1. health and fitness
2. exercise

IN THIS ISSUE
News You Need
Resistance Training for Life
Training for Independence
Successful Resistance Training
For Arthritis
Coaching News
Resistance Training During Pregnancy
Self-Tests
1
1
2
5
7
8
11
ACSM’s
Certified
News
JANUARY-MARCH 2007
News You Need!
The beginning of each New Year should
include good news, and the start of 2007 is no
exception for ACSM’s Committee on
Certification and Registry Boards (CCRB).
Resistance Training for Life
Paul Sorace, M.S., ACSM RCEP, CSCS
Hackensack University Medical Center, Hackensack, NJ
New Educational Course for
ACSM Certified Professionals
Please recall that 2006 provided a successful
launch for our new 1-day CEC Course specifically designed for ACSM Certified
Professionals. “Weight Management for the
Fitness Professional” was held at more than
20 locations across the country to approximately 300 participants. We will continue
offering this course in 2007, as well as a brand
new course titled, “Behavior Change
Strategies for Optimal Client Outcomes.”
Please stay tuned to future issues of ACSM’s
Certified News, ACSM’s Certified E-News,
and/or the ACSM Web site for future dates
and locations.
ACSM Receives NCCA Accreditation for
HFI and ES Certification Programs
As a reminder, ACSM’s CCRB is committed to 3rd-party Accreditation through the
National Commission for Certifying Agencies
(NCCA) for all of our certification programs,
and we received NCCA accreditation for the
ACSM Certified Personal TrainerSM certification program in May, 2006. In December, we
heard additional good news: the ACSM
Health/Fitness Instructor® and ACSM
Exercise Specialist® certification programs
both received NCCA accreditation!
This third-party accreditation of our two
oldest certifications is long overdue, and reestablishes ACSM as the “Gold Standard” of
voluntary certifications within the health/
fitness/clinical fields. Of course, we have one
credential left to submit for NCCA accreditation: the ACSM Registered Clinical Exercise
Physiologist® certification. The RCEP application will be submitted in January, 2007.
Background
ACSM’s acknowledgement of independent,
third-party accreditation for all our credentials, as well as any credential offered within
the health/fitness and clinical industries, complies with the previous recommendation
issued by the International Health, Racquet
News You Need... Continued on Page 9
VOLUME 17, ISSUE 1
The benefits of aerobic exercise have been
well documented over the last several decades.
But many people still react indifferently to
resistance training, thinking only of bodybuilding or training for athletes. Granted,
bodybuilding is the result of progressive resistance training and athletes benefit from resistance training programs specific to their sport.
However there are a large number of health
and fitness benefits from regular resistance
training for people of all ages. Resistance
training enables people to: live a higher quality of life (e.g., greater ease with activities of
daily living); be more physically active (e.g.,
engage in physical recreational activities); prevent/manage certain diseases (e.g., osteoporosis, arthritis); increase body image
self-confidence due to the aesthetic results.
Resistance training is beneficial for many
aspects of life.
As a point of interest, resistance training is
perhaps the best term used to describe this
type of exercise. There are other terms often
used but they can be slightly misleading. For example, resistance
training
enhances
muscular
strength (strength training) but also
muscular size (hypertrophy),
power, and local muscular
endurance. Also, resistance training
can involve free weights and
machines (weight training) but also
bodyweight, elastic tubes / bands,
air resistance (Keiser), and other
forms of resistance (e.g., water bottles).
In a properly designed program,
resistance
training
provides
increased stress to the bones, which
can increase or maintain bone mineral density for those who may
have, or who are prone to osteoporosis5. Generally aerobic exercise
only stresses the lower extremities.
Resistance training can emphasize
all parts of the body. Resistance exercise also
can develop bone and muscle early in life thus
preventing bone loss and maximizing bone
density during growth years.
Resistance training can help overweight/
obese persons pursue a more active lifestyle,
leading to weight loss and weight maintenance1. Even though resistance training
shouldn’t be the emphasis of an exercise program designed to lose weight, it does complement the aerobic component. For example,
resistance training results in additional calorie
expenditure.
Resistance training helps to make the body
more sensitive to insulin not only during, but
following exercise sessions. This is beneficial
to those who have type 1 or 2 diabetes or for
those who are at risk for diabetes (insulin
resistance). A recent study indicated that progressive resistance training can increase
insulin sensitivity, even when not following a
weight loss diet3.
It was once believed that the loss of muscle
Resistance Training... Continued on Page 12
ACSM’s Certified News
AMERICAN COLLEGE OF SPORTS MEDICINE | (317) 637-9200
2
Training for Independence
Thomas P. Mahady, M.S., CSCS
The Cardiac Prevention and Rehabilitation Program
Hackensack University Medical Center
ACSM’S CERTIFIED NEWS
EDITORS
Paul Sorace, M.S.
Larry S. Verity, Ph.D., FACSM
COMMITTEE CHAIR
Dino Costanzo, M.A.
CCRB PUBLICATIONS SUBCOMMITTEE CHAIR
Jonathan N. Myers, Ph.D., FACSM
ADMINISTRATION
PRESIDENT
Carl Foster, Ph.D., FACSM
PUBLICATIONS COMMITTEE CHAIR
Jeffrey L. Roitman, Ed.D., FACSM
EXECUTIVE VICE PRESIDENT
James R. Whitehead
NATIONAL CENTER NEWSLETTER STAFF
NATIONAL DIRECTOR OF CERTIFICATION
AND REGISTRY PROGRAMS
Mike Niederpruem
ASSISTANT DIRECTOR OF CERTIFICATION
Hope Wood
MANAGER, CERTIFICATION PROGRAMS
Traci Rush
CERTIFICATION PROGRAM COORDINATOR
Beth Muhlenkamp
PROFESSIONAL EDUCATION COORDINATOR
Gretchen Dovenmuehle
DIRECTOR OF PROFESSIONAL EDUCATION
AND DISTANCE LEARNING
Karen J. Pierce
ASSISTANT EXECUTIVE VICE PRESIDENT
D. Mark Robertson
SENIOR DIRECTOR OF PUBLICATIONS AND MARKETING
Jeff Richardson
PUBLICATIONS MANAGER
David Brewer
FOR MORE CERTIFICATION RESOURCES CONTACT
THE ACSM CERTIFICATION RESOURCE CENTER:
1-800-486-5643
INFORMATION FOR SUBSCRIBERS
CORRESPONDENCE REGARDING EDITORIAL CONTENT
SHOULD BE ADDRESSED TO:
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E-mail: [email protected]
Tel.: (317) 637-9200, ext. 121
Introduction
Chances are that if you regularly exercise or
participate in some form of physical activity,
resistance training (RT) is probably not a part
of your exercise routine.1,9 According to the
U.S. National Center for Health Statistics, 44
percent of American men and 38 percent of
American women report engaging in some
form of vigorous physical activity or exercise
regularly, while 16 percent of Americans
report participating in some form of resistance
training.12 The impact of RT on muscle is easily understood and well accepted. However,
its beneficial effects on health risk factors and
chronic disease has only recently been recognized.10 In 1990, the American College of
Sports Medicine first recognized RT as a significant component of a comprehensive fitness program for adults of all ages.2
Sarcopenia is the term for the gradual
decrease in muscle tissue with age that begins
for most individuals around the age of thirty.8,11 By the age of seventy, an individual can
expect to lose up to 25 percent of their total
muscle mass and strength and possibly another 25 percent by age 90.12 Some of these
changes are a physiological consequence of
the normal aging process, but disuse and inactivity player a much larger role.
A study of healthy men between the ages of
60 and 72 who trained for twelve weeks using
a standard strength training protocol at 80
percent of their 1 rep maximum (1RM)
demonstrated increases in knee flexion
strength by 107 percent and knee extension
strength by 227 percent.9 These dramatic
improvements were similar to those changes
experienced by younger adults and demonstrate that changes in strength can be achieved
later in life that are similar to those of younger
counterparts with resistance training.
