation for long-term PA

• 1-3 sets for 8-12 reps for all major muscle groups

• Use any type that is found enjoyable. Try BW, machines, and free weights. 

RT Rx for Osteoprorosis

• Normal prescription for average healthy adult and 65+ 

• Special considerations: spine sparking strategies like avoiding rapid, repetitive, weights, loaded, or sustained flexion/torque to the spine. Teach hip hinging for movement like a squat and maintaining a neutral back in compromising positions. 

• Use progressive RT where 8-10 reps with good form is suggested at the start with lighter loads and increasing intensity as long as form is maintained. 

• Impact activities can also help improve bone mineral density. 

RT Rx for Respiratory Conditions

• 2-3 days per week 

• 60-80% or <80% 1 RM id they have more experience. Could also use an muscular endurance scheme of <50%

• 2-4 sets of 8-12 reps or 1-2 sets with 15-20 reps. 

• BW/light free weights/machines as applicable. 

Stages of Change

1. Pre-contemplation - no intention of taking action in the foreseeable future.

2. Contemplation - Intention of taking action within the next 6 months, weighing pros and cons

3. Preparation - intends to take action in next 30 days; has begun preliminary processes.

4. Action - has actively modified behaviour in last 6 months

5. Maintenance - Has sustained the behaviour for at least 6 months and made steps to prevent relapse.

6. Termination - total self-efficacy

SC for Diabetes

Hypoglycemia risk during and after exercise. Perohperal Neurpoathy, consider foot health and appropriate footwear. Autonomic Neuropathy, unreliable HR response use RPE and symptom limited response monitoring as well.

SC for Acute Coronary Syndrome or MI

Understand phases of cardiac rehab and physician guidance, monitor ischemic responses through ECG, HR, and BP, do not exercise when unstable angina is present.