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Coronary Artery Disease Risk Factor Thresholds

Positive Risk Factors: Age- Men greater than or equal to 45 years of age; Women greater than or equal to 55 years of age
Family History- myocardial infarction, coronary revascularization, or sudden death before 55 years of age in father or other male first degree relative (ie. brother or son), or before 65 years of age in mother or other female first degree relative (i.e. sister or daughter)
Cigarette Smoking- current cigarette smoker or those who quit within the previous 6 months or exposure to enviro tobacco smoke
Sedentary Lifestyle- not participating in at least 30 min of moderate intensity (40-60% VO2 ) physical activity on at least three days of the week for at least three months
Obesity-body mass index of greater than or equal to 30 kg/m2, or waist girth of greater than 102 cm (40 inches) for men and greater than 88 cm (35 inches) for women
Hypertension-systolic bp greater than or equal to 140 mm Hg and or diastolic greater than or equal to 90mmHg, confirmed by measurements on at least two separate occasions, or on antihypertensive medication
Dyslipidemia- low-density lipoprotein (LDL-C) greater than or equal to 130 mgdL-1 or high density lipoprotein (HDL-C) cholesterol less than 40 mgdL-1, or on lipid lowering medication. If total serum cholesterol is all that is available use greater than or equal to 200mg*dL-1 rather than low-density lipoprotein (LDL) greater than 130mg/dL-1
Pre-diabetes- imparied fasting blood glucose greater than or equal to 100mg/dL-1 but less than 126 mg/dL or imparied glucose tolerance test (IGT) = 2 hours values in oral glucose tolerance test (OGTT) greater than or equal to 140mg/dL-1 but less than 200 mg/dL confirmed by measurements on at least two separate occasions

Negative Risk Factors: Coronary Artery Disease Risk Factor Thresholds

High Serum HDL cholesterol: greater than 60mg/dL

Max Testing

-might require physician supervision
-often require participants to reach max effort
-typically used to diagnose
Types of tests-diagnostic stress test- Bruce Test Protocol
-Cooper 12 min max field test
-1.5 max mile test

Submax Testing

-do not require max effort
-each test has a predetermined end point
-used to estimate cardiovascular fitness
-more appropriate for the gen pop.
Types of tests -cycle ergometer test
-treadmill test
-3 min step test

Antihypertensive medication

help lower bp
-overall class of antihypertensive agents lower bp, although the mechanisms of action very greatly

Antianginal medication

counters angina pain
-a drug used to treat angina pectoris, a symptom of ischemia heart disease

Bronchiodilators medication

opens the bronchial tubes
-help open the bronchial tubes of the lungs, allowing more air flow thro them.

Hypoglycemic medication

lowers blood sugar levels

Antiarrhythmic medication

supresses fast rhythms of the heart

Psychotropic medication

chem. subst. that crosses the blood brain barrier and acts primarily upon the CNS where it affects brain fxn, resulting in changes in perception, mood, consciousness, cognition, and behavior

Antihistamine medication

for treatment of allergic conditions

Vasodilator medication

relaxes smooth muscle in blood vessels, causes them to dialate

Anti-Cholesterol medication

lowers cholesterol


reduces bp

commonly used medications include

caffeine, nicotine, alcohol...

Indications for Test Termination (low risk)

-onset angina
-abnormal bp
-shortness of breath
-signs of poor perfusion (light headedness, confusion, cold or clammy hands)
-failure of heart rate to increase w/ increased exercise intensity
-noticeable change in heart rhythm
-subject requests to stop
-physical or verbal signs of severe fatigue
-failure of the testing equipment

Order of Fitness Assessment

Medical history, risk stratification and, informed consent
-resting hr, bp, height, weight, BMI, and body comp
-cardiovascular testing
-muscular strength and endurance testing
-flexibility testing

Explanation of the 3 min step test

-The purpose of the test: use recovery HR to estimate cardiovascular fitness level
-The benefits of the test: use this info to design an appro. cardio program
-The procedure: step up and down on a bench for 3 min
-recovery heart rate will be measured immediately following the test
***Tell the client that they can stop the test at any time

3 Min Step Test

-12 inch bench, a metronome and a time keeping device
-96bpm for 3 min
-avoid talking or moving the arms
-assess the client during the test
-remind the client that can stop the test at any time
-upon completion of test have the client sit and locate their pulse w/in 5 sec
-keeping their arm below their heart, count their recovery heart rate for a full minute
-consult the norms for their age and gender