The loss of muscle mass is not only cosmetic. Muscles play an important role in the
maintenance of the body’s metabolism by
controlling the rate at which an individual
burns calories. Combined with a RT program, a boost in metabolism plays a role in
controlling body fat which positively impacts
the risk factors for heart disease and certain
cancers.12 Strong muscles also help alleviate
the strain on the heart when the body is asked
to perform work. Increased muscle mass also
provides a greater surface area for the storage
of blood glucose and improves sensitivity to
insulin. Thus, the ability to maintain muscle
mass later in life helps to prevent or control
type 2 diabetes.12
The most dramatic effects of muscle loss
translate into the loss of physical independIndependence... Continued on Page 3
CHANGE OF ADDRESS
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TEL.: (317) 637-9200, EXT. 139 OR EXT. 136.
ACSM’s Certified News (ISSN# 1056-9677) is published
quarterly by the American College of Sports Medicine
Committee on Certification and Registry Boards (CCRB). All
issues are published electronically and in print.
The articles published in ACSM’s Certified News have been
carefully reviewed, but have not been submitted for
consideration as, and therefore are not, official
pronouncements, policies, statements, or opinions of ACSM.
Information published in ACSM’s Certified News is not
necessarily the position of the American College of Sports
Medicine or the Committee on Certification and Registry
Boards. The purpose of this newsletter is to inform certified
individuals about activities of ACSM and their profession and
about new information relative to exercise and health.
Information presented here is not intended to be information
supplemental to the ACSM’s Guidelines for Exercise Testing
and Prescription or the established positions of ACSM.
ACSM’s Certified News is copyrighted by the American College
of Sports Medicine. No portion(s) of the work(s) may be
reproduced without written consent from the Publisher.
Permission to reproduce copies of articles for noncommercial
use may be obtained from the Rights and Permissions editor.
ACSM NATIONAL CENTER
401 WEST MICHIGAN ST.
INDIANAPOLIS, IN 46202-3233.
TEL.: (317) 637-9200 • FAX: (317) 634-7817
© 2007 American College of Sports Medicine.
ISSN # 1056-9677
JANUARY/FEBRUARY/MARCH 2007 | VOLUME 17; ISSUE 1
Independence... Continued from Page 2
ence. Weak muscles impact an individual’s
ability to perform activities of daily living
(ADL). Activities such as walking, cleaning or
shopping become more difficult when strength
declines. The ability to balance while moving
or standing declines and the potential for falls
increases. By the age of 65, one in three individuals will report experiencing some kind of
fall, with 1 out of 20 of these reports resulting
in some form of bone fracture.12 These injuries
can be debilitating and are often difficult to
recover from.
Enhanced Quality of Life
Even a modest amount of exercise substantially reduces the risk of dying from multiple
risk factors and improves the functional characteristics needed to perform day-to day tasks.
The effects of (RT) along with a sound cardiovascular exercise program may assist with the
management of those risk factors that put an
individual’s long-term independence at risk.
Resistance training has been proven to be
effective in the management of osteoarthritis1.
Functional ability can be improved if the muscles that surround the affected joint are strong
and can share in the support of the stress
experienced by the joint. Shared stress by the
joints and muscles reduces the overall stress
on the joint surfaces. Evidence also supports
the fact that RT reduces the rate of bone loss
and may also increase bone deposition as long
as the training stimulus is weight bearing, of a
magnitude that stimulates bone formation, or
both.1 It is recommended that the training
stimulus mimics those common movements of
daily living that increase the functional capacity of the individual. Training for specific
movements such as rising from a chair or
one’s bed can easily be performed with either
available equipment in a gym setting or
repeated with added resistance in a home setting.12
Research suggests that regular aerobic exercise plays a role in the management of mild to
moderate depression.12 Whether resistance
training plays a significant role in the management of depression has yet to be clarified.
Restoring lost abilities through resistance
training restores confidence and boosts mood.
The ability to move freely without fear of
falling or losing one’s balance creates a better
sense of independence and expands a person’s
social abilities.12
Table I: Summary of Adaptations to
Aging and Resistance Training3
Muscle strength
Muscle endurance
Muscle mass
Muscle fiber size
Muscle metabolic capacity
Resting metabolic rate
Body fat
Bone mineral density
Physical function
Aging
Decreases
Decreases
Decreases
Decreases
Decreases
Decreases
Increases
Decreases
Decreases
Resistance Training
Increases
Increases
Increases
Increases
Increases
Increases
Decreases
Increases
Increases
Program Design
The fundamentals of a RT program design
are the same regardless of age. When developing an individualized exercise prescription
it is important to understand the unique challenges facing older adults and to manipulate
the acute program variables in order to meet
their needs. Incorporating such challenges
begins with a physician’s medical clearance,
especially in the presence of two or more
coronary risk factors or the presence of metabolic disease, and a needs analysis, which
takes into consideration any physical limitations and the individual’s goals.5 Many older
adults may also require a period of time for
basic conditioning so that they can RT at a
level needed to experience adaptations. In
such cases, starting levels of RT may be minimal and trainers should exercise caution in
choosing equipment and movements that will
not injure or over-train the person.
Exercise selection is very important and
should include at least one exercise for all of
the major muscle groups. This can be
attained through a variety of equipment
choices which can range from fixed equipment to soup cans. Equipment selection
depends upon the person’s personal preference, availability, and physical abilities.
Progression of exercises should emphasize
movements that would enhance power and
balance.
The order of exercises should progress from
large muscle groups to smaller muscle groups
in order to minimize fatigue and maximize the
resistance used. Focus efforts on the optimal
stimulation of the lower extremities5 to
enhance balance and power training strategies.
The duration of rest between sets and exercises determines the metabolic demands of the
workout. Rest period lengths should be consistent with program goals and consider the
medical or physical condition of the individual. Longer rest periods optimize gains in
strength and work well for individuals with
type I diabetes while programs with shorter
rest periods enhance muscular endurance and
challenge the acid base balance which may be
compromised in older individuals.5 Take every
precaution to control rest lengths in an effort
to avoid the metabolic stress that accompanies RT.
Single set programs work well for initiating
RT programs for older individuals and provide
a good starting point. Three sets of a single
exercise are usually sufficient in providing a
training stimulus and an adaptation.
However, should the individual desire more of
a training stimulus for a single body part it
would be wise to consider the addition of
another exercise before progressing beyond
three sets.5 Consider also increasing the intensity of the exercise. Older adults may not be
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ACSM’s Certified News
able tolerate intensities up to 80 percent of
1RM with every session. A sound strategy
would consider reducing the intensity over the
course of three days and monitor the progression until the total volume of training is consistent with every workout. Training volume
also factors in the repetitions for each set.
Because of the high prevalence of cardiovascular problems, limit the number of repetitions
to failure. Consider conservative training volumes and reserve the number of prescribed
repetitions as an easy option for progression.
One to three sets of eight to ten repetitions at
an intensity of 70 to 90 percent of 1RM is a
good starting point. Reevaluate the RT program every 12 weeks and carefully consider
which of the aforementioned program variables will offer the best strategy for improvement and safety. Pay close attention to the
person’s training volumes and monitor the
individual for signs of stress and over-training.
Safety Considerations
The basic principles for RT are the same for
older and younger individuals, but the
specifics of the Rx differ and are dependent on
the individual’s prior exercise history, medical
history, available environment and resources,
and personal goals and preferences. Because
of the many co-morbidities that must be considered when prescribing RT for an older
adult, the need for an individualized prescription becomes even more important.1
Similar to an aerobic exercise prescription,
prescribing RT for older adults should begin
with a doctor’s medical clearance. And while
the primary goal of every exercise professional is to keep the individual safe while training,
safety is not to be confused with overprotection. An overcautious exercise prescription
can further the loss of function by failing to
elicit a training stimulus that forces the individual to adapt. The exercise professional
must keep in mind that independence is the
goal and should resist the temptation to assist
the individual throughout the workout and
focus on the movements that the person can
perform and not those movements that are
impossible or elicit pain.
