ACSM's Resources for the Exercise Physiologist

xi
Contents
Preface v
Acknowledgments vii
Contributors viii
Reviewers x
PART I: Overview 1
1 Understanding Physical Activity and Exercise 2
Defining Physical Activity, Exercise, and Physical Fitness 3
Historic Trends in Physical Activity 7
Ancient Times and the Rise of Exercise Physiology 7
T.K. Cureton and the Physical Fitness Movement 7
Historical Evolution of Physical Activity Epidemiology 8
Development of Physical Activity Guidelines and Recommendations 9
Relationship between Physical Activity/Exercise and Health across the Lifespan 12
Physical Activity and Health in Children and Adolescents 13
Physical Activity and Health in Adults 15
Physical Activity and Health in Older Adults 18
Physical Activity and Health in Women during Pregnancy and during the Postpartum Period 18
Physical Activity and Health in Adults with Chronic Conditions and Adults with Disabilities 18
General Risks Associated with Physical Activity/Exercise 19
Risks of Sudden Cardiac Death 20
The Risk of Cardiac Events during Exercise Testing 20
Musculoskeletal Injury Associated with Exercise 20
2 Preparticipation Physical Activity Screening Guidelines 29
Importance of Preparticipation Physical Activity Screening 30
History of Preparticipation Physical Activity Screening 31
Levels of Screening 31
Self-Guided Screening 32
? PHYSICAL ACTIVITY READINESS QUESTIONNAIRE FOR EVERYONE 32
? EPARMED-X ?PHYSICIAN CLEARANCE FOLLOW-UP QUESTIONNAIRE 32
Professionally Supervised Screening 37
? INFORMED CONSENT 37
? HEALTH HISTORY QUESTIONNAIRE 39
? MEDICAL EXAMINATION/CLEARANCE 39
? PREPARTICIPATION PHYSICAL ACTIVITY SCREENING PROCESS 39
Physical Activity (or Exercise) History 46
Known Cardiovascular, Metabolic, and/or Renal Disease 46
ACSM Major Signs or Symptoms Suggestive of Cardiovascular Disease 46
When Should You Seek Medical Clearance? 48
American Association of Cardiovascular and Pulmonary Rehabilitation Risk Stratification 49
Challenges of ACSM Preparticipation Physical Activity Screening 49
Recommendations versus Requirements 50xii
Contraindications to Exercise Testing 51
What Does Contraindication Really Mean? 52
Absolute versus Relative 52
Repurposing Risk Factor Assessment and Management 52
ACSM Atherosclerotic Cardiovascular Disease Risk Factor Assessment and Defining Criteria 52
PART II: Assessments and Exercise Programming for Apparently
Healthy Participants 59
3 Cardiorespiratory Fitness Assessments and Exercise Programming for
Apparently Healthy Participants 60
Basic Anatomy and Physiology of the Cardiovascular and Pulmonary Systems as They Relate to
Cardiorespiratory Fitness 61
Goal of the Cardiovascular and Respiratory Systems 61
Anatomy and Physiology of the Cardiovascular and Respiratory Systems 61
Adenosine Triphosphate Production 62
Overview of Cardiorespiratory Responses to Acute Graded Exercise of Conditioned and
Unconditioned Participants 64
Oxygen Uptake Kinetics during Submaximal Single-Intensity Exercise 64
Oxygen Uptake Kinetics during Graded Intensity Exercise 65
Arteriovenous Oxygen Difference Response to Graded Intensity Exercise 66
Heart Rate, Stroke Volume, and Cardiac Output Responses to Graded Intensity Exercise 66
Pulmonary Ventilation Response to Graded Intensity Exercise 67
Blood Pressure Response to Graded Intensity Exercise 67
Measuring Blood Pressure and Heart Rate before, during, and after Graded Exercise 68
Blood Pressure and Heart Rate Assessment 68
Rate Pressure Product 69
Selecting Appropriate Cardiorespiratory Fitness Assessments for Healthy Populations 70
Cardiorespiratory Fitness Assessments Benefits 70
Types of Cardiorespiratory Fitness Assessments 70
Selecting the Appropriate Cardiorespiratory Fitness Assessment 71
Interpreting Results of Cardiorespiratory Fitness Assessments, Including Determination of
V ?
O
2
and V ?
