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Personal Trainer Exam Review Course

ACE Exam Review

American Council on Exercise

Introduction

ACE Exam Review

About ACE
1) ACE is dedicated to promoting physical activity and protecting consumers against unsafe and ineffective fitness products and instruction ACE sponsors university-based exercise science research that targets fitness products and trends One of three certifying organizations to be accredited by the National Organization of Certifying Agencies (NOCA)

2) 3)

ACE Exam Review

What makes ACE different?


1) ACE exams are legally defensible

2)
3)

ACE develops the study materials without using the actual exam
Rather than teaching answers to the exam, ACE prepares you to be a safe and effective personal trainer

ACE Exam Review

About the ACE Exam


1) Written simulation portion
a. b. Designed to simulate situations that a personal trainer might encounter in actual practice 1 hour to complete

2)

Multiple-choice portion
a. b. c. 150 questions 3 hours to complete 72 seconds per question
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About the ACE exam (cont.)


3) Number of correctly-answered questions to pass exam
a. b. The number will vary because each exam version has a different level of difficulty For example: A candidate may have to answer 60% of the questions correctly on one exam version and 70% on another

ACE Exam Review

About the ACE exam (cont.)


4) How is the exam developed?
a.
b.

Questions are written using the Personal Trainer Exam Content Outline
Exam content
1.
2. 3.

Client assessment (20%)


Program design (21%) Program implementation and adjustment (29%)

4.
5.

Applied sciences (15%)


Professional role (15%)
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About the ACE exam (cont.)


5) Who administers the exam?
a. b. CASTLE Worldwide, Inc., an independent, professional testing company Ensures exam security and integrity, and eliminates bias

6)

Eligibility requirements for exam


a. b. c. 18 years of age Current CPR 100 hours of designing and implementing exercise programs is strongly recommended
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ACE Personal Trainer Manual Chapter 1

Exercise Physiology
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Fitness
A. Being active improves health: 30 minutes of accumulated physical activity on most days of the week Being fit goes beyond health and requires a comprehensive exercise program that includes the following components
1) 2) 3) 4) Cardiorespiratory endurance Muscular strength and endurance Flexibility Body composition
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B.

Components of the cardiorespiratory system


1) Blood: carries nutrients, gases, waste, and hormones
a. b. c. Nutrients glucose/glycogen, fats, and amino acids Gases oxygen and carbon dioxide (carried in red blood cells on the protein hemoglobin) Waste lactic acid and other metabolic byproducts

d.

Hormones sympathetic and parasympathetic nervous system activation


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Components of the cardiorespiratory system (cont.)


2) Vessels: transport system for blood throughout the body
a. Arteries carry oxygenated blood away from the heart

(with the exception of the pulmonary artery)


b. Veins carry de-oxygenated blood to the heart (with the exception of the pulmonary vein)

c.

Capillaries tiny vessels across which the exchange of gases, nutrients, and waste occurs between the blood and the cells of the body
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Components of the cardiorespiratory system (cont.)


3) Heart: four-chambered pump responsible for distributing blood to the lungs and to the rest of the body
a. b. Right side receives venous blood returning from the body Left side receives arterial blood returning from the lungs

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Components of the cardiorespiratory system (cont.)


c. d. Atria two upper chambers Ventricles two lower chambers

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Components of the cardiorespiratory system (cont.)


3) Heart: (cont.)
e. Blood distribution
1. 2. The left and right sides of the heart contract simultaneously At the same time the blood from the right ventricle is pumped to the lungs through the pulmonary arteries, blood from the left ventricle is ejected to the rest of the body through the aorta

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Components of the cardiorespiratory system (cont.)


3) Heart: (cont.)
f. g. Systole contraction phase of the cardiac cycle Diastole relaxation phase of the cardiac cycle
1. 2. During diastole, the heart muscle itself is supplied with oxygen through the coronary arteries Having a high level of cardiorespiratory fitness means the heart spends more time in diastole at rest and at submaximal exercise due to a decreased resting heart rate (RHR)

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Components of the cardiorespiratory system (cont.)


4) Lungs: encase the smaller branches of the trachea that allow gas exchange between the blood and the atmosphere Airways: transport system for carrying gases into and out of the body (commonly referred to as the bronchial tree)
a. b. Alveoli microscopic ducts responsible for gas exchange in the lungs The lungs contain an estimated 300 million alveoli providing a surface area of approximately 230 feet
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5)

Cardiorespiratory adaptations to acute aerobic exercise


1)
2)

Increased heart rate (HR)


Increased stroke volume (SV)
a. b. The amount of blood pumped from each ventricle each time the heart beats Measured in mL per beat

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Cardiorespiratory adaptations to acute aerobic exercise


3) Increased cardiac output
a.
b.

Cardiac output = HR x SV
A typical cardiac output at rest: 60 bpm x 70 mL/beat = 4200 mL/min (approximately 1 gallon of blood per min)

4)

Increased breathing rate

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Cardiorespiratory adaptations to acute aerobic exercise


5) Increased systolic blood pressure
a. Due to the cardiovascular system attempting to increase O2 delivery to the muscles

b. However, blood pressure greater than 250/115 mmHg is an indication to terminate exercise (hypertensive response)

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Cardiorespiratory adaptations to acute aerobic exercise


6) No change (or a slight decrease) in diastolic blood pressure
a. b. Due to the dilation of vessels in the muscles and the skin This decreases peripheral resistance (which is an important benefit for individuals suffering from heart disease, hypertension, diabetes, and peripheral vascular disease)

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Cardiorespiratory adaptations to acute aerobic exercise


7) Blood is shunted from the viscera to the working muscles
a. b. Dilation of vessels that supply blood to the exercising muscles Constriction of vessels that supply blood to the abdominal area

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Cardiorespiratory adaptations to acute aerobic exercise


8) Increased extraction of oxygen from the blood into the working tissues
a. A normal, healthy person is able to load the blood with more O2 in the lungs than he or she is able to use at the cellular level Therefore, the more efficiently an individual can extract O2 from the hemoglobin in the capillaries, the more fit he or she becomes

b.

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Cardiorespiratory adaptations due to regular aerobic exercise


1) Decreased RHR
a. With consistent exercise (as few as three months of regular aerobic training), the interior dimensions of the ventricles increase, allowing them to hold more blood The same cardiac output can be maintained at a lower HR due to the greater SV

b.

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Cardiorespiratory adaptations due to regular aerobic exercise


2) Decreased relative working heart rate
a. Since a given intensity requires a given amount of O2, HR at any given intensity will be lower due to increased SV A trained individual will have to work at higher intensities to achieve the same HR he or she achieved prior to being fit

b.

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Cardiorespiratory adaptations due to regular aerobic exercise


3) Increased VO2max as SV increases
a. VO2max is the total capacity to consume oxygen at the cellular level

b.

VO2max depends on two factors


1. The delivery of O2 to the working muscle by the blood (cardiac output)

2.

The ability to extract the O2 at the capillaries and use it in the mitochondria
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Cardiorespiratory adaptations due to regular aerobic exercise


4) Increased O2 extraction
a. Improved ability to remain aerobic at higher intensities

b.
c. d.