Resting Heart Rate

heart rate taken the first thing in the morning, at rest, averaged over 3 days

Maximal Heart Rate

heart rate at all out effort commonly estimated by subtracting age from 220

Training Heart Rate

training intensity range for safety and effectiveness

Heart Rate Reserve (HRR)

the diff between maximum and resting heart rate

Oxygen Uptake Reserve (VO2R)

the difference btw max and resting oxygen uptake

Recovery Heart Rate

the rate at which the heart recovers from exercise

Rate of Perceived Exertion (RPE)

subjective measure of exercise intensity

Basic recommendations from ACSM and AHA: (healthy adults under age 65)

-do mod intense cardio 30 min a day, 5 days a week or; do vig intense cardio 20 min a day, 3 days a week and; do 8-10 strength-training exercises, 8-12 reps of each exercise twice a week

mod-intensity physical activity

working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation. It should be noted that to lose weight or maintain weight loss, 60-90 min of physical activity may be necessary. The 30 min recommendation is for the avg healthy adult to maintain health and reduce the risk for chronic disease

Basic recommendations for ACSM and AHA:
(healthy adults over age 65, or adults 50-64 with chronic conditions such as arthritis)

-do mod. intense aerobic exercise 30 min a day, 5 days a week or; do vig. intense aerobic exercise 20 min a day, 3 days a week. And do 8-10 strength-training exercises, 10-15 reps of each exercise twice or three times a week. And if you are at risk of falling, perform balance exercises and have a physical activity plan

mod-intense aerobic exercise

means working hard at about a level -six intensity on a scale of 10. You should still be able to carry on a conversation during exercise. Older adults or adults with chronic conditions should develop an activity plan with a health professional to manage risks and take therapeutic needs into account. This will maximize the benefits of physical activity and ensure your safety.

ACSM recommendations for cardio fitness

Frequency: 3-5 days a week
Intensity: 57(64)-94% HRmax
30-(40)-85% (HRR or VO2R)
Time: 20-90min; 90 min for weight management goals
Type: based on client's goals, fitness level, personal preferences and availability of equipment
Enjoyment: selected exercises should be enjoyable, otherwise participation may be poor

Progression Phases: Initial

(4-6 weeks)
-Frequency: 3-5 days a week
-Intensity: 57-74%
HRmax or 30-45% HRR
-Duration: 20-90 min of continuous exercise or 10 min intermittent bouts with 5-10min increases every 1-2 weeks

Progression Phases: Improvement

(4-8 months)
-Frequency: 3-5 times a week
-Intensity: 74-94% of HRmax or 45-85% HRR
-Duration: 20-90min
-small increases every 2-3 weeks in frequency, intensity, time or type

Progression Phases: Maintenance

review and reassess

Classifications of Readiness: Poor

sedentary/no habitual activity or exercise/extremely deconditioned

Classifications of Readiness: Poor-Fair

minimal physical activity/no exercise/ moderately to high deconditioned

Classification of Readiness: Fair-Average

sporadic physical activity/no to suboptimal exercise/ moderately to mildly deconditioned

Classification of Readiness: Average-Good

habitual physical activity/regular mod to vig exercise

Classification of Readiness: Good-Excellent

high amounts of habitual activity/regular vigorous exercise

physical activity

any bodily movement produced by skeletal muscles that requires energy expenditure


bodily exertion for the sake of developing and maintaining physical fitness

physical fitness

a state of physiologic well-being that is achieved tho a combo of good diet, regular physical exercise, and other practices that promote good health

Cardiorespiratory fitness

refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained p. a.

Muscle strength

refers to the amount of force a muscle can produce with a single max effort

muscle endurance

one's ability to perform many reps w/ a sub-max resistance over a given period of time


capable of being bent repeatedly w/o injury or damage

Body Composition

describes the component tissues of the body and is most often used to refer to the relative % of fat and fat free tissues

Inactivity Physiology (A paradigm)

daily sitting time, independent of BMI, smoking, alcohol use and leisure time physical activity, was strongly related to cardiovascular and all cause mortality in a prospective 12 year study

Principle of Adaptation/Overload

-increasing stimulus on the body beyond its normal capacity causes an increase in the system's ability to respond to similar stimuli
-incremental overload will result in tissue adaptation and remodeling
-excessive overload can lead to overuse/acute injury
-sustained absence of overload: Reversibility Principle

Principle of Specificity of Training

-the body will adapt to specific training stimuli with specific physical and physiological adaptations


Specific Adaptation to Imposed Demands
-training induced adaptation will be specific to the acute training variables (speed, volume, intensity, rest, energy, system used, etc)


physiological changes which occur due to exercise
-do not occur at a constant rate, there is a window of adaptation
-window is smaller for trained individuals, larger for untrained individuals.

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