O
2max
76
Metabolic Calculations as They Relate to Cardiorespiratory Exercise Programming 77
Energy Units and Conversion Factors 77
ACSM Metabolic Formula 82
? EXAMPLES 83
FITT Framework for the Development of Cardiorespiratory Fitness in Apparently
Healthy People 84
Frequency 85
Intensity 85
Time 85
Type 86
Additional Variables 86
Volume 86
Progression 86
? PROGRESSIVE OVERLOAD 86
? REVERSIBILITY 86
? INDIVIDUAL DIFFERENCES 87
? SPECIFICITY OF TRAINING 87
Safe and Effective Exercises Designed to Enhance Cardiorespiratory Fitness 87
Interval Training 89
Contentsxiii
Determining Exercise Intensity 89
Heart Rate Reserve Method 90
Peak Heart Rate Method 90
Peak V
?
O
2
Method 90
Peak Metabolic Equivalent Method 91
V
?
O
2
Reserve Method 91
Talk Test Method 91
Perceived Exertion Method 92
Abnormal Responses to Exercise 92
Contraindications to Cardiovascular Training Exercises 93
Effect of Common Medications on Cardiorespiratory Exercise 93
Signs and Symptoms of Common Musculoskeletal Injuries Associated with
Cardiorespiratory Exercise 93
Effects of Heat, Cold, or High Altitude on the Physiological Response to Exercise 94
Heat Stress 95
Cold Stress 95
Altitude 95
Acclimatization When Exercising in a Hot, Cold, or High-Altitude Environment 96
4 Muscular Strength and Muscular Endurance Assessments and Exercise
Programming for Apparently Healthy Participants 103
Basic Structure and Function 105
Muscle Fiber Types and Recruitment 105
Types of Muscle Action 106
Assessment Protocols 108
Assessing Muscular Strength 109
Assessing Muscular Endurance 110
Fundamental Principles of Resistance Training 111
Principle of Progression 111
Principle of Regularity 112
Principle of Overload 113
Principle of Creativity 113
Principle of Enjoyment 113
Principle of Specificity 114
Principle of Supervision 115
Program Design Considerations 115
Types of Resistance Training 116
? DYNAMIC CONSTANT EXTERNAL RESISTANCE TRAINING 116
? ISOKINETICS 117
? PLYOMETRIC TRAINING 118
Modes of Resistance Training 119
Safety Concerns 121
Resistance Training Program Variables 123
Type of Exercise 124
Order of Exercise 125
Training Intensity 125
Training Volume 126
Rest Intervals between Sets 127
Repetition Velocity 127
Training Frequency 127
Periodization 128
General Recommendations 129
Contentsxiv
5 Flexibility Assessments and Exercise Programming for Apparently Healthy
Participants 136
Basic Principles of Flexibility 137
Factors Affecting Flexibility 137
Modes of Flexibility Training 139
Static Flexibility 139
Ballistic Flexibility 140
Proprioceptive Neuromuscular Facilitation 140
Dynamic Flexibility 142
Muscle and Tendon Proprioceptors 144
Flexibility Assessment Protocols 145
Goniometers and Inclinometers 145
Flexibility Program Design 153
Overall Range of Motion Recommendations 154
6 Functional Movement Assessments and Exercise Programming for Apparently
Healthy Participants 175
Sensorimotor Control 176
Motor Learning 176
Proprioception 176
Stability and Mobility 177
Mediators of the Proprioception, Mobility, and Stability 180
Overweight and Obesity and Physical Inactivity 180
Propensity for Inhibition of Stabilizing Muscles 180
Previous Injury and Pain 180
Everyday Posture and Limited Variety of Movement 181
Joint Structure 181
Age 182
What Is Neutral Position and Why Is It so Important? 182
Assessment and Prescription 183
Establishing a Movement Baseline 183
? ASSESSMENT OF STATIC NEUTRAL POSTURE 183
Plumb Line Assessment 183
Wall Test 183
Progressive Approach to Developing Postural Awareness 183
? INTEGRATIVE ASSESSMENTS AND CORRECTIONS 185
Wall Plank-and-Roll 185
Teaching How to Brace 185
Diaphragmatic Breathing Assessment and Corrective Methods 186
Rolling Patterns: Assessment and Correction 187
? ADDRESSING ALIGNMENT ISSUES 191
Instability Training 193
