ACE Personal Trainer Manual 5th Edition Chapter 6: Building Rapport and the Initial Investigation Stage Lesson 6.2

After completing this session, you will be able to: LEARNING OBJECTIVES After completing this session, you will be able to: Describe the classes of medications and their effect on physical activity Discuss the sequencing of physiological assessments Discuss and explain the factors in determining the correct assessments for a client (goals of the assessment, physical limitations of participant, testing environment, equipment, age of participant) Evaluate equipment needed to start performing assessments

MEDICATIONS Medications alter the biochemistry of the body and may affect a client’s ability to perform or respond to exercise. Any client taking a prescription medication that could potentially have an effect on exercise should have a physician’s clearance for physical activity. The most common categories of medications: Antihypertensives Bronchodilators Cold medicines Refer to Table 6-2: Effects of Medication on Heart-rate Response

ANTIHYPERTENSIVES Antihypertensives primarily affect one of four different sites: Heart: to reduce its force of contraction Peripheral blood vessels: to open or dilate them to allow more room for the blood Brain: to reduce the sympathetic nerve outflow Kidneys: to reduce blood volume by excreting more fluid The most common antihypertensives: Beta blockers Calcium channel blockers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-II receptor antagonists Diuretics It is important for personal trainers to have a strong understanding of how medications affect resting, exercise, and maximal heart rate (see Table 6-2). Depending on the medication and its effects, a trainer may over- or underestimate training intensity, potentially causing harm or creating program ineffectiveness.  

ADDITIONAL MEDICATIONS Bronchodilators (medications for asthma) Relax or open the air passages in the lungs Stimulate sympathetic nervous system Increase exercise capacity when limited by bronchospasm Cold medicine Decongestants Stimulate vasoconstriction, which reduces the volume of swollen tissues Vasoconstriction may raise blood pressure and increase heart rate both at rest and possibly during exercise. Antihistamines Produce a drying effect in the upper airways and may cause drowsiness

SEQUENCING ASSESSMENTS Proper test selection can minimize client intimidation, embarrassment, or even fear of the results. Assessments that merit consideration include: Resting vital signs (heart rate, blood pressure, height, and weight) Static posture and movement screens Joint flexibility and muscle length Balance and core function Cardiorespiratory fitness Body composition Muscular endurance and strength Skill-related parameters (agility, coordination, power, reactivity, and speed) Testing for muscular strength and endurance is not suggested for many novice clients within the first few weeks, given the initial neurological adaptations and motor-skill changes that occur during the first one to four weeks of a resistance-training program. During the administration of any exercise test involving exertion (e.g., a cardiorespiratory fitness test), trainers must always be aware of signs or symptoms they can identify that merit immediate test termination and referral to a more appropriately qualified healthcare professional. These symptoms include: Onset of angina pectoris or angina-like symptoms that center around the chest Significant drop (>10 mmHg) in SBP despite an increase in exercise intensity Excessive rise in blood pressure: SBP reaches >250 mmHg or DBP reaches >115 mmHg Fatigue, shortness of breath, difficult or labored breathing, or wheezing (does not include heavy breathing due to intense exercise) Signs of poor perfusion: lightheadedness, pallor (pale skin), cyanosis, nausea, or cold and clammy skin Increased nervous system symptoms (e.g., ataxia, dizziness, confusion, or syncope) Leg cramping or claudication Physical or verbal manifestations of severe fatigue The test should also be terminated if the client requests to stop or the testing equipment fails.

SEQUENCING ASSESSMENTS When establishing a timeline for assessment, take into consideration the physiological influences of exercise: Resting blood pressure (BP) and heart rate (HR) Measure before exertion to avoid falsely elevated scores Skinfold measurements; take before activity to avoid: Underestimation of fat stores from dehydration Overestimation of fat stores due to vasodilation for thermoregulation Cardiovascular testing If following resistance exercise, this may elevate HR responses and invalidate the results

SEQUENCING ASSESSMENTS Be fully prepared when conducting assessments: Instructions – outline the client’s responsibilities in advance (e.g., clothing, eating, and hydration recommendations) Organize all necessary forms, data sheets, and assessment tables Informed consent Obtain a signed copy in advance from the client Allow the client the opportunity to ask questions about the protocols Additionally: Clearly explain the tests, sequence, and instructions Ensure calibration and working condition of all equipment Ensure environment is ideally between 68 and 72⁰ F (20 to 22⁰ C) with a relative humidity below 60% Ensure a quiet and private testing environment to reduce test anxiety

CHOOSING THE RIGHT ASSESSMENTS Not all clients need or desire a complete assessment; consider the following: Goals of the assessment Fitness and training goals are different; testing should also be unique Physical limitations of the participant Choose tests that will provide valid results without causing undue stress Testing environment Equipment calibration or proper surface Adequate lighting Proper emergency response protocol Appropriate temperature Availability of equipment Participant age An older, deconditioned client will not perform the same test as a younger client

TOOLS TO GET STARTED There are a number of computer and PDA software programs available to aid in calculations, documentation, and reporting. The American Council on Exercise also provides valuable calculation tools and assessment support materials through its website (www.acefitness.org/calculators).

BUILDING A PROFESSIONAL NETWORK If you work with athletes, whether they are high school student-athletes or Olympic hopefuls, it is important to build a network of professionals who help you better understand the needs of athletes in a particular sport. In class, develop a list of potential resources in your area. If time permits, draft a letter or email that explains your services and asks specific questions that will help you better serve these potential clients.

SUMMARY Medications alter the biochemistry of the body and may affect a client’s ability to perform or respond to exercise. The most common categories are antihypertensives, bronchodilators, and cold medicines. Proper assessment selection can minimize client intimidation, embarrassment, or even fear of the results. Not all clients need or desire a complete assessment. Consider the assessment goal, participant age and limitations, testing environment, and equipment availability. A personal trainer may have access to a variety of fitness-assessment instruments and equipment. The most common tools may include a stopwatch, calculator, blood pressure cuff and stethoscope, HR monitor, and skinfold calipers.