$5.00
Volume 15
Issue 6
October/November 2009
8
10 TIPS FOR GAINING CONFIDENCE
AS A GROUP FITNESS INSTRUCTOR
3
Learn 10 tips for fast-tracking confidence so you can stand in front of a class or
boot camp of any size with poise. self-assuredness and a greater ability to command the crowd.
6
RESISTANCE TRAINING RECONSIDERED
KEEPING YOU POSTED
18
ConEd Spotlight
New research suggests that low-intensity resistance training is an acceptable sub-
ACE in the News
stitute for high-intensity resistance training for healthy ind ividuals, thereby offerACE Partners With IDEA
ing fitness professionals the option to do resistance training with any client while
minimizing the risks.
WHAT ACE-CERTIFIED FITNESS PROFESSIONALS
NEED TO KNOW ABOUT EXERCISE STRESS TEST ECGs
8
CALENDAR OF EVENTS
22
23
This article offers important information for making informed
decisions regarding which clients should be referred for a physiciansupervised graded exercise test and when. as well as what
functional and prognostic information this test can provide.
[YOUR NAME], CERTIFIED PERSONAL
TRAINER AND . . . NUTRITIONIST?
If you've been confused about your role as a fitness professional and
what nutritional advice you can and can't give-or what to call yourselfthis article is for you.
14
GOT INSURANCE?
As a fitness professional, you need to protect yourself, and acquiring
liability insurance can give you much-needed peace of mind.
CHRONIC HEART FAILURE AND EXERCISE:
A RESEARCH UPDATE
ACE CERTIFIED NEWS
AC£ Certified News Is published six
times per year by the American Council
on Exercise. No material may be
PUBLISHER: Scott Goudeseune
ACE PRO SITE:
TECHNICAL EDITOR:
Cedric X. Bryant, Ph.D.
www.acefitness.org/cp
EOITOR IN CHIEF:
Christine J. Ekeroth
ASSOCIATE EDITOR: Marlon Webb
reprinted without permission. ACE does
ART DIRECTOR: Karen F. McGuire
not recommend or endorse any product
or service of any advertiser.
PROOIJCTJON: Nancy M. Garcia
2
CC108(RINO\'Cll8(R 2009 I ltE CEAtlHEO NIWS
17
ACE WEB SITE: www.acefitness.orq
C•rtlflcatlon/Study Mat•l'lals:
support@acefitness.org
MAILING ADDRESS:
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4851 Paramount Orive
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Publlc Rtlatlons & Markttlnq:
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Resource Center:
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S T O R Y
BY
AMANDA
VOGEL, M.A.
@
AINING CONFIDENCE AS A GROUP FITNESS INSTRUCTOR COMES WITH EXPERIE NCE, BUT IF YOU ARE A NEW INSTRUCTOR, YOU PROBABLY WANT TO BE
THE BEST YOU CAN BE, RIGHT NOW. LUCKILY, ALLOWING YOUR CONFIDENCE
TO SHINE THROUGH INVOLVES MORE THAN JUST EXPERIENCE. THERE ARE
IMMEDIATE STRATEGIES YOU CAN APPLY TO APPEAR MORE CONFIDENT AS A GROUP
LEADER (EVEN IF YOU DON 'T FEEL 100 PERCENT CONFIDENT). THIS ARTICLE PROVIDES
10 T IPS FOR FAST-TRACKI NG CONFIDENCE SO YOU CAN STAND IN FRONT OF A CLASS
OR BOOT CAMP OF ANY SIZE WITH POISE, SELF-ASSUREDNESS AND A GREATER ABI LITY TO COMMAND THE CROW~
Continued on page 4
AMANDA VOGEL, M.A., human kinetics, is a certified fitness instructor in Vancouver, B.C. She owns Active Voice, a
writing, editing and consulting S81Vice that helps fitness pros and organizations improve the quality and effectiveness
of their promotional and educational material. Read her fitness writing tips at http://FotnessWriter.blogsoot.com. and
receive a lree copy of here-book, 51 Need-to-Know Writing & Marketing Tips for Fitness Pros, at www.ActiveVoice ca.
AC( CIJITIFl!ONEWS I OCTOO[RINOl'l:N.B!R 2009
3
1.
Be Prepared.
This first strategy is the most obvious, but it's foundational to the
other n.ine strategies. Preparalion
for group leaders comes in the form of
ongoing education and lesson plans.
Knowing the how's and why's behind what
you teach automatically makes you feel
more secure in your abilities. And stepping
into a class or boot camp with a blueprint
of how you want the workout to play out
helps quell any jitters about making sure
the class runs smoothly. For boot camps,
devise a plan for how participants will transition Crom one move to the next, and be
clear on why you've selected certain exercises. For group fitness classes, jot down your
choreography and practice it on your own
before introducing it to participants.
3
2
Anticipate "Bumps"
in the Road.
Even if you map out how you
• want the class or boot camp to
pan out, it doesn't always go as you would
have hoped. So anticipate challenges and
potential pitfalls. Knowing how to handle
tricky situations before they arise helps
eliminate worry about what to do if something doesn't go your way. For example,
stash an extra CD in your bag in case you
forget your iPod at home or its battery dies.
Pre-plan exercise modifications in case a
pregnant or injured participant shows up
for )'Our drop-in class or an outdoor bench
or park space you planned to use for your
boot camp is unexpectedly occupied.
4
CC108(Rlt<l)IU,a(R 2009 I ltE CER11f111l MEWS
Develop Your
"Leader Persona."
Hone your teaching personal• ity and what you are most
known for as a group leader. Analyze what
special experience you provide in your
workouts, then emphasi1,e that experience
in your classes or boot camps. For example,
how would people describe you as a leader?
This is about you; it's not about how participants would describe your classes or
boot camps. Consider the "leader persona"
you convey when you stand in front of a
group. Your leader persona could be a combination of what you say (e.g., you offer a
lot of technical instruction), how you look
(e.g., your style of dress or body type), what
you teach (e.g., class format or style of boot
camp), or how you act (e.g., mellow, boisterous, funn)1) .
4
Identify Your Allies.
It can be especially intimidating for new instructors
• to stand in front or a group
that changes every week, which is exactly
what happens with traditional group exercise. You never know who is going to be
in a group fitness class, so there are almost
always unfamiliar face!l. Get to know your
most regular participants, and consider
them your allies. Most of your "regulars"
are specifically there because of you; look to
their familiar faces to help boost your confidence as you teach.
5.
Accept That Some
People Won't Like
You. On the fUpside of
6.
Command Attention.
the previous point, accept
that some people just won't care for your
classes/boot camps or your style of instmction. Eve.n though it happens to almost
every group fitness instructor at one time or
another, it can be a real confidence-shaker.
When I was a lcss-cx1.>erienccd instructor than I am now, two participants at an
upscale fitness club approached me after
class to inform me that my 9:30 a.111. work•
out "wasn't worth getting out of bed for in
the morning." Ouch! I was obviously upset,
but I still really, really wanted these women
to like me! And guess what? They never did.
When I stopped trying to win them over
and started concentrating on other participants who enjoyed and appreciated m)'
classes, I was much happier. TI1e sooner you
let go of tryin.g to please everyone, the more
confidence you'll gain.
If you are a personal trainer
and boot camp instructor, you
might be most fam iliar with
the individual interactions you have with
clients. However, you must adopt a different
style for sharing information and teaching
exercises to a group, especially a large one.
Communicating to a group is vastly different from communicating in a one-on-one
situation.
Herc are three key techniques for commanding attention as a group fitness instructor, whether you teach boot camps or traditional group exercise:
• Use animated body movements and
gestures to show particip.1nts what you
want them to do andfor which direction
you want them to go. Make arm move-
8
Manage First
Impressions.
The fi rst five minutes or so
• of a traditional group fitness
class or boot camp helps set the stage ror
the entire workout. Yet, new group fitness
instructors often miss the opportunity to
make a stellar first impression during this
crucial time. Don't wait until the middle
of the class to showcase your strong leadership and motivational skills. Pump lots of
energy and enthusiasm into the start of
your class or boot camp-before and during
the warm-up. Greet people as they arrive,
and when the class or ·boot camp begins,
command the crowd (see tip #6) to assert
your leadership role.
ments strong and precise all the way
to your hands and fingertips.
• Your facial expressions can create a
powe1ful impression about your le,,el of
confidence. New group fitness instructors sometimes forget to smile because
they're nervous or preoccupied with
teaching the exercises. Make it a point to
smile often at participants. It helps put
them, and you, at ease.
• S~k ~\1oib!y (witi!0\11yelling), \1$Lng ~
friendly but commanding voice. To help
engage the entire group, address the peopleat the bad: of the class, not just those
who are directly in front of )'OU.
7
Consider Your
"Visual Brand."
How you present yourself as
• a group fitness instructor can
make you appear either 1t1ore confident or
less confident, regardless of how you actually feel. for example, when you walk onto
the boot camp fic>ld or into a fitness studio,
it helps to be immediately identifiable as
the instructor. Part of your "visual brand" as
a group fitness instructor is based on your
body language and how you carry yourself.
However, it may also be connected to what
you wear (e.g., professional-looking t-shirt
with your business logo; traditional boot
camp outfit; athletic shoes that look clean
and new, not old and overused). Even if
you exercise alongside participants (as is
common in traditional group exercise), you
are not just working out-you are at work.
A well-worn t-shirt might be most comfortable, but it may not effectively set you apart
as the leader.
9.
Love What You Teach.
There is a lot of pressure these
clays for trainers and instructors to keep up with the latest
fitness fads. Unfortunately, you are bound
to struggle with waning confidence if you
find you rself tcad1ing a format that is
beyond your knowledge base> or one you
wouldn't participate in for your own enjoyment. Likewise, trying to instruct in a style
tlmt doesn't mesh with who you really are
not wise. You might never be comfortable
as a boisterous boot camp "drill sergeant" if
your personality is more subdued. Stick to
what you know and love best, and a greater
sense of confidence will naturally follow.
is
10
"Fake It" When
Necessary.
Sometimes it seems as if
• the most critical participants can "smell" fear or nervousness in a
new group fitness instn1ctor, which-as
unfair as it is-just ma.kes them more critical. As a credible fitness pro, you wouldn't
"fake" your fitness knowledge or expertise,
but faking your level of confidence is a different story! Doing so can help you win
over those discerning participants who
expect only the best. Use the previous nine
tips io t11is article to help create the impression that you are a calm, cool and collected
group fitness instructo.r, evm if you happen
to be doubting yourself or feeling like a
bundle of nerves on the inside. When you
show confidence in yourself, your partil'ipants are more likely to have confidence in
you, as weU. A-
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AC( CUITIFIIO Nll'IS I CX:rOll(Rl!<Ql'tMBIR lOl9
5
S T O R Y
BY
AMY
ASHMORE
esearch published In the November 2008 Issue of the Journal of Strenqth & Condltlonlnq
Research shows that low-intensity resistance traininq (RT) can produce the same muscle
strenqth, size and tone qains as tradi1ional hiqh·intensity RT (Tanimoto et al., 2008).