Increased capillary density


Increased mitochondrial density Increased ability to create ATP

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Cardiorespiratory adaptations due to regular aerobic exercise


5)
6) 7)

Increased fatty acid oxidation at any submaximal intensity


More glycogen is stored in trained muscles and less lactic acid is produced Increased tolerance to lactic acid produced during exercise

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Altitude
1) 2) Since there is less partial pressure of O2 at higher altitudes, HR and respiratory rate increase During exercise HR may increase up to 50% higher than normal

3)
4)

Decrease exercise pace so the client can complete the session without becoming exhausted
It can take up to 25 weeks to acclimate to a new altitude

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Heat
1) 2) Due to increased dilation of blood vessels near the skin, venous return and SV decrease At any given exercise pace, HR will be higher as the heart tries to maintain cardiac output to meet the needs of the working muscles Producing sweat so that it may evaporate from the skin is the bodys cooling mechanism High humidity does not allow sweat to evaporate The main concerns of exercising in the heat are sweat evaporation and consumption of 48 ounces of water every 1015 minutes during exercise
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3) 4) 5)

Cold
1) 2) Exercising in the cold causes the kidneys to increase urine production, risking dehydration Heat production during exercise is usually enough to prevent hypothermia

3)
4)

When exercise stops, however, the client needs to be protected from the cold
Keys to exercising in the cold are drinking plenty of fluids and dressing in layers

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Energy production
1) Adenosine triphosphate (ATP)
a.
b. c. d.

Manufactured by the mitochondria in the muscle cell


ATP is the energy source used to drive muscle contraction Fatty acids and glucose are used to produce ATP Amino acids are not a preferred energy source, but are used in an undernourished individual

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Energy production
Energy System Substrate Limitation to Produce ATP Primary Use

ANAEROBIC
Phosphagen Creatine phosphate (CP) Stored ATP Muscle stores very little CP and ATP High-intensity, shortduration activities; less than 10 seconds to fatigue High-intensity, shortduration activities; from 13 minutes to fatigue

Anaerobic glycolysis

Glucose and glycogen

Lactic acid build-up causes rapid fatigue

AEROBIC
Fatty acids, glucose, and glycogen Depletion of muscle glycogen; insufficient O2 delivery Long-duration, subanaerobic threshold activities; longer than 3 minutes to fatigue
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ACE Exam Review

Metabolic equivalent (MET)


1) A system for classifying physical activities based on their intensities (in other words, based on their requirement for O2 consumption) 1 MET = resting O2 consumption, which is approximately 3.5mL/kg/min Physicians commonly prescribe exercise in terms of METs for cardiac rehab patients

2) 3)

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MET (cont.)
4) To determine the VO2 equivalent of any MET value, simply multiply the MET value by 3.5
a. For example, a typical step aerobics class is about 7 METs

b.

Therefore, the O2 consumption for a typical step aerobics class is:


3.5 mL/kg/min x 7 METs = 24.5 mL/kg/min

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Metabolism and exercise


1) Two terms are commonly used when describing metabolic rate: basal metabolic rate (BMR) and resting metabolic rate (RMR) BMR is the bodys minimum daily energy requirement for normal function
a. Assessed after an overnight stay in a lab where subject has been fasting for 12 hours and sleeping for 8 hours at a constant temperature
Consists of energy used for ventilation, blood circulation, and temperature regulation Measured in calories
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2)

b. c.

Metabolism and exercise (cont.)


3) RMR is a more common measurement than BMR
a. b. c. d. Assessed after an overnight fast and 8 hours of sleep The sleep is at home and the measurement is in the lab BMR is usually 10% lower than RMR RMR typically ranges from 1,200 cal/day for women to 1,500 cal/day for men

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Metabolism and exercise (cont.)


4) Effect of regular exercise
a. Moderate aerobic exercise plus strength training increase BMR to a greater degree than aerobic exercise alone Aerobic training increases caloric expenditure during the activity and uses body fat for fuel Strength training may increase lean mass and cause an increase in caloric requirement by 710 calories per day for each additional pound of lean mass Therefore, both aerobic exercise and strength training are recommended for weight loss
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b. c.

d.

Metabolism and exercise (cont.)


5) BMR tends to decrease with age
a. b. c. For each decade after age 25, 35% of muscle mass is lost Some decline still occurs in individuals who exercise regularly Training may attenuate or slow the decline

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Neuromuscular anatomy
1) Motor nerve: conducts impulses from the central nervous system (CNS) to the periphery signaling muscles to contract or relax

2)

Motor unit: a motor nerve and all its associated muscle fibers
a. All fibers comprising a motor unit are homogeneous (they are either all fast-twitch or all slow-twitch) Motor units made up of 510 fibers are responsible for fine, delicate movements such as blinking the eye Motor units made up of thousands of fibers are responsible for forceful movements such as jumping
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b.

c.

Musculoskeletal anatomy
1) Muscle fiber: a muscle cell

2)

Myofibrils: a contractile protein in a muscle fiber; there are many myofibrils arranged in patterns within a muscle fiber Sarcomere: the functional contracting unit of the muscle cell
a. b. Myofibrils are made up of several repeating sarcomeres along the length of the muscle cell The area between the Z-lines
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3)

Musculoskeletal anatomy (cont.)

4)

Actin and myosin: contractile protein filaments within the myofibril; they generate muscle contraction by sliding past one another
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Musculoskeletal anatomy (cont.)


5) Muscle contraction
a. b. An electronic impulse from the brain to the muscle is transmitted to cause contraction Contraction occurs due to the interaction of the actin and myosin filaments, which causes shortening of the individual muscle fibers

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Musculoskeletal anatomy (cont.)


6) Sliding filament theory
a. For muscle contraction to occur there must be two factors present
1. 2. Sufficient ATP A nervous impulse from the CNS

b.

When these two factors are present, tiny projections from the myosin filament attach to the actin filament forming a cross-bridge

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Musculoskeletal anatomy (cont.)


6) Sliding filament theory (cont.)
c. The myosin pulls the actin toward the center of the sarcomere and the individual muscle fiber shortens

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Musculoskeletal anatomy (cont.)


7) Discontinuation of contraction occurs when
a. b. Neural impulses stop Muscle fiber runs out of ATP

c.
d.

There is a build-up of metabolic by-products


Myosin and actin filaments bump up against the Z-lines

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Musculoskeletal anatomy (cont.)


8)
a. b. c.

Muscle spindles
Sensory receptors that lie parallel to the muscle fibers Respond to muscle fibers being over-stretched by causing a muscular contraction Component of the stretch reflex

9)
a.

Golgi tendon organs


Sensory receptors located in the muscle tendon

b.
c.

Respond to extreme muscle tension by causing the muscle to relax


Component of inhibition
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Musculoskeletal anatomy (cont.)


10) Connective tissue
a.
b. c. d.

Fascia
Tendons Ligaments Cartilage

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All-or-none theory
1) When a single muscle fiber shortens, it generates its maximum force capability; there is no gradation of force When a motor unit is stimulated, all the muscle fibers it innervates contract with maximum force

2)

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All-or-none theory (cont.)


