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040-444 - ACSM Registered Clinical Exercise Physiologist - Dump Information

Vendor : ACSM
Exam Code : 040-444
Exam Name : ACSM Registered Clinical Exercise Physiologist
Questions and Answers : 370 Q & A
Updated On : December 14, 2018
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040-444 Questions and Answers

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040-444 ACSM Registered Clinical Exercise Physiologist

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040-444 exam Dumps Source : ACSM Registered Clinical Exercise Physiologist

Test Code : 040-444
Test Name : ACSM Registered Clinical Exercise Physiologist
Vendor Name : ACSM
Q&A : 370 Real Questions

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ACSM ACSM Registered Clinical Exercise

RESISTANCE practicing FOR CARDIAC sufferers: Maximizing Rehabilitation | killexams.com Real Questions and Pass4sure dumps

Cardiorespiratory undertaking has historically been the emphasis of cardiac rehabilitation courses. although, resistance training (RT) has progressively develop into a essential element of cardiac rehabilitation because of its big health benefits and high-quality results on cardiac comorbidities (1). There are safeguard considerations that should be considered when enforcing a RT application for the cardiac patient. due to this fact, certain RT instructions have been established for cardiac rehabilitation (2,3). this article will address the merits of RT in cardiac rehabilitation. moreover, safety concerns and instructions and how to increase, implement, and display screen an RT application for sufferers in cardiac rehabilitation and after cardiac rehabilitation could be presented.

RT benefits FOR CARDIAC patients

The benefits of RT for men and women with heart problems are a large number of. the most established benefit of RT is accelerated muscular energy and patience (1,4-10). typical muscle electricity improvements of 25% to 30% are usually seen (4,eight-10). in addition, a 46% growth in muscle power has been followed in frail individuals who perform RT (four).

here's important for cardiac patients because many actions of each day residing require extra muscular electricity and endurance than what is developed from cardiorespiratory undertaking. moreover, the requisite drive to complete these activities may also exceed medically imposed lifting restrictions positioned on this affected person population (eleven). These activities encompass rising from a chair, carrying groceries, mountaineering stairs, and preserving/carrying toddlers and grandchildren. Many cardiac sufferers also lack the confidence to operate many projects of day by day residing (1,2). Resistance training can provide them with both the muscular energy and confidence to are living a more lively and unbiased way of life (1,four-6,10,11).

For cardiac patients returning to work after rehabilitation, RT could be of certain interest, notably for these with physically worrying occupations. Resistance training reduces cardiac calls for at given workloads via cutting back the expense-power product (RPP) (systolic blood pressure × heart fee) (2,4,6-10,12) and might make initiatives comparable to lifting heavy objects safer to operate. mixed cardiorespiratory pastime and RT had been proven to improve aerobic health more than cardiorespiratory working towards on my own (eight,13), additional improving practical potential and quality of existence (1,4,10).

Resistance practising helps control and prevent a few coronary chance components (5,6,12) and different continual diseases (5,6,10,12). These include category 2 diabetes, hypertension, obese/weight problems, arthritis, frailty/sarcopenia, and osteoporosis. for the reason that many cardiac rehabilitation patients are of increased age, preserving or bettering practical independence is a noteworthy advantage received from RT (1,4,5,eleven). See table 1 for a summary of RT merits for cardiac sufferers.

RT PRECAUTIONS AND safeguard issues FOR CARDIAC patients

Resistance training turned into once notion to be bad for the cardiac patient. Cardiac patients were (and sometimes nonetheless are) instructed no longer to elevate anything else heavier than 5 to 10 lbs for an indefinite time duration after a cardiac adventure or manner (eleven). This, if the rest, will motivate much less actual pastime (1,11). although, analysis has shown RT to be protected in chosen cardiac sufferers (6-eight,eleven-18). Many stories have shown that low-chance (e.g., useful means, ≥7 metabolic equivalents [METs]) and moderate-chance (e.g., mild to reasonable silent ischemia all over undertaking trying out or recovery) cardiac sufferers can interact in RT devoid of excessive myocardial stress (6-12). This comprises definite individuals with congestive heart failure who've validated the capacity to tolerate RT (14,19,20). however, excessive-chance cardiac sufferers (e.g., presence of complicated ventricular dysrhythmias) may still now not operate RT. Circuit RT can result in decrease myocardial stress than an eighty five% effort on a treadmill examine (10,21,22) or stationary bicycling at 70% of oxygen consumption at top effort (7).