RT intensity is determined by a percent of one-repetition maximum ORM). Hiqh·intensity RT Is
defined as a load or welqht that exceeds 80 percent of lRM, while low-intensity RT is defined as
a load or weiqht that represents 65 percent ,or less of lRM.
R
Ph.D.
What is particularly relevant is that this study used
36 healthy young men to show that low-intensity
RT can yield the same benefits as high-intensity RT.
TI1is suggests that low-intensity RT is an acceptable
substitute for high-intensity RT for healthy individuals,
providing fitness professionals with the option to do
RT training with any client while minimizing the risks.
Risks Associated With Highintensity Resistance Training
The risks associated with RT have caused many people to
avoid strength training and made many fitness professionals reluctant to do RT with high-risk clients. The
primary benefit of low-intensity RT is that it minimizes the risks to the exerciser. High-intensity
Suggested
RT is associated \\1th risks such as orthopedic
Exercises
injuries, an elevation in blood pressure (BP) and
aortic dissection. With regard to musculoskeletal
Single-joint
injuries, 20 percent of poople age 70 to 90 show
• Seated knee extensions
orthopedic injury after I RM training, whereas
• Knee fle)(ion
only 8 percent showed injuries during moderate• Biceps curls
intensity !IT (Pollock et al., 1991). High-intensity
RT can be contraindicated for persons with mus• Triceps extensions
culoskeletal issues, older people, those who are
• Lateral shoulder raise
severely dcconditioncd, and young people who
Multi-joint
have not yet reached skeletal maturation. And
as research sho1"5 it can also be contraindicated
• Vertical squat
over tbe lifespan for even healthy people. ·n1is is
• Chest press
because joints begin to show ei1dence of degen• Lat pull down
erative changes around the age of 40 to the degree
• Abdominal bend
that a~nost all elderly persons show some signs
• Back extension
of osteoarthritis (l'\atiom~ Council for Physical
Activity & Disability, ZOOCJ). One study found
!1 1 'I~ 11 ' that nearly 100 percent of the study participants
,,. ,,.,
I
AMY ASHMORE, Ph.D., holds a doctorate in kinesiology from the University
of Te)(aS at Austin. She is an educator and author, and may be reached at
amyashmoreohd@aoJ com.
6
CC108(AINl)l'(ll8ER 2009 I ltE CERtlflto M
IWS
over the age of 65 showed at least minimal radiographic
signs of osteoarthritis in the hands, feet, spine, knees or
hips (l.awrence et al., 1998). 'lhe severity of joint disease
varies from person to person based on a number of lifestyle
and genetic factors. Lifestyle factors include the loads that
we place on our joints over the lifespan. Low-intensity RT
makes it possible to strength train over the lifespan while
reducing dangerous loads on joints.
Another major safety concern with high-intensity RT
is cardiovascular health. Strength training elevates blood
pressure (BP), and the relationship between BP and RT
intensity is li near: the higher the intensity of the RT, the
greater the elevation in BP and associated cardiovascular
health risks. For some people, particularly those who are
hypertensive and/or overweight, any increase in BP is dangerous. Significant increases in BP during exercise should
be avoided if at all possible. However, the dilemma is this:
Those who are overweight need to increase or preserve
muscle mass to increase or maintain metabolic rate, but
RT increases BP. Again, low-intensity RT offers a solution
in that it enables overweight persons and h)•pertensivc
patients to reap the benefits of resistance training without
experiencing dangerous spikes in BP.
A less commonly known risk of high-intensity RT is aortic dissection, in which the wall of the aorta tears, allowing
blood to flow between the layers of the wall of the aorta
and ultimately forcing the layers apart. Aortic dissections
resulting in mpture have an 80 percent mortality rate and
50 percent of patients die ~fore they reach the hospital
(Hatzaras et al., 2007). Aortic dissection, which is a risk for
anyone who does resistance training, is directly related to
the degree of physical exenion. High-intensity exercise,
particularly heavy weight lifting, dramatically increases the
risks of aortic dissection.
'l11e risks associated with high-intensity RT are well
known and documented. These risks have created a serious conflict for fitness professionals because clients need
the associated benefits of muscle development, but for
some the risks may simply outweigh the benefits. As a
How to Design Effective Low-intensity
Resistance-training Programs
resu lt, many trainers simply avoid RT with their high-risk clients
and/or modify RT programs to the point of being overly cautious. However, a viable solution now exists. tow-intensity RT
performed using specific guidelines offers a safe and plausible
way to provide all clients, regardless of risk factors, the benefits
of RT.
How Low-intensity Resistance
Training Works
Simply put, low-intensity RT causes the same changes in the
working muscle as high-intensity RT and thus yields similar
muscle strength, size and tone results. In fact, the physiology of
working muscles is the same regardless of training intensity. The
key is that for muscles to show size, strength and tone gains under
any circumstance, a series of physiological events must happen,
and these events are the same regardless of training intensity.
Under any training intensity condition, these evcms arc triggered
or "turned on" by the spedfic demands that we place on muscles.
What 111rns on the cascade of events during high-intensity RT is
different than during low-intcnsit)' RT, but nonetheless under
both training conditions the same series of physiological events
ultimately occurs: (1) restriction of blood flow, which (2) creates
an oxygen deficit, and (3) ultimately causes:
a. Growth hormone (GH) secretion
b. Production of reactive oxygen species (ROS)
c. Recmitment of additional muscle fibers
What triggers these events during low-intensity RT is tonic or
continuous force generation. It is the single most critical factor
to low-intensity RT. Tonic force generation is defined as "prolonged muscular contraction." Think of it as the time that the
muscle is held in contraction. It is the catalyst that triggers the
cascade of events in the muscle for the muscle to increase in size,
strength and tone. As the trainer, you control tonic force generation by manipulating the speed per repetition. Specifically, for
low-intensity RT to be as effective as high-i ntensity RT, the speed
per repetition must be extended (three seconds) for both the
concentric (shortening) and eccentric (lengthening) muscle
con tracrion phases, with a one second pause between the
two phases.
For low-intensity RT programs to be an effective substitute for
high-intensity RT, certain training conditions must be met. TI1e success of low-intensity RT has been shown for both single-joint isolated movement and more complex ftuictional exercises (l'animoto
and Ishii, 2006). Single-joint isolation exercises have the distinct
ad.vantage of being able to easily produce continuous force throughout the exercise and maintain constant joint torque at any joint
position. And, while they also are easy for novice exercisers to learn
and execute correctly, they have limited applirntions due to the
fact that they do not simulate real-world movements. In contrast,
complex whole-body exercises sirm~ate both functional movements
and actMties of daily Living. TI1e choice to include either type of
strength training or both is left to the trainer based on the needs of
the individual dient.
Follow these guidelines to recr<>ate the same conditions used by
the researchers for either single-or multi-joint exercises during your
training sessions:
l. Frequency: Aminimum of two training sessions per week. Allow
13 weeks to see significant improvements in muscle size, strength
and tone.
2. Intensity: RT intensities as low as 40 percent of 1R.M have
been shown to cause several similar physiological responses
as high-intensity RT and can thus be assumed to be as effective as 80 percent I RM training (Koba et al., 2004). However,
an intensity that represents 65 percen t I RM is recommended
where appropriate.
3. Repetitions per set: Eight
4- Slits per ewrc.:ise: On~ warm-11p set followe<l l>y three
training sets
5. Rest periods: Sixty-second rest period between each set
or exercise
6. Speed of contraction: Three seconds for the concentric (shortening) and eccentric (lengthening) phases, with a one-second
pause between the two phases (NOTE: More is NOT better:
Five seconds is too long and appears to reduce the effectiveness of a given exercise.)
7. Do NOT allow your clients to fully extend the arms or
legs. Aslight bend in the joint maintains continuous force
generation.
Conclusion
Low-intensity RT minimizes the risks associated with high-intensity RT and makes RT a viable, effective option for many populations for whom RT might have once been considered contraindicated. 111e latest research on low-intensity !ff suggests that you can
have your high-risk clients do RT safely and confidently. And even
for those clients that do not currently exhibit high-risk health concenis, you may want to consider using tow-intensity RT training
protocols to protect ll1e integrity of their joints over the lifespan
and address any other concerns. ·n1e appLication of low-intensity RT
training is also a valuable tool that gives you t11e option to use lighter loads while teaching the txirrect biomechanks of exercise. This is
a partiet~arJy useful strategy to control the teaming phase that
many of our clients stmggle \-\1th during the initial weeks of RT. ll1e
bottom line is that low-intensity RT gives trainers a way to safely
and effectively offer the benefits of RT to most clients, opening up
Continued 011 pag1' 24
ACl Clllllfl!O WlWS I <ICT06(M<l)Y(JtB!R lOO!
7
What ACE
Professionals N
Kn
1
TABLE 1
Cllnlcal and Prognostic
Information Provided by a
Properly Administered QXT
1.
•
a.
Electrocardiographic monitoring before,
during and after the GXT can fully evaluate a resting 12-lead ECG and its value
in assessing cardiac rhythm, left ventricular hypertrophy, various electrical
conduction defects, and other abnormal
wave form morphologies-all of which
can be of helpful prognostic value.
Computer-assisted stress ECG soft- ware can evaluate the rate of devel~
ment of abnormal S-T changes
(e.g., ST/heart rate slope).
-certified Fitness
eed to
ow About
s
T 0
R y
EXERCISE
STRESS TEST ECGs
BY
RALPH
LA FORGE,
M.S.
CE-CERTIFIED FITNESS PROFESSIONALS SHOULD UNDERSTAND THE CIRCUMSTANCES NECESSITATING A MEDICAL CLEARANCE FOR THOSE BEGINNING AN EXERCISE
PROGRAM, PARTICULARLY THO SE R EQUIRING A MEDICALLY SUPERVISED GRADED
TREADMILL ECG TEST (GXT). AS A FITNESS PROFESSIONAL, YOU HAVE A LEGAL DUTY
TO APPROPRIATELY INTERVIEW AND SCREEN, WITH IN ACCEPTABLE STANDARDS OF CARE,
NEW CLIENTS WHO HAVE BEEN PREVIOUSLY SEDENTARY.
