ACE PT Sample Page (version 2) by ProactiveProducts and the Fitness Tutor Legend o "# 2# %# &# '# +,# symbols

used in this sample summary! Arro$ up () means increase or increasing Arro$ do$n () means decrease or decreasing CPT! means Certi ied Personal Trainer C means Client (2 is )*ygen

SPEC+AL P)P-LAT+).S A./ 0EALT0 C).CE1.S A# Approval by a medical doctor re2uired or these clients 3# Lo$ or non4impact5 lo$ intensity e*ercise program $ith gradual progression# C# Cardiovascular /isorders "# Leading cause o death in 6estern $orld 2# CA/ results rom atherosclerosis $hich is a speci ic orm o atherosclerosis $ith accumulation o atty material on inner $alls o arteries causing them to harden5 thic7en and lose elasticity# .arro$ing may result rom initial in8ury to inner lining o arteries due to high blood pressure5 L/L cholesterol5 elevated blood glucose or other chemical agents rom cigarettes# )nce inner lining damaged5 accumulation o pla2ue (calci ied cholesterol and at deposits) diameter# Atherosclerosis also causes cerebral and peripheral vascular diseases e#g# heart attac75 angina5 stro7e and intermittent claudication (spasms or bloc7ages) %# E*ercise and CA/! Cs $ho su ered heart attac75 cardiac surgery etc can bene it rom supervised cardiac rehab program# &# E*ercise 9uidelines or CA/ a# C can only see a CPT a ter passing cardiac rehab program# Then CPT should as7 cardiologist to provide upper4limit heart rate and guidelines or e*ercise# b# Lo$4ris7 cardiac clients (") de inition! C that have (a) uncomplicated clinical course in hospital5 (b) no evidence o resting or e*ercise induced ischemia (local de iciency o blood supply caused by constriction or obstruction o arteries $hich causes supply o o*ygen to tissues# (c) functional capacity : ;4< =ETS % $ee7s ollo$ing any medical event>treatment that re2uired hospitali?ation5 (d) normal ventricular unction : '( @ ejection fraction (@ o blood pumped out o heart per beat) and (e) no signi icant resting or e*ercise induced arrhythmias (abnormal heart rhythms seen on electrocardiogram)# (2) should have stable cardiovascular and physiological responses to e*ercise# (%) Cs $ith 2 or more ACS= CA/ ris7 actors! need =/ approval to start $or7ing out# Asee Chpt BC (&) /ocumented CA/! should have maximal-graded exercise test (GXT) to see unctional capacity and cardiovascular status# 9,T uses treadmill or cycle ergometer test measuring or estimating ma*imum aerobic capacity by gradually increasing intensity until person has reached voluntary e*haustion (ma*imal level)

'# Sample E*ercise 1ecommendation a# =ode! lo$4intensity endurance (e#g# $al7ing5 s$imming5 stationary bi7e) as primary activity# Lo$ $eight and high reps as $ell unless cardiovascular problem $ithin last month# Avoid isometric e*ercises because drastically blood pressure b# +ntensity! 1PE D4"&# 01 can be as slo$ as 2( beats over resting 01 and up to &(4E'@ o ma*imal HR Reserve (Farvonen Formula) c# /uration! total duration should be gradually to 2(4%( minutes o continuous or interval training G additional time or $arm4up and cool4do$n# d# Fre2uency! %4' times>$ee7 /# 0ypertension (high 3P) "# blood pressure : "&(>D( mm0g 2# ris7 o CA/ by %4&* and stro7e by up to E* %# 0o$ to 1educe a# E*ercise and 0ypertension! regular cardio systolic (top H) and diastolic (bottom H) 3P by an average o "( mm0g# Probably because cardiac output and total peripheral resistance $hen body at rest# Should not hold breath during or strain during e*ercise (Valsalva maneuver or pressure on thoracic cavity caused by orced e*halation $ith breath held# So glottis in the bac7 o the throat is closed# E*erting orce $ith the glottis closed results in an increase in pressure $ithin chest cavity This increase in pressure s2uee?es do$n on the large veins in chest cavity5 impeding venous return o blood bac7 to heart5 causing di??iness or ainting as less blood lo$ to brain#)# Circuit training $ith lo$ $eight and high reps rather than heavy li ting# -se 1PE scale to monitor intensity since medications can alter training 01 during $or7out# (") =ode! primary e*ercise should be endurance but can also use lo$ $eight5 high reps $eight training# Avoid isometric e*ercises# (2) +ntensity! &(4;'@ 01 (%) Fre2uency! &*>$ee7# Elderly or initially lo$ unctional capacity or shorter duration# (&) /uration! $arm4ups and cool4do$ns : ' mins# 9radually total e*ercise duration to %(4;( mins per session depending on medical history and clinical status o C# b# $eight c# salt &# 3e$are o medication changes and get $ritten instructions rom =/# '# =/ may tell C to record their blood pressure be ore and a ter e*ercise ;# =ove slo$ly $hen getting up rom loor because more at ris7 rom orthostatic hypotension (drop in 3P $hen rising to erect position) $hen ta7ing hypertensive medication# E# 3oth hypertensive and hypotensive responses are possible during and a ter e*ercise or those $ith hypertension# <# Care ully monitor your clientIs 3P during e*ercise initially and possibly long4term# 3P is more accurately measured during lo$er body activity (e#g# bi7ing and leg e*tensions)# E# Stro7e (a7a cerebrovascular accidents or CBA) "# %rd leading cause o death# 2# similar to a heart attac7 but a ects arteries o C.S# 6hen nerve cells are deprived o o*ygen because o bloc7age or rupture o blood vessel supplying blood to brain then die $ithin mins# %# 1is7 Factors a# high 3P (a7a hypertension) is primary ris7 actor

