ACE CPT Chapter 6 – Building Rapport and the Initial Investigation Stage

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What is Rapport:

Rapport is the personal interactions that a person has with another, such as the one that a personal trainer has with their client. It requires good communication and mutual respect for one another.

The three important attributes:

Genuineness:

This is being open, honest, and authentic.

Warmth:

This is having unconditional respect and positivity towards other people, no matter who they are. This will communicate acceptance and safety.

Empathy:

The ability to understand someone else’s position as if you were in their shoes.

• Requires being able to separate the unnecessary from the meaningful.
• The ability to notice certain patterns of emotion (such as a client getting upset when you talk about their challenge with weight loss).
• The ability to be conscious of the differences between cultures while communicating.

How does one build rapport?

The stages of building rapport

1. Rapport: Number of impressions demonstrating warmth, genuineness, and empathy. Having multiple impressions.
2. Investigation: Noticing a readiness to change one’s behavior
3. Planning: Various adherence and motivation strategies, setting goals, and programming.
4. Action: Demonstrating instructions and carrying out a program allows proper feedback.

Different styles of communication:

• Educating: This is a way of informing clients about information so that they can make better decisions.
• Preaching: Preaching is a way of lecturing clients about what they should and shouldn’t do. It comes across as judgmental and minimizes one’s chances of rapport.
• Counseling: This is the most effective style out of the four listed when modifying or implementing a workout program. It is very supportive. Overall it is a collaborative effort toward helping personal training clients make better and more informed decisions.
• Directing: This form is instructive. The trainer will provide directions and instructions. It can be effective. Technique and form are crucial.

Questions to ask pre-exercise:

Ask the client about what types of physical activity/exercises they do in a typical week. This can include recreational activities, business activities, traveling, and pain that they experience while moving.

It would help if you asked as many questions as possible to understand better your client’s habits, history with exercise, and overall lifestyle.

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Motivational interviewing: This helps increase your client’s intrinsic motivation that is client-centered. It helps explore mixed feelings about how they may feel about exercise and health habits in general.

It will help you determine if a particular client is ready to change.

Health risk appraisal

• Preparticipation screening: Helps pinpoint metabolic, pulmonary, or cardiovascular disease symptoms.

Identify risk factors:

• Some positive risk factors (bad): Having a family history of the disease and having coronary artery disease.
• Negative risk factors (good): A high-density lipoprotein (HDL good cholesterol) score over 60 mg/dl.
• Helps to determine whether or not they need medical clearance to exercise.
• Helps determine whether or not they need a program that is medically supervised.
• Physical activity readiness questionnaire (PAR-Q)
• The minimal health risk appraisal prerequisite
• Noninvasive, easy, and quick
• It is not very detailed

The positive risk factors

If any of the answers are yes, one point is applied

• Age: Older than 45 years for men, Older than 55 years for women
• Family history: A history of sudden deaths, coronary revascularization, and myocardial infarction. Before age 55, the client’s father or a male relative of the 1st degree. B for the age of 65 in the client’s mother or a female relative that is of the 1^st degree.
• Smoker: This includes current smokers or ones who quit within six months. It also includes people with high exposure to environmental/secondhand smoke.
• Sedentary lifestyle: This is for people who either do no physical activity or have less than 30 minutes of moderate-intensity activity for three days a week for at least three months.
• Obesity: This is classified as a body mass index over 30 or a waste girth of 40 inches (102 cm) for men or 35 inches (88cm) for women.
• Hypertension: This is for people with a systolic blood pressure of more than 140 mmHg and/or a diastolic blood pressure reading of more than 90 mmHg. These readings need to be read at least two times. Or the client is on antihypertensive medication.
• Dyslipidemia: The client has an LDL cholesterol of more than 130 mg/dl or an HDL cholesterol of less than 40 mg/dl. It also applies if they are on a lipid-lowering prescription drug or if their total cholesterol serum is over 200 mg/dl.
• Prediabetes: Pre-diabetes in your client is considered to have a fasting plasma glucose of more than 100 mg/dl but less than 125 mg/dl. It is also considered to have IGT (impaired glucose intolerance) in which a two-hour OGTT (oral glucose tolerance test) is more than 140 mg/dl but less than 199 mg/dl. This has to be confirmed on a minimum of two different occasions.

The negative risk factors.

If any of the answers are yes, one point is subtracted.

• HDL-cholesterol: with a reading of more than 60 mg/dl.

Risk classifications for PAR-Q:

Low risk:

• Asymptomatic
• Having less than two risk factors.
• A medical exam before vigorous to moderate exercise is not required
• An exercise test is not recommended
• It is not necessary to receive a doctor’s supervision to start exercising.