A
The purpose or this article is to provide sufficient informa•
tion for making informed decisions on which clients should
~ referred for a physician-supervised GXT and when, as wel1
as what fm1ctional and prognostic information the GXT can
provide. lt is not my intent to provide an explanation of how
to administer or to line-item interpret GXT electrocardiograms
and associated physiological responses. It is important, however, to understand that in the appropriate circmnstances fitness
professionals who work with individual clients should follow
current standards of care that specify when GXTs should be
performed prior to engaging in a new exercise program. Both
the American College of Sports Medicine (ACSM, 2009) and
the American Heart Association (Gibbons, 2002) have issued
periodic reconunendations on this subject, which are refer•
enced in this article.
Trainer Scenario
As an illustration of how such situations arise, let's consider
the case of a 55-year-old man who has just hired you as his
trainer to increase his aerobic capacity and lose 30 pounds. On
initial evaluation you find that this gentleman has a family
history of coronary heart disease (CHD) (his father died of a
heart attack at 60 years of age), a body mass index of 34, is borderline hypertensive and recently stopped smoking. If he has
also Ileen previously sedentary, and at some point you plan
on increasing his exercise intensity to more intensive or vigorous levels (vigorous defmecl as >60% VO,max or \10,R), then
decisions need to be made lo first have a medical exam and a
physicia11-supervised GXT.
What Kind of Information
can a GXT Provide?
Exercise stress ECG testing has played a role in both sports
medicine and clinical cardiology for more than 50 years.
Traditionally, clinic office-based GXTs have been used to evaluate the risk of c-ardiovascular disease (CVO) and/or project a
prognosis of worsening of existing CVD. ·n1is determination
was almost solely based on changes in the S-T line segment of
ihe exercise electrocardiogram. Today, GXTs offer much more
functional and clinical infom1ation, which can help dete1mine a
wider spectnun of disease risk and fm1ctional capacity (Table !).
The GXT is considered the initial diagnostic evaluation of choice
in both mm1 and women, although it may be somewhat less
indicative in women (Gibbons 2002a). A tndy abnormal exercise
test r('(juires a hemoctynamically significant coronary lesion (e.g.,
>75 percent stenosis), yet nearly 90 percent of a<.1.1te myocardial
infarctions occ11r at the site of previously nonobstructive atherosclerotic plaques (Falk, 1995).
GXTs for Screening Apparently
Healthy Individuals: Some
Important Caveats
Fitness professionals should also understand the limitations
of GXTs in apparently healthy adults. The probability of an
individual having CVD cannot be accurately evaluated from a
GXT alone. It also depends on the likelihood of having disease
Continued un pa,~e JO
RALPH LA FORGE, M.S., a physiologist and board·certified clinical lipid specialist. is currently the managing director
of the Cholesterol Disorder Physician Education Program at Duke University Medical Center. Endocrine Division in
Durham, N.C. Formerly, he was managing director of preventive medicine and cardiac rehabilitation at Sharp Health
Care in San Diego. where he also taught applied exercise physiology at the University of California at San Diego. He
has helped more than 300 medical staff groups throughout North America organize and operate lipid disorder clinics
and diabetes and heart disease prevention programs, and has published more than 300 professional and consumer
publications on exercise science and preventive endocrinology/cardioloqy.
ACE CI.RTIFl!O NEWS I CX:106(Rlf<O\U'BLR l00!
9
before the test is administered. ·111e prob•
ability of a patient having disease before the
test is related, most importantly, to the pres•
ence of symptoms (particularly chest pain
characteristics), but also to the patient's age,
sex and the presence of major risk factors for
cardiovascular disease.
TI1ere is insufficient evidence to support
exercise testing as a routine screening modality in asymptomatic individuals. Such testing
can have potential adverse conscquen~ (e.g.,
psychological, work and insurance status, costs
for subsequent testing) by misclassifying a
large percentage of those without CVD as having disease (J\CSM, 2009). However, assuming
that the appropriate and judicious selection
of individuals for a GXT is made (e.g., higher
CVD-risk individuals who have been previously sedentary and Starting an exercise pr01,<ram),
it may serve a valid and helpful cl.inical service
for high-level fitness professionals working
with relatively high-risk clients.
GXTs are not perfect predictors of CVD.
Even when relatively high CVO-risk adults
are tested, using minimal electrocardiographic
criteria for an abnonnal test, there is still an
approximately 10 percent chance of false
positives in men (abnormal ECG but normal
coronary arteries) and a 20 percent to 30 percent chance of false positives in women. Fal~
negatives can also occur (normal ECG but with
significant coronary disease). For this reason,
GXTs do not stand by themselves as the final
diagnostic word. These limitations are quite
weU explained in the 2001 /\HJ\ paper on this
topic (Fletcher, 2001).
Caution should also be made with interpreting GXT electrocardiograms in women,
particularly apparently healthy women.
Compared with mei1, in women it is kno\\11
that S-T segment depression is less likely to be
associated with coronary disease (Wong, 2001;
Sketch, 1975). Mora and colleagues (2007) fol•
lowed 2,994 asymptomatic women without
known CVD for two years and reported that
exercise capacity (e.g., total treadmill exercise
time) rather than electrocardiographic changes
predicted long-term CVD mortality.
GXT Exercise Protocols
GXT protocols are distinguished by the
increments in treadmill speed, percent grade
and duration of each exercise stage (usually
two to three minutes per stage). Apparently
healthy adults who arc active generally should
have a standard llruce GXT, which is perhaps the most commonly used protocols in
medicine; however, it employs rather large
increments (2-3 METs per stage) every three
minutes. Protocols with smaller increments in
10
0Cf06(1!ll«)V[MS(R 1009 I ACE CERflFIUI •EWS
work, such as the Naughton or Balke protocols
(i.e., -1 MET per stage), are preferable in older
or deconditioncd individuals and patients
with chronic diseases. See chapter s of ACSM's
Exercise Te.1ti11g and Presaiptio11, 8th edition, for
detailed descriptions of GXT protocols.
be used to move sequentially through the
process to determi ne the risk-('ategory placement for each individual.
The ACSM GXT Exercise
Testing Recommendations
Prior to Physical Activity
Guidelines for ACEcertified Professionals
ACSM's GXT decision tree (Figure l) is
the most applicable and authorative decision
scheme to detcnnine when an individual
needs a GXT (physician supervised or otherwise) prior to participating in a new physical
actiVity program. This fi&>ttre has been slightly
modified in that J excluded the criteria for
GXTs that are not supervised by a physician as
I believe that au pre-program high CVD-risk
referrals should be physician super.~sed.
Note that the primary GXT referral dctermillants in Fii,>tire I are the number of existing
risk factors and the level (intensity) of physical
activity the individual is assumed to engage in.
The exercise testing recommendations found
in the GXT decision tree reflect the notion
that the risk of cardiovascular events increases
as a direct function of exercise intensity (i.e.,
,~gorou.~ > moderate> low exercise intensity)
and the presence of risk factors. For example,
if a 55-)rear-old man who has two CVD risk
factors (fable 2) wishes to engage in a physical
activity program where it is assumed that he
wiU at some point and on a regular basis reach
or exceed 60 percent of his aerobic capacity,
GXTs for Physical Activity
Screening and Readiness
ACE-certified Fitness Professionals,
particularly Advanced Health & Fitness
Specialists, are required to perform exercise program- readiness assessments prior
to individualized exercise programming in
new clients and, when indicated, a medical
exam and GXT (AC£ J>erso11al Tminer Manual,
3rd Edition, 2003). Numerous organizations
have position and consensus statements on
pre-program exercise testing inclucling the
American College of Sports Medicine (2009),
American College of Cardiology (Gibbons,
2002), American Heart Association (Gibbons,
2002) and the U.S. 1>reventive SeNice Task
Force (Brown, 2004). The American College
of Sports Medicine and the American Council
on Exercise have both published guidelines
and pathways for assessing physical activity
rrodiness (ACSM, 2009; ACE, 2003/2009).
ACSM (2009) published the relatively simple
Logic Model for Risk Stratification, which tan
FIGURE 1
ACSM's GXT Decision Tree
Risk stratification
Low risk
Asymptomatic
$1 total risk
factor
;
Medical exam
and GXT before
exercise?
Moderate
exerc ise:
Not necessary
Vigorous
exercise:
Not necessary
Moderate risk
Asymptomatic
$2 total risk
factors
i
M edical exam
and GXT before
exercise?
Moderate
exercise:
Not necessary
Vigorous
exercise:
Recommended
High risk
Symptomatic
or know cardiac,
pulmonary, or
metabolic
disease
M edic! exam
and GXT before
exercise?
Moderate
exercise:
Recommended
Vigorous
exercise:
Recommended
Adapted from ACSM (2009). ACSM's cxe«ise Tesllng 8nd Pmscription, 8th edition, Lippincott Wiliams Md
W'1kins: Pniladelphia. Pa.
'
TABI.E 2
CVD Risk Factor Thrssholds for
Use with ACSM Risk Stratification
(ACSM, 2009)
ACSM Risk Factors Thresholds
for Risk Stratification for Exercise
Participation and GXT Decision Making
Age (>45 men; >55 women)
Family History
(Myocardial infarction, family history
coronary artery bypass grafting surgery. sudden cardiac death of father
<55 years or mother <65 years)
Cigarette Smoking
a.Uy not true maximal capacity but nearly
always expressed in METs), peak heart rate
and peak blood pressure.
• Note if there were any abnormal signs or
symptoms reported during or after the test
(e.g., chest discomfort, unusual fatigue,
palpitations, dizziness, excessive shortness
of breath).
• Detennine the physician's recornmenda•
tions on medical clearance for exercise
progranuning and note if there are any
specific provisional recommendations for
your d ient.
• DO NOT attempt to interpret the GXT ECG
or test outcome to )'Our client other than
supporting the official physician interpreta·
tion and recommendation.
It is important to lhave a keen knowledge of what is considered moderate
versus what is considered vigorous
physical activity (see Figure 2). Many, if
not most, trainers advocate exercising
in the vigorous range at some point in
their client's training program. In those
instances where you definitively recommend (in writing or personal verbal
instruction) activities in the vigorous
intensity range requiring greater than
60 percent of aerobic capacity, this
needs to be factored into the decision
tree in Figure 1. This is particularly
relevant if your client has been previously sedentary over the last 12 or
more months.
Other GXT Procedures
That May Be Performed
(Current or previous 6 months)
Sedentary Lifestyle
(no 30 minutes of moderate physical
activity, 3x/wk for at least 3 months)
GXT Results Outcomes
Reporting Recommendations
Obesity (BMI >30)
Fitness professionals who refer a client for a
physirian-supen~sed GXT should have some fundamental understanding of what is (or should be)
included in the GXT results report.
• Request a copy of U1e test summary and physician's interpretation. (Note that Uus is an official medical record and must be held as confidential and subject to the federal HIPAA privacy
rule gttidelines.)
• Evaluate the overall ECG results: abnonnal or
normal (if abnormal proceed with physician's
recommendations).
