Domain II Study Guide

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JTA: E, KSA: a

Exercise prescriptions for achieving weight related goals, including weight gain, weight loss and weight maintenance

Resources: Chapter 7 ACSM-Resources for the EP, Chapter 6 ACSM-GETP

FITT-VP Aerobic Exercise Recommendations

F - >/= 5 days/week of moderate intensity exs, 3 days/week of vigorous intensity exs, or combination of moderate-to-vigorous intensity exs 3-5 days/week

I - moderate-to-vigorous intensity

T - 30-60 minutes/day

T - regular, purposeful ex that involves major muscle groups and is continuous and rhythmic

V - >/= 500-1000 MET-min/week is recommended to maintain body weight

P - gradual progression of exs volume by adjusting exs duration, frequency, and/or intensity is reasonable until the desired goal is met

FITT-VP Resistance Exercise Recommendations

F - each major muscle group trained >/= 2-3 days/week

I - 60-70% 1RM to improve strength, experienced strength trainers can gradually increase to 80% 1RM

T - 8-12 reps, 2-4 sets

T - resistance exercises involving each major muscle group

P - gradual progression of greater resistance and/or more reps/set and/or increasing frequency

For safe and effective weight loss, ACSM recommends no more than 1-2 pounds per week. To do this, caloric expenditure must be greater than caloric consumption, this creates a caloric deficit. For safe and effective weight gain, caloric intake must exceed caloric expenditure, however diet plays a huge role in gaining lean body mass and not unhealthy mass.

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JTA: E, KSA: b

Energy balance and basic nutritional guidelines (e.g., MyPlate, USDA Dietary Guidelines for Americans)

Resources: Chapter 7 Powerpoint slides 22-25, ACSM - Resources for the EP pg. 198, 205-207 , ACSM - GETP pg. 287-288

Energy Balance - energy intake (the amount of calories consumed) and energy expenditure (the amount of calories expended). The management of body weight is dependent on energy expenditure:

to reduce body fat, energy expenditure must exceed energy intake (negative energy balance)

body weight is maintained during energy balance; intake = expenditure

Total Energy Expenditure (TEE) - the total number of calories expended each day; reflects the amount of energy required to carry out all the metabolic processes within the body, including the growth of new cells, maintaining the functions of body tissues, and providing fuel for movement. 3 main components to determining TEE:

60-70% TEE: Resting energy expenditure (REE or resting metabolic rate [RMR] or basal metabolic rate [BMR])

10% TEE: thermic effect of food

20-30% TEE: PA expenditure

REE - energy required to maintain normal regulatory balance and body functions at rest; metabolism, lean body mass, age, gender, and ethnicity all effect REE

Thermic effect - energy required to eat and digest foods

Calculating caloric needs and energy expenditure - pg 200-201

USDA Dietary Guidelines for Americans - dietary guidelines to help improve individuals overall health through evidence-based recommendations for healthy food choices

Healthy eating pattern:

variety of vegetables from all subgroups

whole fruits

whole grains

fat-free or low-fat dairy products

variety of proteins including seafood, lean meats and poultry, legumes, nuts, seeds, and soy

oils

MyPlate - useful tool to visualize a healthy eating pattern and is in accordance with the updated Dietary Guidelines; http://www.choosemyplate.gov/dietary-guidelines

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JTA: E, KSA: c

Weight management terminology (e.g., obesity, overweight, percent fat, BMI, lean body mass, anorexia nervosa, bulimia nervosa, binge eating, metabolic syndrome, body fat distribution, adipocyte, bariatrics, ergogenic aid, fat-free mass (FFM), sing metabolic rate (RMR) and thermogenesis)

Domain II JTA: E, KSA: c flashcards

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JTA: E, KSA: d

The relationship between body composition and health

Resources: Chapter 7 Powerpoint, Chapter 7 ACSM - Resources for the EP

Body composition - amount of fat in relation to amount of lean body mass

Underweight, normal weight, overweight, Obese (Class I, II, or III)

Obesity - characterized by high amounts of body fat in relation to overall lean body mass and is linked to numerous chronic diseases such as HTN, cardiorespiratory disease, dyslipidemia, Type 2 Diabetes, some cancers, sleep apnea, arthritis, and numerous other musculoskeletal problems