3) The amount of force generated during a muscle groups contraction depends on the following
a. The size of the individual muscle fibers contracting (the larger the fiber, the greater the force) The number of muscle fibers recruited (more fibers equal more force) The length of the muscle fiber prior to contraction

b. c.

d.

The speed of contraction

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The length-tension relationship


1) The amount of force that a muscle can exert is related to its length

2) Peak force production is usually seen at resting length or slightly greater (1.2 times resting length)
3) At approximate resting length, more of the myosin cross-bridge heads can align with active actin receptor sites 4) Therefore, clients with poor posture that have chronically shortened or lengthened muscle groups are not able to produce optimal force at the misaligned joints
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Force vs. velocity


1) 2) A maximal force contraction is dependent on the number of actin and myosin cross-bridges formed The higher the speed of contraction, the fewer the number of connected myosin and actin crossbridges An optimal speed of contraction while lifting weights appears to be 1 to 2 seconds concentric, followed by 2 to 4 seconds eccentric

3)

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Muscle fiber types


Slow-twitch (Type I, Oxidative) Contract slowly Fast-twitch (Type II, Glycolytic) Contract rapidly

Contract less forcefully


Fatigue resistant Primary energy system is aerobic Used in endurance activities

Contract forcefully
Fatigue quickly Primary energy system is anaerobic Used in short-term activities requiring strength and power Fast-twitch fibers are further classified into type IIa and type IIb Type IIa fibers are slightly more oxidative than type IIb It is possible to increase either the oxidative qualities or the glycolitic qualities of type IIa fibers through training However, muscle fibers cannot be changed from one type to another
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Muscle fiber types (cont.)


1) 2) Muscles contain a mixture of fast-twitch and slow-twitch fibers (determined genetically) Different fiber types are recruited for different activities

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Muscular adaptations to regular resistance training


1) Neural adaptations
a.
b.

Improved recruitment patterns


Improved motor learning

c.

Neural adaptations are responsible for gains in strength with little or no change in muscle crosssectional area after as much as 6 weeks of training

2)

Hypertrophy of fast-twitch fibers


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Muscular adaptations to regular resistance training (cont.)


3) 4) 5) Increased size and number of actin and myosin Increased lean body mass Increased connective-tissue strength

6)
7)

Decreased risk for joint injury


Increased bone density

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Chronic stress has many negative effects on the body


Physiological system
Musculoskeletal system Cardiovascular system

Effects of stress
Tension headache, neck and shoulder discomfort, and back pain Premature coronary artery disease (CAD), hypertension, increased platelet adhesiveness, and heart attack

Immune system
CNS Gastrointestinal system

Suppression of T-cell function, increased vulnerability to infections, and viral illnesses


Impaired memory and neural degeneration Stomach ache, nausea, constipation, and diarrhea

These negative changes primarily occur due to elevated levels of stress hormones (norepinephrine and cortisol) Exercise may help decrease stress hormone levels and alleviate these symptoms
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Muscular actions
1) Isometric (static)
a. b. No visible movement occurs The resistance matches the muscular tension

c.

Examples
1. 2. Wall sit Plank

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Muscular actions (cont.)


2) Concentric (shortening)
a.
b.

Muscle shortens and overcomes resistive force


Examples
1. 2. Up-phase of biceps brachii curl Up-phase of push-up

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Muscular actions (cont.)


3) Eccentric (lengthening)
a.
b. c.

Muscle produces force as it lengthens, returning toward resting position


External force exceeds the contractile force of the muscle Examples
1. 2. Down-phase of biceps brachii curl Down-phase of push-up
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ACE Personal Trainer Manual


Chapter 2

Human Anatomy
Please refer to the Anatomy Supplement and ACE Personal Trainer Manual for tables, descriptions and illustrations of the skeletal system and major muscle groups.
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ACE Personal Trainer Manual Chapter 3

Biomechanics & Applied Kinesiology


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Levers
1) A lever is a rigid bar (bone) with a fixed point around which it rotates when an external force is applied to it The fixed point is the fulcrum (joint)

2)

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Torque
1) Rotation at a joint

2)
3)

Result of a force acting on a lever at some distance from the fulcrum


Rotation occurs in the direction of the greater force

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Muscular roles
1) Agonist (prime mover)
a.
b.

Causes a desired motion


Opposite of antagonist

2)

Antagonist (opposing muscle)


a. b. Acts in opposition to the action of the agonist The antagonist stretches as the agonist contracts

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Muscular roles (cont.)


3) Synergist
a.
b.

Can act as an assister, stabilizer, or co-contractor


Assister
1. 2. A muscle that assists an agonist muscle in its function Example: the teres major is involved in all the same actions as the latissimus dorsi but due to its smaller size and position it can only contribute a fraction of the amount of force

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Muscular roles (cont.)


3) Synergist (cont.)
c. Stabilizer
1. Example: when all portions of the trapezius contract to stabilize the scapulae during a side lateral arm raise This allows the scapula to become a stable base for efficient arm movement

2.

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Muscular roles (cont.)


3) Synergist (cont.)
d. Co-contractor
1. Example: when the gluteus maximus contracts to counteract the hip flexion that occurs while rising from a low squat This allows the rectus femoris to extend the knee as a person is rising without inclining the trunk forward

2.

e.

Both stabilizing and co-contracting play important roles in posture and efficient joint mechanics
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ACE Personal Trainer Manual Chapter 4

Nutrition
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Energy balance equations


1) Neutral calorie balance
a. b. Calories consumed = calories expended No change in weight

2)

Positive calorie balance


a. b. Calories consumed > calories expended Weight gain

3)

Negative calorie balance


a.
b.

Calories consumed < calories expended


Weight loss
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Rate of weight loss


1) 2) 3) Regular exercise and proper nutrition result in the best long-term weight loss One pound of fat = 3,500 calories For realistic weight loss
a. 300400 calories per workout session

b.
c.

Minimum of 3 days per week


Create a deficit of 5001000 calories per day

4) 5)

Average person can expect to lose 12 pounds per week Obese person can expect to lose 13 pounds per week
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National Institutes of Health recommendations


1)
2) 3)

Healthy eating plans that reduce calories but do not rule out specific foods or food groups
Regular physical activity and/or exercise instruction Tips on healthy behavior changes that also consider your cultural needs

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National Institutes of Health recommendations


4) Slow and steady weight loss of about to 2 pounds per week and not more than 3 pounds per week (weight loss may be faster at the start of a program) Medical care if you are planning to lose weight by following a special formula diet, such as a very-low-calorie diet
A plan to keep the weight off after you have lost it
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5)

6)

Scope of practice
As a fitness professional, it is within your scope to make dietary suggestions using the MyPyramid Food Guidance System (www.mypyramid.gov) and the 2005 Dietary Guidelines for Americans (www.nal.usda.gov/fnic); this information updates the Food Guide Pyramid released in 1992 and the 2000 Dietary Guidelines for Healthy Americans
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MyPyramid Food Guidance System

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1)

MyPyramid Food Guidance System (cont.)