• Determine the peak exercise capacity (usu•
Hypertensio n (>140/90)
Dyslipidemia (LDL >130. HDL<40)
Prediabetes
(impaired fasting glucose or
impaired glucose tolerance)
then it is strongly recommended that he have
a physician-supervised GXT prior to engaging
in such activity. In short, individuals at significant CVD risk (i.e., ~2 CVD risk factors) who
are plamung to engage in an intensive exercise
program are required to have a pre-program
physician exam and GXT. nus is even more
imperative when the individual has existing
CVD or diabetes.
The CVD risk factors (Table 2) used in
the decision tree figure are very similar,
but not identical, to that pubLished by the
National Cholesterol Education Program
(Framingham risk scoring) and the American
Heart Association. However, these have been
adjusted specifically to include U1ose clinicaUy relevant risk factors that should be considert'(I collectively when maki ng decisions
about the level of medical clearance and the
need for pre-exercise program GXTs (ACSM,
2009). This table includes clinically relevant
established CVD decisions about: (a) the level
of medical clearance; (b) the need for exercise
testing before risk factor criteria that should
be considered collechvely when making initiating participation; and (c) the level of supervision for both exercise testing and exercise
program participation.
If a GXT is abnormal, the physician,
usually a cardiologist, may perform a more
advanced GXT that includes supplemental
imaging tecllllologies, pharmacologic stress or
carcliometabotic anal~-sis, each of whid1 can
improve diagnostic accuracy. The following
are among the most common tests:
• Radio1111clide Stress Test. Radionuclide stress
testing involves injecting a radioactive isotope (typically thallium or cardiol}~e) into
the patient's vein after which an image of
the patient's heart and coronary vessels
become visible with a special camera.
• Stress Echocardiogmphy. During stress
Co11ti1111ec/ on page 16
FIGURE 2
Exercise Intensity Definitions (ACSM, 2009)
Moderate-intensity Physical Activity
(Approximately 3-6 METS)
Vigorous-intensity Physical Activity
(Approximately >6 METS)
Requires a moderate amount of
effort and noticeably accelerates
the heart rate.
Requires a large amount of effort and
causes rapid breathing and a substantial
increase in heart rate.
Examples of moderate-intensity
exercise include:
Examples of vigorous-intensity
exercise include:
• Running
• Walking/climbing briskly up a hill
• Brisk Walking
• Dancing
• Housework and domestic chores
• Traditional hunting and gathering
• Active involvement with children/
walking domestic animals
• General building tas1ks (e.g., roofing, thatching, painting)
• Carrying/moving moderate loads
(<20kg)
• Fast cycling
• Aerobics
• Fast swimming
• Competitive sports and games (e.g.. tradi•
tional games, football, volleyball, hockey,
basketbal9
• Heavy shoveling or digging ditches
• Carrying/moving heavy loads (>20kg)
AC( m11mo Nl:WS I OCTOOERINOV(M!l!R 2009
11
S T
O
R
[Your Name],
Certified Personal Trainer an
j j
I
CAN PROMOTE MYSELF AS A NUTRITIONIST," PROCLAIMED A FELLOW FITNESS PROFESSIONAL RECENTLY, "BECAUSE l'VE GOT 30 CREDIT HOURS IN NUTRITION."
WHILE NUTRITION TENDS TO BE A SORT OF GRAY AREA FOR FITNESS PROFESSIONALS,
THE BLACK AND WHITE CAN BE SIFTED OUT WITH A LITTLE RESEARCH. IF YOU' VE BEEN
CONFUSED ABOUT YOUR ROLE AS A FITNESS PROFESSIONAL AND WHAT ADVICE YOU CAN AND
CAN'T GIVE-OR WHAT TO CALL YOURSELF-READ ON.
BY
CARRIE
MYERS
Registered Dietitian
Nutritionist?
=
"All dietitians are, in fact, nutritionists," explains
Elizabeth B. Ramirez, M.Ed., R.D., L.D., a registered dieti•
tian specializing in sports nutrition from Norman, Okla.,
"but not all nutritionists are dietitians."
Nor shou ld everyone who claims to be a nutritionist be giving nutrition advice.
Ramirez explains that the requirements to become
a registered dietitian (RO.) are vastly difierent from
the requirements to become a nutritionist without
R.D. status. "Unl.ike the term 'nutritionist,' which in
some states requires as little as sending a check in for a
certificate, R.D.s have no less than a bachelor's degree,
followed by a year-long internship and the successful
completion of a national registration exam."
Registered dietitians are also required to complete
75 hours of continuing professional education every
five years and arc regulated by the American Dietetic
Association (ADA).
tf/ Design food
~
plans or diets
t?/ Tell clients where they
should cut calories
tf/ Recommend any diet
t ff Recommend or sell
supplements
'?f
Promote yourself as a nutritionist without proper credentials
CARRIE MYERS is the fitness coordinator at the Mt. Washington Resort in
Bretton Woods, N.H., and has been a freelance writer for 10 years.
12
OCIOBI.Rlt«lYEl,IS[R 1009 I ACE CI.JlllFIEO •1:WS
And what are the educational requirements for
nutritionists'/
"While a nutritionist could be someone who has
a degree in Food Science or Food Technology,'' says
Meridan Zerner, M.S., R.D., L.D., a registered dietitian
for the Cooper Clinic/Cooper l'itness Center in Dallas,
Texas, "in general, it's a non-accredited title that may
apply to anyone who has done a short course in nutrition or who has given themselves the title.
•·n1e term 'nutritionist' is not protected by law in
almost all countries so people with different levels of
knowledge can call themselves a 'nutritionist'. ·n1ere [is
only a handful oij states that recognize the term and
reqttire their nutritionists to meet certain criteda."
While most states regulate the use of the tenn "dietitian," not all of them regulate "nutritionist," because
"regulation of the term 'nutritionist' varies from statNOstatc," explains R.1mirez. She also believes that the best
way individuals can be assured that they are receiving
sound and dinically-based food and nutrition solutions
is to "seek out a registered dietitian."
Let's say you've taken a nutrition course and at the
successful completion of it you receive a certificate stat•
ing that you're a certified nutritionist. L~n't this your
license to practice as a nutritionist?
Not really, says Todd Galati, M.A., ACE certification
and exam development manager. He compares it to
other fields that require certification and/or licensure.
You may know how to give one great massage, for
instance, but that d0t.>sn't give you legal permission to
practice as a massage therapist. Or perhaps you dabble in
day trading. Does that mean you should be taking other
people's money and investing it?
"My undergraduate degree is in athletic training," he
explains, "and while I have the knowledge, I never sat
for the exam and became licensed. Therefore, I am not
qualified to practice as a certified athletic trainer.
" If you really want to design ealing and diet plans
for the general public and special p0pulations, go
back to school and become a registered dietitian. It is
not within a fitness professional's scope of practice to
give specific nutrition and supplement advice."
It is important to realize that if you choose to
do so without the proper traini ng and credentials,
you could be setting yourself up for potential legal
or financial problems. "Your liability insurance does
not cover issues outside your scope of practice,"
adds Galati.
But what if you work in a facility that encourages you to sell their supplements? Galati explains
that while it's not illegal to sell supplements, there
are some serious ethical questions, especially if a registered
di etitian isn't on staff. There are also potential issues with
interactions between supplements and other drugs clients
may be Ill king.
"Supplements aren't regulated by the FDA," explains Galati,
"so there's no guarantee or purity, strength or interactions with
other d111gs."
\\~1ile you should never recommend any supplement, Galati
says it is still important to educate yourself as much as possible
so that you can steer clients away from inconclusive or dangerous supplemen ts (see sidebar on "Medline Plus").
What Is Within My
Scope of Practice?
As a certified fi tness professional, you arc qualified to lead
and design fitness programs for clients. Your focus should be
on fitness. rt is almost impossible, however, to avoid nutrition
topics with clients, since fitness and nutrition are so intricately
connected. So when a client asks you to design an eating plan,
is this withi n your scope of practice?
Where nutrition is concerned, says Galati, there arc two
principles to keep in mind: educating versus implementing. As
a trainer, you not only educate, but you implement programs
for others. You are not, however, qualified to go beyond educati ng clients in nutrition matters.
"Your mai n scope of pract ice," explains Galati, "is to help
people improve their health and fitness through exercise and
behavior change."
Some of these behavioral changes, he says, are in helping
them make better food selections. "But we can't teUpeople
what to choose, including specific diets and eating plans."
A good approach is to ask your clients to keep a food log to
get a general idea of what they are eating. "You can then use
~
ACE Position Statement on
Nutritional Supplements
It is the position of the American Council on Exercise (ACE) that it is
o utside the defined scope of practice of a fitness professional to recommend, prescribe, sell, or supply nutritional supplements to clients.
Recommending supplements without possessing the requisite qualifications (e.g., R.D.) can place the client's health at risk and possibly
expose the fitness professional to disciplinary action and litigation. It a
client wants to take supplements, a fitness professional should work
in conjunction with a qualified registered dietitian or medical doctor
to provide safe and effective nutritional education and recommendations. ACE recognizes that some fitness and health clubs encourage or
require their employees to sell nutritional supplements. It this is a condition of employment, fitness professionals should protect themselves
by ensuring their employers possess adequate insurance coverage for
them should a problem arise. Furthermore, ACE strongly encourages
c ontinuing education on diet and nutrition for all fitness professionals.
¥!'
',,, i
,,
! ii
their log to educate them on healthier food options," explains
Galati. "For i nstance, if they eat a lot of fried foods, educate
them on what that type of fat does to a body and what some
health ier options may l>e."
The key, says Galati, is to be su re your clients arc making
their own decisions, rather than being told by you what they
should and shouldn't be eating. TI1is includes not recommending any commercial diets. ''You should not be helping people
lose weight with conunercial diets," says Galati, "and do not
recommend 311)' diet."
You can, however, help people understand that all diets
help reduce calories and that crash dieti ng usually results in
long-term weight-loss failure.
One of the best tools you have available to help educate
you r clients is the food pyramid at www.mypyramid.gQY. There
they can get as little or as much information they want, from
the basics of healthy eating to 70 pages of more in-depth information written for the general public.
Make your primary focus fitness. Sprinkle in a little nutrition
education to help steer your clients down the path to healthy
eating. But i f they have special dietary needs or want a specific
diet or eating plan designed for them, refer them to a registered
diet itian. By worki ng withi n your scope of practice and creating
a network of other professionals, you increase the odds of them
ret11rning the favor and referring their clients to someone who
is tmly a professional in their field-you. A-
One of the best resources on supplements currently available is the Medline Plus Web site. A search for
specific supplements will result in an overview of the substance, including its background, synonyms, dosing,
safety and interactions with other drugs. In addition, there is a thorough chart that lists the various conditions
and situations the supplement has been tested for in laboratory studies. Each supplement is given a grade,
from A (strong scientific evidence for this use) to F (strong scientific evidence against this use). Again, unless
you're a M.D. or R.D., this information is not to be used to promote or recommend supplements. It is to simply steer clients away from those that could be potentially harmful. It is also a great resource for your clients,
so when they ask you about a supplement, recommend this site: http://medlineplus.gov.
