ACSM Clinical Exercise Physiologist Exam 2022 with complete solution

ACSM Clinical Exercise Physiologist Exam 2022 with complete solution Factors for a valid VO2 Max? -Answer- RER > 1.1 Lactate >8mmol/L RPE>18 Plateu in VO2 HR @ age predicted max Drug has half life of 4 hours. IF g ...

ACSM Clinical Exercise Physiologist Exam 2022 with complete solution Factors for a valid VO2 Max? -Answer- RER > 1.1 Lactate >8mmol/L RPE>18 Plateu in VO2 HR @ age predicted max Drug has half life of 4 hours. IF given 1000mg, what concentration is left after 12 hours. -Answer- 125mg Can HR max be changed with training? -Answer- NO How many factors must we see for Valid Vo2 max test? -Answer- 3 RER vs RQ -Answer- RER: co2 expired/ o2 consumed at mouth RQ: Co2 produced by cell metabolism/ o2 used by tissues What variable caueses VO2 max to increase with training? -Answer- Stroke volume because heart gets bigger (NOT MAX HR) Lactates main job is to _______________ and does not cause -Answer- buffer Ph, muscle fatigue Client DOES NOT regularly exercise, when do they need clearance? -Answer- - Have a chronic disease - Have a chronic disease and S/S Client DOES regularly exercise, when do they need clearance? -Answer- Only if they have S/S Acute EXSC affect on leukocytes? -Answer- INC concentration Gold std for diagnosing cardiac issues -Answer- Cardiac catheterization ST segment elevation vs depression -Answer- Elevation: Myocardial infarction Depression: ischemia 2 cases when you should not do a regular exsc stress test: -Answer- - Client uses Beta Agonist - Client uses dipyridamole (a vasodilator)What BP level contraindicated during exsc test -Answer- 250/115 Patient w/ CAD will exhibit what symptom relating to HR and BP after EXSC? -AnswerVERY slow to return to resting levels Primary cause of type 2! diabetes? -Answer- Inflammation S/S of diabetes mellitus: -Answer- Polydipsia (thirst) Polyuria (urination) Polyphagia (hunger) Which diabetic medications is contraindicated for exercise? -Answer- Insulin (if exercising at peak insulin effect) When programming EXSC for clinical population, what variables should be progressed first? -Answer- Frequency, then duration, then intensity *When adjusting intensity, duration should be dropped back to baseline Primary cause of obesity -Answer- Hypercaloric Diet Obesity BMI classifications -Answer- >30 = OBESE 30-34=mild 34-39=moderate >40=morbid waist circumference -Answer- > 40 Males >35 Females INCREASED RISK What type of adiposity is most inflammatory? -Answer- Central (visceral) adiposity Most effective method for losing weight? -Answer- Surgical intervention NIH's weight loss goal for obese individuals (what is clinically significant) -Answer- 5- 10% What is exercises effect on weight loss? -Answer- LITTLE TO NONE! BMI qualifications for pharmacotherapy/surgery -Answer- Pharma: BMI >27 w/comorbidities BMI >30Surgery: BMI>35-39 w/comorbidities BMI>40 Average weight loss with bariatric surgery? -Answer- 25% BP classifications -Answer- Normal: 120/80 Elevated: 120-129/80 St 1 Hypertension: 130-139/80-89 St 2 Hypertension: >140/>90 Which physiological variable has greatest impact on BP? -Answer- Blood vessel radius Atherosclerosis vs. Arteriosclerosis -Answer- Athero: Thickening (Via damage to media of BV being patched by LDL cholesterol) Arterio: Stiffening (vascular remodeling due to high BP, inflammation and hyperglycemia) What does a higher DBP mean? -Answer- Pt has a better elastic recoil What is the best predictor of future cardiovascular events? -Answer- Arterial stiffness score (PP/Pulse wave velocity) BP changes during EXSC -Answer- Aerobic: SBP inc, DBP dec Resistance: SBP inc, DBP inc ACE inhibitors -Answer- stop conversion of angiotensin 1 to angiotensin 2 --- VASODILATE ARB's -Answer- Block angiotensin 2 from binding to its receptor on artery -- VASODILATE which hypertension medication effects exercise? -Answer- B-Blockers EXSC affect on blood lipid profile -Answer- Decrease TG, Increase HDL Statin effect on lipids -Answer- Decrease LDL, TG Increase HDL what drug decreases TG -Answer- FibratesYou need 2/3 of these criteria to diagnose heart attack -Answer- Chest pain >30 mins EKG shows ST Segment elevation / T wave inversion Presence of biomarkers in blood Fibrinolytics -Answer- Streptokinase, Tenecteplase (TNKase) Clot buster used in emergencies Aspirin -Answer- Inhibits thromboxane A2 (inhibiting clot formation) Recovery time after heart attack before EXSC -Answer- 1-2 days What intensity should you exercise ACS/Heart attack patients -Answer- 10 BPM below their ischemic threshold (elicits chest pain) Types of congestive heart failure: -Answer- Right side: due to increased pulmonary pressure Left side: due to peripheral resistance - Systolic: <30% EF <30 SV Right side: <60 EF <30 SV Ejection fraction equation -Answer- EF=(EDV−ESV)/EDV Edema is more prevalent in _________ sided heart failure -Answer- Right sided (because there is a back up in venous return) gold std for diagnosis congestive heart failure -Answer- Echocardiogram Which common medication is a negative chronotropic and how does it effect exercise - Answer- B blocker When pt on B-blocker, must lower expectation of HR for a given intensity (lower hr for given intensity) What is PAD? -Answer- Blockage of leg arteries by plaqueWhich population are at highest risk of PAD? -Answer- Diabetics Diagnosis of PAD? -Answer- Ankle Brachial index Ankle/brachial USUALLY = 1 Ankle/brachial of <.9 diagnostic of PAD What should you stress while EXSC someone with PAD? -Answer- Push through leg pain!! Risk Stratification NOT a regular EXSCer -Answer- Disease or S/S: CLEARANCE NO Disease or S/S: NO CLEARANCE Risk stratification REGULAR EXSCer -Answer- NO disease or S/S: NO CLEARANCE Disease Asymptomatic: NO CLEARANCE Disease or S/S: CLEARANCE Cardiovascular disease Risk Factors -Answer- NEGATIVE: Age: Men >45 Women >55 Family History: Myocardial infarct, coronary revascularization, sudden death before 55 father or 65 mother Cigarette Smoking: Current, quit within 6mo, secondhand smoke Sedentary lifestyle: doesnt exercise 30 minutes moderate intensity 3 days per week for 3 mo Obesity: BMI >30 / Waist Circ 40 male 35 female Hypertension: SBP >130 and or DBP >90 / antihypertensive meds Dyslipidemia: LDL >130 / HDL<40 / Lipid lowering meds Diabetes: Fasting BG >126 / OGTT >200 POSITIVE: HDL>60 Lipid Classifications -Answer- LDL: >130 highHDL: <40 low TC: >200 high TG: >200 high General Indications for Stopping an Exercise Test -Answer- - Angina - Drop in SBP >10 with increase in workload - Systolic >250/110 - SOB, wheezing, leg cramps, claudication - Poor perfusion: Light headed, confused, naseua, cyanosis - HR fails to increase with increased intensity - Change in heart rhythm - Subject requests to stop - Failure of equipment - Visually severely fatigued Absolute contraindications to exercise testing -Answer- - Acute myocardial infarction within 2 days - Unstable Angina - Uncontrolled arrhythmia - Active endocarditis - Symptomatic aortic stenosis - Pulmonary embolism, infarction, deep vein thrombosis - Acute Aortic Dissection Relative Contraindications to Exercise Testing -Answer- - Known obstructive left main coronary artery stenosis - Moderate aortic stenosis - Taccharythmias - Advanced or complete heart block - Recent stroke - resting hypertension: >200/110 - Uncorrected medical conditions: electrolyte imbalaces, significant anemia, hyperthyroidism Terminating a symptom limiting max exercise test -Answer- ABSOLUTE: - ST elevation >1 - Drop in systolic >10 w/ increased workload - Moderate/severe angina - Ataxia, diziness, syncope - poor perfusion (cyanosis, pallor) - Sustained