Self-Myofascial Release and Stretching 194
Lifestyle Recommendations 197
7 Body Composition and Weight Management 200
Anthropometric Measurements 201
Height and Weight 202
Body Mass Index 202
? CIRCUMFERENCE MEASURES 204
Contentsxv
Measuring Body Composition 206
? SKINFOLD MEASUREMENTS 207
? BIOELECTRICAL IMPEDANCE 209
? LABORATORY METHODS FOR MEASURING BODY COMPOSITION 211
Weight Management 213
Energy Balance 213
Preventing Weight Gain 217
Treatment of Obesity 217
FITT Recommendations 217
Training Considerations 218
Weight Loss Goals 219
Metabolic Equations 219
Weight Management Myths 219
? MYTH 1: FAT TURNS INTO MUSCLE 219
? MYTH 2: SPOT REDUCING WORKS 220
? MYTH 3: GAINING WEIGHT AT THE START OF AN EXERCISE PROGRAM IS FROM
INCREASED MUSCLE 220
Treatment of Obesity through Nutrition 221
Treatment of Obesity through Other Methods 223
Behavioral Strategies 224
Weight Loss Supplements 224
Dieting 225
Medications 225
PART III: Exercise Programming for Special Populations 231
8 Exercise for Individuals with Controlled Cardiovascular, Metabolic, Pulmonary,
and Chronic Kidney Disease 232
Pathophysiology 233
Cardiovascular Disease 233
? CORONARY HEART DISEASE 233
? HYPERTENSION 234
? PERIPHERAL ARTERY DISEASE 235
Metabolic Diseases 235
? DIABETES 236
? DYSLIPIDEMIA 236
? OBESITY 236
? METABOLIC SYNDROME 237
Pulmonary Diseases 237
? CHRONIC OBSTRUCTIVE PULMONARY DISEASE 237
? CHRONIC RESTRICTIVE PULMONARY DISEASE 238
Chronic Kidney Disease 238
Role of Exercise Training 238
Cardiovascular Diseases 238
Metabolic Diseases 240
Pulmonary Diseases 240
Chronic Kidney Disease 240
The Art and Science of Exercise Prescription and Programming in Controlled Disease Populations 241
Special FITT Considerations for Persons with Chronic Diseases 241
? HIGH-INTENSITY INTERVAL TRAINING 241
? CARDIOVASCULAR DISEASE 244
Contentsxvi
? METABOLIC DISEASE 244
? PULMONARY DISEASE 245
? CHRONIC KIDNEY DISEASE 246
Effects of Myocardial Ischemia, Myocardial Infarction, and Hypertension on Cardiorespiratory
Responses during Exercise 246
Myocardial Ischemia 246
Myocardial Infarction 247
? HYPERTENSION 247
Exercise Concerns, Precautions, and Contraindications 247
Cardiovascular Disease 247
Metabolic Disease 250
Pulmonary Disease 251
Chronic Kidney Disease 252
Effect of Common Medications on Exercise Capacity and Tolerance 253
Over-the-Counter Drugs 253
Prescription Drugs 255
Teaching and Demonstrating Safe and Effective Exercise 256
9 Exercise Programming for Individuals with Musculoskeletal Limitations 265
Traumatic Movement–Related Injuries 266
Fractures 266
Strains 267
Sprains 268
Contusions 268
? IMMEDIATE CARE 269
? MEDICATIONS FOR MUSCULOSKELETAL PAIN AND INFLAMMATION 269
? EXERCISE TO REDUCE RISK OF STRAINS AND SPRAINS 270
Overuse Injuries 271
Tendinopathy 271
? CLINICAL PRESENTATION/ASSESSMENT 271
? SAFE AND EFFECTIVE EXERCISE 272
? EXERCISE CONSIDERATIONS FOR TENDINOPATHIES 272
Bursitis 273
? CLINICAL PRESENTATION/ASSESSMENT 273
? SAFE AND EFFECTIVE EXERCISE 273
Plantar Fasciitis 273
? CLINICAL PRESENTATION/ASSESSMENT 273
? SAFE AND EFFECTIVE EXERCISE 274
Examples of Safe and Effective Exercises for Overuse Injuries 274
Low Back Pain 275
? CLINICAL PRESENTATION/ASSESSMENT 276
? SAFE AND EFFECTIVE EXERCISE 277
Chronic Conditions 281
Arthritis 281
? RHEUMATOID ARTHRITIS 281
Clinical Presentation/Assessment 281
Safe and Effective Exercise 282
? OSTEOARTHRITIS 283
Obesity and Osteoarthritis 283
Clinical Presentation/Assessment 283
Safe and Effective Exercise 283
Contentsxvii
? MEDICATION EFFECTS FOR RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS 284
? EXERCISE GUIDELINES FOR RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS 284
Osteoporosis 285
? RISK FACTORS FOR OSTEOPOROSIS 285
? CLINICAL PRESENTATION/ASSESSMENT 287