By adhering to the following guidelines, the
exercise professional can be reassured that the
individual that is being trained will safely
progress:1
• Design the program to develop sufficient
muscular fitness to enhance ability to live
independently.
• Closely supervise and monitor initial sessions with trained personnel who are sensitive to the special needs and capabilities of
older adults.
• Use minimum levels of resistance for the
first eight weeks to allow for adaptation of
connective tissue.
• Instruct and use proper technique for perIndependence... Continued on Page 4
ACSM’s Certified News
AMERICAN COLLEGE OF SPORTS MEDICINE | (317) 637-9200
4
Independence... Continued from Page 3
forming all exercises.
• Instruct all older participants to maintain
normal breathing patterns while exercising.
Teach them to avoid the Valsalva maneuvers.
• Overload by increasing number of repetitions at first only subsequently by increasing
resistance.
• Use a resistance that can be comfortably lifted for at least eight to twelve repetitions per
set. Heavy resistance is dangerous and may
damage skeletal and joint structure.
• Weights should be lifted and lowered in a
slow, controlled manner. No ballistic movement should be allowed (to prevent orthopedic trauma to joint structures).
• Perform all exercises in a pain-free range of
motion, that is, the maximum range of
motion that does not elicit pain or discomfort. As positive adaptations occur, individuals may gradually increase range of motion
and improve flexibility.
• Perform multijoint exercises (as opposed to
single joint exercises) that tend to assist in
the development of functional muscular fitness.
• The use of machines offers several advantages:
- They require less skill to use.
- They generally provide more support for
the back by stabilizing body position.
- They enable participants to start with
lower levels of resistance (depending on
the specific type of equipment).
- They typically enable increased resistance
level through smaller increments (not true
for all resistance training machines).
- They allow greater control of the exercise
range of motion.
- They generally provide a more timeefficient workout.
Do not over train your client. Two resistance training sessions per week is the minimum number required to produce positive
physiological adaptations. While more frequent training may elicit larger strength gains,
additional improvement is relatively small.
Resistance training must be avoided during
periods of active pain or inflammation in
older adults with arthritis. Exercise during
these periods may exacerbate the inflammation.
The exercise professional should always
emphasize proper form while instructing the
individual. Always progress from large muscle
groups to smaller muscle groups in an effort to
minimize injury. RT progression should be
gradual while working toward a goal or some
application of the movements to those of
everyday living. Constantly monitor the individual for signs of discomfort and cease any
exercise in the event pain is experienced anywhere. Encourage proper hydration at all
times and offer advice regarding proper nutri-
tion and performance. Find ways to motivate
the individual. Don’t allow routines to become
stale by resetting goals and incorporating variety into a routine.
Conclusion
The challenge for the exercise professional
is to motivate increased numbers of older
adults to exercise and to provide programs
that meet their needs over a long period of
time.1 And while resistance training is considered safe for most populations, the art of prescription challenges the exercise professional
to balance the needs of the individual with the
basic precepts regarding safety, common
sense, and basic exercise physiology. The
resources and research regarding resistance
training and older adults is numerous and
growing, providing the exercise professional
with the means to facilitate a healthier and fitter population of older adults.
About the Author
Thomas Mahady, M.S., CSCS is the senior exercise physiologist for The Cardiac Prevention and Rehabilitation
Program at Hackensack University Medical Center in
Hackensack, NJ.
References
1. American College of Sports Medicine. ACSM’s Resource
Manual for Guidelines for Exercise Testing and Prescription. 4th
ed. Baltimore: Williams & Wilkins, 1998. p 452.
2. American College of Sports Medicine Position Stand: The
Recommended Quantity and Quality of Exercise for Developing
and Maintaining Cardiorespiratory and Muscular Fitness in
Healthy Adults. Med Sci Sports Exerc. 1990; 22:265-274.
Medline.
3. Baechle, T.R. and R.W. Earle. Essentials of Strength and
Conditioning. Human Kinetics 2004. Second edition. p 182.
4. Braith, R.W., K.J. Stewart. Resistance Exercise Training.
Circulation. 2006; 113:2642-2650. Guyton, A.C. Textbook of
Medical Physiology. W.B. Saunders Co..1991. p 78.
5. Fleck, S., and W. Kraemer. Designing Resistance Training
Programs. Human Kinetics 2004. p 318.
6. Earle, R.W. and T.R. Baechle. NSCA’s Essentials of Personal
Training. Human Kinetics 2004. p 551.
7. Ehrman, J.K., P.M. Gordon, P.S. Visich and S.J. Keteyian.
Clinical Exercise Physiology. Human Kinetics 2003. p 457.
8. Hall, Linda K. Developing and Managing Cardiac
Rehabilitation Programs. Human Kinetics 1993.
9. McArdle, W.D., F.I. Katch, V.L. Katch. Exercise Physiology. Lea
& Feibiger. 1991.
10. Pollock, M.L.., B.A. Franklin, G.J. Balady, B.L. Chaitman, J.L.
Fleg, B.F. Fletcher, M. Limacher, I.L. Pina, R.A. Stein, M.L.
Williams, T. Bazzarre. Resistance Exercise in Individuals with
and Without Cardiovascular Disease. Circulation. 2000;
101:828. pp 71-7.
11. Stamford, B.A., Exercise and the Elderly. Exercise and Sport
Sciences Reviews. Vol.16. New York, Macmillan, 1988.
12. Strength and Power Training: A guide for adults of all ages.
Harvard Health Publications. A Special Health Report from
Harvard Medical School. Frontera, Walter, and Jonathan Bean,
Editors.
13. Vincent, K.R., H.K. Vincent. Resistance Training for
Individuals With Cardiovascular Disease. Journal of
Cardiopulmonary Rehabilitation. 2006; 26:207-216.
JANUARY/FEBRUARY/MARCH 2007 | VOLUME 17; ISSUE 1
Successful Resistance
Training for Arthritis
John Patzan, BS, CSCS
Senior Exercise Specialist
The Fitness Club
Hackensack University Medical Center
Introduction
Arthritis is a general term encompassing
similar diseases1. Arthritis can affect people of
all ages, genders, and ethnic groups. A recent
CDC report in the Morbidity and Mortality
Weekly Report found approximately 22 percent of Americans had doctor diagnosed
arthritis13. Common symptoms are joint pain,
stiffness; especially in the morning, swelling,
inflammation and loss of physical function.
Arthritis negatively impacts not only exercise
ability, but an active lifestyle as well. The two
most prevalent types of arthritis are
osteoarthritis and rheumatoid arthritis.
Osteoarthritis (OA) is a dynamic disease
process characterized by the uncoupling of the
normal balance between degradation and
repair of the components of the articular cartilage and bone2. It is the most common form
of arthritis. This leads to pain, stiffness, movement problems, and limited physical activity.
The most common affected areas of the body
are the hands, knee, hip, foot, and spine. This
type of arthritis is commonly referred to as
“wear and tear” arthritis3.
Rheumatoid arthritis (RA) is a systemic
inflammatory disease of the joint capsule
inner lining affecting multiple joints. Women
are more affected than men. General symptoms include fatigue, malaise, fever, weight
loss, and depression4. As with OA, pain, stiffness, and swelling are also characteristics of
RA. RA can decrease range of motion
(ROM), muscle strength, and aerobic
capacity. In severe cases, RA can affect
connective tissue and blood vessels
throughout the body.
One may think that exercise and
arthritis do not go hand in hand.
However, research has shown that exercise is a valuable tool in managing arthritis5. In a recent study, persons with RA
underwent a dynamic strength training
program for two years6. Subjects performed a program which trained all
major muscle groups of the body. The
program consisted of two sets of 8-12
repetitions using rubber bands and
dumbbells as resistance. The frequency
was 2 times per week. Subjects showed
an average of 19-59 percent increase in
strength6. Stronger muscles absorb more
of the attendant stress on a joint, thereby
reducing stress placed on affected joint
surfaces7. In addition to resistance training,
cardiovascular and flexibility exercises are also
components of a well-rounded program for a
person with arthritis. This article will focus
primarily on the resistance training portion of
exercise.