~
~
~
~
~
~
~
~
~
~~
AC( eummoNEWS I OCTOOEM<O'/tM!l{R2009
13
S T O
R Y
Q
e
e
IF A CLIENT FILES A SUIT AGAINST YOU, WHAT'S
ONE OF TI-IIE FIRST THINGS YOU DO (BESIDES
TRYING NOT TO FREAK OUT!)?
A
GOT
e
e
IF YOU HAVE LIABILITY INSURANCE, YOU TAKE A DEEP
BREATH AND CALL YOUR INSURANCE COMPANY. THEY
THEN TAKE IT FROM THERE.
BUT WHAT If YOU DON'T HAVE LIABILITY INSURANCE?
Insurance?
BY
CARRIE
MYERS
You need to find a lawyer willing to take the case.
Insuring Peace of Mind
Then expect to shell out quite a lot or cash. "Even if it's a
"It really is a minimal cost for peace of mind," says Susan
pseudo-claim, you can expect to pay out about $-5,000 to
Patten
or Fitness and Wellness Insurance, a member of
start with for an attorney," says Bob Kushefski of Hoffman
Philadelphia Insurance Companies, Solana !leach, Calif.
Insurance Services, Inc. out of Wellesley, Mass.
liability can broadly be defined as the responsibility
Add to that lost work time and additional expenses, and
society
confers on businesses and individuals to compensate
you'll be wondering why you didn't just fork out U1e couple
those lnjured by their activities. As a fitness professional,
hundred dollars for an insurance policy.
there are two types of liability insurance to consider: business and professional. Business liability insurance provides
protection for bodily injury caused whi le the client is on
your premises. This would indude tripping and falling. It
also typically provides protection against property damage
claims, personal injury lawsuits involving libel or slan•
der, and claims arising from false advertising. You want a
business policy if you own or rent space or have other
people working for you. Professional liabllity covers only your professional services. This would
mostly include injuries suffered by your clients due to alleged negligence.
Wail, you say, negligence?
~ Not you! No one likes the thought
of being sued or thinking they were negligent wilh
their clients or class participants. You may even th.ink that
by having insurance )'Oti're going to jinx yourself somehow
or that it may give you more leeway to become sloppy with
your work.
Get Covered Today
Regardless of how confident you are in your abilities and,
Discounts are available for
therefore, feel you should never be sued, it's really about what
ACE-certified Fitness Professionals
the client suing feels you've done. "It's not always that you've
through JnsurePersonalTrainers.com
done anything wrong," explains Patten. "It's that someone
and fitnessPak com. For details
thinks you have."
and rate information, visit
And as Kushefski already pointed out, regardless of wheth•
www.acefitness org/jnsurancecenter.
er or not the claim is valid, you still need to defend yourself.
''"''""'''''''''""''''''''''"'"'''''''''''''''''''''"'''
//QQQ////////,W,W////////////////////Q,W//M'/#//#//////
Are You Sure You're Covered?
One error many people make, says Patten, is they think
they're covered when they're not. "Just b«ause )'OU're working for someone else, doesn't mean you're automatically
covered under their policy."
Chances are higher that you're covered-but not guaranteed-if you're an
actual employee on the payroll. However,
if you're an independent contractor,
you're probabl)' not covered. Most gyms
and studios require their independents to
carry their own policies. If you arc covered
under a gym's policy as their employee, it's
important to note that you're not covered
if you work as an independent contractor
outside that gym. In other words, if you
work at another gym or studio, train cl ients out of your home or at their homes,
or at your local park, don't expect your
employer's iJlsurance to cover you.
One detail you want to make sure you're
covered on is sexual harassment, especially
considering the nature of the fitness business
where instmctors and trainers often touch
clients. Regardless of your intentions, touch
and language can sometimes be misinterpreted. Are you covered if a client makes a sexual
abuse or harassment claim against you? Both
Hoffman Insurance and Fitness and Wellness
Insurance include this in their policies.
"Sexual abuse charges are something a lot
of people don't think about, but it's important to know that you're covered for ' just
in case,"' says Patten. "You also want your
policy to offer a small amount to help cover
medical costs of clients' injuries."
Since training and teaching can occur
in very diversified environments, make sure
you're covered whether you're training or
teaching at homes, gyms, studios, resorts,
churches, sd1ools, parks or online-basically,
anywhere you might teach or train. But how
much coverage is enough? Experts recommend you get a policy with a minimum
SI million limit per occurrence.
''How much coverage you end up purchasing often depends on your experience
and what your business entails," explains
Kushefski.
Kusllefski finds that older, more experienced trainers who have more to lose tend to
purchase policies with higher limits-up to
SS million. ''111ey ,1lso tend to be professionals who teach and train 'higher end' clientele, like doctors and lawyers."
The bottom line is, says Kushefski, purchasing liability coverage is your first dollar
coverage. You're covered regardless of whether the claim is valid or not. Having peace of
mind can be priceless-and allow you to do
your job without worry. A -
Want to increase your chances of having a lawsuit brought against you? Of
course not! But many fitness professionals fall into the following traps, says Dan
Weedin of Toro Consulting, Inc. in Poulsbo, Wash.
\ · Not understanding the physical limitations of your clients. Having no idea
what your clients' medical and fitness histories are set you up for potential
trouble. Take a thorough history. After all, they don't call it personal training
because you're handing out one-size-fits-all programs.
'tl- Not staying current on professional development. Like any profession, not
keeping current in our industry standards could create a problem and cause a
client injury. Take workshops, stay up-to-date on the latest research, join trade
associations, read your latest ACE publications.
'tl- Providing poor supervision. Conversations with other members or coworkers,
talking or texting on the phone, and watching television while your clients are
working out can set them up for injury-and you for a lawsuit. Pay attention to
your clients and students!
~
Not communicating effectively. Some people do fine with just audio instructions. Others are more visual. Ask your clients what they need and how they
learn best to make your communication with them as effective as possible.
'tl' Wor1<ing at a gym
with poor facilities. If a client gets injured on a gym's piece
of equipment that is broken, the gym isn't the only one liable. So are you. "Only
work where you would train yourself," recommends Weedin.
CARRIE MYERS is the fitness coordinator at the Mt. Washington Resort in Bretton
Woods, N.H., and has been a freelance writer for 10 years.
ACE Emeritus
Historian Ash Hayes
Awarded President's
Council on Physical
Fitness and Sports
2009 Lifetime
Achievement Award
shel "Asll" Hayes, f.d.D., long-time
ACE Board Member and Emeritus
Historian, was recently honored by
the I>resident's Council on Physical Fitness
and Sports (PCPFS) \\1th a 2009 Lifetime
Acl1ievernent Award. Dr. Hayes was recog•
uiZed for "the important role [he has] played
in promoting physical activity, fitness and
the benefits of leading an active lifestyle."
According to current J>CPFS acting executive director Penelope Slade-Sawyer, winners of the award are chosen based on the
span and scope or the individual's career,
the estimated number of lives they have
touch('(!, their legacy, and the additional
award or h onors received over the course
of his or her career. With a career spanning
more than six decades, Dr. Hayes certainly
meets-and exceeds-this criteria.
As a former executive director of the
President's Council on Physical Fitness and
Sports during the Reagan administration,
Dr. Hayes worked at the national level to
further the programs, initiatives and messages of the PCPFS. Additi.onally, he also
had a distinguished career at the San Diego
Unified School District, San Diego, Calif.,
working as a teacher, coach, department
head, athletic director and district administrator of health, physical education and
athletics. Dr. Hayes earned his doctorate in
education and a master's degree in physical education/exercise science from the
University of California, Los Angeles.
Today, Dr. Hayes continues to work to
encourage healthy lifestyles through his
work as a physical education, fitness and
sports consultant. A -
A
ACi cammo NEWS , OCTCIIER<NOYtMll!R ;oog
15
What ACE-Certified Fitness Professionals Need To Know About Exercise Stress Test ECGs
Continued from page I 1
echocardiography (cardiac ultrasound),
the sound waves of ultrasound are used to
produce images of the heart at rest and during peak exercise (immediate post-exercise).
Stress echoes (ultrasounds) are also used to
evaluate tl1e function of the cardiac valves,
particularly post exercise.
• l'hcm11t1cologic stress tests (no GXT exercise).
n1ere are a number of pharmacologic stress
tests. lllis refers specifically to a pharmacologic cardiac stress test in whid1 certain
meditations are administered that stimulate
the heart to mimic the physiologic effects
of exercise. One of the medications used in
a pharmacologic stress test is dobutamine,
which is similar to adrenaline.
• M,1abolic Exercise Testing: GXTwith Expired
Air 1\1111/ysis. Metabolic GXTs measure
expired air to analyze direct measures of
oxygen uptake (VO,), peak \rO,. CO2
production, minute respiratory ventilation,
and respiratory exchange ratio (RER or
VO/VCO2) . lltis test is administered when
a precise cardiopulmonary response to a specific performance or therapeutic intervention
is required. n1is test is often used by pu~nonologists to evaluate the etiology of dyspnea
(diffirult or labored breathing) in patients at
riSk or who have pt~monary disease.
GXT Costs
One last but important rnnsideration is the
cost of a physician-supervised GXT. Costs generally range from S270 to $500. Unless there is
a Medicare or Blue Cross-approved l'l!tlson-code
or a recogniZed cliniml inclication for a GXT, it
may not be a covered procedure by a health
plan or health insurance. Indications such as
the evaluation of dysrhythmias or cardiac-related symptoms, post-cardiac procedure assessment, cardiac rehabilitation program entrance
requirement, or pacemaker evaluation are
all generally approved ror reimbursement by
most insurers and health plans. If the referring
exercise specialist clearly documents that the
patient is relatively h.igh risk ~2 risk factors)
and is starting a relatively intensive exercise
program and this information is entered into
the patient's referral history for the medical
facility administering the GXT, there is a good
likelihood of insurance coverage.
Summary
Recommendations for
Fitness Professionals
The following are summary recommen-
16
OCI06(1!1!«)'1!!18(R 2009 I AC( cmmro •!WS
elations for GXT referrals for ACE-certified
Fitness Professionals:
1. Fitness professionals must be thorough in
their initial screening and interview with
new clients such that they have a thorough
understanding of their dient's health and
exercise history.
