Chapter 9. Client Consultation and Health Appraisal

Responsibility The practice of a personal trainer involves the responsibility of interviewing potential clients to gather important information regarding their personal health, lifestyle, and exercise readiness. Best way to describe the role and responsibilities of a personal trainer is through the acronym MATER.

MATER Motivate performance and compliance Assess health status Train clients safely and effectively to meet individual objectives Educate clients to be informed consumers Refer clients to health care professionals when necessary

Meeting with the client During the initial interview, the personal trainer and client assess compatibility, develops goals, and establishes a client-trainer agreement.

Informed Consent Gives clients information about the content and process of the program delivery system. 1. Detailed description of the program 2. The risks and benefits associated with participation 3. A confidentiality clause 4. Responsibilities of the participant 5. Documentation of acknowledgment and acceptance of the terms described within the form.

Physical Activity Readiness Questionaire PAR-Q, a tool that consists of a questionnaire that requires self-recall of observations and signs and symptoms experienced by the client, in addition to confirmation of diagnosis by a physician. Health Risk Analysis- Identifies positive and negatives aspects of the the clients health behavior.

Coronary Artery Disease Risk Factors Coronary Artery Disease is the leading cause of mortality in Western society. Buildup of plaque inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis.

Risk Factors Positive risk factors Family history- death before 55 years of age of biological father or other first-degree relative or before 65 years of age in biological mother or other female first-degree relative. Cigarette smoking- Current or who quit within the previous 6 months Hypertension- Systolic blood pressure>140 mmHg or diastolic >90 mmHg (a measure of mercury in milimeters)

Risk Factors Hypercholesterolemia- cholesterol is carried in the bloodstream by molecular proteins known as high-density lipoproteins (HDLs) >35 and low-density lipoproteins (LDLs) <200. Impaired fasting glucose- fasting blood glucose. Obesity- Over body mass index Sedentary lifestyle- no participation in a regular exercise program or meeting the minimal physical activity recommended.

Coronary Artery and Pulmonary Disease Personal history plays a fundamental and critical role in the process of early detection of CAD.

Cardiovascular Disease Cardiovascular disease: While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease).

Cardiovascular disease

Pulmonary Disease Pulmonary disease: Chronic obstructive pulmonary disease (COPD) is comprised primarily of two related diseases - chronic bronchitis and emphysema. In both diseases, there is chronic obstruction of the flow of air through the airways and out of the lungs, and the obstruction generally is permanent and progressive over time.

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Symptoms of cardiovascular and pulmonary disease Pain, discomfort in the chest, neck, jaw, arms, or other areas that may be due to ischemia (lack of blood flow). Shortness of breath at rest or with mild exertion Dizziness or syncope (fainting). Orthopnea (the need to sit up to breathe comfortably) or paroxysmal (sudden, unexpected attack) nocturnal dyspnea (shortness of breath at night). Type A personality!

Symptoms of cardiovascular and pulmonary disease cont… Ankle edema (swelling/water retention). Palpitations or tachycardia (rapid heart rate). Intermittent claudication (calf cramping) Known heart murmur. Unusual fatigue or shortness of breath with usual activities.

Risk Stratifications Low Risk: Younger individuals (men < 45; women < 55) who are asymptomatic (having no symptoms of illness or disease ). Moderate Risk: Older individuals (Men > 45 ; women > 55). High Risk: Individuals with known cardiovascular, pulmonary, or metabolic disease.

Question 1 Which of the following should a personal trainer do during the initial meeting with a new client? I. Perform a submaximal bike test to estimate the client’s VO2 max. II. Have the client complete a medical history form. III. Evaluate the client’s level of exercise readiness. IV. Discuss the client’s goals for his or her exercise program. A. I and II only B. III and IV only C. I, II, and III only D. II, III, and IV only

Q 1 Explanation B You do not want them to fill out a medical form if they are not ready to exercise and to commit to making goals. You also have to make sure you are compatible with the client.