Resistance Training
Recommendations
The sequencing of exercises for persons
with arthritis is similar to that of the general
population. One should begin with an aerobic warm-up to increase the tissue temperature throughout the body8. Because a person’s
joints are often irregular and mechanically
unsound, persons with arthritis have to be
taught to warm-up very slowly and increase
their activity level gradually within the confines of comfort9. A typical exercise session
might consist of the following: 10 minutes of
range of motion exercises such as head turns
or head tilts, arm side-raises, side bends,
elbow curls, standing hip extension and ankle
circles; 10 minutes of stretching exercises such
as a calf stretch, lower back and hamstring
stretch, and shoulder and upper back stretch.
An aerobic warm-up of approximately five
minutes can follow the stretching. Skeletal
muscle strengthening exercises should be performed following the warm-up. An aerobic
session of 15-60 minutes is next. A cool-down
period should end all sessions. Exercises dur-
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ACSM’s Certified News
ing the cool-down should mimic the same
exercises that were performed during the
warm-up14.
Persons with RA performing strength training exercises may perform either isometric or
isotonic exercises when doing a program.
Isometric exercises are of particular value for
painful or inflamed joints10. These exercises are
the choice when a person is in the acute
arthritic stage because they produce low articular pressures8. An acute stage can be recognized by signs and symptoms such as fatigue,
joint pain, swelling, and reduced joint tissue
tensile strength attributable to inflammation11.
Isometric exercises may be done with such
equipment as resistance rubber bands or no
equipment. General guidelines for performing
isometric exercises are listed in Table 1.
Table 1: Guidelines for Performing
Isometric Exercises10
• Start with 1-3 repetitions of the exercise
• When using resistance bands, use the thickest band,
which provides the most resistance and affords the least
joint movement
• Perform 1 repetition if they have intolerable pain, or if
pain is accompanied by noticeable inflammation.
• During each repetition, push or pull for 6 seconds. Rest
for approximately 15-20 seconds between each repetition.
Between each exercise, rest 15-60 seconds.
• Never hold the muscle contraction for more than 6
seconds because this could cause a ValSalva Maneuver,
which could lead to an excessive rise in blood pressure.
10. Gordon, N.F. Arthritis Your Complete Exercise Guide: The Cooper
Clinic and Research Institute Fitness Series. Human Kinetics
1993. pp 38-9.
Isotonic exercises are preferred during the
chronic stage of arthritis. The chronic stage
can be identified by signs and symptoms such
as permanent joint damage, pain at the end of
normal ROM, stiffness after rest, poor posture and range of motion, joint deformities,
pain with weight bearing, abnormal gait,
weakness, contractures or adhesions, and
reduced aerobic endurance11. Isotonic exercises are beneficial because they closely correspond to everyday activities and promote
improved daily function8. Free weights,
weight machines, elastic tubing, water, or
manual resistance may provide the training
stimulus5. An advantage of many types of
weight machines are that they can be double
pinned. This technique allows people to exercise through their pain-free ROM5. This
entails placing the first pin in the desired
resistance and placing the second pin in a
desired hole below the resistance to cut down
the range of motion of the exercise. A person
must pay particular attention when doing
this, because many machines are not intended
to be double pinned. Placement of the second
pin should be reversed because the hole in the
bar is larger than the hole in the resistance
plate. The person must also remember to carefully remove the pin when finished. One
application that is particularly helpful in peoArthritis... Continued on Page 6
ACSM’s Certified News
Arthritis... Continued from Page 5
ple with OA is aquatic exercise. The naturally buoyant properties of water allow individuals to exercise with significantly less joint
loading than with other forms of activity2.
Resistance exercise programs using predominately open kinetic chain exercises in the
upper extremity are recommended. Closed
kinetic chain exercises such as push-ups are
contraindicated due to the compressive nature
of the exercise at the glenohumeral joint12. In
the lower extremity, open kinetic chain exercises are typically indicated with the exception
of full ROM leg extension exercises for the
person
with
patellofemoral
OA12.
Modifications for this exercise could include
partial ROM arcs from 90 degrees to 45
degrees or from 0 degrees to 30 degrees of
knee motion, where the compressive forces of
the patellofemoral joint are the least damaging12. Lightweight closed kinetic chain exercises for the lower extremities can be performed
based on the presence of pain and the person’s
general tolerance12. Open Kinetic Chain may
be defined as exercising muscle groups
through a single joint movement with resistance applied distally in a nonweightbearing
mode. Closed Kinetic may be defined as the
distal segment being fixed against an external,
unmoving resistance. The feet or hands are
fixed from moving15. Table 3 shows the differences between open and closed kinetic chain
exercises.
Table 3: Open and Closed
Kinetic Chain Exercises
Open
Closed
Knee extensions
Back Squats
Knee curls
Lunges
Leg Press
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6
Enhancing proprioception and motor control is another recommendation for people
with OA, in particular older individuals, who
frequently have problems with balance.
Persons with RA may require modifications of
certain exercises. People who have incurred
problems with their wrists and hands may
need to have the diameter of the bar, dumbbell, or handle decreased in an attempt to offset their weakened grip. If this is not feasible,
then using elastic tubing attached to the forearms can substitute for the free weight or
weight machine equipment4.
Starting out with about 4-6 repetitions per
exercise is recommended. It is possible to use
as little as 2-3 repetitions with progression to
10-12 repetitions provided that the resistance
is acceptable and does not cause joint pain4.
Each repetition should be performed slowly
with emphasis on form and not on speed. One
to two sets of each exercise can be performed
2-3 days per week. This can be modified for
people who are new to resistance training or
have not done any resistance training in some
time. Single set routines, especially for people
just beginning a resistance training program,
may produce as much benefit as multiple sets
performed 2-3 days per week16. Of course in
today’s society, single set routines have another benefit; they are more time efficient and generally result in greater adherence4. Resistance
training sessions should consist of 8-10 different exercises that train the major muscle
groups4. Table 2 summarizes the FIT Principle
just discussed.
Table 2: F.I.T. Principle for
Resistance Training
4-6 repetitions (2-3 if very novice) progressing to
10-12 repetitions
Start with 1 set and progress as tolerated to multiple sets.
2-3 days per work
8-10 exercises that train the major muscle groups
When dealing with persons new to resistance training, education and safety are major
considerations. It cannot be emphasized
enough to enforce good form and safety
instead of how much a person can lift.
Conclusion
Remember, whatever exercise program a
person with Arthritis is going to embark on,
they should always consult with their doctor
before starting out. A well-designed and monitored exercise program incorporating range of
motion flexibility exercises, muscular strength
and endurance exercises, and aerobic exercises
will provide great benefit to people with arthritis. Exercise can help alleviate the deconditioning associated with arthritis as well as
improve quality of life. Communication with
the person as well as their medical team will
help ensure a safe and effective program.
Table 4: Comparison of
Rheumatoid and Osteoarthritis17
Rheumatoid arthritis (RA) is a
disease in which your own
immune system mistakenly
attacks healthy tissue, causing
inflammation that damages
your joints.
Osteoarthritis (OA) is a condition
of wear and tear associated with
aging or injury. Your immune
system is not affected.
RA usually causes pain or
stiffness lasting for more than
30 minutes in the morning or
after long rest and lack of
activity.
OA usually occurs as individuals
age and in those whose joints
have become worn down
by excessive use.
RA is associated with
symmetrical swelling (e.g.,
both hands, both elbows, etc.)
OA is associated with
asymmetrical (not “matching”)
swelling in individual joints
that are not part of a pair —
e.g., one knee and an elbow,
instead of both knees.
Most typically, RA symptoms
include joint pain, swelling,
tenderness, and redness of the
joints; prolonged morning
stiffness; and less range of
movement. Some people also
experience fever, weight loss,
fatigue, and/or anemia.
Generally, OA symptoms include
joint stiffness, pain, and
enlarged joints.