? DIETARY AND PHARMACOLOGICAL SUPPORT FOR BONE HEALTH 287
? SAFE AND EFFECTIVE EXERCISE 288
10 Exercise Programming across the Lifespan: Children and Adolescents, Pregnant
Women, and Older Adults 299
Children and Adolescents 300
Physical and Physiological Changes 300
? BODY SIZE AND COMPOSITION 300
? CARDIORESPIRATORY FUNCTION 301
? MUSCULAR STRENGTH, FLEXIBILITY , AND MOTOR PERFORMANCE 301
? RATING OF PERCEIVED EXERTION 302
? THERMOREGULATION 302
Motor Skills and Physical Activity 302
The Impact of Chronic Exercise 302
Exercise Programming and Specific Exercise Considerations 303
? CHILDREN 304
? ADOLESCENTS 304
Pregnant Women 305
Physical and Physiological Changes 305
The Impact of Chronic Exercise 306
Exercise Programming and Specific Exercise Considerations 308
Special Considerations during Pregnancy 310
Older Adults 310
Physical and Physiological Changes 311
? BODY COMPOSITION AND MUSCULOSKELETAL FUNCTION 311
? CARDIORESPIRATORY FUNCTION AND THERMOREGULATION 312
The Impact of Chronic Exercise 313
Exercise Programming and Specific Exercise Considerations 313
? AEROBIC ACTIVITY 315
? MUSCLE-STRENGTHENING ACTIVITY 315
? FLEXIBILITY ACTIVITY AND NEUROMOTOR EXERCISES 316
? THERMOREGULATION 316
PART IV: Behavior Change 325
11 Theories of Behavior Change 326
Importance of Theories and Models 327
Transtheoretical Model 327
Social Cognitive Theory 328
Self-Efficacy 329
Relapse Prevention 333
Social Ecological Model 334
Theory of Planned Behavior 337
Self-Determination Theory 338
Hedonic Theory 339
Contentsxviii
12 Facilitating Health Behavior Change 347
Practical Strategies for Behavior Change 348
Identifying Benefits of Physical Activity 348
Setting Goals 349
Using Self-Monitoring Tools 349
? SELF-MONITORING RECOMMENDATIONS 350
? PHYSICAL ACTIVITY MONITORS 351
Increasing Social Support 351
Regulating Emotions 351
Enhancing Self-Efficacy 353
Problem-Solving Barriers to Physical Activity 354
Increasing Options for Physical Activity 356
Preventing Relapse 356
Facilitating Behavior Change: The Role of the Exercise Physiologist 357
Incorporating Behavior Change into Practice 357
Improving Communication 359
Using Motivational Interviewing 360
Working with Diverse Populations 366
? OLDER ADULTS 366
? RACE/ETHNICITY 367
13 Healthy Stress Management 371
The Stress Response 372
Sources of Stress 372
Appraisal of Stress 373
Coping 373
? PROBLEM-FOCUSED COPING 374
? EMOTION-FOCUSED COPING 374
The Physiological and Psychological Response to Stress 374
General Adaptation Syndrome and Allostasis 374
The Effects of Stress on Health 376
? DIGESTIVE ISSUES 376
? HEADACHES 377
? CARDIOVASCULAR AND METABOLIC DISEASES AND THE ROLE OF CORTISOL 378
? IMMUNE SUPPRESSION, CANCER, AND MULTIPLE SCLEROSIS 378
Stress and Psychological Functioning 378
? PSYCHOLOGICAL DISTRESS, ANXIETY, AND DEPRESSION 378
? FATIGUE AND BURNOUT 379
? COGNITIVE DEFICITS 379
Healthy Stress Management 379
Exercise 379
Enhancing Social Support 380
Improving Personal Control and Self-Efficacy 382
Mind–Body Techniques for Reducing Stress 383
? DIAPHRAGMATIC BREATHING AND BODY SCANS 384
? PROGRESSIVE MUSCLE RELAXATION 384
? BIOFEEDBACK 384
? MASSAGE 385
? MEDITATION AND PRAYER 385
? MINDFULNESS 385
? YOGA AND MARTIAL ARTS 386
? REFERRING A CLIENT OR PATIENT TO A PSYCHOLOGIST 386
Contentsxix
PART V: Business 395
14 Legal Structure and Terminology 396
The Law and Legal System 397
Primary Sources of Law 397
Tort Law 399
Negligence 399
Insurance Coverage 402
Federal Laws 403
Sexual Harassment 403
Occupational Safety and Health Administration Guidelines 404
Health Insurance Portability and Accountability Act Guidelines and Recommendations 404
Client Rights and Responsibilities 405
Client Rights 405
Client Responsibilities 406
Contract Law 406
Employer and Employee Rights and Responsibilities 406