Emphasizing activity, moderation, personalization, proportionality, variety, and gradual improvement will help clients gain control of their nutritional habits Approximate daily energy intakes
Sedentary older adults Active teenage girls, active women, and sedentary men Active teenage boys, active men, and very active women

2)

1,600 calories: 2,200 calories: 2,800 calories:

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Updated Physical Activity Recommendations

2005 Dietary Guidelines for Americans


1)

To reduce the risk of chronic disease in adulthood: engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration
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2)

Updated Physical Activity Recommendations

2005 Dietary Guidelines for Americans


(cont.) 3) To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements

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Updated Physical Activity Recommendations 2005 Dietary Guidelines for Americans (cont.)
4) To sustain weight loss in adulthood: participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity.
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ACE Personal Trainer Manual Chapter 5

Health Screening
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Typical forms
1) Legal issues
a. b. Informed Consent Liability Waiver Health Risk Appraisal/Health History Form PAR-Q Medical/Physicians Release Form Lifestyle Information Form Exercise History and Attitude Questionnaire Exercise Confidence Survey
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2)

Health and medical issues


a. b. c.

3)

Psychological issues
a. b. c.

Reasons for health screening


1) Referral: identify those in need of referral to a healthcare provider for more extensive medical evaluation Safety: ensure the safety of exercise testing and participation Testing and/or program development: determine the appropriate type of exercise test or program

2) 3)

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ACSM intensity guidelines


1) Moderate-intensity exercise
a. 36 METs

b.
c. d.

4060% VO2max
4060% HRR 1213 RPE Greater than 6 METs Greater than 60% VO2max

2)

Vigorous-intensity exercise
a. b.

c.
d.

Greater than 60% HRR


Greater than 13 RPE
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1)

Heart-rate and blood-pressure measurements


Heart Rate
a. b. Palpation Auscultation with a stethoscope

c.
d.

Sites: radial and carotid


Average resting heart rate: 60100 bpm

2)

Blood Pressure
a.
b.

Systolic blood pressure / diastolic blood pressure


Measured using a sphygmomanometer, cuff, and stethoscope

c.
d.

Expressed in mmHg
Allow 30 to 60 seconds between trials to allow normal circulation to return
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7th JNC report on high blood pressure


Category
Normal Prehypertension Hypertension, Stage 1 Hypertension, Stage 2

SBP mmHg

DBP mmHg
and or or or

<120 120139 140159

<80 8089 9099

160

100

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Medication
1) Health history forms should include information regarding any medications the client may be taking (prescription or over-the-counter) The personal trainer must be aware of the effects of medications on heart rate

2)

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Musculoskeletal conditions
1) 2) Both chronic and acute injuries must be addressed in the health screen Serious injuries and past surgeries also should be included

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ACE Personal Trainer Manual Chapter 6

Testing & Evaluation


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Purpose of measurements
1) 2) 3) Establishes a baseline Helps to monitor progress Increases your level of professionalism

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Disadvantages of measurements
1) Can be intimidating

2)
3)

Can be discouraging
Not always accurate

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Maximal oxygen uptake


1) 2) Also known as maximal oxygen consumption, VO2max, and aerobic capacity The maximum amount of oxygen a person can consume during exercise

3)

Expressed in liters or milliliters

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Absolute vs. relative VO2max


1) Absolute
a.
b. c.

O2 uptake determined without body weight as a factor


Usually used for non-weightbearing exercise tests such as cycling Expressed in L/min

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Absolute vs. relative VO2max (cont.)


2) Relative
a.
b. c. d.

Absolute O2 uptake divided by body weight


Used for weightbearing exercise tests such as walking, jogging and stepping Expressed in mL/kg/min This method allows for comparison to others of different body weights

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Absolute vs. relative VO2max (cont.)


2) Relative (cont.)
e. A heavy person may have a high VO2max (L/min) when compared to a lighter person, but when expressed in relative terms (mL/kg/min), the lighter person may show a higher level of cardiorespiratory fitness

Formula:
Relative O2 uptake = O2 uptake (L/min) x 1,000
BW (kg)
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Percentage of maximal heart rate (MHR)


1) Method of monitoring exercise intensity

2)

Can be determined by a maximal functional capacity test or by the age-predicted maximal heart rate formula (220 age)

Formula:
Target heart rate (THR) = 220 age x desired intensity %

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Heart-rate Reserve (HRR)


1) 2) The result of subtracting resting heart rate (RHR) from maximal heart rate (MHR) Represents the working range between resting and maximal heart rate within which all activity occurs

Formula: HRR = (220 age) RHR

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Karvonen formula
1) 2) The mathematical formula that uses HRR to determine target heart rate (THR) A common mistake is forgetting to add back in the RHR

Formula: HRR x desired intensity % + RHR

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Metabolic equivalent (MET)


1)
2)

A simplified system for classifying physical activities where 1 MET = resting O2 consumption
Resting O2 consumption equals approximately 3.5 mL/kg/min

Formula: 1 MET = 3.5 mL/kg/min

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Rating of perceived exertion (RPE)


1) Developed by Gunnar Borg, this scale provides a standard means for subjective self-evaluation of exercise intensity level 2) Original scale: 620

3) Revised (modified) scale: 010


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Submaximal aerobic exercise test


1) A cardiorespiratory fitness test designed so that the intensity does not exceed 85% HRR

2)
3)

Provides an estimation of the VO2max without the risks associated with maximal exercise testing
Examples
a. b. YMCA Submaximal Step Test McArdle Step Test

c.
d.

Rockport Fitness Walking Test (1-mile walk)


BYU Jog Test
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Graded exercise test (GXT)


1) A treadmill or cycle-ergometer test that measures (clinical setting) or estimates (field setting) maximum aerobic capacity by gradually increasing the intensity until a person has reached a maximal level or voluntary exhaustion Examples
a. b. YMCA Submaximal Bicycle Test Ross Submaximal Treadmill Protocol
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2)

Body Mass Index (BMI)


1) 2) A relative measure of body height to body weight for determining degree of obesity Should not be used solely in determining body composition for the athletic client, because BMI does not distinguish between fat mass and fat-free mass

Formula:

Weight (kg) Height2 (m)


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Skinfold measurements
1) 2) 3) 4) Used to determine the ratio of fat mass to fat-free mass in the body Fat mass: adipose tissue Fat-free mass: bone, muscle, and organs Measurements are performed with a skinfold caliper

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Skin-fold measurements (cont.)


5) The Jackson and Pollock (1985) three-site method has a relatively small margin of error for the general population
a. b. Sites for men: chest, abdomen, and thigh Sites for women: triceps, suprailium, and thigh

6) 7)

Should be repeated by the same technician during reassessment to decrease error Should be performed prior to physical activity because fluid transfer to the skin could result in overestimations
ACE Exam Review 104

Bioelectrical impedance analysis


1) Involves passing a small current through the body and measuring the opposition to the currents flow
a. b. Fat-free tissue is a good conductor of electricity Fat tissue is a poor conductor of electricity

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Bioelectrical impedance analysis (cont.)