About the Author
John Patzan, BS, CSCS is the senior exercise specialist at
The Fitness Club at Hackensack University Medical Center
in Hackensack, NJ. John is also an adjunct professor at
William Paterson University in Wayne, NJ.
References
1. Earle, R.W. and T.R. Baechle. NSCA’s Essentials of Personal
Training. Human Kinetics 2004. p 551.
2. Ehrman, J.K., P.M. Gordon, P.S. Visich and S.J. Keteyian.
Clinical Exercise Physiology. Human Kinetics 2003. p 444.
3. Porth, C.M. Pathophysiology: Concepts of Altered Health
States. Lippincott 1998.
4. Barnes, J.T., T.J. Pujol, and C.L. Elder. Exercise Considerations
for Patients with Rheumatoid Arthritis. Strength and
Conditioning Journal. Tom LaFontaine (Editor), 24(3):46-50,
June 2002.
5. Arthritis Foundation. Exercise and Arthritis. Available at
www.arthritis.org/. Accessed October 15, 2006.
6. Hakkinen, A., T. Sokka, A. Lietsalmi, H. Kautiainen, and P.
Hannonen. Effects of Dynamic Strength Training on Physical
Function, Valpar 9 Work Sample Test, and Working Capacity in
Patients with Recent-Onset Rheumatoid Arthritis. Arthritis &
Rheumatism. 49(1) pp 71-7.
7. American College Of Sports Medicine. ACSM’s Resource
Manual for Guidelines For Exercise Testing And Prescription.
3rd ed. Baltimore: Williams & Wilkins, 1998. p 452.
8. Ehrman, J.K., P.M. Gordon, P.S. Visich and S.J. Keteyian.
Clinical Exercise Physiology. Human Kinetics 2003. p 457.
9. American Academy Of Orthopaedic Surgeons. Athletic Training
and Sports Medicine. 2nd ed. American Academy of
Orthopaedic Surgeons, 1991. p 953.
10. Gordon, N.F. Arthritis Your Complete Exercise Guide: The
Cooper Clinic and Research Institute Fitness Series. Human
Kinetics 1993. pp 38-9.
11. Ehrman, J.K., P.M. Gordon, P.S. Visich and S.J. Keteyian.
Clinical Exercise Physiology. Human Kinetics 2003. p 454.
12. Earle, R.W. and T.R. Baechle. NSCA’s Essentials of Personal
Training. Human Kinetics 2004. pp 552-3.
13. Morbidity and Mortality Weekly Report (CDC). Prevalence of
Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity
Limitation —- United States, 2003—2005. October 13, 2006 /
55(40);1089-1092.
14. Gordon, N.F. Arthritis Your Complete Exercise Guide: The
Cooper Clinic and Research Institute Fitness Series. Human
Kinetics 1993. pp 28-36.
15. Earle, R.W. and T.R. Baechle. NSCA’s Essentials of Personal
Training. Human Kinetics 2004. pp 552-3.
For a complete list of references, please e-mail
[email protected].
Staying up to date with the
ACSM Calendar of Events
Whether it’s upcoming dates, home study
opportunities, or upcoming conferences, you will
find the latest continuing education information
in the ACSM Calendar of Events at
www.acsm.org/coe. Calendar entries include
conferences endorsed by ACSM that offer
continuing education credits, as well as general
non-ACSM approved programs that have been
submitted to our office. If you would like to
have your meeting reviewed for endorsement,
select “Endorsement Application” to access the
Guidelines for Endorsement and Continuing
Education Credit application. For questions on
ACSM continuing education opportunities, the
ACSM endorsement process, or to receive the
monthly calendar of events e-mail, please
contact the education department at
[email protected]. For questions on nonACSM endorsed continuing education that
could be accepted for recertification, please
contact Traci Rush at [email protected].
JANUARY/FEBRUARY/MARCH 2007 | VOLUME 17; ISSUE 1
Coaching News
A Wellness
Coach’s
Guide to
Working
with
Physicians
This is the fourteenth edition of the
Coaching News column, sponsored by
Wellcoaches Corporation in alliance with
ACSM, and it appears regularly in ACSM’s
Certified News.
Opening the door to the medical world is
like trying to pry open a door that has been
nailed shut, both by the American Medical
Association as well as pharmaceutical companies. Is it even possible to begin to open that
door? Yes, the time has never been better for
wellness coaches to collaborate with physicians to better serve the health needs of their
patients.
One important trend is that women will
dominate family practice in the future because
they are well-suited to be nurturers who are
interested in prevention as well as treatment
of illness, and who look out for the health
interest of the entire family.
Today, family physicians are overwhelmed
and understand that while pharmaceutical
companies have an important role to play,
they are not the only solution. The opportunity to combine medication with lifestyle
change supported by wellness coaches will
provide physicians welcome support.
Wellness coaches are trained to deliver mastery of wellness and behavioral change, and
will make major strides in supporting patients
to pursue healthy behaviors, including medication compliance, to treat and prevent disease. We now know that our lifestyle choices
determine 70 percent of our health status, and
the coaching model has measurable outcomes,
including behavior self-efficacy and biometrics.
The door is open for the collaboration of
physician and wellness coach. Here are eight
guidelines based on my experience as a
licensed therapist and wellness coach who has
worked closely with a family physician for the
past three years.
1. Have your credentials available in print
form
Physicians are required to post their medical
credentials, and they want to readily see and
understand the scope of training you bring to
this new partnership. It is important for physicians to understand your specialties as a wellness coach, and how you can best intervene.
Describe client scenarios when presenting your
services to a physician and her team. Provide
references to demonstrate that you can work
with all kinds of personality types. They want
to know how you will work under conflict if a
patient is volatile. Let them know what you
have been able to do with your clients and
show them the results.
2. Help make the physician’s day easier
I work in a family practice with a woman
doctor, her husband who is a physician assistant, and one nurse. On a Monday in the cold
weather, this office sees between 60-70
patients, not including the patients who I
work with. I step in to calm someone down
and try to make an appointment with him/her
for the next day. If there is a patient who
would like information on the new drug for
nicotine addiction, I give that to him/her
because I sat in on the drug reps’ educational
lecture, and the physician knows that is in my
scope of practice. If a patient needs advice on
losing weight to respond to a recent diabetes
diagnosis, I give the relevant educational
information to him and then send him to a
certified diabetes educator or a personal trainer. Doctors want help: not more work. They
rejoice if they get some assistance in their daily
office life.
3. Present coaching outcomes simply and
clearly
Behavioral goal charts and readiness/confidence ratings are excellent tools because they
capture the coach’s skill and the patient’s
efforts. Presenting material succinctly is critical because physicians have so little time.
4. Reduce unnecessary physician visits
We now have reports that health coaches,
who help patients manage medical conditions,
are effective in assisting people to better manage their illnesses and cut down on their emergency room visits. With a wellness coach
working in a doctor’s office and being available at all times with specific information and
resources related to patients needs, unnecessary doctor visits can be reduced. The coach
can also use his/her time in the office to meet
their other clients’ needs by using cell phones
and laptops.
5. Be available, mobile, and efficient
Being available and being mobile are two
very important steps to take to set up in the
medical arena. The medical world is overloaded with patients and paperwork, so be as
efficient as possible. Be present but with as little baggage as possible.
7
ACSM’s Certified News
6. Handle referrals professionally
I always follow up with a thank you letter
to the professional who refers a patient to me.
I put a “First Time Contact” on the doctor’s
desk to let her know that a patient that she
referred to me came to the coaching session,
and then describe the goals we will be working on.
When appropriate, I refer to an ACSM-certified personal trainer, and to certified diabetes
educator (CDE) and a certified alcohol counselor (CDAC).
7. Stay up to date with the latest high quality research
Read the latest research on the impact of
health behaviors, and share a succinct synopsis with the doctor to support his/her discussions with patients. Be sure that everything
you recommend is backed up by the latest
high quality research. Prepare educational
handouts to give to patients, and display
handouts in your office or the waiting area
with your company name and contact details.
I subscribe to Dr Weil’s newsletter and some
other current journals to help stay up to date.
