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Notes - Lab 1
- Students will be familiar with what kinds of records a trainer might keep.
- Students will understand the reasons for keeping various records.
Types of Records
- Questionnaires (health status, demographics, patient goals and concerns, dietary assessments, informed consent, incident report)
- fitness assessments (cardiovascular, flexibility, strength, muscular endurance)
- daily notes (what is the client telling you that may be relevant to success)
- exercise sheets (keeps a log of what was done)
- re-evalutions (allows you to measure progress and determine effectiveness of program)
- exit interviews (helps you to understand how the person feels about you as a trainer and their experience under your guidance)
Purpose of Keeping Records
- minimizing liability
- screening patients for health issues that may effect training sessions
- helps the trainer to identify barriers to success
- provides a baseline
- allows the trainer to measure progress
- source of encouragement
- providing a history for purposes of sharing and comparison
- promotes communication between the client and the trainer
Health Screening Forms
- Student should be familiar with the Par Q form.
- Student should be familiar with the Health Screening Questionnaire (HSQ)
- Students will become confident at administering the HSQ.
- Students should understand the advantages and disadvantages of both forms.
- Students should understand the concept of risk stratification.
- Students should be familiar with the acronym M.R.P.L.E.A.S.E.
Par Q – a self administered flow chart that helps an individual determine whether they should seek a physician’s clearance before beginning a low-moderate intensity exercise program. (located on page 19 of you book)
Advantages – short, easy to administer, provide the opening for further questions and dialogue.
Disadvantages – short and therefore potential for false positives and false negatives.
Health Screening Questionnaire (HSQ) -a more thorough health analysis, administered by a fitness professional to identify risk factors, lifestyle behaviors, exercise history, and red flags that may require program modifications or a physician’s consent.
Advantages – more thorough than the Par Q.
Disadvantages – takes longer and requires the person administering the test to stratify risk.
Risk Stratification - the process of determining relative risk based on the screening and program goals.
- Low Risk – < 1 risk factor from the table 2.2 on page 26 of the text and summarized below.
- Moderates Risk – > 2 or more risk factors
- High Risk – Men or women who have known cardiovascular, pulmonary or metabolic disease (see table 2.1 page 25)
The HSQ coupled with the participant’s desired activity level determines whether a participant requires a physician’s consent to begin exercising. (Bottom line – it all depends.)
Risk Factors (Summarized from table 2.2)
- Men over 45 and women over 55
- MI, coronary revascularization, or sudden death in father or other male first degree relative or before 65 in mother or other female first degree relative.
- Current cigarette smoker, or quite within last 6 months, or other environmental exposure to tobacco smoke.
- Sedentary lifestyles as defined by not participating in at least 30 min of moderate intensity aerobic activity on at least 3 days/wk for last 3 months.
- Obesity – BMI greater than 30, or waist girth greater than 40 inches for mane and 35 inches for women.
- Hypertension – 140/90 on resting measurements on at least two separate occasions, or on a anti-hypertensive drug.
- Dislipidemia – LDL >130; HDL<40, or total >200 or on lipid-lowering medication.
- Prediabetes – impaired fasting glucose >100 but < 126 or impaired glucose tolerance >140 after 2 hours but < 200 confirmed by testing on 2 occasions.
Students should be familiar with the acronym M.R.P.L.E.A.S.E.
M – Medical History Review
R – Risk factor assessment and stratification
P – Prescribed medications
L – Level of physical activity
E – Establishment of the necessity of physician consent
A – Administration of fitness tests and evaluation of results
S – Setup of exercise prescription
E – Evaluation of progress with follow-up tests
Other Important Forms/Concepts
- Students should be familiar with the physician consent forms.
- Students should be familiar with informed consent.
- Students should be familiar with scope of practice.
Students should understand the reason for obtaining a physician consent.
Form located on page 32 of text
Bottom line: when in doubt get a consent. The HSQ along with a risk stratification will help to identify relative risk. However, risk needs to be measured against the client''s goals and the trainers training and competence in various areas. A chart located in your lab book (page 12) offers a flow chart to help you determine if a physician''s consent if warranted.
Students should understand the purpose of the informed consent form.
Page 160 of text.
May help to reduce liability…but no guarantee.
Scope of Practice
Scope of practice refers to the training functioning with their level of expertise. Was the trainer operating within his/her scope of practice? Was medical advice given, or a specific diet prescribed? Were ergogenic aids prescribed?
Trainers generally are not in a position to give medical advice, prescribe diets or supplements. You can certainly share you thoughts but realize it is your responsibility to educate the client on your scope of training.
Were reasonable measures taken to ensure safety? Was the activity appropriate? Were precautions taken? Were records kept? Was a physician consulted when appropriate?
Do you need liability insurance? Depends on who and where you are working. You should ask your employer. Often they do not want you to carry additional insurance if you are covered under their plan as it can often make you a more desirable defendant in a law suit.
Assessing Heart Rate
- Students will know the difference between the carotid vs. the radial pulse as well as the advantages and disadvantages of both while at rest and during activity.
- Students will demonstrate taking a pulse to determine Resting Heart Rate (RHR).
- Students will be familiar with the different methods for determining Maximum Heart Rate (MHR) and Target Heart Rate (THR).
- Students will demonstrate how to take a blood pressure using an inflatable cuff.
- Students will understand the significance of a blood pressure for screening and monitoring purposes.
Radial is taken at the wrist using the index and middle fingers.
- more accessible during activity
- more comfortable/less invasive
- may be weaker or hard to find
Carotid is taken at the neck.
- may be easier to find
- may be difficult to take during activity
- may be more uncomfortable and invasive
Pulse is take for 10, 15, 30, 60 and then multiplied by a 6, 4, 2, or 1.
Tips for taking blood pressure:
- make sure that client is comfortable
- apply the cuff with the arrow over the brachial artery
- cradle left arm or have supported at about the level of the heart
- inflate cuff to 160
- make sure the client sits quietly, breathing deeply with feet planted on the floor
- if you get and error repeat pumping up further
Normal is 120/80 or below.
Equations for determining Maxium Heart Rate (MHR)
- Max HR formula: 220 - age
- Tanaka formula: 208 - 0.7 (age)
Target Heart Rate is then MHR X desired intensity (50%-90%) though can be as low as 40%.
Using the Percent of Heart Rate Reserve (HRR) method to determine THR
- Determine MHR
- Determine Resting Heart Rate (RHR)
- [(MHR-RHR) X desired percent - 60%-80%] + RHR = Target Heart Rate.
Refer to your text page 230 under key point:
The exercise intensity for CRF training effect can be described in a variety of ways: 40% or 50% to 84% (HRR), 60% or 65% to 90% HRmax, and 12-16 on the original RPE scale).