Many cardiac patients produce other cardiac- (e.g., hypertension, diabetes, implantable cardiac defibrillators [ICDs], and pacemakers) and noncardiac-related (e.g., osteoarthritis, osteoporosis, and shoulder impingement) situations that may still be considered when setting up an RT program. Most cardiac patients take a couple of medicines for their heart situation. The sidebar describes probably the most more general drugs taken via cardiac sufferers.

it is prudent that the fitness knowledgeable knows the cardiac background of the patient/customer before initiating RT (1). table 2 outlines the time route for initiating RT in low- to moderate-risk cardiac sufferers.

Resistance working towards is contraindicated and/or requires health care provider clearance for definite larger risk sufferers (2,3,10). Absolute and relative RT contraindications had been centered for cardiac sufferers (desk 3). particular RT precautions should be excited about sufferers who've had myocardial infarction (MIs), coronary artery bypass surgical procedure (CABG), implantable defibrillators (ICDs), pacemakers, diabetes, and hypertension (1-three,8-eleven). exercises involving big shoulder girdle involvement and elevation are often restricted for four and 6 weeks for patients having ICDs/pacemeakers and CABGs, respectively (2,three,eleven). Adams and colleagues (eleven) examined 13 commonplace RT workout routines for defense, efficacy, and general usefulness for sufferers who had a heritage of MI, CABGs, and ICDs/pacemakers. They developed a list of acceptable workout routines and a timeline for selected circulation/pastime restrictions. upper-physique RT should still be constrained until the sternum has healed sufficiently (e.g., frequently 3 months) in patients receiving CABGs and until physicians clear recipients of ICDs and pacemakers (2,10,11). Repetitive action activities such as weight lifting can result in pacing lead fractures and dislodgement (2,10,11). Resting BP values should be lower than one hundred sixty/a hundred mmHg (3), and an endeavor BP cutoff of 220/one hundred and five mmHg can be prudent (2). computer screen rate-power product in sufferers with hypertension (10) by way of taking and paying consideration to each heart fee and systolic blood pressure (11). agree with the usage of single-limb (as an alternative of double limb) upper-extremity practicing in patients who've an exaggerated upward push in blood pressure or RPP throughout RT (1). This can also be constructive in those sufferers with congestive coronary heart failure (eight).

further RT security precautions and counsel for specific circumstances include here:

Hypertension
  • mix RT with cardio working towards (3,6,10,12).
  • Use lighter weights (≤50% of 1-repetition highest) (three,6,10,12).
  • select 8 to 10 workouts for the essential muscle corporations (three).
  • select a resistance permitting efficiency of 12 to 15 repetitions (three).
  • evade tight gripping and breath protecting (Valsalva maneuver) (three).
  • Use a BP cutoff of 220/105 mmHg all over RT (2).
  • Diabetes
  • steer clear of speedy changes in physique position to steer clear of dizziness and falls. Some individuals with diabetes have autonomic neuropathies (a anxious gadget ailment) that can negatively effect circulation and steadiness.
  • Use the RPE scale (Borg) if autonomic neuropathies are existing.
  • motivate fluid alternative all through pastime, and prevent dehydration.
  • delivery with RT lots of between 40% and 60% of 1RM and perform 10 to fifteen repetitions.
  • evade short-term muscle fatigue.
  • evade tight gripping and the Valsalva maneuver (2,10).
  • Implantable Defibrillators (ICDs) and Pacemakers
  • Repetitive motions like RT may end up in pacing and lead fractures and dislodgement.
  • folks with ICDs and pacemakers may still comply with their health professional's instructions concerning elevating their hands above shoulder height.
  • upper-extremity electricity may well be lowered from lack of use. Return to or start upper-physique RT regularly (2,10).
  • Osteoporosis
  • avoid spinal flexion (bending ahead), twisting, running, and leaping to reduce the dangers of vertebral fractures.
  • perform exercises in an upright posture, and emphasize actions like scapular retraction and melancholy (scapular rows), and hip and knee extension (partial squats and leg presses.
  • start with 1 set of 8 to 10 repetitions of workout routines for all essential muscle groups.
  • Use an RPE range of 13 to 15.
  • undertaking 2 days/week.
  • steer clear of painful activities.
  • avoid swift alterations of physique position, and provide close supervision (some people with osteoporosis may have postural alterations that may additionally negatively affect their stability).
  • growth to 2 to 3 units, if tolerated (2,23).
  • Arthritis
  • prevent RT right through durations of worsening ache and swelling.
  • keep away from RT within the early morning in humans with rheumatoid arthritis.
  • Some folks with arthritis can also handiest tolerate 2 or 3 repetitions at a time with short rest durations. Repetitions should be introduced as tolerated.
  • opt for eight to 10 exercises (1 endeavor for each and every most important muscle group).
  • eliminate exercises that aggravate or cause extra pain.
  • activity inside a ache-free latitude of motion.
  • Isometric workouts and resistance bands and machines are all proper alternatives, if tolerated.
  • avoid repetitive workouts in humans with unstable joints (2).
  • continual respiratory during RT is notably important for cardiac patients, to evade the Valsalva maneuver. Exhaling throughout the exertion (lifting) section is informed. warding off tight gripping and sustained static (isometric) contractions also will support avoid excessive increases in blood force throughout RT (1-3,8,10,eleven). pastime authorities should still stop RT sessions instantly if any of here hostile responses turn up together with:

  • diastolic BP of a hundred and ten mmHg or higher
  • reduce in systolic BP of 10 mmHg or better
  • enormous ventricular or atrial dysrhythmias (Dysrhythmia means an irregular cardiac rhythm. It can be both a single beat or sustained beats and might come from both the atria or ventricles.)
  • 2nd- or third-degree coronary heart block (Two forms of obstructions or delays in the conduction of electrical pastime between the atria and ventricles.)
  • signals/signs of exercise intolerance, together with angina (chest ache), marked dyspnea (labored respiration), gentle-headedness or dizziness, and electrocardiogram changes suggestive of ischemia (inadequate oxygenated blood move to the heart muscle or myocardium) (2,three)
  • no longer all health facilities could have electrocardiogram or blood force equipment to monitor these a must have signs. although, many ACSM certified professionals (i.e., endeavor professional, registered scientific exercise physiologist, and application administrators) have the expertise to video display blood power, take a pulse, and calculate RPP. it is prudent that health experts working with this population possess or acquire these skill units.

    RT PROGRAMMING FOR CARDIAC patients

    once a patient has been medically cleared to start RT, a personalized program should still be developed. it is essential to agree with other health situations that might also alter the RT application design. A cardiac patient with osteoporosis should still operate all workout routines with an upright posture and evade spinal flexion (forward and lateral) and spinal rotation (twisting) (2,23). A affected person with a shoulder impingement should maintain actions beneath ninety degrees of shoulder abduction and flexion and retain arms just a little in front of the body in the scapular airplane. Emphasis should be placed on scapular retraction and depression and on shoulder internal and external rotation. Rows are an acceptable alternative for sufferers with a shoulder impingement (24).

    There may still be a balance among major muscle businesses trained (5,6,10,12,25,26). this could steer clear of power imbalances between opposing muscle groups, which could result in musculoskeletal injury. each reduce- and upper-body muscle organizations should still be trained on the same day to keep time (5,10,26). on account of their efficiency and functional outcomes, multijoint exercises should be emphasized and use single-joint workout routines to praise the RT application (1,2,5,10,26). no longer all cardiac rehabilitation courses have the time, area, and machine to increase wide RT courses. This amplifies the value of performing multijoint exercises. When a number of RT device is available, opt for modes that may be most at ease for the affected person (1).

    besides the fact that children there are recommended 1RM percentages for lower- and higher-physique exercises for cardiac patients (table 4), 1RM testing frequently isn't carried out because of safeguard considerations and a scarcity of RT experience that's ordinary in cardiac patients. An RPE of eleven to 13 (relatively easy to just a little tough) on the Borg Scale is a suitable system for settling on preliminary masses for RT workout routines (2,three). A gradual enhance in resistance (5%) may still happen as soon as the patient can comprehensive 12 to 15 repetitions effortlessly (three). just a few working towards counsel consist of right here:

  • operate a heat-up before the delivery of all RT sessions; a standard warm-up would encompass light aerobic pastime for 5to 10 minutes; a specific warm-up would encompass gentle stretching and/or lively latitude of action workouts with gentle or no resistance (2).
  • resist the favored movements/synergies while keeping resistances (weights, bands, tubes, drugs balls, and many others.) parallel to the airplane of action and opposite the supposed course of their movement(s).
  • keep away from "throwing" or "shedding" the resistance; all the time retain control of the resistance.
  • Use a leisure interval period, which enables the affected person to recover adequate to produce the preferred repetitions/work for the following set or activity.
  • keep suitable body and joint alignment consistently (e.g., ankles, knees, and hips in line during a leg press or squat) (26).
  • Machines customarily enable for extra time-effective RT sessions, are simpler to operate with proper method, and stabilize the body, cutting back balance necessities (more muscle isolation) (1,26).
  • Free weights customarily use extra muscular tissues for balance and stabilization, present numerous approach manipulations (e.g., quite a lot of hand positions), and work the muscle groups in a extra purposeful manner (1,26). See desk four for a summary of RT programming instructions for cardiac sufferers.
  • RT FOR patients WHO completed CARDIAC REHABILITATION

    The RT program design for the affected person after cardiac rehabilitation will depend upon where the patient plans on exercising upon completion of their allotted cardiac rehabilitation periods and what RT machine (e.g., variable dynamic resistance machines, free weights, and variable resistance [or color] bands/tubing) a person will have entry to. In an ideal situation, upon completion of the monitored part of cardiac rehabilitation (regularly known as section II), an individual can be offered the opportunity to continue exercising in the same facility as a member of their upkeep software (often known as phases III to IV). last in a familiar ambiance will boost each an individual's consolation and self assurance stage in relocating forward with their undertaking software, mainly RT. despite the fact, as is regularly the case, many patients need to discover a brand new location to exercise with diverse machine and, simply as crucial, a brand new workforce.

    With the various modes of RT and undertaking equipment accessible to the fitness and fitness knowledgeable, every cardiac affected person should be evaluated on an individual basis. realizing the brand new client's scientific background (e.g., MI, CABG, and angioplasty) is basic. In a phase IV environment, the health and health professional together with the scientific application director could be charged with constructing the customer's activity prescription. despite the fact, in a nonclinical environment (e.g., native health membership or gym), the fitness skilled have to contact and work with the client's surgeon or medical professional in designing the client's activity prescription (table 4). as an example, a cardiac patient who had open-heart surgery and participated in precisely 4 weeks of supervised cardiac rehabilitation (section II) would not be ready to function the same RT workout routines that an individual who had an angioplasty with stent placement 4 weeks prior can be able to operate. during this selected case, both the open-heart surgical procedure patient and the health and fitness expert should be cognizant of sternal precautions (healing constantly takes 12 weeks), which might primarily include limiting higher-body RT workout routines (table 2).

    health and health specialists working within the scientific atmosphere also need to be relaxed with preparing cardiac sufferers for exercising in their homes. As is the case with many cardiac patients, they do not transition into an additional formal environment, hence they have to be organized to proceed their electricity-practicing software at home. Many cardiac rehabilitation programs will comprise using coloured tubing or resistance bands (distinct colorings point out a distinct stage of resistance) into their RT programs. in addition to being a safe and constructive sort of energy practising, using this class of RT device is handy for the affected person to be taught. furthermore, cardiac rehabilitation classes can always accommodate distributing these resistance bands and colored tubing to be used by means of their customer's at domestic upon completion of their software.

    The number of cardiac sufferers isn't going to decrease in the years forward, thus the cardiac rehabilitation programs and health amenities are charged with the following: amenities need to have the elementary device (e.g., treadmills, higher-physique ergometers, variable dynamic resistance machines, free weights, and colored tubing/bands) to elicit anticipated outcomes; and body of workers should be appropriately educated/educated (e.g., degreed, certified) to work not simplest with cardiac sufferers but also with the increasing numbers of numerous special populations.

    summary

    Resistance practicing is safe for chosen cardiac rehabilitation sufferers and offers a number of fitness and fitness advantages. it is essential for each cardiac affected person to comply with the suitable time path for initiating RT and cling to specific RT programming and safeguard guidelines. Cardiac patients should have their RT software adapted to their selected wants and capabilities. this can permit them to achieve the benefits of RT, while minimizing the risk of adversarial hobbies or injury. Resistance practicing, like cardiorespiratory exercise, should still be continued after the completion of a cardiac rehabilitation application to preserve or extra boost muscular health.