2.. GXTs are most appropriate for indiViduals
who have lx>en previously sectcnrJry ancl
are at sufficient CVD risk, and who also arc
going to engage in moderate-to-high exercise intensities. Fitness professionals should
have a working knowledge of the relative
and absolute intensity of physical acthiity
for which they will be recommending and/
or supervising. TIie)' should also have a
good working knowledge of the differences
between moderate versus vigorous physical
activity (see Figure 2).
3. GXTs arc rccommcnde<I for all adults in
accordance with the 2009 ACSM guidelines for those indiv'iduals beginning an
exercise program. The primary criteria for
GXTs in this group are baseline pretest
CVD risk and the expected intensity level
of physical activity.
4. Anyone referred for a GXT must have a preGXT medical exam. In other words, it is not
judicious to have just a GXT without a brief
medical exam where the physician reviews
current and past medical history. This will
help determine the pre-GXT likelihood of an
abnormal test. In rare instances, the pre-test
risk is high enough to temporarily preclude
theGXT.
5. Most importantly, GXTs arc most useful
when applied to higher-risk groups, such as
persons with two or more risk factors for coronary heart disease. Selection of a higher-risk
group for screening increases the prevalence
of disease in those screened and, thus, the
predictive value or a positive test resttlt. ·n1is
fact is agreed on by all of tl1e respected clinical professional orga11i1.ations (e.g., AHA,
ACC, ACSM, AACVPR). ..,._
References
Amclican ,lssociation or Cardiovascular and
Pulmonary Rehabilitation (2004). G11i,telim-s for
c,mfia( Relu1/Jilitntio11 (111(/ s«o11rlary Pr<Wll/i(})I
l'ro:;nims, 4th Edition. Human Kinetics l'llblishers:
Champaign, m.
American CoUege of Cardiology/American
Heart Association. (2002). Task Force on Pmctire
Guidelines; Committee on E.xerci~ Testing.
Cirntlnti(})1, 106, t4, 1883-1892.
American College of Sports Medicine (2009).
A111eria111 Ci>ll<'Se ofSports M<'tlid11e's G11itleli11es
for E.venise Testing mu/ l'rescriptim1. 8th Edition.
Lippincott Wllliams and Wilkins: Philadelphia, Pa.
American Council on E.xercise (2010). ACE l'ersc,1111
·1mi11er M111111nt. 4th F.dition. American C"..ounctl on
F.,ercise: San Diego, Calif.
American Coundl on F.xercise (2009). ACE A<lm1u-<'!I
Health & f'i/111'$$ Sp«iatist M111111al. American Council
on f"crci.Se: S.1n Diego, Calif.
American Oluncil on Exercise (2003). ACE l'ersa1•1I
Tmi11tT Ma111111t. 3rd Edition. American Council on
Exercise: S.1n Diego, C"..alif.
Brown, A.F.. et al. (2004). E.xercise Tolerance Testing
To Screen for Coronary Heart Disease: ASystematic
Review for the Technjcal Support for the U.S.
Preventive Sen•ces Task Force. A111111/s of/11tem11/
M<'llici11e, 1-!0, W9--W24.
Falk, f., Shah, P.K. and Fuster, V. (1995). Coronary
plaque disntption. Cira1/atim1. 92, 657--07.
Fletcher, G.F., et al. (2001). Exerci~ Standards for
Testing and Training: A Staterncnt for Healthcare
Professionals from the American Heart Association.
C:irat111ti()l1, 104, 1694--1740.
Gibbons, R.J., ct al. (2002a). ACC/AHA 2002
Guideline Update for E.xercise Testing: A Report
of the American College of Cardiology/American
Hean Association Task Force on l'ractia- Guidellnes
(Committee on F.,ercise Testing)."""·•« org
Mora, S., et al. (2007). Ability or exercise testing to
predict cardiovascular and all cau~ death in asymptomatic women: a 20-)~ar roUow up or the lipid clinics prevale11ct m1dy. Jotmtal oftlte A111eri(1111 Ml'ilih1l
1\sscci11li()l1, 290, 1600-1607.
Sketch, M.H .. et al. (197S). Significant sex differences
in the correlation or elc-ctrocardiographic exe.rci~
testing and coronary arteriograms. A111<?ia111 Jo11m11/ ll{
C,,n/iology, 36, 169--73.
U.S. Preventive Sen1res Task l'orre (2004). Screening
for Coronary Heart Dis=: Recommendation
Statement. A111mls1>{/111m111t Medid11e, 140, 569-S72.
Wong, Y., ct al. (2001). Sex diffcrencts in investigation results and treatment in subjects referred for
investigation of chest pain. He111t, 85. 149-52.
Further Reading
American CoUcgc of Sports Medicine (2009). AC.SM's
Re.wurrt M111111(1/ for G11ideli11es for £xerris<' Testi11g a11,t
Pres<riptim,, 8th edition. Uppincott Williams and
Wilkins: Philadelphia, Pa.
Evans, C H. and \\~lite, R.D. (2009). f.xer~ Te.sti11g
for Prit11111)' C"re amt Sports Metlid11c. Springer
Publishing: New York. (Note: ll1is practical book is
a guide to the exercise stress test perfonned to deter•
mine a p.1ticnt's risl: of developing coronary heart
disease.)
Froelicher, V.F. and Myers, J.N. (2006). F.xen·i~ am/
the t/<'11rt, 5th Edition. WB S.1undcrs Company:
Philadelphia, Pa.
M)'crs.J., ct al. (2009). American Heart Association
Recommendations for Cl.inical Exercise Laboratories:
AScientific Statement. Cim1l11tio11, 119, 3 t H-3161.
ONIC HEART FAILURE AND EXERCISE:
A Research Update
HARACTERIZEO BY SHORTNESS OF BREATH ANO FATIGUE, CHRONIC HEART
FAILURE-ALSO KNOWN AS CONGESTIVE HEART FAILURE, ANO OFTEN REFERRED
TO SIMPLY AS CHF-iS A CHRONIC AND DEBILITATING SYNDROME AFFECTING
MORE THAN FIVE MILLION AMERICANS ANNUALLY.
C
BY NATALIE
DIGATE MUTH,
M.D., M.P.H., R.D.
While CHFcan be caused by a variety assaults to the
heart muscle, such as heart attack, chronic h~rtension
and congenital heart disease, the result is the same: ·n1e
heart is unable to ptunp enough blood and oxygen to meet
tissue demands. /\ hallmark of CHF is a decreased ability
to perform aerobic exercise, which, not surprisingly, leads
many people with CHF to avoid physical activity.
Yet, despite the discomforts of exercise, numerous
studies have sho"11 that exercise is beneficial in helping
to improve aerobic capacity and reduce the symptoms
of CHF (Pi1\a et al., 2003). Until recently, no large-scale
randomized trials had ev-dluated the role of exercise on
survival and quality of life of people with CHF. lln April,
two papers derived from a study caUed Heart Failure: A
Control Trial Investigating Outcomes of Exercise Training
(HF-ACl'IOl'-.ry, both of wl1ich were published in the Joumal
o( the American Medical Association, provided the longanticipated results: Exercise likely has a modest effect on
longevity and quality of life (O'Connor ct al., 2009; Flynn
et al., 2009).
A Clinical Trial Exploring the
Role of Exercise in CHF
HF·ACl'ION followed the disease course of more than
2,300 medically stable outpatients in the U.S., Canada
NATALIE DIGATE MUTH, M.D., M.P.H., R.D., is a resident in pediatrics at UCLA
Mattel Children's Hospital. She is also a registered dietitian and ACE Master Trainer.
and France with New York Heart Association (NYHA)
class II to class IV systolic heart failure (slight to severe
limitation in physical activity). The participants were
randomized to usual care and exercise groups. The usual
care group received all of the guideli ne-based, best treat•
ments for CH F. The exercise group received the standard
care plus 36 supervised exercise sessions (15 to 35 minutes of cardiovascular exercise at 60 percent to 70 percent of heart-rate reserve) and a cycle or treadmill and
heart-rate monitor for home exercise. In all, the exercise
group exercised for about 95 minutes per week in the
fi rst si,x months of follow•up, and 74 minutes per week
from months 10 to 12 (O'Connor et al., 2009}.
In the first study, researchers evaluated the effect
of exercise ou clinical outcomes. They found that
exercise did not significantly decrease the risk of allcause death or all-cause hospitalization. However,
when the researchers adjusted for pre-specified confounders (including cause of heart failure, duration
of the exercise test, left ventricular ejection fraction,
depression score and history of atrial fibrillation or
atrial flutter), the exercise group had a non-statistically
significant 11 percent decreased risk of death or hospitalization and a significant 15 percent lower risk of
cardiovascular-related death or heart-failure hospitalization. Tile exercise group also had substantially better
cardiovascular fi tness-assessment results than the usual
care group (O'Connor et al., 2009).
Co11tin11ed on page 24
AC( cummoNCWS I OCIOOCRINOVIM!l(R 2009
17
ACE Partners with IDEA
Industry Leaders Join Forces to Enhance Offerings for Fitness Professionals
CE is excited to have recently partnered with IDEA
Health & Fitness Association-a long-term relationship that will include multiple initiatives over the
coming months. This partner-
delivered in an online video format-filmed live at the 2009
IDEA World Convention. The courses offer the latest tips
and techniques on a variety of health and fitness topics
from renowned industry professionals such as Todd Durkin,
ship is intended to benefit the
Al ~ ✓ ~,.,,_~-Cfitf
ll'J'Ol,l~'t,...'1.lt,l.aoc..
• 11«1'>10StfJI
• 0.CtOtfltQwof
Juan Carlos Santana, Leslee
fitness industry by allowing both - ~.,..~
• ~fore:......
,,....~~
ACE and IDEA to offer expanded
Bender and Helen Vanderburg.
resources for education, training
Ideal for those who enjoy learnSave money by bundling!
and professional growth.
ing in the comfort of their own home, the
ACE-certified professionals
"We are thrilled to embark on a stracourses are individually priced at $79.95
receive a $25 discount when
tegic partnership with an industry peer
for non-IDEA members and $64.95
purchasing the 2009 IDEA
as highly respected as IDEA," said Scott
for IDEA members, and are available
World Fitness Convention
Goudeseune, ACE president and CEO.
through ACE's ConEd Center at
Online Video Package.
"We look forward to collaborating w ith
www.acefitness.org/continuingeducation.
Use special coupon code
IDEA to better serve the health and fitness
Be on the lookout-ACE and IDEA plan to
WVPACE at checkout. Visit
industry, as well as continue to provide
announce additional components of the partwww. cefit ss. r /c ntinu
valuable resources for our members."
nership over the months to come. For more
in education to learn more.
The partnership kicked off with co•
information, please visit www.acefitness.org
branded continuing education courses
or www.ideafrt.com. A-
A
,..