Federal Employment Laws 407
Hiring and Prehiring Statutes 407
Facility Policies and Procedures 410
15 Leadership and Management 415
Defining Leadership and Management 416
Operational Definitions 416
Evidence-Based Management 418
Leadership: Past, Present, and Future 419
Transactional Model 419
Visionary Model 419
Organic Model 420
Leadership Theory and Model 420
Leadership Behaviors and Theories 421
Trait Theory 421
Situational Leadership Theory 421
Path–Goal Leadership Theory 422
Transformational and Transactional Leadership 422
Lewin’s Leadership Styles 423
Servant Leadership 423
Leader–Member Exchange Theory 424
Emotional Intelligence 424
Contextual Intelligence and Three-Dimensional Thinking 425
Management Techniques 427
Management Grid (Blake and Mouton) 427
Scientific Management (Frederick W. Taylor) 427
Bureaucratic Model of Management (Max Weber) 428
Total Quality Management (W. Edwards Deming) 428
Management by Objective (Peter Drucker) 429
Motivator-Hygiene Theory (Fredrick Herzberg) 429
Theory X and Y (Douglas McGregor) 430
Behavioral Approach (Mary Parker Follet) 430
Organizational Behavior 431
Strategic Planning 431
Contentsxx
16 General Health Fitness Management 436
Human Resource Management 437
Organizational Culture and Teamwork 437
Staffing 438
? TYPES OF POSITIONS 438
? EMPLOYEE VERSUS INDEPENDENT CONTRACTOR 439
? EXEMPT VERSUS NONEXEMPT 441
? FULL-TIME VERSUS PART-TIME 441
? JOB DESCRIPTIONS 442
Recruiting and Selection 442
? RECRUITING STRATEGIES 442
? SELECTION PROCESS 444
? INTERVIEW PROCESS 445
Compensation 445
Employee Orientation, Development, and Training 446
Performance Management and Employee Retention 447
? SETTING GOALS 447
? PERFORMANCE APPRAISALS 448
? EMPLOYEE RETENTION 449
Section Summary 449
Risk Management 449
Standards and Guidelines for Risk Management and Emergency Procedures 449
Types of Business Liability Insurance 452
Risk Management Summary 453
Facility Management and Operations 453
Clinical and Nonclinical Health/Fitness Facility Settings 453
? CLINICAL FITNESS SETTING 454
? NONCLINICAL FITNESS SETTINGS 454
Operations 455
Equipment 455
Financial Management 457
Accrual and Cash Accounting 458
Financial Statements 458
? BALANCE SHEET 458
? PROFIT AND LOSS STATEMENT 460
Budgeting 461
? TYPES OF BUDGETS 461
? CREATING A BUDGET 461
Income Management 462
Expense Management 462
Section Summary 463
Marketing and Sales 463
Marketing 463
? MARKETING TOOLS 464
Sales 465
Section Summary 465
Programming 466
Programs in Demand 466
Steps to Successful Programming 466
Section Summary 467
Contentsxxi Contents
17 Marketing 469
Marketing Basics 470
People 470
Product 472
Place 472
Price 474
Promotion 475
? BRANDING 476
? ADVERTISING 476
? REFERRAL 476
? DIRECT MAIL/E-MAIL 477
? INTERNET 477
? BUSINESS TO BUSINESS 477
? SPONSORSHIP 477
? PERSONAL SALES 478
Finding Leads 478
Qualifying Prospects 479
The Art of the Deal 479
? PUBLIC RELATIONS 479
18 Professional Behaviors and Ethics 484
History 485
Accreditation 485
Committee on the Certification and Registry Board 489
ACSM Code of Ethics 489
Scope of Practice 489
Scenario 1 491
Scenario 2 492
Scenario 3 493
Conflict of Interest 495
Providing Evidence-Based Information 495
Step 1: Develop a Question 495
Step 2: Search for Evidence 496
? PERSONAL EXPERIENCE 496
? ACADEMIC PREPARATION 496
? RESEARCH KNOWLEDGE 496
Step 3: Evaluate the Evidence 496
Step 4: Incorporate Evidence into Practice 496
Maintaining Certification 498
Ways to Earn Continuing Education Credits 499
Personal Characteristics 499
Appendix A Editors from the Previous T wo Editions of ACSM’s Resources for the Exercise
Physiologist 507
Appendix B Contributors from the Previous T wo Editions of ACSM’s Resources for the Exercise
Physiologist 508
I n dex 511