E(4<(@ caused by thrombosis! ormation o blood clot $ithin intact blood vessel# heart disease smo7ing high red blood cell count transient ischemic attac7s (T+As)! momentary reductions in o*ygen delivery to brain possibly resulting in sudden headache5 di??iness or blac7out# &# E*ercise and Stro7e a# best to stro7es because high 3P (a7a hypertension) is primary ris7 actor# b# =ay enhance ibrinolytic activity $hich is system or dissolving blood clots# c# Follo$ same standards as or CA/ and hypertension# F# Peripheral Bascular /isease (PB/) "# caused by atherosclerotic lesions in peripheral arterial and>or venous blood vessels usually in arteries in legs# =ost $ith PB/ are older and have long established CA/ ris7 actors# 2( times more li7ely i diabetic# 2# Symptoms! muscular pain caused by ischemia (reduced blood lo$) to $or7ing muscles# Spasms or bloc7ages (a7a claudication)# 1anges rom mild pain to unbearable pain# %# Treatments! a# Complete medical e*am be ore begin e*ercise program b# drugs to dilation o arteries and veins5 c# regular daily e*ercise $ith re2uent rest to blood lo$ and unctional capacity and CA/ ris7# Lo$4intensity5 non4$eight bearing acts are best# Avoid cold air or $ater $hich ris7 o vasoconstriction (narro$ing o openings o blood vessels caused by contraction o smooth muscle cells in vessel $alls)# -se '4"( min $arm4up and cool do$n# +nterval training o '4"( mins5 "4%* daily may initially be good# Since many PB/ clients are diabetic5 they need to avoid blisters on eet and other in8uries that can cause in ection# Should be closely supervised by cardiac rehab program# d# artery by4pass surgery# 9# diabetes! "# /iabetes mellitus involves reduced insulin secretion by pancreatic beta cells and>or reduced sensitivity to insulin# +t is an interruption in the bloodIs supply line o ood# +nsulin is the crucial hormone secreted by pancreas to allo$ glycogen to penetrate the cell $all# The receptor is the loc7 and insulin is the 7ey to unloc7 the receptor# 2# Seventh leading cause o death in -S but it may be cause o even more deaths as <(@ o diabetics die o cardiovascular events# 0eart attac7 $ill be deemed cause o death $hen it $as caused by diabetes# (=enIsI 0ealth Sept 2((")! %# Signs (=enI 0ealth Sept 2((")! a# 3lood sugar level : "2' is diabetic# Avoid misconceptions that sports drin7s5 nutritional supplements5 ruit 8uices5 and at4 ree oods are good or you# (") /anger Foods (a) "' tangerines a day $ill cause your blood sugar to s7yroc7et# Avoid a lot o bananas5 $hite bread5 $ine and pasta# (b) Fruit 8uices are a big problem# "; ounces o 8uice e2uals ' apples# (c) Energy bars have &(( calories per bar# b# Jou eel sleepy right a ter a meal#