Putting the most recent health and wellness
information on the doctor’s desk every week
with an FYI is an invaluable service and one
that will earn you great respect.
8. Describe your compensation and payment process clearly
Present your means of being paid clearly
and firmly. Physicians have enough trouble
getting paid both by insurance companies as
well as patients, without having more hassles
to deal with. Let there be no misunderstanding between the coach and the doctor’s staff as
to how you will be reimbursed. Also, make
sure that there is a specific boundary between
you and the doctor’s services.
As a therapist as well as a wellness coach, I
am credentialed by major insurance companies, so I bill insurers myself using as much
online and direct reimbursement as possible. I
do not send out bills to patients, and I ask for
payment immediately from those with no
insurance.
In conclusion, I believe that wellness coaches will become firmly established as health
practitioners, and ultimately we will be integrated into the family practice office, and perhaps sooner for integrative medicine practices.
Good Luck!
About the Author
Lisa Todd Graddy, LCSW, MS, is a Certified Wellness
Coach and is ACSM Certified Personal Trainer Certified.
The Coaching News column is sponsored by Wellcoaches
Corporation, the leader in health, fitness, and wellness coach training and delivery of wellness coaching services, in partnership with
ACSM. To learn more about this topic or other topics on coaching
health, fitness, and wellness, visit www.wellcoach.com.
ACSM’s Certified News
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8
Resistance Training
During Pregnancy
Jacalyn J. Robert-McComb, Ph.D., Professor in the Department of Health, Exercise, and
Sport Sciences at Texas Tech University, Lubbock, TX
ACSM Certified Exercise Test Technologist, Exercise Specialist, and Program Director,
Table 1: Royal College of
Obstetricians and Gynecologists Key
Points for Exercise During Pregnancy
• All women should be encouraged to participate in aerobic
and strength-conditioning exercise as a part of a healthy
lifestyle during pregnancy
• Reasonable goals of aerobic conditioning in pregnancy
should be to maintain a good fitness level throughout
pregnancy without trying to reach peak fitness level or
train for athletic competition
• Women should choose activities that will minimize the
risk of loss of balance and fetal trauma
• Women should be advised that adverse pregnancy or
neonatal outcomes are not increased for exercising
women
• Initiation of pelvic floor exercises in the immediate
postpartum period my reduce the risk of future urinary
incontinence
• Women should be advised that moderate exercise during
lactation does not affect the quantity or composition of
breast mile or impact fetal growth.
These recommendations were produced on behalf of the Guidelines and Audit
Committee of the Royal College of Obstetricians and Gynaecologists by: Dr BB Bell
MBChB, DipObsSA, Dorset, Mr MM P Dooley FRCOG, Dorset The final version is the
responsibility of the Guidelines and Audit Committee of the RCOG. Valid until
January 2009 unless otherwise indicated. The Source: Royal College of Obstetrics
and Gynecologists. Exercise in pregnancy. RCOG Statement No. 4 - January 2006;
1-6. (Accessed July 19, 2006 from http://www.rcog.org.uk/printindex.asp?
PageID=1366&Print=Yes)
In 2002, the American College of
Obstetricians and Gynecologists (ACOG)
published updated recommendations and
guidelines for exercise during pregnancy and
the postpartum period1. The basis of their recommendations was that clinical and epidemiological studies have not provided evidence
that there were adverse maternal or fetal
effects for women who engaged in mild to
moderate exercise during pregnancy4. To the
contrary, mild and moderate exercise during
pregnancy can have very positive benefits on
the mother and infant.
Some of the benefits include: (a) a reduction
in pregnancy-related symptoms such as back
pain, heartburn, leg cramps, nausea, fatigue,
varicosities, and swelling of the extremities;
(b) a reduction in the ‘active stage’ of labor
(the time from 4-10 cm dilation); (c) an
increased sense of maternal well-being; (d)
fewer delivery complications because of the
endurance gained that is needed to get
through the long hours of labor; (e) reduction
in risk of developing pregnancy induced
hypertension (PIH); (f) reduction in bone den-
sity loss during the lactation state; (g)
enhancement of birth weight ; and (h) a reduction in risk of developing gestational diabetes
(especially in women with at BMI index
greater than 33)3,4,5,6,7.
The American College of Obstetrics and
Gynecologists (ACOG) currently recommends 30 minutes or more of moderate-intensity exercise per day for most days of the week
during pregnancy in the absence of medical or
obstetric complications. Two new components of the ACOG guidelines merit special
attention4. First, the updated recommendations promote exercise for previously sedentary pregnant women and those with medical
or obstetric complications, but only after having gone through an extensive medical evaluation and clearance. Secondly, the updated
guidelines suggest that exercise may play an
important role in the prevention and management of gestational diabetes mellitus.
To date, most exercise and pregnancy recommendations have focused on aerobic exercise. But what about resistance training (RT)?
In support of the recommendations from the
ACOG, the Royal College of Obstetrics and
Gynecologists (RCOG) issued a position statement on exercise and pregnancy in January of
2006. A summary of their key points can be
found in Table 18. They stated that all women
should be encouraged to participate in aerobic
and strength-conditioning exercise as a part of
a healthy lifestyle during pregnancy.
While there is less evidence on RT, and
stretching exercise such as yoga and Pilates in
pregnancy, it seems that appropriate RT provides pregnant women with an enhanced level
of muscular fitness, which may help compensate for the postural adjustments that typically occur during pregnancy2. However, heavy
lifting during pregnancy is never appropriate.
Additionally, the recommendation from the
ACOG is that exercise in the supine position
should be avoided, especially after the first
trimester.
All RT exercises should be performed in a
slow and controlled manner. RT should occur
every other day with one day of rest between
sessions. One to three sets is appropriate
depending on the exercise and the stage of
pregnancy. An exercise set consisting of at
least 12-15 repetitions without undue fatigue
is recommended for the lower body and 1012 reps for the upper body for the desired
goal6. If the client cannot perform the desired
number of repetitions initially, start with
fewer repetitions and build up to the desired
number before adding additional weight.
Increased recovery time between sets may be
needed with fewer repetitions and less weight
as time of pregnancy increases.
Heavy lifting should be avoided during
pregnancy since it may expose the joints, connective tissue, and skeletal structures of an
expectant woman to excessive forces. An
Pregnancy... Continued on Page 9
JANUARY/FEBRUARY/MARCH 2007 | VOLUME 17; ISSUE 1
Pregnancy... Continued from Page 8
intensity of 9 (very light) to 14 (somewhat
hard) or ‘moderate exertion’ on the RPE scale
would be appropriate for RT during pregnancy. For a copy of the “Determining Moderate
and Vigorous Exercise Intensity Using the Borg
Rating of Perceived Exertion (RPE) Scale, visit
http://ahsmail.uwaterloo.ca/kin356/rpe/rpe/Bo
rg%20RPE%20Scale.html. However, in the
third trimester arm lifting more than 15
pounds or arm pushing more than 25 pounds
should be avoided6. Also, RT on machines if
preferred to free-weights because machines
can be more easily controlled and require less
skill. Table 3 lists guidelines for RT during
pregnancy.
9
ease. Indications to stop exercising include
abdominal pain, dizziness, and vaginal bleeding1.
In closing, the pregnant mother must be
aware of her limitations and exercise within
those limitations. She should also know the
contraindications to exercise and the signs
and symptoms to stop exercising. If properly
educated on the appropriate exercise to perform during pregnancy, the mother and her
baby can enjoy the benefits of exercise, even
light resistance exercise throughout her entire
pregnancy. Readers are encouraged to read Fit
to Deliver, An Exercise Program for You and
Your Baby by Karen Nordahl, Susi Kerr, and
Carl Peterson for more explicit instructions on
RT exercises during pregnancy6.
Table 3: Recommendations Regarding
Resistance Training during Pregnancy
• Medical advice and physician recommendations should be
obtained prior to resistance training during pregnancy.
• Resistance training for all pregnant women may not be
appropriate. If women have any of the contraindications to
aerobic exercise as proposed by American College of
Obstetrics and Gynecology they should not participate in
resistance training.