Associated with premature mortality from CVD and other diseases such as cancer

central abdominal obesity is associated with metabolic syndrome and increased risk for CVD

Important component of health-related physical fitness

EP-C must measure body composition, make sound weight loss goals, formulate exs and nutritional recommendations for weight loss and weight management

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JTA: E, KSA: e

The unique dietary needs of client populations (e.g., women, children, older adults, and pregnant women)

Resources: http://www.open.edu/openlearncreate/mod/oucontent/view.php?id=316&printable=1, https://www.betterhealth.vic.gov.au/health/healthyliving/food-and-your-life-stages

Children

increased requirements of energy, protein, essential fatty acids, calcium and phosphorus, and zinc

limit energy-dense, nutrient-poor snack foods; avoid sugary foods and drinks, especially if sticky or acidic

total water requirements are also higher, fruit juices should be limited and soft drinks avoided

reduced-fat milks are not recommended for children under the age of two, due to increased energy requirements and high growth rate

fast foods need to be balanced with nutrient-dense foods such as whole grain breads and cereals, fruits, legumes, nuts, vegetables, fish and lean meats

milk, yoghurt and cheese (mostly reduced fat) should be included to boost calcium intake

Women

eat foods rich in calcium

high-fiber, low-fat and low-salt diet – a diet high in phytoestrogens has been found to reduce many symptoms of menopause, such as hot flushes. Good food sources include soy products (tofu, soymilk), chickpeas, flax seeds, lentils, cracked wheat and barley.

variety of whole grain, nutrient-dense food – wholegrains, legumes and soy-based foods (such as tofu, soy and linseed cereals), fruits and vegetables, and low-fat dairy products

Older Adults

well-balanced eating and regular exercise

eat foods that are nutrient dense rather than energy dense, including eggs, lean meats, fish, liver, low-fat dairy foods, nuts and seeds, legumes, fruit and vegetables, wholegrain breads and cereals

try to spend time outside each day to boost vitamin D synthesis for healthy bones

limit foods that are high in energy and low in nutrients such as cakes, sweet biscuits and soft drinks

choose foods that are naturally high in fiber to encourage bowel health

limit the use of table salt

choose from a wide variety of foods and drink adequate fluids

Pregnant Women

don't "eat for two" as this will lead to unnecessary weight gain

increased requirements include folate, iron, vitamin B12 and iodine

high-folate foods (such as green leafy vegetables, fruits and legumes)

food sources such as seafood, iodised salt and bread

dairy products for adequate calcium intake

no alcohol, no tobacco, no drugs

drink plenty of fluids

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JTA: E, KSA: f

Common nutritional ergogenic aids, their purported mechanisms of action, and associated risks and benefits (e.g., protein/amino acids, vitamins, minerals, herbal products, creatine, steroids, caffeine)

Resources: EXS 499 - Ergogenic Aids Powerpoint, Anabolic Steroids Powerpoint

Caffeine

central nervous stimulant that can elevate blood glucose and increase fat utilization; effect is variable and dose-related, can even be diminished in regular users

moderate-to-high doses increases endurance exs performance; recommended dose between 3-6 mg/kg

enhanced delivery of fuel to skeletal muscle

Anabolic Steroids

effects blood testosterone concentration

clinical uses such as in burn treatments, surgery, radiation therapy and anti-aging lated sarcopenia

binds to androgen receptor to exert androgenic activity

increased BP, blood clotting, production of RBC's, decreased HDL:LDL ratio, left ventricular hypertrophy, decreased left ventricular function

greater risk of prostate cancer and atherosclerotic disease

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JTA: E, KSA: g

Methods for modifying body composition including diet, exercise, and behavior modification

Resources: Chapter 7 Powerpoint, ACSM-Resources for the EP pg. 201-209, Chapter 6 ACSM-GETP

Regarding weight loss, the combination of diet and moderate-to-vigorous physical activity produces the largest weight loss. The ACSM uses the FITT-VP principle: Frequency, Intensity, Time, Type, Volume, and Progression. The FITT principle for weight loss owing ACSM guidelines is:

F: >/= 5 days/week

I: moderate-to-vigorous aerobic activity; progression to more vigorous intensity may result in further health benefits

