1. ACE Personal Trainer Manual 5th Edition
Chapter 6: Building Rapport and the Initial Investigation Stage
Lesson 6.2

2. After completing this session, you will be able to:
LEARNING OBJECTIVES
After completing this session, you will be able to:
Describe the classes of medications and their effect on physical activity
Discuss the sequencing of physiological assessments
Discuss and explain the factors in determining the correct assessments for a client (goals of the assessment, physical limitations of participant, testing environment, equipment, age of participant)
Evaluate equipment needed to start performing assessments

3. MEDICATIONS
Medications alter the biochemistry of the body and may affect a client’s ability to perform or respond to exercise.
Any client taking a prescription medication that could potentially have an effect on exercise should have a physician’s clearance for physical activity.
The most common categories of medications:
Antihypertensives
Bronchodilators
Cold medicines
Refer to Table 6-2: Effects of Medication on Heart-rate Response

4. ANTIHYPERTENSIVES
Antihypertensives primarily affect one of four different sites:
Heart: to reduce its force of contraction
Peripheral blood vessels: to open or dilate them to allow more room for the blood
Brain: to reduce the sympathetic nerve outflow
Kidneys: to reduce blood volume by excreting more fluid
The most common antihypertensives:
Beta blockers
Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-II receptor antagonists
Diuretics
It is important for personal trainers to have a strong understanding of how medications affect resting, exercise, and maximal heart rate (see Table 6-2). Depending on the medication and its effects, a trainer may over- or underestimate training intensity, potentially causing harm or creating program ineffectiveness.

5. ADDITIONAL MEDICATIONS
Bronchodilators (medications for asthma)
Relax or open the air passages in the lungs
Stimulate sympathetic nervous system
Increase exercise capacity when limited by bronchospasm
Cold medicine
Decongestants
Stimulate vasoconstriction, which reduces the volume of swollen tissues
Vasoconstriction may raise blood pressure and increase heart rate both at rest and possibly during exercise.
Antihistamines
Produce a drying effect in the upper airways and may cause drowsiness

6. SEQUENCING ASSESSMENTS
Proper test selection can minimize client intimidation, embarrassment, or even fear of the results.
Assessments that merit consideration include:
Resting vital signs (heart rate, blood pressure, height, and weight)
Static posture and movement screens
Joint flexibility and muscle length
Balance and core function
Cardiorespiratory fitness
Body composition
Muscular endurance and strength
Skill-related parameters (agility, coordination, power, reactivity, and speed)
Testing for muscular strength and endurance is not suggested for many novice clients within the first few weeks, given the initial neurological adaptations and motor-skill changes that occur during the first one to four weeks of a resistance-training program.
During the administration of any exercise test involving exertion (e.g., a cardiorespiratory fitness test), trainers must always be aware of signs or symptoms they can identify that merit immediate test termination and referral to a more appropriately qualified healthcare professional. These symptoms include:
Onset of angina pectoris or angina-like symptoms that center around the chest
Significant drop (>10 mmHg) in SBP despite an increase in exercise intensity
Excessive rise in blood pressure: SBP reaches >250 mmHg or DBP reaches >115 mmHg
Fatigue, shortness of breath, difficult or labored breathing, or wheezing (does not include heavy breathing due to intense exercise)
Signs of poor perfusion: lightheadedness, pallor (pale skin), cyanosis, nausea, or cold and clammy skin
Increased nervous system symptoms (e.g., ataxia, dizziness, confusion, or syncope)
Leg cramping or claudication
Physical or verbal manifestations of severe fatigue
The test should also be terminated if the client requests to stop or the testing equipment fails.

7. SEQUENCING ASSESSMENTS
When establishing a timeline for assessment, take into consideration the physiological influences of exercise:
Resting blood pressure (BP) and heart rate (HR)
Measure before exertion to avoid falsely elevated scores
Skinfold measurements; take before activity to avoid:
Underestimation of fat stores from dehydration
Overestimation of fat stores due to vasodilation for thermoregulation
Cardiovascular testing
If following resistance exercise, this may elevate HR responses and invalidate the results

8. SEQUENCING ASSESSMENTS
Be fully prepared when conducting assessments:
Instructions – outline the client’s responsibilities in advance (e.g., clothing, eating, and hydration recommendations)
Organize all necessary forms, data sheets, and assessment tables
Informed consent
Obtain a signed copy in advance from the client
Allow the client the opportunity to ask questions about the protocols
Additionally:
Clearly explain the tests, sequence, and instructions
Ensure calibration and working condition of all equipment
Ensure environment is ideally between 68 and 72⁰ F (20 to 22⁰ C) with a relative humidity below 60%
Ensure a quiet and private testing environment to reduce test anxiety

9. CHOOSING THE RIGHT ASSESSMENTS
Not all clients need or desire a complete assessment; consider the following:
Goals of the assessment
Fitness and training goals are different; testing should also be unique
Physical limitations of the participant
Choose tests that will provide valid results without causing undue stress
Testing environment
Equipment calibration or proper surface
Adequate lighting
Proper emergency response protocol
Appropriate temperature
Availability of equipment
Participant age
An older, deconditioned client will not perform the same test as a younger client

10. TOOLS TO GET STARTED
There are a number of computer and PDA software programs available to aid in calculations, documentation, and reporting. The American Council on Exercise also provides valuable calculation tools and assessment support materials through its website (

11. BUILDING A PROFESSIONAL NETWORK
If you work with athletes, whether they are high school student-athletes or Olympic hopefuls, it is important to build a network of professionals who help you better understand the needs of athletes in a particular sport.
In class, develop a list of potential resources in your area. If time permits, draft a letter or that explains your services and asks specific questions that will help you better serve these potential clients.

12. SUMMARY
Medications alter the biochemistry of the body and may affect a client’s ability to perform or respond to exercise. The most common categories are antihypertensives, bronchodilators, and cold medicines.
Proper assessment selection can minimize client intimidation, embarrassment, or even fear of the results. Not all clients need or desire a complete assessment. Consider the assessment goal, participant age and limitations, testing environment, and equipment availability.
A personal trainer may have access to a variety of fitness-assessment instruments and equipment. The most common tools may include a stopwatch, calculator, blood pressure cuff and stethoscope, HR monitor, and skinfold calipers.