• Women who have never participated in resistance training
should not initiate one during pregnancy.
• Women should be encouraged to breathe normally during
resistance training, breath holding reduces oxygen
delivery to the placenta
• Heavy resistance should be avoided since it may expose
the joints, connective tissue, and skeletal structures of an
expectant woman to excessive forces. An exercise set
consisting of at least 12-15 repetitions without undue
fatigue is recommended.
• As training occurs, overload initially by increasing number
of repetitions and, subsequently, by increasing resistance.
Resistance training on machines if preferred to free-weights
because machines can be more easily controlled and
require less skill
Source: Byrant C, Peterson J, Graves J. Muscular strength and endurance. In:
Roitman J, ed. ACSM’s Resource Manual for Guidelines for Exercise Testing and
Prescription, 3rd ed. Philadelphia: Williams and Wilkins, 1998:448-455.
As with all exercise programs, precautionary measures should be taken prior to and
during RT. All prenatal populations should
obtain a clearance from their physician prior
to beginning an aerobic or RT exercise program. One of the most often used screening
tools, the PAREMED-X for pregnancy, is
available to download from the Canadian
Society for Exercise Physiologists at
http://www.csep.ca/pdfs/parmed-xpreg.pdf6.
It is also recommended that women who
have never participated in RT not initiate a
program during pregnancy. Absolute and relative contraindications to exercise during
pregnancy and the postpartum period as recommended by the American College of
Obstetrics and Gynecologists (ACOG) are
pregnancy-induced hypertension, preterm
rupture of membranes, preterm labor during
the prior or current pregnancy, incompetent
cervix or cerclage placement, persistent second- or third- trimester bleeding, placenta
previa, and intrauterine growth retardation1.
Relative contraindications are chronic hypertension, thyroid function abnormality, cardiac
disease, vascular disease, and pulmonary dis-
ACSM’s Certified News
References
1. ACOG Committee. Opinion no. 267: Exercise During Pregnancy
and the Postpartum Period. Obstet Gynecol 2002;99:171-3.
2. Byrant C, Peterson J, Graves J. Muscular Strength and
Endurance. In: Roitman J, ed. ACSM’s Resource Manual for
Guidelines for Exercise Testing and Prescription, 3rd ed.
Philadelphia: Williams and Wilkins, 1998:448-455.
3. Clapp J. Exercising Through your Pregnancy. Champaign, IL:
Human Kinetics, 1998.
4. Dempsey J, Butler C, Williams M. No Need for a Pregnant
Pause: Physical Activity May Reduce the Occurrence of
Gestational Diabetes Mellitus and Preeclampsia. Exercise and
Sport Sciences Reviews 2005;33(3):141-149.
5. Ezmerli NM, Exercise in pregnancy. Primary Care Update
Obstetrics and Gynecology 2000;7(6):260-265.
6. Nordahl K, Petersen C, Jeffreys RM. Fit to Deliver, 2nd ed.
Canada: Fit to Deliver Inc, 2005.
7. Pivarnik JM. Potential Effects of Maternal Physical Activity on
Birth Weight: Brief Review. Med Sci Sport Exerc 1998;30(3):400406.
8. Royal College of Obstetrics and Gynecologists. Exercise in
Pregnancy. RCOG Statement No. 4 - January 2006; 1-6.
(Accessed July 19, 2006 from http://www.rcog.org.uk/printindex.asp?PageID=1366&Print=Yes)
News You Need... Continued from Page 1
and Sportsclub Association (IHRSA) Board
to its member clubs as follows:
“Whereas, given the increasing importance
personal training plays in health, fitness and
sports clubs, IHRSA recommends that, as of
January 1, 2006, member clubs hire personal
trainers who hold at least one current certification from a certifying organization/agency
that has obtained third-party accreditation of
its certification procedures and protocols
from an independent, experienced, and
nationally recognized accrediting body.
Furthermore, given the twenty-six year history of the National Organization for
Competency Assurance (NOCA) in establishing quality standards for certifying agencies,
IHRSA has identified the National
Commission for Certifying Agencies
(NCCA), the accreditation body of NOCA,
as being an acceptable accrediting organization. Other equivalent accrediting organizations may be recognized as well, as they come
to IHRSA’s attention.”
The National Commission for Certifying
Agencies (NCCA) is the accreditation body
of the National Organization for
Competency
Assurance
(NOCA).
Certification programs may apply and be
accredited by the NCCA if they demonstrate
compliance with each accreditation standard.
NCCA’s Standards exceed the requirements
set forth by the American Psychological
Association and the U.S. Equal Employment
Opportunity Commission. NCCA is an independent nongovernmental agency that
accredits professional certifications in a variety of professions. NCCA reviews the certification organization’s procedures, protocols
and operations and determines if the certification properly discriminates between those
who are qualified and those who are not
qualified to be awarded the respective credential.
Established in 1977, NOCA is the leader in
setting quality standards for credentialing
organizations. Through its annual conference,
regional seminars, and publications, NOCA
serves its membership as a clearinghouse for
information on the latest trends and issues of
concern to practitioners and organizations
focused on certification, licensure, and human
resource development.
CAAHEP to Finalize Academic Standards and
Guidelines for Personal Fitness Training
Programs
Finally, the Committee on Accreditation for
the Exercise Sciences (www.coaes.org) has
submitted a final draft version of standards
and guidelines for academic programs in
Personal Fitness Training. A public comment
period was made available through the
Commission on Accreditation of Allied
Health Education Programs’ Web site
(www.caahep.org). Because ACSM is a sponsoring organization of the CoAES, this information was disseminated previously through
Certified E-News, the ACSM Web site, as
well as through ACSM’s Sports Medicine
Bulletin (SMB) both to current certified professionals and ACSM members. CAAHEP is
hosting an open hearing on the proposed
standards and guidelines on Friday, January
26. This hearing may have already occurred
by the time you receive this newsletter. Please
visit
either
www.coaes.org
or
www.caahep.org for the latest updates on this
process. If the standards and guidelines are
approved, interested academic institutions
can begin submitting “Request for
Accreditation Services” forms in the spring of
2007.
SELF-TEST ANSWER KEY FOR PAGE 11
————— QUESTION ——————
1
2
3
4
5
TEST #1:
B
C
D
T
T
TEST #2:
C
B
D
F
T
TEST #3:
D
T
D
A
D
ACSM’s Certified News
10
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Exercising the Future of Fitness!
MARCH 21-24, 2007
ADAM’S MARK HOTEL
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JANUARY/FEBRUARY/MARCH 2007 | VOLUME 17; ISSUE 1
11
ACSM’s Certified News
January-March 2007 Continuing Education Self-Tests
Credits provided by the American College of Sports Medicine • CEC Credit Offering Expires March 31, 2008
SELF-TEST #1 (1 CEC): The following questions were
taken from “Training for Independence” published in this
issue of ACSM’s Certified News, pages 2-4.
1. Any person who is reasonably healthy or has their
health problems controlled may safely participate in an
exercise program provided that:
A. Their doctor has contacted you regarding their
health status.
B. Their exercise prescription adheres to the FITT
principle and takes into account their medical history.
C. Their immediate family has expressed their
approval.
D. They have slept well and taken their medications
prior to exercise.
2. Sarcopenia is the term for:
A. Normal aging.
B. Unusual aging effect.
C. Muscle tissue loss.
D. Muscle tissue gain.
3. The most dramatic effect of muscle loss is:
A. Clothes no longer fit well.
B. Increase in blood sugars.
C. Weight gain.
D. Loss of physical independence.
4. True of False: It is possible to be overcautious with a
strength training prescription and assist functional
muscle loss.
5. True or False: It is possible for a septuagenarian to
gain muscle mass and strength at a rate similar to a
twenty-five year old when strength training.
ACSM’s
Certified
News
SELF-TEST #2 (2 CECs): The following questions were
taken from “Successful Resistance Training for Arthritis”
published in this issue of ACSM’s Certified News, pages
5-6.