    CONDENSED version AND bottom line

    facts now clearly demonstrates that cardiac rehabilitation patients should be performing RT. The merits got from RT will praise the cardiorespiratory component of cardiac rehabilitation. once a cardiac patient has been deemed protected and ready to provoke RT, certain safeguard and programming guidelines may still be adopted to maximize RT protection and efficacy. besides conserving their cardiorespiratory practising after cardiac rehabilitation, cardiac sufferers should still proceed to engage in RT to enrich their excellent of existence.

    References 1. Spencer, J.L. Resistance practising in outpatient cardiac rehabilitation. strength and Conditioning Journal 29(1):18-23, 2007. 2. ACSM's guidelines for undertaking checking out and Prescription. 7th ed. Whaley, M.H., P.H. Brubaker, and R.M. Otto (Editors). Baltimore: Lippincott Williams & Wilkins, 2005:176-177, 189-191, 199-200, 223-225. 3. American affiliation of Cardiovascular and Pulmonary Rehabilitation. instructions for Cardiac Rehabilitation and Secondary Prevention courses. 4th ed. Human Kinetics, 2004:36, 119, 182. 4. Ades, P.A., P.D. Savage, M.E. Cress, et al. Resistance practising on actual efficiency in disabled older feminine cardiac patients. medication & Science in activities & recreation® 35(eight):1265-1270, 2003. 5. American faculty of activities medicine and the American heart affiliation. actual recreation and public health in older adults: techniques from the American school of sports medication and the American heart affiliation. drugs & Science in activities & recreation® 39(eight):1435-1445, 2007. 6. Pollock, M.L., B.A. Franklin, G.J. Balady, et al. Resistance recreation in people with and with out cardiovascular disease: advantages, intent, defense, and prescription. An advisory from the Committee on undertaking, Rehabilitation, and Prevention, Council on clinical Cardiology, American heart association. Circulation one hundred and one:828-833, 2000. 7. Meyer, k. Resistance undertaking in chronic heart failure: landmark reports and implications for practice. scientific and Investigative drugs. 29(3):166-169, 2006. 8. Volaklis, ok.A., and S.P. Tokmakidis. Resistance recreation working towards in sufferers with coronary heart failure. sports medicine 35(12):1085-1103, 2005. 9. Volaklis, okay.A., H.T. Douda, P.F. Kokkinos, et al. Physiologic modifications to detraining following extended combined strength and aerobic practising in cardiac patients. European Journal of Cardiovascular Prevention and Rehabilitation 13:375-380, 2006. 10. Williams, M.A., W.L. Haskell, P.A. Ades, et al. Resistance practicing in individuals with and without heart problems: 2007 update. A scientific update from the American coronary heart association Council on medical Cardiology and Council on food, physical exercise, and Metabolism. Circulation 116:572-584, 2007. eleven. Adams, J., M.J. Cline, M. Hubbard, et al. a new paradigm for submit-cardiac adventure resistance undertaking guidelines. American Journal of Cardiology 97:281-286, 2006. 12. Franklin, B.A., D.P. Swain, and R.J. Shephard. New insights in the prescription of pastime for coronary patients. Journal of Cardiovascular Nursing 18(2):116-123, 2003. 13. Stewart, k., L.D. McFarland, J.J. Weinhoffer, et al. security and efficacy of weight training soon after acute myocardial infarction. Journal of Cardiopulmonary Rehabilitation 18:37-forty four, 1998. 14. Weber-Zion, G., E. Goldhammer, E. Shaar, et al. Left ventricular characteristic throughout strength testing and resistance activity in patients with left ventricular dysfunction. Journal of Cardiopulmonary Rehabilitation 24(2):100-109, 2004. 15. Maiorana, A.J., T.G. Briffa, and J. Hung. A controlled trial of circuit weight training on cardio capability and myocardial oxygen demand in men after coronary artery bypass surgery. Journal of Cardiopulmonary Rehabilitation 17(4):239-247, 1997. sixteen. Vanbiervliet, W., J. Pélissier, B. Lédermann, et al. strength practicing with elastic bands: measure of its consequences in cardiac rehabilitation after coronary diseases. Annales de réadaptation et de médecine physique. forty six(8):545-552, 2003. 17. DeJong, A.T., C.J. Womack, J.A. Perrine, et al. Hemostatic responses to resistance practicing in patients with coronary artery ailment. Journal of Cardiopulmonary Rehabilitation 26(2):eighty-83, 2006. 18. Beniamini, Y., J.J. Rubenstein, and A.D. Faigenbaum. excessive-intensity strength practising of sufferers enrolled in an outpatient cardiac rehabilitation application. Journal of Cardiopulmonary Rehabilitation 19:eight-17, 1998. 19. King, M.L., okay.A. Dracup, G.C. Fonarow, et al. The hemodynamic effects of isotonic exercise the usage of hand held weights in patients with heart failure. Journal of heart Lung Transplant 19:1209-1218, 2000. 20. Karlsdottir, A.E., C. Foster, J.P. Porcari, et al. Hemodynamic responses during aerobic and resistance endeavor. Journal of Cardiopulmonary Rehabilitation 22:170-177, 2004. 21. DeGroot, D., T. Quinn, R. Kertzer, et al. Circuit weight practicing in cardiac sufferers: picking most advantageous workloads for security and power expenditure. Journal of Cardiopulmonary Rehabilitation 18(2):a hundred forty five-152, 1998. 22. Ebben, W.P., and D.H. Leigh. The consequences of resistance practising on cardiovascular patients. power and Conditioning Journal 28(2):52-58, 2006. 23. country wide power and Conditioning association. NSCA's necessities of non-public practicing. Earle, R., and T. Baechle (Editors). Champaign, IL: Human Kinetics, 2004:468. 24. Ronai, P. recreation adjustments and techniques to enhance shoulder feature. energy and Conditioning Journal 27(4):36-45, 2005. 25. national energy and Conditioning affiliation. essentials of power practicing and Conditioning. 2nd ed. Baechle, T., and R. Earle (Editors). Champaign, IL: Human Kinetics, 2000:400-401. 26. Sorace, P., and T. LaFontaine. Resistance practising muscle power: design classes that work. ACSM's fitness & fitness Journal® 9(2):6-12, 2005.