2) Estimations can have the same margin of error as skinfold measurements as long as the client follows the correct pre-test protocol
a. b. c. d. e. Abstain from eating or drinking within 4 hours of the assessment Avoid moderate or vigorous physical activity within 12 hours of the assessment Void completely before the assessment Abstain from alcohol consumption for 48 hours before the assessment Avoid diuretic agents, including caffeine, prior to the assessment unless prescribed by a physician
ACE Exam Review 106

Circumference (girth) measurements


1)
2)

Can be used to assess body composition as well as body-fat distribution


Measurements are taken with a cloth measuring tape and must be taken at specific anatomical sites for accuracy More practical for obese clients

3)

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Calculating desired body weight


1) Once body composition is known, the personal trainer can assist the client in goal-setting using the desired body-weight equation This equation assumes there is no loss in lean BW

2)

Formula:
Desired body weight = lean body weight

1 desired body fat %


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Common flexibility tests


Measures range of motion (ROM) at specific joints
1) 2) Trunk flexion (sit-and-reach) Trunk extension

3)
4)

Hip flexion
Shoulder flexibility

As with any test or exercise, the clients health and injury history should be considered
ACE Exam Review 109

Muscular strength assessments


Muscular strength assessments measure the greatest amount of force that muscles can produce in a single maximal effort
1) Common muscular strength tests
a.
b.

1 repetition maximum (1 RM) bench press


1 RM leg press

2)

1 RM strength testing is not commonplace among personal trainers as the risks typically outweigh the benefits
ACE Exam Review 110

Muscular endurance assessments


Muscular endurance assessments measure a muscles ability to exert a submaximal force either repeatedly or statically over time
1) Common muscular endurance tests
a.
b.

Push-up test
Half sit-up test

As with any test or exercise, the clients health and injury history should be considered
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Test termination criteria


1) 2) Onset of angina or angina-like symptoms Significant drop (20 mmHg) in systolic blood pressure or failure of systolic blood pressure to rise with an increase in exercise intensity Excessive rise in blood pressure: systolic pressure >260 mmHg or diastolic pressure >115 mmHg Signs of poor perfusion: lightheadedness, confusion, ataxia (uncoordinated movement), pallor (pale skin), cyanosis (bluish coloration, especially around mouth), nausea, or cold and clammy skin
ACE Exam Review 112

3)

4)

Test termination criteria (cont.)


5) 6) 7) 8) Failure of heart rate to increase with increased exercise intensity Noticeable change in heart rhythm Subject requests to stop Physical or verbal manifestations of severe fatigue

9)

Failure of testing equipment


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Reassessment
1) 2) Measurable changes usually take about 46 weeks The first follow-up assessments should be administered 412 weeks after the onset of training The information gained during the follow-up assessment can be useful in client motivation as well as in future exercise programming

3)

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ACE Personal Trainer Manual Chapter 7

Cardiorespiratory Fitness & Exercise


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General training principles


1) 2) Specificity: a specific demand made on the body will result in a specific response by the body Overload: beneficial adaptations occur in response to demands placed on the body at levels beyond a certain threshold, but within the limits of tolerance and safety Reversibility: use it or lose it; the bodys fitness level will decline in response to discontinuing an exercise program
ACE Exam Review 116

3)

Cardiorespiratory endurance exercise programs


1) Expected improvements over 1020 weeks of training
a. b. Increase in aerobic capacity of 1520% Decrease in RHR by approximately 10 bpm

2)

Components
a. b. c. Warm-up Target heart-rate zone training Cool-down

3)

Monitoring intensity
ACE Exam Review 117

Cardiorespiratory endurance exercise programs (cont.)


4) Overload and progression
a. Phases
1. Conditioning (initial 47 weeks) Lower end of training range 34 days per week 1530 minutes 4060% HRR

Helps clients to achieve early success and to want to continue


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Cardiorespiratory endurance exercise programs (cont.)


a. Phases (cont.)
2. Improvement (820 weeks)
Frequency, intensity and duration all increase to mid-range

34 days per week initially, then 35 days per week


3040 minutes 6070% HRR initially, then 70 85% HRR when client is ready Goal is to expend 300+ calories
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Cardiorespiratory endurance exercise programs (cont.)


a. Phases (cont.)
3. Maintenance (56 months after initiation)
Higher end of training range 35 days per week

3045 minutes
7085% HRR Should be enjoyable, convenient, and adaptable Goal is to maintain fitness developed during improvement phase
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Cardiorespiratory endurance exercise programs (cont.)


b. These are only guidelinesit may take some clients longer to progress through conditioning and improvement phases After the initial conditioning stage, increase intensity 510% every 2 weeks Decrease intensity if overtraining occurs Signs of overtraining
1. 2. 3. 4. Increased RHR Depression or mood disturbances Increased incidence of colds and flu Overuse injuries
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c. d. e.

Cardiorespiratory endurance exercise programs (cont.)


e. Signs of overtraining (cont.)
5. 6. 7. 8. 9. Muscle and joint soreness Fatigue Insomnia Decreased appetite Plateau or worsening of performance that is not improved by rest or reduced training

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Cardiorespiratory endurance exercise programs (cont.)


5) Methods
a. Continuous training
1. Intermediate Slow Distance (ISD) 2. 2060 min of continuous aerobic exercise Most common for fitness improvement 60+ min of continuous aerobic exercise Usually for athletic training after at least 6 months of successful ISD training Increased risk of injury

Long Slow Distance (LSD)

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Cardiorespiratory endurance exercise programs (cont.)


b. Interval training
1. 2. 3. 4. Alternating high-intensity and low-intensity training in the same session Aerobic or anaerobic Predetermined intervals of intensity, duration, and repetition Can be used for beginners as well as athletes

c.

Fartlek training
1. 2. Similar to interval training except the work-rest intervals are determined by how the client feels Has great application for running
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Cardiorespiratory endurance exercise programs (cont.)


d. Circuit training
1.
2.

Client performs a series of exercises at different stations


Relatively brief rest intervals between stations

3.

Has applications for both aerobic and muscular endurance exercise

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Cardiorespiratory endurance exercise programs (cont.)


e. Aerobic composite (cross-training)
1. 2. 3. Combining a group of aerobic activities into one training session Example: cycling to a track, running for 20 minutes, and cycling home Great for decreasing boredom and chronic injuries

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Cardiorespiratory endurance exercise programs (cont.)


6) Specificity
a. Group 1 (beginners): activities in which intensity is maintained at a constant level and energy expenditure is low such as walking or cycling
Group 2 (intermediate): activities in which energy expenditure is related to skill, still maintaining a constant intensity such as aerobics or cross-country skiing

b.

c.

Group 3 (advanced): activities that are variable in both skill and intensity such as soccer or racquet sports
ACE Exam Review 127

ACE Personal Trainer Manual

Chapter 8
Muscular Strength & Endurance

Chapter 9
Strength Training Program Design
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Muscular conditioning programs


1) Importance of opposing muscle groups and muscular balance (neutral alignment)

2)

Assess tightness and weakness (kyphosis and lordosis)refer to student outline for illustrations and associated muscle imbalances Ask clients about their lifestyles and repetitive movements they perform throughout their day
Design a program to address those issues, but dont neglect the importance of training the entire body as a system
ACE Exam Review 129

3)
4)

Muscular conditioning programs (cont.)