Moderate risk:

• Asymptomatic
• Having more than two risk factors
• Having a medical exam for moderate exercise is not required
• Having a medical exam for rigorous exercises IS required
• Performing an exercise test before is not recommended
• It is not required to receive Dr. supervision

High risk:

• Symptomatic, or you know that they have metabolic, pulmonary, renal, or CV disease.
• A medical exam before moderate/vigorous exercise IS required.
• It is recommended to do an exercise test before a moderate/vigorous exercise
• It is recommended to receive Dr. supervision for both maximal as well as submaximal exercise

Moderate exercise

• This is defined as between 40% to 60% VO2R or between 3-6 METs
• Vigorous exercise: 60% or more VO2R or more than six METs

Symptoms and signs to be noted

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• Tightness, pain, or discomfort (angina) in the neck, chest, arms, jaw, or any of the other areas that may come from ischemia.
• Difficulty breathing while at rest or shortness of breath from minimal exertion (dyspnea)
• Paroxysmal nocturnal dyspnea or Orthopnea (Reclined position dyspnea).
• Ankle edema
• Tachycardia or palpations
• Intermittent claudication (Cramping and/or pain in lower extremities from a lack of blood supply)
• Heart murmurs
• Difficulty breathing or abnormal fatigue during normal activities
• Syncope or dizziness

Evaluation forms

• Informed consent: These are NOT liability waivers
• A release of liability and agreement waivers: These release the personal trainer from injury-related liability.
• History of health questionnaire
• Medical release forms
• Testing forms

Health conditions and how they affect exercise

Cardiovascular

Atherosclerosis: When fat, cholesterol and calcium deposits gather in the arterial walls.

• Causes the arteries to thicken
• They lose their elasticity
• It can lead to heart attacks, myocardial infarction, and angina

Respiratory

• Asthma
• Emphysema
• Bronchitis
• COPD (chronic obstructive pulmonary disease)

Musculoskeletal

• Consists of tendons, ligaments, bones, and muscles
• Sprains (Involves ligaments that connect bones to other bones) and strains (Involves tendons that connect bone to muscle).
• Overuse injuries (These are the most common)
• Bursitis
• Herniated discs
• Atrophy
• Tendinitis
• Arthritis

Metabolic

• Diabetes
• Disorders of the thyroid
• Overall, diseases that mess with metabolism or how energy is utilized

Other conditions

• Hernia
• Pregnancy
• Infection or illness

Medications (Refer to Table 6 – 2)

Antihypertensive

Beta-blockers (These limit the sympathetic nervous system)

• Will block the effects of norepinephrine and epinephrine (catecholamine)
• Instead of target heart rate, use RPE if a client is using beta blockers
• Will lower the exercise, resting, and maximum heart rate of the client

ACE (angiotensin-converting enzyme) inhibitors

Angiotensin-2 receptor antagonist

Calcium channel blockers:

• Will not significantly alter maximum heart rate
• It can both decrease, increase or have no effect on exercise or resting heart rate.

Diuretics

• It will increase the excretion of electrolytes and water through the kidneys.
• It can cause imbalances in electrolytes and water that lead to arrhythmias.
• Has no major effect on heart rate
• Can predispose the client to dehydration

Bronchodilators

• Can open and relax air passageways to lungs
• Will help to improve air exchange

Cold medications

• Helps to stimulate vasoconstriction

Performing cardiovascular assessments

Taking the client’s pulse manually

• Carotid artery: Is located laterally to the trachea on the neck.
• Radial artery: Anterior/ventral on the wrist on the thumb side

Resting heart rates:

• Bradycardia: a slow heart rate that is less than 60 bpm
• Normal heart rate: between 60 in 100 bpm
• Tachycardia: A fast rate of over 100 bpm
• Overall averages are between 70 and 72 bpm

Males: between 60 and 70 bpm

Females between 72 and 80 bpm

• Due to smaller heart chambers for women
• Women have a lower blood volume.
• Women have lower hemoglobin

Body position can affect the resting heart rate

Digestion increases the resting heart rate

Methods for measuring

• 12 lead electrocardiogram (EKG or ECG)
• Telemetry (These are commercial heart rate monitors)
• Palpation
• Auscultation with a stethoscope

Ways of measuring exercise heart rate:

• Measuring your client’s pulse for 10 seconds and then multiplying that number by 6
• Measuring your client’s pulse for 15 seconds and then multiplying that number by 4

Blood pressure

• Kiritkoff sounds: These are sounds made from the vibrations of blood moving along the walls of the blood vessels
• Sphygmomanometer – Blood pressure cuff

Rating of perceived exertion (RPE)

Borg’s scale

• 6 to 20
• 6 = Nothing at all (heart rate of 60 bpm)
• 12 = Strong (heart rate of 120 bpm)
• 20 = Super strong (Heart rate of 200 bpm)

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