V-tach - 2nd or 3rd degree block - Technical difficulties measuring ECG/BP - subject requests to stop HRR Equation -Answer- Target HR = [intensity x (HRmax-HRrest)] + HRrestAerobic FITT-VP for healthy adults -Answer- F: 5 days of moderate / 3 days of vigorous I: Moderate/Vigorous T: 30-60 min moderate / 20-60 min Vigorous T: Major muscle groups, continuous, rhythmic V: >500-100 Metmins / >7000 steps P: One continuous session or multiple sessions >10 mins flexibility FITT-VP for healthy adults -Answer- F: >2-3 days a week I: Stretch until discomfort T: 10-30 second hold (30-60 more beneficial) T: Major muscle groups V: Total of 60 s for each exercise P: repeat each exsc 2-4 times Absolute contraindications for testing during pregnancy -Answer- - Hemodynamically significant heart disease - Restrictive lung disease - Incompetent cervix - Risk for premature labor - Persistent 2nd or 3rd trimester bleeding - placenta previa after 26 wk gestation - Ruptured membranes - Preeclampsia / pregnancy induced hypertension FIT for Cardiorespiratory Fitness Programming -Answer- F: 3-5 days/wk I:Mod to vig (40-80%) T: 20-60 min FIT for PAD -Answer- F: 3-5 days/wk I: moderate (40-60%) / 3-4 on claudication pain scale T: 30-45 min T: Ideally weight bearing Diagnostic criteria for Diabetes -Answer- Normal: - A1c: <5.7 - FPG: <100 Pre-diabetes: - A1c: 5.7-6.4 - FPG: 100-125 Diabetes: - A1c: >6.5 - FPG: >126Health Belief Model -Answer- People will engage in a given behavior when: - they perceive threat of disease **Involved cues to action and Self-Efficacy Transtheoretical Model -Answer- People progress through 5 stages at varying rates (and can move back and forth between them) - Precontemplation: No intention to change - Contemplation: Intention to start exsc within 6 mo - Preparation: Some participation in exsc / not enough to meet guidlines - Action: exsc that meets guidlines for <60mo - Maintenance: exsc that meets guidlines for >6mo social cognitive theory -Answer- Observational: we learn by watching others model behavior (and have expectations as to their benefits from engaging in said behavior) Self-Efficacy: confidence of performing a specific behavior Managing emotional arousal: - Cognitive restructuring: thinking about the problem in a constructive way Vicarious reinforcement: Seeing other people benefit from a certain behavior Common Cardiovascular Medications -Answer- B-Blockers: hypertension, angina - acebutolol, atenolol, botaxolol, carvedilol, nadalol Ace Inhibit: Hypertension, CAD - Benazepril, captopril, enalapril Angiotensin receptor blocker (ARB): HTN, Neuropathy - azilsartan, candesartan, eprosartan Calcium channel blocker: HTN, angina - Amlodipine, clevidipine, felodipine, Diuretics: Edema, HTN, HF - Bendroflumethiazide, chlorothiazide Nitrates: Angina, Acute MI, HF - amyl nitrate, isosorbide mononitrate,Antiarrythmatic agents: surpress A-fib - disophyramide, quinidine, Lidocaine Antilipidemic: Elevated TC/LDL, low HDL - Bile acid sequestriants: Cholestyramine, colesevelam Inhaled corticosteriods: Asthma - Beclomethasone, budesonide B2 agonists: CPD, Asthma - Albuterol Biguanides: Diabetes(decrease sugar prod by liver) - Metformin Joint classifications -Answer- Fibrous- sutures Cartilaginous- discs Synovial (diarthroses) - freely movable - Hip, elbow Synarthroses - Immovable Amphiarthroses - slightly movable skinfold locations -Answer- *ALL ON RIGHT SIDE Chest: Diagonal halfway between nipple and anterior axillary line Midaxillary: Vertical on midixaillary line Abdominal: Vertial 2cm right of umbilicus Suprailiac: Diagonal 2cm above suprailiac crest Subscapular: Diagonal 2cm below inferior angle of scap Triceps: Vertical halfway Biceps: Vertical - roughly halfway up biceps- 1 cm above tricep measurement Thigh: Vertical halfway anterior midline Medial calf: Vertical halfway