T: >/= 150 minutes/week of moderate-intensity aerobic activity; progression to >/= 300 minutes/week may result in further health benefits

T: Primary mode of exs should be aerobic physical activities that involve the large muscle groups; for a balanced program, resistance training and flexibility exercises should be incorporated

Healthy eating pattern:

variety of vegetables from all subgroups

whole fruits

whole grains

fat-free or low-fat dairy products

variety of proteins including seafood, lean meats and poultry, legumes, nuts, seeds, and soy

oils

Limit: saturated fats (<10% of cal/day), trans fats, added sugars (<10% of cal/day), and sodium (<2,300 mg per day). Consume alcohol in moderation: Men = 2 drinks/day, Women = 1 drink/day

MyPlate - useful tool to visualize a healthy eating pattern and is in accordance with the updated Dietary Guidelines; http://www.choosemyplate.gov/dietary-guidelines

Nutritional Behavior Strategies - self-monitor by keeping food or PA log, set goals that are realistic and specific, modify the environment to support behavior change, and identify situations that are challenging and experiment with solutions

Avoid common weight management myths:

"fat turns to muscle or vice versa" - fat and muscle are two separate tissues, it is impossible to change one type into the other

"spot reducing works" - it is impossible to reduce the amount of fat in a chosen region of the body

"gaining weight at the start of an exercise program is from increased muscle" - muscle hypertrophy occur sly after 6-8 weeks of higher intensity resistance training

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JTA: E, KSA: h

Fuel sources for aerobic and anaerobic metabolism including carbohydrates, fats, and proteins

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JTA: E, KSA: j

The importance of maintaining normal hydration before, during and after exercise

Hydration is crucial when exercising, especially in hot and humid conditions. Possible heat illnesses include heat cramps, heat exhaustion, and heat stroke.

symptoms of heat cramps include painful muscle spasms in the legs, stomach, arms, or back

symptoms of heat exhaustion are more serious and can include faint or weak feelings, nausea, headache, fast heartbeat, and low blood pressure

the most serious heat-related illness is heat stroke; symptoms can include high body temperature (higher than 104°F), fast heartbeat, flushed skin, fast breathing, and possibly even delirium, loss of consciousness, or seizures

Proper Hydration

before exs - 17 to 20 ounces of water 2 to 3 hours before you start exercising and 8 ounces of water 20 to 30 minutes before exercising or during warm-up

during exs - 7-10 ounces every 10-20 minutes

after exs - 8 ounces no more than 30 minutes; 16-24 ounces for every pound lost

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JTA: E, KSA: k

The consequences of inappropriate weight loss methods (e.g., saunas, dietary supplements, vibrating belts, body wraps, over-exercising, very low-calorie diets, electric stimulations, sweat suits, fad diets)

Resources: Chapter 7 Powerpoint, ACSM-Resources for the EP pg. 207-208

Per ACSM, appropriate weight loss methods include exercise, dietary modification, behavioral strategies, and bariatric surgery. Inappropriate methods to losing weight can have negative health consequences associated with them.

Saunas - dehydration, only lose water weight, low amount of weight loss, temporary weight loss

Vibrating belts - no weight loss

Body wraps - small weight loss temporary weight loss, skin irritation

Electrical muscle stimulators - no change in body composition, bruising, skin irritation

Sweat suits - dehydration, only lose water weight, low amount of weight loss, temporary weight loss

Dietary supplements - not regulated by FDA, so dosage may to be known; my have nutrient drug interactions, drug-drug interactions, and other side effects such as nausea, dizziness, and racing heart

Very-low calorie diets - may not meet nutrient needs of the individual promoting deficiencies in specific nutrients (e.g., calcium deficiency leads to brittle, broken bones, hip fractures); could lead to dehydration, constipation, or fatigue

Fad diets - often "cut-out" a food group, which leads to specific nutrient, vitamin, and mineral deficiencies; not sustainable for long periods; low carbohydrate diets do not meet the body's requirement of a minimum of 130 g of carbohydrates/day; could lead to lack of energy and fatigue; could lead to dehydration and/or constipation

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JTA: E, KSA: l

The kilocalorie levels of carbohydrate, fat, protein, and alcohol

Resources: http://www.dining.ucla.edu/housing_site/dining/SNAC_pdf/CaloriesCount.pdf

Domain II JTA: E, KSA: l slide set

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JTA: E, KSA: m

The relationship between kilocalorie expenditures and weight loss

Resources: ACSM-Resources for the EP pg. 197-199, https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/calories/art-20048065

Per ACSM, healthy weight loss should not exceed 1-2 pounds per week. There are multiple factors that determine an individual's daily caloric needs, such as their body size and their physical activity level.