5) Overload and progression
a. b. c. Progressive increase in resistance over time that causes muscles to fatigue in 3090 seconds Increase the intensity by no more than 510% 2-for-2 rule: if the client can perform 2 or more repetitions over his or her assigned repetition goal in the last set in 2 consecutive workouts, load should be added to the next training session

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Muscular conditioning programs (cont.)


6)
Load Light

Specificity
Outcome Endurance % 1 RM <70 Rep Range Sets 1220 812 18 13 16 15+ Rest Periods 2030 sec. 30120 sec. 25 min.

Moderate Hypertrophy, 7080 strength Heavy Maximum strength 80100

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Muscular conditioning programs (cont.)


7) Exercise sequence
a. b. Work the largest muscle groups first This allows clients to perform the most strengthoriented exercises while they are the least fatigued

8)

Range of motion
a. b. c. Full range of joint motion should be executed with each lift This strengthens the agonists and stretches the antagonists Strength training can improve range of motion if done properly
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Exercise progression and modification


1) Strategies to overcome strength plateaus
a.
b. c.

Modify FITT
Change order of strength-training exercises Substitute new exercises that target the same muscle groups Exercise specificity Injury prevention Plyometrics
ACE Exam Review 133

2)

Competitive Athletes
a. b. c.

ACE Personal Trainer Manual Chapter 10

Flexibility
ACE Exam Review 134

Flexibility exercise programs


1) When to stretch?
a. b. c. After the body has been warmed-up 515 min of light warm-up activity followed by a static stretch Post-workout is probably the best time to stretch

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Flexibility exercise programs (cont.)


2) Overload and progression
a. b. Stretch to the point of mild discomfort Because connective tissue is visco-elastic, the stretch needs to be of low-force and long-duration to produce tissue elongation even after the stretch position is discontinued This type of permanent elongation as a result of static stretching is called plastic deformation Over time, a consistent stretching program may cause the connective tissues to reset to an elongated length, and range of motion will increase
ACE Exam Review 136

c. d.

Flexibility exercise programs (cont.)


3) Specificity regarding client needs
a. Posture
1. 2. Base a stretching program on the initial assessment results Be aware of the types of postures associated with specific muscular tightness

b.

Injuries
1. 2. Be aware of previous injuries Recently injured soft tissues should not be stretched
ACE Exam Review 137

Flexibility exercise programs (cont.)


4) Types of stretching
a. Ballistic
1.
2.

High-force, rapid, jerking movements often referred to as "bouncing"


Not recommended because it may activate the muscle spindles and invoke the stretch reflex

b.

Dynamic
1. 2. 3. An active stretch that mimics the activity to be performed Done through a full range of motion in a slow and controlled manner Examples include running in slow motion and practicing slow swings of a tennis racquet

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Flexibility exercise programs (cont.)


4) Types of stretching (cont.)
c. Proprioceptive neuromuscular facilitation (PNF)
1. A method of promoting the response of neuromuscular mechanisms through the stimulation of proprioceptors in an attempt to gain more stretch in a muscle There are several methods, but the most common used in training is the contract-relax method This requires a trained and experienced partner and involves an isometric contraction followed by a passive, static stretch

2. 3.

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Flexibility exercise programs (cont.)


4) Types of stretching (cont.)
d. Static
1. 2. A slow, controlled stretch that holds the desired tissues at an elongated length for 1030 seconds Recommended form of stretching because it takes a minimum of 6 10 seconds to elicit the stretch response from the neuromuscular mechanisms

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ACE Personal Trainer Manual Chapter 11

Programming for the Healthy Adult


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Sources of information
1) The forms

2)
3) 4)

The interview with the client


The assessment and test results The clients primary care physician

Only after gathering these pieces of information can the personal trainer design the appropriate, safe, and effective exercise program
ACE Exam Review 142

Rates of change
1) Weight Loss
a. b. Maximum rate of weight loss is 12 lb per week Body fat decrease of approximately 1% per month

2)

Muscle Gain
a. Maximum rate of muscle gain is 12 lb per month

b.

Initial rate of muscle gain is 24 lb in the first 8 weeks 10% rule


Increases in resistance, time, or distance should be no greater than 10% per week
ACE Exam Review 143

3)

Progression
a.
b.

The energy cost of exercise


1) Regular exercise should be partly responsible for creating a negative energy balance for weight loss Educating clients about the energy cost of exercise may help them understand the role of physical activity in weight management Estimated calorie costs of selected exercises

2)

3)

Formula:
Energy cost of an activity = calorie cost x BW (lb) x minutes of activity

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Goal setting
1) 2) Effective goal-setting will translate a clients vague statements into precise goals SMART goal
a. b. c. d. e. S pecific M easurable A ttainable R elevant T ime-bound
ACE Exam Review 145

Goal setting (cont.)


3) SMART goal example: I will lose 10 lb in three months by performing 30 minutes of cardio three days per week and strength training two days per week and through proper nutrition so that I can really enjoy my upcoming holiday cruise! a. b. Specific: lose 10 lb body fat Measurable: progress will be assessed using a change in body weight and the skinfold caliper bodycomposition method

c.

Attainable: by increasing physical activity and decreasing caloric intake by 150 cal per day, losing 10 lb in 3 months can safely and effectively be achieved (equates to approximately .8 lb lost per week)
Relevant: look better for cruise and have more energy to enjoy it Time-bound: goal is set to be achieved within 3 months
ACE Exam Review 146

d. e.

Goal setting (cont.)


4) Behavior-centered goals
a. Focus on establishing a pattern of behavior (exercising 3 days per week for 20 minutes per session) Good for beginners who may be intimidated by the evaluation process (weight scales, body-fat measurements, tape measures, etc.)

b.

5)

Outcome-centered goals
a. b. Focus on results (losing 10 lb, as in the previous SMART goal example) May be good for clients who are motivated by physiological results rather than behavior-change results
ACE Exam Review 147

ACSM recommendations for exercise program design


1) Based on the FITT principle
a. b. c. d. Frequency: days per week Intensity: difficulty of exercise Time: duration Type: mode of activity

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ACSM recommendations for exercise program design (cont.)


Freq. Intensity
Cardio
35 (55/65)-90% HRmax, (40/50)-85% HRR or VO2R, or 12-16 RPE

Time
2060 continuous minutes or 10minute bouts accumulated throughout the day 1 set of 3-20 reps (e.g., 3-5, 8-10, 1215); 1 set of 10-15 reps if >50 yrs 15-30 sec.; 2-4 reps

Type
Large muscle groups; dynamic activity

Resistance

23

Volitional fatigue (e.g., 19-20 RPE) or stop 2-3 reps before volitional fatigue (e.g., 16 RPE) Stretch to tightness at the end of the ROM but not to pain; mild discomfort

8-10 exercises that include all the major muscle groups Static stretch for all the major muscle groups

Flexibility

Minimum 23; ideal 5 7

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ACE Personal Trainer Manual Chapter 12

Special Populations & Health Concerns


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Guidelines for most special populations (refer to hand-out for specific concerns)
1) Physicians clearance
a. b. Request exercise guidelines and limitations from clients physician Maintain close contact with clients physician Longer than 10 minutes Many special populations have compromised metabolic and/or cardiorespiratory systems and it takes longer for their bodies to adjust during acute bouts of exercise
ACE Exam Review 151

2)

Extended warm-up and cool-down


a. b.