b# c# d# e# #

c# Jour vision has become a little blurry or headaches a ter reading# + too much sugar is in your blood stream it causes the lenses in your eyes to stretch resulting in blurred vision# d# Jour blood pressure is higher than normal even i only slightly# e# Jour breath constantly smells li7e acetone (nail polish remover) because insu icient insulin to turn carbs into glycogen so liver $ill begin to brea7 at do$n as uel# # Those $ith thri ty genes $hich helped people survive during lean times are contributing to diabetes# &# E ects o either type! a# glucose becomes to*ic as cannot be used by body so to*ic to heart5 7idney5 retinas b# causes nerve damage so amputations re2uired# '# T$o Types! a# +//= (+nsulin /ependent /iabetes =ellitus or Type ") (") caused by destruction o insulin producing beta cells in pancreas causing little or no insulin secretion# 9enerally occurs in childhood and regular insulin in8ections re2uired to regulate blood glucose levels# Pancreas mal unctions and stops producing insulin ormerly 7no$n as 8uvenile diabetes because erroneously thought to only happen to 7ids) (2) Symptoms are e*cessive thirst and hunger5 re2uent urination5 $eight loss5 blurred vision5 recurrent in ections# /uring insulin de iciency5 higher4than4normal level o glucose in blood because or upta7e and storage# Portion o e*cess glucose is e*creted in urine causing thirst5 $eight loss5 and appetite# (%) =ust spea7 to =/ or /iabetes Educator to develop diet5 e*ercise5 and medication# Primary goal o e*ercise or +//= is better glucose regulation and 0eart disease ris7# Timing o e*ercise5 amount o insulin in8ected5 and in8ection site are important to consider be ore e*ercising# E*ercise should be consistent so a regular pattern o diet and insulin dosage can be maintained# +deal i per orm similar e*ercise routine every day5 $ithin " hour o consuming meal>snac7# (&) /isadvantages o +//= (a) causes abnormalities in metabolism o carbohydrates5 protein5 and at# (b) ris7 or 7idney ailure5 nerve disorders5 eye problems5 heart disease# Prolonged and re2uent elevation o blood sugar damages capillaries (microangiopathy) causing poor circulation# (c) Chronic high glucose levels called hyperglycemia# (d) /eadly i untreated but symptoms not al$ays clear in early stages# (') E ective /iabetic Control (a) glucose regulation by regular glucose assessment5 diet5 e*ercise and insulin medication (b) E*ercise not proven to help +//= but $ill improve unctional capacity5 CA/ ris75 insulin receptor sensitivity# =ust spea7 to =/ or /iabetes Educator to develop diet5 e*ercise5 and medication# ") =ode! endurance e*ercise e#g# $al7ing5 s$imming5 cycling 2) +ntensity! '(4;(@ o cardiac reserve5 gradually progressing to ;(4E(@ %) Fre2uency! &4E days per $ee7# Some may need to start out $ith several shorter daily sessions# &) /uration! +//= then gradually $or7 up to 2(4%( mins per session# (c) /o not in8ect insulin into primary muscle groups that $ill be used during $or7out because it $ill be absorbed too 2uic7ly causing hypoglycemia (sugar de iciency

in blood commonly caused by too much insulin5 too little glucose5 or too much e*ercise in the insulin dependent diabetic# (d) Chec7 blood glucose levels re2uently5 especially during and a ter $or7out# Lac7 o insulin during or a ter $or7out may cause hyperglycemic e ect and rapid mobili?ation o insulin $hich dangerously lo$ers blood glucose levels# E*ercise has an insulin4li7e e ect5 so insulin dosages should be lo$ered prior to e*ercise# (e) Al$ays carry a rapid acting carb (e#g# 8uice or candy) i they get hypoglycemia# Carb snac7 should be consumed be ore and during prolonged e*ercise# ( ) Should al$ays e*ercise at same time each day or better control# b# .+//= (.on4+nsulin /ependent /iabetes =ellitus a7a Type 2 /iabetes) (") most common orm o diabetes5 a ecting D(@ o diabetics# Typically a ects over$eight adults# +nsulin does not unloc7 receptors so glycogen cannot lo$ into cells# (2) Some never have any classic symptoms o diabetes but mostly caused by diet5 genetic predisposition to store at5 i over &' related to a diabetic5 or are blac75 Latino or native# 3ut /r# La?ar at -niv# o Penn discovered in 2((" that at cells secrete resistin hormone $hich acts li7e rust in a loc7# (%) Treatment! (a) diet modi ication# )nly eat lo$ 9+ oods5 ta7e &(( mg o vitamin E daily5 %4; drin7s o alcohol per $ea75 change cholesterol medication to pravastatin# (b) medication (insulin or oral agents) (c) e*ercise therapy# 6al7ing ast and long is one o best $ays to lose at# ) ten reversible $ith permanent $eight loss# blood cholesterol levels and $eight# 6ith e*cessive blood glucose elevation5 blood ats rise to become primary energy source or body# 0igher4than4normal blood at levels put diabetics at : ris7 or heart disease# Primary goal o e*ercise or .+//= is $eight loss and control# <(@ o .+//= diabetics are over$eight# Losing $eight may allo$ them to reduce amount o oral insulin to ta7e# So long4duration e*ercise is best to lose $eight but should be lo$ intensity# /o not in8ect insulin into primary muscle groups that $ill be used during $or7out because it $ill be absorbed too 2uic7ly causing hypoglycemia (sugar de iciency in blood commonly caused by too much insulin5 too little glucose5 or too much e*ercise in the insulin dependent diabetic# ") =ode! endurance e*ercise e#g# $al7ing5 s$imming5 cycling 2) +ntensity! '(4;(@ o cardiac reserve5 gradually progressing to ;(4E(@ %) Fre2uency! &4E days per $ee7# Some may need to start out $ith several shorter daily sessions# &) /uration! + .+//= then &(4;( mins is recommended# (d) Chec7 blood glucose levels re2uently# E*ercise only i lood glucose levels are !"-"#$ mg%dl# /onIt e*ercise i blood glucose is K E( mg>dl or : "'( mg>dl# C should have speci ic instructions rom =/ in these cases# (e) Al$ays carry a rapid acting carb (e#g# 8uice or candy) i they get hypoglycemia# Carb snac7 should be consumed be ore and during prolonged e*ercise# ( ) Should al$ays e*ercise at same time each day or better control#