1. An acute stage of arthritis can be identified by all
except:
A. Joint pain
B. Fatigue
C. Permanent joint damage
D. Swelling
2. People who have severe RA in the wrist or hand may
benefit from this piece of equipment:
A. Exercise machines
B. Elastic tubing
C. Free-weights
D. None of the above
3. Which of the following is not a guideline when
performing isometric exercises?
A. Hold the muscle contraction for 10-12 seconds
B. Between each exercise, rest for 15-60 seconds
C. Start with 1-3 repetitions of the exercise
D. When using resistance bands, use the thickest
band
B. Heavy resistance should be avoided since it may
expose the joints, connective tissue, and skeletal
structures of an expectant woman to excessive forces.
C. An exercise set consisting of at least 12-15
repetitions without undue fatigue is recommended.
D. As training occurs, overload initially by increasing
resistance, and subsequently by increasing the
number of repetitions
2. True or False: Resistance training on machines during
pregnancy is preferred to free-weights because machines
can be more easily controlled and require less skill.
3. According to the American College of Obstetricians
and Gynecologists an absolute contraindication to
aerobic exercise during pregnancy is:
A. Severe anemia
B. Poorly controlled Type 1 Diabetes
C. History of extremely sedentary lifestyle
D. Preeclampsia/pregnancy-induced hypertension
4. In the absence of either medical or obstetric
complications, the American College of Obstetricians and
Gynecologists suggests that pregnant women should:
A. Accumulate 30 min or more of moderate exercise
on most days, if not all, days of the week
B. Accumulate 60 min or more of moderate exercise
4. True or False: Resistance exercise programs using
on most days, if not all, days of the week
predominately closed kinetic chain exercises in the upper
C. Accumulate 60 min or more of vigorous exercise
extremity are recommended.
on most days, if not all, days of the week
D. Accumulate 30 min or more of vigorous exercise
5. True or False: Osteoarthritis (OA) is also known as
on most days, if not all, days of the week
“wear and tear arthritis.”
5. The American College of Obstetricians and
SELF-TEST #3 (1 CEC): The following questions were
Gynecologists advice is to avoid exercise in this position
taken from “Resistance Training During Pregnancy” pub- as much as possible. This position should especially be
lished in this issue of ACSM’s Certified News, pages 8-9. avoided after the first trimester.
A. Prone
1. Which of the following recommendations regarding
B. Upright
resistance training during pregnancy is false?
C. Semi-inclined
A. Women who have never participated in resistance
D. Supine
training should not initiate a training program during
pregnancy.
To receive credit, circle the best answer for each question, check your answers against the answer key on page 9, and mail
entire page with check or money order payable in US dollars to: American College of Sports Medicine, Dept 6022,
Carol Stream, IL 60122-6022
ACSM Member (PLEASE MARK BELOW)
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($25 fee for returned checks)
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PLEASE PRINT OR TYPE REQUESTED INFORMATION
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January-March 2007 Issue EXPIRATION DATE: 03/31/08
SELF-TESTS SUBMITTED AFTER THE EXPIRATION DATE WILL NOT BE ACCEPTED.
Federal Tax ID number 23-6390952
Tip: Frequent self-test participants can
find their ACSM ID number located on
any credit verification letter.
ACSM’s Certified News
AMERICAN COLLEGE OF SPORTS MEDICINE | (317) 637-9200
12
Resistance Training... Continued from Page 1
ACSM’s Regional Chapters
Enjoy top-notch educational presentations
and unmatched opportunities to network with
fellow professionals at ACSM’s Regional
Chapter meetings. In addition, earn valuable
continuing education credits to keep your
certification current. Below is a listing of
upcoming meetings near you:
• February 8-10, 2007, Southeast Chapter,
Charlotte, NC
Contact: Lynn Berry, Ph.D., [email protected],
www.seacsm.org
• February 16-17, 2007, Northwest Chapter,
Seattle,WA
Contact: Wendy Repovich, Ph.D., FACSM,
[email protected],
http://northonline.northseattle.edu/nwacsm,
10 ACSM CECs
• March 1-2, 2007,Texas Chapter,
Fort Worth,TX
Contact: Joel Mitchell, Ph.D., FACSM,
[email protected], www.tacsm.org
• March 2-3, 2007, Rocky Mountain Chapter,
Colorado Springs, CO
Contact: Kurt Dallow, M.D., FACSM,
[email protected], www.rmacsm.org
• March 30, 2007, Northland Chapter,
St. Cloud, MN
Contact: John Keener, Ph.D.,
[email protected], www.d.umn.edu/~nacsm
• April 13, 2007, New England Chapter,
Westfield, MA
Contact: NEACSM Office, [email protected],
www.neacsm.org
ACSM’S Certified News ISSN # 1056-9677
P.O. Box 1440
Indianapolis, IN 46206-1440 USA
mass, especially in the upper body, was a normal part of the aging process (sarcopenia).
Resistance exercise helps offset the loss in
muscle mass and muscular strength typically
associated with normal aging2.
Resistance training has been shown to
modestly lower resting blood pressure4.
Resistance training may also assist in improving blood lipids, though the evidence is limited at this point6.
Healthy, elderly individuals who are
stronger are at less risk for falls and associated injuries (e.g., fractures)2. An appropriately
designed resistance program can also help
maintain/increase strength, flexibility, and
balance. It can also have significant cardiovascular benefits. Resistance training plays a vital
role in preventing heart attacks by conditioning the cardiovascular system to cope more
efficiently with sudden changes in blood pressure and heart rate. There are specific resistance training program design guidelines and
safety considerations that should be followed
when working with the elderly population.
Thomas Mahady, MS, CSCS does an excellent job explaining how resistance training
can benefit elderly persons to maintain their
independence.
Resistance training has beneficial effects on
osteoarthritis and rheumatoid arthritis. John
Patzan, BS, CSCS provides the readership
with great information on how resistance
training helps manage these diseases.
Resistance training reverses some of the
deconditioning associated with arthritis, alleviates stress on the affected joints, improves
functions of daily living, enhances aerobic
exercise tolerance, and helps improve quality
of life.
Resistance training also has specific benefits
for pregnant women. These include reduced
back pain, lower risk of pregnancy-induced
hypertension and gestational diabetes, and
less delivery complications.
Jacalyn McComb, Ph.D., FACSM, has
written an excellent article discussing these
benefits as well as how to safely and effectively design a resistance training program during
pregnancy.
About the Author
Paul Sorace, MS, ACSM RCEP, CSCS is a clinical exercise
physiologist for The Cardiac Prevention & Rehabilitation
Program and the program coordinator for The Bariatric
Rehabilitation Program at Hackensack University Medical
Center in Hackensack, NJ. Paul also is a member of the
ACSM Exam Development Team, the ACSM Publications
Subcommittee, and an editorial board member for ACSM’s
Health & Fitness Journal.
References
1. American College of Sports Medicine Position Stand.
Appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 33 (12):
2145-2156, 2001.
2. American College of Sports Medicine Position Stand. Exercise
and physical activity for older adults. Med Sci Sports Exerc. Jun;
30(6):992-1008, 1998.
3. Ibanez J, Izquierdo M, Arguelles I, Forga L, Larrion JL, GarciaUnciti M, Idoate F, Gorostiaga EM. Twice-weekly progressive
resistance training decreases abdominal fat and improves insulin
sensitivity in older men with type 2 diabetes. Diabetes Care.
Mar; 28(3):662-667, 2005.
4. Kelley GA, Kelley KS. Progressive resistance exercise and resting
blood pressure: A meta-analysis of randomized controlled trials.
Hypertension. Mar; 35(3):838-843, 2000.
5. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR,
ACSM. American College of Sports Medicine Position Stand.
Physical activity and bone health. Med Sci Sports Exerc. Nov;
36(11):1985-1996, 2004.
6. Petitt, D.S., S.A. Arngrimsson, and K.J. Cureton. Effect of resistance exercise on postprandial lipemia. J. Appl. Physiol. 94 (2):
694-700, 2003.