Guidelines for most special populations (cont.)


3) Cardiorespiratory exercise
a. b. c. Low- or non-impact Longer duration and lower intensity May be accumulated in shorter bouts throughout the day

4)

Strength
a. Lower resistance and higher repetitions

b.

Exceptions are osteoporosis and obesity

5)

Modify as needed
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ACE Personal Trainer Manual Chapter 13

Principles of Adherence & Motivation


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Factors that affect adherence


1) Personal factors
a.
b. c. d. e. f. g.

Education
Income Smoking Weight Past exercise experience Exercise perceptions Self-efficacy
ACE Exam Review 154

Factors that affect adherence (cont.)


2) Program factors
a.
b. c. d. e. f. g.

Convenience
Location Cleanliness Friendliness of staff Cost Variety in programming and equipment Intensity
ACE Exam Review 155

Factors that affect adherence (cont.)


3) Environmental factors
a.
b.

Support from family and friends


Contracts

c.

External rewards

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ACE Personal Trainer Manual Chapter 14

Communication & Teaching Techniques


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Four stages of a client-trainer relationship


1) Rapport
a.
b. c.

Empathy: ability to experience another persons world as if it were your own


Warmth: unconditional positive regard for another person Genuineness: being honest and open

2)

Investigation
a.
b.

Health screen
Physical tests
ACE Exam Review 158

Four stages of a client-trainer relationship (cont.)


3) Planning
a.
b.

Set SMART goals


Client should be involved in this process

4)

Action
a. Where the teaching and training takes place

b.

The personal trainer coaches the client toward his or her goals
ACE Exam Review 159

Stages of learning
1) Cognitive stage of learning
a. Learners make many mistakes and have highly variable performances

b.

Participants rely on the instructor to detect errors in performance


Learners have acquired the basic fundamentals or mechanics of the skill Participants begin to detect their own errors

2)

Associative stage of learning


a. b.

3)

Autonomous stage of learning


a.
b.

The skill now becomes autonomic or habitual


Participants can now perform without thinking and can detect their own errors
ACE Exam Review 160

Types of learners
1) Auditory learners
a. b. Listen intently to the content of your words Instruction example: teach auditory learners breathing by making a light sound while exhaling and inhaling

2)

Visual learners
a. b. Watch you and your actions carefully Instruction example: teach visual learners breathing by exaggerating facial expressions and moving hands in the direction of the airflow
ACE Exam Review 161

Types of learners
3) Kinesthetic learners
a. b. Gather information through physical changes or feelings Instruction example: teach kinesthetic learners breathing by having the participant focus on the feeling of the air moving through the airway and the feeling of the lungs expanding and contracting

4)

Most people prefer one style of learning but can adapt to others
ACE Exam Review 162

Exercise instruction
1) Tell-show-do approach to teaching
a. b. c. d. Tell: a concise verbal description of the skill to be attempted Show: demonstration of the accurate desired action Do: an opportunity for the client to perform and practice the desired skill This approach allows the personal trainer to provide the client with an auditory, visual, and kinesthetic learning experience
ACE Exam Review 163

Exercise instruction (cont.)


2) Feedback
a. Should be informational rather than controlling

b.
c. d.

Based on performance standards


Specific Immediate

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Exercise instruction (cont.)


3) Spotting techniques
a. Trainer safety: the personal trainer should position his or her body in correct biomechanical position when spotting Client safety
1. The personal trainer should be able to recognize muscle substitution patterns that occur as muscles fatigue and approach failure

b.

2.

It is the personal trainers responsibility to provide protection in high-risk barbell exercises such as the squat, bench press, and incline press
ACE Exam Review 165

ACE Personal Trainer Manual


Chapter 15

Basics of Behavior Change & Health Psychology


ACE Exam Review 166

Transtheoretical Stages-of-Change model


1) Pre-contemplation
a.
b.

Individual is not exercising and not intending to start


Pre-contemplators deny having a problem and are typically unaware of the problem

c. Most difficult people to reach for behavioral change d. e. Education is critical at this stage Typically, they initiate change only when others pressure them
ACE Exam Review 167

Transtheoretical Stages-of-Change model (cont.)


2) Contemplation
a.
b.

Individual is not exercising but seriously intends to start


Contemplators acknowledge they have a problem and begin to seriously think about overcoming it

c.

They are not quite ready for change and are planning to take some action within the next 6 months
The average contemplator stays in this stage for approximately 2 years, telling themselves they will change but continuously putting it off Education and peer support are critical
ACE Exam Review 168

d.

e.

Transtheoretical Stages-of-Change model (cont.)


3) Preparation
a.
b. c.

Exercise is occurring occasionally but not regularly


People in this stage are planning on starting to exercise within the next month Goal setting and creating a specific plan of action are important during this stage

d.

Continued environmental and peer support are helpful


ACE Exam Review 169

Transtheoretical Stages-of-Change model (cont.)


4) Action
a.
b. c.

Exercise has occurred regularly for less than 6 months


During this stage the exerciser is following specific program guidelines Relapses are common, as this is the least stable stage

d.

Personal trainers are critical during this stage

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Transtheoretical Stages-of-Change model (cont.)


5) Maintenance
a. A regular exercise program has taken place for longer than 6 months and the exerciser strives to prevent relapses This stage also requires adherence to specific exercise program guidelines
5 years of continuous maintenance is likely to result in termination of the unwanted behavior (being sedentary)
ACE Exam Review 171

c.
d.

ACE Personal Trainer Manual Chapter 16

Musculoskeletal Injuries
ACE Exam Review 172

Acute injury
1) 2) Seek medical approval and recommendations prior to continuing existing program Rest, decrease FITT, and cross-train

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Chronic injury
1) If chronic injury with pain exists for two weeks or more, seek medical approval and recommendations prior to continuing existing program

2)

Rest, decrease FITT, and cross-train

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New medical conditions and/or changes in health status


1)
2)

Seek medical approval and recommendations prior to continuing existing program


Use ACE and other resources to create program modifications

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Environmental conditions
1) Exercising in heat
a. b. c. Begin exercising in the heat gradually Always wear lightweight, well-ventilated clothing Never wear impermeable or non-breathable garments

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Environmental conditions
1) Exercising in heat (cont.)
d. Replace body fluids as they are lost
1.
2. 3.

48 ounces of water every 1015 minutes during exercise


816 ounces of water 1 hour prior to exercise 1624 ounces of water during the 30 minutes after exercise, whether thirsty or not

e. f. g.

Record daily body weight Reduce FITT when appropriate Avoid times of day when heat and/or humidity are the greatest

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Environmental conditions (cont.)


2) Exercising in cold
a.
b.

Wear several layers of clothing


Allow for adequate ventilation of sweat

c.