Question 2 2. Which of the following should be included in an informed consent? A summary of the client’s testing results Benefits associated with participation The client’s exercise goals Responsibilities of the client I and III only II and IV only I, II, and III only II, III, and IV only

Q 2 Explanation B because the informed consent (pg 190) explains about the actual fitness evaluations tests that will be performed. It explains that some of the tests are very physically demanding and that a physical examination is recommended for 45> males and 55> females. By signing this form the client is acknowledging that they have been informed and understand that no responsibility is assumed by the personal trainer.

Question 3 3. Which of the following factors discovered at a preparticipation health appraisal screening reveal a client’s risk of coronary artery disease? HDLs: 33 mg/dl Family history: uncle died of stroke at age 42. Blood pressure: 128/88 mm Hg; measured twice Quit smoking 60 days ago I and II only II and IV only I and IV only II and II only

Q 3 Explanation C because HDLs are lower than 35mg, needs to be 35>, and there is still a risk of CAD (Coronary Artery Disease) if they quit smoking 6 months ago or less. Uncle is not a factor, needs to be the mother or father in the family having stroke before 55. 128/88 is a healthy blood pressure (it is not over 140/90).

Question 4 4. Which of the following clients is in the highest risk stratification for coronary artery disease? A. 44-year-old male whose father died of a heart attack at 60 years of age B. 46-year-old male with a serum cholesterol reading of 205 mg/dL C. 48-year-old female with a BMI of 30 D. 50-year-old female who has COPD

Q 4 Explanation D because a female under the age of 55 with COPD (Chronic Obstructive Pulmonary Disease) is at high risk. The 44 year old’s father that died at 60 is at low risk- needs to be <55. Cholesterol reading is at 205mg and the cutoff is 200 so he is at moderate risk. A BMI of 30 is right on the cusp of obesity so she moderate to high risk.

Applied Knowledge Question: A 45-year-old sedentary male accountant wants to begin working with a personal trainer. After completing the initial interview and preparticipation health appraisal screening, the personal trainer learns the following information about the client: 11/9/2018 copyright 2006 www.brainybetty.com; All Rights Reserved.

copyright 2006 www.brainybetty.com; All Rights Reserved. AK continued Family History: both his father and grandmother had heart attacks at age 60 Cigarette Smoking: Non-smoker Resting Blood Pressure: 122/85 mmHg Blood Lipids: Serum cholesterol 240mg/dl; HDLs 35 mg/dL Fasting Glucose: 100 mg/dL BMI (Body Mass Index): 25 ***Evaluate and stratify his health status 11/9/2018 copyright 2006 www.brainybetty.com; All Rights Reserved.

copyright 2006 www.brainybetty.com; All Rights Reserved. AK continued Based on comparisons to the coronary artery disease risk factor thresholds table: Family History: No risk- his father’s heart attack occurred after age 55 (his grandmother’s heart attack is not a factor Cigarette Smoking: No risk- He is a non-smoker Hypertension: No risk- Blood pressure is below the 140/90 mmHg (a measure of mercury in milimeters) reading 11/9/2018 copyright 2006 www.brainybetty.com; All Rights Reserved.

copyright 2006 www.brainybetty.com; All Rights Reserved. AK continued Hypercholesterolemia: At risk- His cholesterol is over the 200 mg/dL (It stands for the weight of cholesterol in milligrams in a deciliter of blood. A deciliter is one-tenth of a liter or about one-tenth of a quart). His HDL level is at the 35 mg/dL which is the cutoff 11/9/2018 copyright 2006 www.brainybetty.com; All Rights Reserved.

copyright 2006 www.brainybetty.com; All Rights Reserved. AK continued Fasting Glucose: No risk- His reading is below the 110 mg/dL recommendation Obesity: No risk- His BMI (Body Mass Index- Weight compared to height) is less than 30kg/m2 . To calculate BMI: weight divided by height squared x 703 ie: 127 /64squared x 703= 22 BMI Sedentary Lifestyle: At risk – Client is sedentary 11/9/2018 copyright 2006 www.brainybetty.com; All Rights Reserved.

Forms Pg. 179- 192 *Partner up with packets* The Attitudinal Assessment Personal Training Contract Physical-Activity-Readiness Questionaire Health/Medical Questionarre Health Risk Analysis Informed Consent Form Release/Assumption of Risk Agreement Physician’s Referral