I • •£ fl ..-
..........
....
·-
ACE in the News
erving as America's Authority on Fitness~, the
American Council on Exercise and its extended
spokesperson network are regularly featured or
quoted in print, online and broadcast media, reaching
more than 450 million people each year. Check out
these recent highlights:
S
SheKnows.com (August 19, 2009} - In August's installment of the ACE/SheKnows exclusive monthly workout
series, ACE spokesperson Sabrena Merrill, discusses the
benefits of working out w ith a partner. Also included in the
article are several exercise demonstrations-perfect for you
to do with a client or workout partner-featuring step-bystep instructional images from ACE'S online exercise library.
CNNhealth.com (August 14, 2009}- 'Toning shoes' claim to
provide exercisers muscle toning and enhanced benefits. In
a recent CNNhealth.com article titled, "Shoes' Toning Claims
Draw Experts' Doubts," ACE's Pete McCall describes some of
the shoe manufacturers' claims as "definitely far-fetched," and
18
OCIOBlM«MMS(R 20()9 , ACE cummo •rws
also points out a few interesting findings from recent independent research studies on the shoes.
Ladies Home Journal (July 2009 and September 2009)
- ACE was featured in the 'Health' section of Ladies Home
Journal in the July and September issues. First, ACE's Jessica
Matthews offers a few one-minute workouts anyone can
do during routine and non-workout activities, such as while
watching TV, waiting in a line or emptying the dishwasher. In
the September issue, Pete McCall provides helpful recommendations for training for a 5K charity walk - an ideal postsummer activity for you and your friends and family.
For access to articles and media coverage featuring helpful tips
and advice from ACE, visit www.acefitness org/media. A-
ontinuing education courses
offered through AC E's ConEd
Center cover a wide range of
topics. Check out the following ACE
courses - new to the ConEd Center when working on earning CECs
toward certification renewal:
C
Coi1Ed
Sef.rrl . ~:T
,c,• .,., •.
Conducting Postural Assessments
(0.2 CECs) - $49.95
Full postural-assessment screenings
help clients experience more favorable
results from their exercise programs.
ACE developed this course to provide you w ith an invaluable guide to
conducting comprehensive postural
assessments on all of your clients. In
this course you 'll learn to:
• Identify key physiological principles associated w ith muscle
imbalance and poor posture
• Implement the right angle rule to
body design
• Distinguish correctible from noncorrectib le compensations
• Incorporate practical solutions for
....J
Lifestyle & Weight Management
Consultant and Advanced Health
& Fitness Specialist Exam Review
Online Courses (1 .6-2.0 CECs,
respectively) - $149.00 each
The all-new exam review courses
designed for the Lifestyle & Weight
Management Consultant and
Advanced Health & Fitness Specialist
Certifications are valuable study tools
to help personal tra iners and group
fitness instructors prepare for these
New Webinar Series!
e're excited to announce a new opportunity for learning
and earning CECs. Be sure to check out our new webinar
series available through the ACE ConEd Center. Join us for
monthly webcasts and enjoy the convenience and comfort of
online learning, while experiencing the benefits of live instruction
from an ACE expert. All webinars are two hours in length, 0.2 CECs
and $34.95. .-....
W
October 15
Strategies to Help
4-6 pm Pacific Busy Clients M eet
Endurance Goals
Taught by Todd Galati, M.A.,
ACE Certification & Exam
Development Manager
November 11
Taught by Julia Valentour.
M.S., ACE Academy Program
Coordinator
How Sleep Patterns
4-6 pm Pacific Influence Fitness
Perlonnance
December9
Intelligent
4-6 pm Pacific Sequencing for
Yoga Classes
January 13
Strategies for
4-6 pm Pacific Fat Metabolism
and Weight
Management
~
restoring good posture through
proper stretching and strengthening p rograms
Course includes DVD, online quiz
and downloadable reference materials.
Taught by Jessica Matthews,
M.S., R.Y.T. , ACE Continuing
Education Coordinator
Taught by Fabio Comana,
MA , M.S., ACE Exercise
Physiologist
advanced certification exams. These
courses also serve as a great way to
earn CECs and gain knowledge in a
more specialized area of instruction.
The online exam review course
format is ideal for people who learn
best on their own and in a selfpaced environment, but also want
the in-depth teaching and support of ACE-developed curriculum.
Addressed in each course are key
exam content topic areas: Client
Assessment, Program Design, Program
Implementation and Management, and
Professional Responsibility. Listen to
pre-recorded lectures, complete fill-inthe-b lank exercises and take interactive
quizzes. Go step-by•step through the
required knowledge and skill sets and
gain deeper insight into how to apply
what you learn to your career as an
advanced fitness professional.
Visit www.acefitness.org/continuingeducation to access these and
nearly 3,000 other courses. A-
California Personal
Trainer Certification
Bill Will Not Move
Forward This Year
arlier this year, California State Senator
Ron S. Calderon introduced Senate Bill 374,
which would prohibit individuals from hold ing themselves out as personal trainers unless
they are certified by either a national independent organization accredited by the NCCA or
by an organization accredited by an accrediting body recognized by either the Council for
Higher Education Accreditation or by the U.S.
Department of Education; or hold a bachelor's
degree in exercise science, kinesiology, fitness
science, or another closely related field.
The bill, however, failed to move out of the
Appropriations Committee and will therefore not
move forward this year. ACE will continue to
monitor the progress of this b ill and others around
the country that could have a direct impact on
ACE-certified Fitness Professionals. .-....
E
AC( wmmoNCWS I OCIOO[RINQVtMS(R 2009
19
AMERICAN COUNCIL ON EXERCISE
~lili~ ES~
OQ
NOVEMBER 4-7, 2
•••
SA,.r-:,J DIEGO,
..
Join us fottfie"4thannual~ CE FitnessSymposium - a uniquely intimate, eaucational
event to aavance and inspire fitness professionals of all levels. Discover refreshing and
creative ideas in exercise programming, sports conditioning, nutrition, mind/body: and
working with special populations. A experience you won't find else ere!
~NOOR SHOWROOM
Featuriog equiRment and !2(oducts from efi Sports Medicine, Fitness ~ r e ,
New leaf, SPRI, Tvvist SRQrt Conditionire, Traini119 Peaks b)' Peaksware, Y99aFit ana
lnsurePersonalTrainers.com
- - - --
New leaf- learn aoout Active Metaoolic Training ana how you can benefit fro
individualizea training pr99rams that deliver real results for clients.
KEYNOTE SPEAKERS
Enjoy keynote addresses from industry experts Todd Durkin, 1-:leidi S •
Dr. Nicholas DiNubile, as they cover intriguing and timely toRics on: •
personal performance, getting answers to the top 10 most frequent!
ana nutritional questions and the important ole you play in preventi
reversing musculoskeletal disorders.
.
.
,
OTHER HIGHLIGHTS
1.8 CE Cs towara certification renewal
lntroauction to ACE's new personal training moael
Welcome reception witli
w1tli exciting, live entertain
entertainment
Networking opportunities at no aaaitional cost
"11••
,'\fforclaole oeachfront accommoaat1ons ana fr
downtown San Di~o·s historic Gaslamp District
,
.
... ...
•
.
CALE~DAR OF. EVENTS·
Personal Trainer
Exam Review
Webinar
Strategies
to Help Busy
Clients Meet
Endurance
Goals Webinar
Dates: Oct. 7, 14, 21 , 21, 28 (W ed.)
Nov. 3, 10, 17, 24 (Tues.)
Cost: $34 .95
Start time: 7 p .m. Eastern (4 p.m. Pacific)
Cost: S199
CECs: 0.2
Date: October 15, 2009
Start time: 7 p.m. Eastern (4 p.m, Pacific)
Do you have clients who want to participate in long distance
event s but have limi ted time to t rain? Each year, millions of
people compete in marathons, triathlons, and other endurance events, squeezing training time between work, family,
and other commitments. Many of them finish, but few truly
"peak ." Thi s webinar reviews the steps for identifying the
skills and abilities that are critical for success in a specific
event and provides strategies for adapting training principals of elite endurance athletes to create individualized
programs to help your clients reach their goals on limited
training schedules.
CECs: 1.0
The Personal Trainer Exam Review Course is a valuable study tool to
help you prepare for the ACE Personal Trainer Certification Exam, The
webinar format offers live, real-time lectures and an interactive environment to ask questions. all through the convenience of your own home
computer. This course is ideal for people who prefer to learn in their own
setting but want the teaching and live support of an ACE instructor,
This complete course includes all four individual modules presented in
weekly live webcasts that cover all the key topic areas of the exam content outline along w ith a review of key concepts and an open forum, The
individual modules for the course can also be purchased separately,
• Module 1 - Fo undational Knowledge: Applied Science
• Module 2 - Client Interview and Assessment
• Module 3 • Program Desig n, Implementation,
Progression, Modification & M aint enance
• Module 4 - Keys to Success: Test-Taking Strategies & Prof essional Role
Functional
Training &
Assessment
Workshop
Cost: S175
For additional information
or to register, go to
www.acefitness.org/Jiveprograms
CECs: 0.8
Date: October 24, 2009
Locations: Austin, TX; Balt imore, MD
Functional training continues to grow in popularity as the foundation for fitness and sports conditioning programs. Training to
improve posture, movement efficiency and overall muscular performance related to a variety of activities defines functional training.
Enhance your knowledge and applied skills with the latest tools
and techniques in personal training to stay ahead of the game.
The one-day (8,5-hour) ACE Functional Training workshop
teaches the important concepts of functional training by instructing personal trainers on how to:
• Conduct postural assessments and movement screens
• Develop core-training progressions
• Design exercise progressions for postural compensations
• Implement effective dynamic warm-ups
• Introduce sport-condi tioning principles into your clients' training programs
22
0CIOlllRll«)V{N8[R 2009 I ICECutllflfll •!WS
Heartsaver
First Aid with
CPR and AED
Workshop
Cost: $99
CECs: 0.6
ACE and the American Heart Association (AHA) have
teamed up to deliver a dynamic message of hope - the
hope of saving lives. New treatments have improved the possibility of survival from cardiovascular emergencies, cardiac
arrest, and stroke in a fitness setting where
individuals are most at risk when exercising.
Nov. 21, 2009
Increasing public awareness of the imporAnn Arbor, Ml
tance of early intervention and ensuring
Chicago, IL
greater public access to defibrillation will save
Denver, CO
many lives.
Los Angeles. CA
The seven-hour Heartsaver First Aid with
NewYork, NY
CPR and AED training course will provide fitSan Diego, CA
ness professionals with the critical lifesaving
San Jose, CA
skills needed to care for a victim of an illness or
Washington, DC
injury until EMS arrives.
