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

ACE Study Guide Chapter 6

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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:


    This is being open, honest and authentic.


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


    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 their 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 be doing in what they shouldn’t be doing. 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 towards helping personal training clients make better and more informed decisions.
    • Directing: This form is instructive. The trainer will provide directions and instructions. 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, pain that they experience while moving.

    You need to ask as many questions to better understand your client’s habits, history with exercise and overall lifestyle.

    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 to pinpoint symptoms of metabolic, pulmonary or cardiovascular disease.

    Identify risk factors:

    • Some positive risk factors (bad): Having a family history of disease, 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 or men, Older than 55 years for women
    • Family history: A history of sudden deaths, coronary revascularization, myocardial infarction. Before the age of 55 in 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 1st degree.
    • Smoker: This includes current smokers or ones that quit within the last six months. It also includes people with high exposures to environmental/secondhand smoke.
    • Sedentary lifestyle: This is for people that either do no physical activity, or 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 that have 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: This is with the client has 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 more than 200 mg/dl.
    • Prediabetes: Pre-diabetes in your client is considered having a fasting plasma glucose of more than 100 mg/dl but less than 125 mg/dl. It is also considered having IGT (impaired glucose intolerance) in which a two-hour OGTT (oral glucose tolerance test) is more than 140 mg/dl but it is 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 needed 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/rigorous 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 MET’s
    • Vigorous exercise: 60% or more VO2R or more than six METs

    Symptoms and signs to be noted

    • 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 a 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 do release the personal trainer for liability related to injuries.
    • History of health questionnaire
    • Medical release forms
    • Testing forms

    Health conditions and how they affect exercise


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

    • Causes the arteries to thicken
    • They lose their elasticity
    • Can lead to heart attacks, myocardial infarction’s and angina


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


    • 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


    • 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)


    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 client

    ACE (angiotensin-converting enzyme) inhibitors

    Angiotensin-2 receptor antagonist

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    Calcium channel blockers:

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


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


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

    Cold medications

    • Helps to stimulate vasoconstriction

    Performing cardiovascular assessments

    Taking clients pulse manually

    • Carotid artery: Is located laterally to 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 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 chamber for women
    • Women have lower blood volume
    • Women have lower hemoglobin

    Body position can affect 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 clients pulse for 10 seconds and then multiplying that number by 6
    • Measuring your clients 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)

    If you want additional study materials, check out the team over at Trainer Academy. They have incredible study materials for ACE And I have a special limited-time discount for my readers. I also suggest you check out my review on Trainer Academy here.

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