- 3,500 kilocalories = 1 pound of fat

- 1-2 lbs/week is equal to an average daily caloric deficit of 500-1000 calories; the individual should expend that many more calories/day than they are consuming

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JTA: E, KSA: o

The relationship between body fat distribution patterns and health

Resources: ACSM-GETP pg. 71-72

The pattern of body fat distribution is recognized as an important indicator of health and prognosis.

Android obesity (abdominal fat) - characterized by more fat in the trunk, increases the risk of HTN, Metsyn, Type 2 Diabetes, dyslipidemia, CVD, and premature death

Gynoid/Gynecoid obesity (distributed in hip and thigh) - characterized by more fat in the lower part of the body, increased risk for CVD risk factors but not to the degree of android obesity

Increased visceral fat (within and surrounding thoracic and abdominal cavities) confer a higher risk for development of the Metsyn compared to distribution of fat within the subcutaneous compartment

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JTA: E, KSA: p

The physiology and pathophysiology of overweight and obese clients

Resources: Chapter 7 Powerpoint, Chapter 7 ACSM-Resources for the EP, ACSM-GETP pg. 287-288

For all ages and ethnicities, overweight and obesity are linked to an increased risk of the development of numerous chronic diseases including CVD, Diabetes Mellitus, some forms of cancer, and countless musculoskeletal problems.

management of body weight is dependent on energy balance that is determined by energy intake and energy expenditure

to lose weight, expenditure must exceed intake

sustained weight loss of 3-5% is likely to result in clinically meaningful reductions in several CVD risk factors including:

triglyceride, blood glucose, and HbA1C levels, and risk of developing Type 2 Diabetes

lifestyle interventions for weight loss that combine energy intake with increases in energy expenditure through exercise a forms of PA stern result in an initial 5-10% reduction in body weight

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JTA: E, KSA: q

The recommended FITT-VP principle for clients who are overweight and obese

Resources: Chapter 8 Powerpoint, ACSM-GETP pg. 289

Aerobic FITT-VP Recommendations

F - >/= 5 days/week

I - initial intensity moderate (40-59% Vo2R/HRR); progress to vigorous (>/= 60% Vo2R/HRR)

T - 30 minutes/day; 150 minutes/week; increase to 60 minutes/day or more (250-300 minutes/week)

T - prolonged, rhythmic activities using large muscle groups (walking, cycling, swimming)

Resistance FITT-VP Recommendations

F - 2-3 days/week

I - 60-70% 1RM; gradually increase to enhance strength and muscle mass

T - 2-4 sets 8-12 reps for each of the major muscle groups

T - resistance machines and/or free weights

Flexibility FITT-VP Recommendations

F - >/= 2-3

I - stretch to the point of feeling tightness or slight discomfort

T - hold static stretch for 10-30 seconds; 2-4 reps of each exercise

T - Static, dynamic, and/or PNF

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JTA: E, KSA: r

Comorbidities and musculoskeletal conditions associated with overweight and obesity that may require medical clearance and/or modifications to exercise testing and prescription

Resources: Chapter 7 Powerpoint, Chapter 7 ACSM-Resources for the EP, ACSM-GETP pg. 287

Hypertension

Cardiorespiratory disease

Dyslipidemia

Type 2 Diabetes

some cancers

sleep apnea

Arthritis

Premature mortality from cardiorespiratory disease

Metabolic syndrome

CVD

Musculoskeletal issues, particularly in the knee, hip, ankle, and hands

All of these will require modification to exercise testing and prescription. Some GXT protocols would not be appropriate for overweight and/or obese individuals and exs prescription would have to be modified to a more appropriate FITT-VP guideline.

All CV, metabolic, or renal disease S/S and physical inactivity would all induce a medical clearance be required.

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