Select garment materials that allow the body to give off body heat during exercise and retain body heat during inactive periods
Replace body fluids in the cold, just as in the heat

d.

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Environmental conditions (cont.)


3) Exercising in higher altitudes
a. b. c. d. Acclimatize to altitude Reduce FITT when appropriate Increase warm-up and cool-down periods Be aware of the signs and symptoms of altitude sickness
1.
2. 3. 4.

Shortness of breath
Headache Nausea Lightheadedness

e.

Allow a minimum of three weeks to adjust at moderate altitudes (4,000 feet and higher)
ACE Exam Review 179

ACE Personal Trainer Manual Chapter 17

Emergency Procedures
ACE Exam Review 180

Facility readiness
1) First aid box
a. b. c. Where is it? Whats in it? How often is it restocked?

d.

Whos in charge of it?

2)

Emergency medical system (EMS) plan


a.
b.

Procedures and the role of the personal trainer


Emergency contact information
ACE Exam Review 181

Emergency
1) A situation that requires the activation of EMS (life threatening condition, heart attack, neck or back injury) A health professional will need to clear the client prior to exercise, and the program may need modification

2)

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Acute injury
1) 2) A condition caused by a singular event that requires either an EMT or an immediate referral Medical attention is advised prior to the next exercise session

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Overuse injury
1) 2) A condition that has increased in pain or discomfort over a short period of time If there is general discomfort for two weeks or more advise the client to seek medical attention prior to exercise

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RICE
1) Rest, Ice, Compression, and Elevation

2)
3)

Do not apply ice directly to the skin


Ice should be applied no more than 2030 minutes per hour

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Responses to exercise
Normal responses Elevated heart rate Warning signs Squeezing pressure in chest

Increased respiration
Sweating Cramping Fatigue Redness in face

Extreme shortness of breath


Profuse sweating or no sweating Pain inappropriate for intensity Nausea Red, hot appearance

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ACE Personal Trainer Manual


Chapter 18

Legal Guidelines & Professional Responsibilities


ACE Exam Review 187

Scope of practice
1) The range and limit of responsibilities normally associated with a specific job or function

2)
3)

Limits the authority of a personal trainer


Examples
a. b. c. Referring to more qualified professionals when necessary Educating a client about the USDA Dietary Guidelines Designing an exercise program for an apparently healthy adult

Important point: personal trainers never diagnose or prescribe


ACE Exam Review 188

Standard of care
1) 2) 3) Appropriateness of an exercise professional's actions in light of current professional standards Based on the age, condition, and knowledge of the participant Examples:
a. b. Proper risk factor and medical screening Exercise testing and physical assessments

c.
d.

Proper development of exercise program


Proper supervision of a client during exercise
ACE Exam Review 189

Standard of care (cont.)


4) With the ACE Personal Trainer certification, your conduct could be compared to the standards presented in the manual and your ethics could be equated to the ACE Code of Ethics

(Appendix A: ACE Personal Trainer Manual)

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Negligence
1) Both the failure to act and appropriateness of action

2)
3)

Acting inappropriately as compared with what a reasonable and prudent professional would do
Examples
a. Failing to stop a client from exercising above a recommended heart rate (failure to act or act of omission)
Encouraging a client to work above his or her recommended heart rate (appropriateness of action or act of commission)
ACE Exam Review 191

b.

Comparative negligence
1) 2) Measures the relative fault of both the plaintiff and defendant The court may apportion guilt and any subsequent award and damages

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Contributory negligence
1) The client plays a role in getting injured

2)

The plaintiff (client) cannot recover damages from the defendant (trainer)

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Forms
1) Health risk appraisal (health history screen)
a. Purpose
1. Aids the personal trainer in determining heart disease risk factors and/or medical conditions that may make it unsafe for the client to participate in physical activity Provides a framework for designing a safe and effective exercise program

2.

b.

Limitations
1. 2. Cannot be used by a personal trainer to diagnose any medical condition Must be updated when any new medical condition arises (having clients update their health history forms every 612 months is a good practice)
ACE Exam Review 194

Forms (cont.)
2) Physical Activity Readiness Questionnaire (PAR-Q)
a. Purpose
1. Serves as a minimal prerequisite for beginning a low- to moderate-intensity exercise program

2.

Quick and easy to administer

b.

Limitations
1. Lack of detail

2.

May overlook important health conditions, medications, and past injuries

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Forms (cont.)
3) Physicians clearance (medical release)
a. Purpose
1. 2. Provides the personal trainer with clarification of a clients status Explains any limitations and/or modifications to physical activity

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Forms (cont.)
4) Informed consent (express assumption of risk)
a. Purpose
1. When a client signs an informed consent, he or she is acknowledging to have been specifically informed about the risks associated with the activity
The two most important issues are voluntary participation and known danger Uses assumption of risk defense if challenged in court

2. 3.

b.

Limitations
1. 2. Not a liability waiver Intended to communicate the dangers of the exercise program or test procedures
ACE Exam Review 197

Forms (cont.)
5) Liability waiver
a. Purpose
1. 2. Used to release a personal trainer from liability for injuries resulting from an exercise program Represents a clients voluntary abandonment of the right to file suit

b.

Limitations
1. 2. Does not protect the personal trainer from being sued Documents that are poorly worded hold little value in court, as each state has its own policies

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Insurance coverage
1) General liability
a. Covers basic trip and fall injuries that occur in a non-business environment

b.

These policies will not provide coverage for accidents that occur at work or while working
Includes coverage based on allegations claiming injury to clients Covers acts of omission (things the personal trainer did not do)

2)

Professional liability
a. b.

c.
d.

Covers acts of commission (actual conduct)


Necessary for independent contractors (selfemployed personal trainers)
ACE Exam Review 199

Securing information and confidentiality


1) Do's
a.
b. c.

Do keep all client records in a secure, locked place


Do keep client records on file for at least 5 years Do inform your client that you will keep all information confidential

2)

Don'ts
a. Do not disseminate client names, addresses, or any other information to anyone without written permission from the client
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Health Insurance Portability and Accountability Act (HIPAA)


1) In 1996, this federal statute was designed to protect the health information of individuals from unnecessary use or abuse Protected health information (PHI) applies to information created or received by healthcare providers HIPAA does not currently affect personal trainers or fitness facilities

2)

3)

4)

However, as part of the personal trainers initial interview and assessment with a potential client, PHI is gathered
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Health Insurance Portability and Accountability Act (HIPAA)


5) The following precautions are recommended for the handling of PHI
a. b. c. Shred any duplicative or unnecessary medical documents that you may have for the client Keep all files and offices locked when not in use Ensure that PHI is not openly displayed on a workspace

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Health Insurance Portability and Accountability Act (HIPAA)


5) The following precautions are recommended for the handling of PHI (cont.)
d. If an electronic system is used to store client information, ensure that the system is password protected

e.

Sending a fax with PHI requires the personal trainer to first notify the recipient that a fax is going to be transmitted and mark the cover sheet "private and confidential"
If hard copies of PHI are mailed, label the envelope as confidential It is not advisable to e-mail PHI
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f. g.