Course materials will be shipped to you
prior to the live workshop date. Please review
the materials and bring them w ith you to the workshop.
The course runs from 9:00 am to approximately 3:30 pm on
the date selected.
ACE Certified News
Continuing Education Self-test
OCT/NOV
2009
To earn 0.1 continuing education credits (CECs), you must carefully read this issue of ACE Certified News, answer the 10 questions below, achieve a passing score (a minimum of 70 percenQ, and complete and return the credit verification form below, confirming that you have read the materials and achieved
a minimum passing score. In a hurry? TaJ<e the quiz online at www.acefitness.org/cnguiz for instant access to CECs.
Circle the single best answer for each of the following questions.
1. An estimated __ percent of people age
70 to 90 show orthopedic injury after 1 RM
training, whereas _ _ percent showed
injuries following moderate-intensity resistance training (Al).
A. 40; 30
8. 30; 15
c. 20; 8
0. 10; 6
2. Professional liability insurance covers
A. Property damage claims
8. Personal injury lawsuits involving
slander
C. Claims against false advertising
0. Client injuries due to your alleged
negligence
3. Which of the following statements about
GXTs is NOT true?
A GXTs may be less accurate for women
than for men.
8. All clients over age 40 should be referred
for a physician-supervised GXT.
C. GXTs should not be considered the final
diagnostic word.
o. The chance of a false positive is
1Opercent in men and 20-30 percent in
women.
4. A "nutritionist" _ _ _ _ _ _ _ __
A. Is an individual who haas completed a yearlong internship and passed a national registration exam.
8. Has completed 75 hours of continuing professional education every five years.
c. Is a term that is not protected by law in
almost all countries.
0. Is an accredited title that gives a person
legal permission to offer nutrition advice.
5. Which of the following is NOT considered
a known risk of high-intensity resistance
training?
A. Increased blood pressure
8. Increased risk of orthopedic injuries
C. Aortic dissection
o. Abnormal chronotropic index
6. A recent study of patients with
chronic heart failure revealed that
A. Patients who exercised were less likely 10 be
hospitalized for any reasoo.
8. Exercise had no effect on patient's
quality of life.
C. Those in the exercise group had a
15 percent lower risk of death or
heart-failure hospttalization.
D. Exercise was not well-tolerated by
most patients.
Evaluation of credit offering:
1. Was material
0 New
:i Review f0< yru?
0 Yes
2. Was material presented c'-IY?
::J No
3. Was material covered adequately?
Cl Yes
:J No
4. Will you be able to use the information learned
:J No
Yes
from this credft offering in your profession?
II yes, how? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
•
Please attach business card, or type or print legibly:
Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
7. As a certified fitness professional, which of the
following would NOT be considered within your
scope of practice?
A. Educating clients about portion sizes.
8. Teaching clients how lo read food labels.
C. Learning about supplements.
0. Recommending specific diets.
8. Which of the following would NOT necessarily
increase your chances of having a lawsuit brought
against you?
A. Taking a variety of cootinuing education C01Jrses.
8. Woll<ing at a gym with poor facilities.
C. Not communicating effectively.
o. Being unaware of your dients' health histories.
9. Which of tile following is NOT one of the three
physiological events that occurs following
resistance training exercise?
A. Increase in blood flow and oxygen
8. Growth hormone secretion
C. Production of reactive oxygen species
0. Recruitment of additional muscle fibers
10. Which of Ille following is NOT part of the American
Heart Association's exercise guidelines for
individuals with chronic heart failure?
A. Avoid resistance training.
B. Include a prolonged warm-up and cool-down.
C. Aim for a perceived exertion rating of
"somewhat hard."
o. Go for walkS on non-training days.
Iattest tha1 I have read the attioles ,n this issoe. answered ll1e test questions
using tile knowledge gained through those articles and raceived a pass,,g
grade (mmum score: 70 percent). C:00,pleting this !elf-test w,111 a pass,og
SCO<e ..i1 eam you o. 1 cominuing edU(ation cted~ {CEC~
Sil,lature:._ _ _ _ _ _ _ _ _ _ _ Oate:_ __
u Change rny acld<ess as ShOWn at tel1. Effec1ille date:_ _ _ __
To receive ACE Credits. mail tl>s page. l'Jth a S20 Processlng Fee IOI
ACE-oE!11ifoeds or $25 for non-ACE-cErtifieds. to the fOIIOWing adCtess:
ACE Correspondence Courses
American Council on Ex..-cise. 4851 "-"<iont Ori"8, San Oiego, CA 92123
Payment Melhod;
City:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
State:_ _ _ ZIP:_ _ _ _ _ _ _ Country: _ _ _ _ _ _ _ __
E-mail: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(e-mail required for electronic CEC confirmation receipt)
t.)
..:
.J I've er>:losed a checl< or mooey o«Je< made payable to tne
American Coooci on Exercise.
':l Please 1>11 mycteeit
Q American Express® 0 VISA®
=:
0 MasterC~
Business Phone:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Card Number_ _ _ _ _ _ _ _ _ _ _ _ _ _ _- !
Fax: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
CVSCocle - - - - - -1
Sil,la1ute _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __,
ACE Certification#: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Degree/Major/Institution: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Exp.~•-------
An add~ional 525 fee will be assessed on 8"'/ cel\Jmed Cllecks.
Expires Novembel ~. 2010
CH
Resistance Training
Continued from page 7
both fitness options to the public and business opporttlllities to fitness professionals. A-
4851 Paramount Drive
San Diego, CA 92123
Ref erenc es
Hatzaras, I.S., et al. (2007). Weight lifting and aonic dissenion: more
evidence for a connection. C.mliology, 107, 2, 103-106.
Koba, S., et al. (2004). Pressot response to static and d)~iamlc knee
extensions at ~uivalent workloads in hwnans. 71,e J1,pa11es,, Jo11mal
o{l'l,ysiology, 54, 471-481.
Lawrence, R.C., et al. ll998). Estimates of the prc,valenceof arthritis
and selected musculoskdetal disorders in U1e United States. Arthritis
/111<1 Rh<'tmlllliSIII, 41, 5, 77S-799.
National Council for Pht'Skal Actiloty & Disability. (2009).
Retri<'\·edJuly 22, 2009, from htJp·//""m nqml.org/disabilily/
fact shei:1 php?s1u:e1;1zo&sectiQn;969
Pollock, M.L, et al. (1991). Injuries and adherence to walk/jog and
resistance training programs in the elderly. Merfid11e & Srie••·e i11
Spo,ts & £.,erris,,, 2-1, 10, 1194-1200.
Tanimoto, M., et al. (2008) Effects of whole-bo<ly low-intensity
resistance training \\1th slow mol'ement and tonic force generation
on muscular size and strength in young men. Jo11n111/ o{ Slm,stl, met
(;011ditio11i11s Re$trirrh, 22, 6, 1926-1938.
Tanimoto, M. and Ishii, N. (2006). Efft'Cts ol low-intensit)' resistance
exercise with slow movement and tonic force generation on muscular function in young mei,, Jounml 11( Applied l'hysir1/ngy, 100, 4,
1150-1157.
Chronic Heart Failure and Exercise: A Research Update
C<mti1111e1t from page I7
In the sernnd study, researchers looked
at the erfoct of exercise on self-reported
health status, as measured by the Kansas City
C1rdiomyopathy Questionnaire (KCCQ). The
KCCQ is a 23-item questionnaire that assesses
an indMdual's perception of physical iimita•
tions, symptoms, quality of life and social
limitations. Scores range from Oto 100, with
higher scores indicating better health status.
Less than one-third of people in the usual
care group had a five-point or more increase
in the KCCQ scale compared to 54 percent of
individuals in the exerci.se group. The authors
considered a 5-point improvement or more
to be indicative of improved clinical status.
Both groups had an increase in the KCCQ
scale in the first three months of the study: U1e
standard care group had a 3.28-point increase
while the exercise group had a significantly
higher increase of 5.21 poinl~. The improvement both in the overall summary score as
well as the subscales of physical limitations,
symptoms, quality of life and social limitations
persisted throughout the duration of the study
(Flym1 et al., 2009).
Overall, the authors concluded that,
though the benefits of exercise on clinical
outcomes and quality of life were modest,
they were meaningful. Furthermore, exercise
was well tolerated and safe. Together these
results convinced the authors that exercise
is an important component of treatment for
individuals with beart failure.
Exercise Guidelines
Interestingly, 55 percent of the participants randomized to usual care reported
that they would have preferred to be in
the exercise group (O'Connor et al, 2009),
which suggests that not only may exercise
benefit people with CHF, but also that many
people with CHF would like to parlicipate
in a supervised exercise program. While
physical therapy and cardiac rehabilitation
is the best place for these individuals to
begin an exercise program, qualified fitness
professionals may help ease the transition
from supervised therapy into a home-based
routine. If you work with clients with CHF,
keep the following exercise guidelines from
the American Heart As:sociation in mind
(Pilia et al, 2003):
• Work closely with the client's physician, cardiac rehab specialist, and
physical therapist to design an individualized program based on the client's
healthy history, interests and capabilities. Encourage the client to follow up
with these practitioners regularly to
as.~ess the benefits: of the home exercise
program, evaluate any problems and
advance to higher levels of exertion, if
appropriate.
• Don't forget to include a prolonged
(at least 10 minutes) warm-up and
cool-do"~1.
• Encourage exerdse three to five days
per week for 20 to 30 minutes at a
rating of perceived exertion (RPE)
of 12-13 (somewhat hard).
• Include resistance training using light
free weights or elastic bands.
• Encourage walking on non-training days.
Breathing Easy
Empowering an individual with CHF to
commit to an excrcis~ program offers them
more than improved fitness-it may just
help them live a little bit longer, healthier
and happier lives. A-
References
K.E., Pii\a, 1.L., Whellan, D.J., Cl al (2009).
Effects of exercise training on health status i.n
patients with d1ronic heart failure: HF-Action randomized controlJcd trial.. Jo11n111I o( the A111e,im11
Mi,/iml ,tSS(J(iati/111, 301, 14, 1451-1459.
O'Connor, C.M., Whellan, D.J,, Lee, K.1. , et al
(2009). Efficacy and safety of exercise training
in p.1tients with chronic hea11 failure: HF-/\ction
randomized controlled trial. Jmm111I a{ the J\111erit m1
Mediml Assod11ti1111, 301, H, 1439-1450.
Pu1a, 1.L., Apstein, C.S., B.1Jady, G.J., et al (2003).
Exercise and heart fuilutl': a statement from the
American ~lcart Association Committee on f.xercisc,
Rehabilitatiori and Prevention. Cimtlati1111, 107,
1210-1225.
fl~lll,
C 2009 AMERICAN COUNCIL ON EXERCISE Pl0-009 39.SK 9/09