ACE Personal Trainer Manual
5th Edition
Chapter 6: Building Rapport and the Initial Investigation Stage
Lesson 6.3
LEARNING OBJECTIVES
• After completing this session, you will be able to:
 Conduct and interpret essential cardiovascular
assessments (heart rate and blood pressure)
 Differentiate between the Borg 15-point scale and
the modified 10-point category ratio scale and know
how to use them to measure ratings of perceived
exertion
 Implement the exercise-induced feeling inventory
© 2014 ACE
HEART-RATE MEASUREMENT
• Radial artery–the ventral aspect
of the wrist on the thumb side
• Carotid artery–located in the
neck, lateral to the trachea
• Other sites can also provide a
pulse location:
 Brachial artery
 Femoral artery
 Posterior tibial artery
 Popliteal artery
 Abdominal aorta
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HEART-RATE MEASUREMENT
• Heart rate is a valid indicator of work intensity or
stress on the body:
 Lower resting and submaximal heart rates indicate
higher fitness levels.
 Higher resting and submaximal heart rates indicate
poor physical fitness.
• Resting heart rate (RHR) is influenced by:

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Fatigue
Body composition
Drugs and medication
Alcohol
Caffeine
Stress
• Average RHR is 70–72 bpm
 Males 60–70
 Females 72–80 bpm
© 2014 ACE
RHR MEASUREMENT PROCEDURE
• Allow the client to rest comfortably for
several minutes.
• Palpate a pulse site or listen using a
stethoscope (auscultation).
• Place the tips of the index and middle fingers
over the artery and lightly apply pressure.
• Avoid using your thumb, which has a pulse of
its own.
• Place the bell of the stethoscope to the left of
the client’s sternum just above or below the
nipple line.
• Count the number of beats for 30 or 60
seconds.
• True RHR is measured just before rising from
bed in the morning.
• The client may also measure his or her own
resting HR and report back.
© 2014 ACE
EXERCISE HEART RATE MEASUREMENT PROCEDURE
• Measuring for 30 to 60 seconds is
generally difficult during exercise.
• A 10- to 15-second count is
recommended.
• Count the first pulse beat at the
start of the time interval.
• Multiply the counted score by
either six (for a 10-second count)
or four (for a 15-second count).
• Start counting at “one” instead of
“zero” to accurately estimate HR.
© 2014 ACE
MEASURING BLOOD PRESSURE
• Systolic blood pressure (SBP):
 The pressure created by the heart as it pumps blood into
circulation via ventricular contraction
 Greatest pressure during one cardiac cycle
• Diastolic blood pressure (DBP):
 The pressure exerted on the artery walls as blood remains in the
arteries during the filling phase of the cardiac cycle, or between
beats when the heart relaxes
 Minimum pressure that exists within one cardiac cycle
• The brachial artery is the standard site of measurement.
• Korotkoff sounds are sounds made from vibrations as blood
moves along the walls of the vessel.
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MEASURING BLOOD MEASURING
PRESSURE BLOOD PRESSURE
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BLOOD PRESSURE ASSESSMENT EQUIPMENT AND PROCEDURES
• Equipment needed:
 Sphygmomanometer (BP monitor
cuff)
 Stethoscope
 Chair
• Procedure set up:
 Client is seated with both feet flat
for two full minutes
 Proper cuff placement and cuff
size
 Client’s arm supported by an
armchair or by the trainer
© 2014 ACE
BLOOD PRESSURE ASSESSMENT EQUIPMENT AND PROCEDURES
• Measuring procedure:
 Place the stethoscope over the brachial
artery.
 Close the cuff valve.
 Rapidly inflate the cuff to 160 mmHg or to
where no pulse can be felt at the wrist.
• Release pressure by slowly turning the
knob:
 Release at a rate of about 2 mmHg per
second
 Listen simultaneously for Korotkoff sounds
• SBP – reading the dial at the first
perception of sound
• DBP – reading the dial when the sounds
cease to be heard or become muffled
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BLOOD PRESSURE CLASSIFICATION
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RATINGS OF PERCEIVED EXERTION (RPE)
• RPE is used to subjectively quantify a client’s
overall feelings and sensations during the stress
of physical activity.
• Borg Scale:
 6 to 20 point scale
 Each value corresponds to a heart rate:
o 6 = heart rate of 60 bpm
o 12 = heart rate of 120 bpm
o 20 = heart rate of 200 bpm
• Modified Borg Scale:
 0 to 10 point scale
 Can be used to gauge intensity when a trainer
does not need to measure HR via the RPE
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RATINGS OF PERCEIVED EXERTION
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EXERCISE-INDUCED FEELING INVENTORY (EFI)
• The EFI quantifies a client’s emotions and feelings
following an exercise session.
 Administer the survey verbally or give it to the client to
self-complete.
 Instruct the client to score each item to describe how he or
she feels.
 Initially, survey more frequently (e.g., every session or
every other session for the first two weeks).
 Gradually diminish the frequency to avoid a desensitization
effect.
 A change in the program is a good time to re-administer
the survey.
© 2014 ACE
EXERCISE-INDUCED FEELING INVENTORY
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SCORING THE EFI
• The four subscales of the EFI:
 Positive engagement – items 4, 7, and 12
 Revitalization – items 1, 6, and 9
 Tranquility – items 2, 5, and 10
 Physical exhaustion – items 3, 8, and 11
• Track subscale scores over a period of four to six
weeks:
 Plot the total scores of all four subscales against time
to demonstrate each client’s progress.
 Build a positive emotional change with exercise over
time by influencing the subscales accordingly.
© 2014 ACE
SCORING THE EFI
© 2014 ACE
SUMMARY
• Heart rate is a valid indicator of work intensity on the
body and is measured by palpating an artery or by using a
stethoscope.
• Blood pressure is measured indirectly by listening to the
Korotkoff sounds to distinguish between SBP and DBP.
• RPE is used to subjectively quantify a client’s overall
feelings and sensations during the stress of physical
activity.
• The EFI quantifies a client’s emotions and feelings
following an exercise session based on four subscales –
positive engagement, revitalization, tranquility, and
physical exhaustion.
© 2014 ACE