    ACSM: Registered medical recreation Physiologist | killexams.com Real Questions and Pass4sure dumps

    Do you see recreation as a crucial point within the prevention and medication of disease, and need to motivate americans to follow healthy behaviors? ACSM licensed undertaking Physiologists® take working towards to an advanced degree through conducting and decoding physical health assessments and constructing undertaking prescriptions for americans who are healthy or have medically controlled ailments.

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    Q&A: ACSM’S substances FOR scientific recreation PHYSIOLOGY | killexams.com Real Questions and Pass4sure dumps

    Q&A: ACSM’S elements FOR clinical activity PHYSIOLOGY

    ACSM is diagnosed globally for defining science-based mostly framework for professionals who behavior fitness-related recreation contrast, individual actual undertaking plans, and endeavor classes for adults. Now, a brand new version of ACSM’s materials for scientific pastime Physiology: Musculoskeletal, Neuromuscular, Neoplastic, Immunological, and Hematological conditions is assisting scientists and clinicians convert research into apply. The activity-based mostly recommendations contained in the manual closely relate to the ideas of endeavor is drugs™. study the Q&A with Jon Myers, Ph.D., FACSM, senior editor of the ebook.

    Myers and David Nieman, Ph.D., FACSM, were the senior editors of the booklet, and coordinated the writing with a bunch of contributing specialists. Myers is a scientific professor of cardiology on the Veterans Administration Palo Alto fitness Care gadget and Stanford school. He chaired the publications subcommittee of ACSM’s committee on Certification and Registry Boards (CCRB) from 2001-07, and contributed content for several critical ACSM publications, together with distinctive variants of ACSM’s guidelines for activity trying out and Prescription.

    Q: What’s entertaining about this new medical pastime physiology resource manual?A: here is one in all three books in a sequence that ACSM publishes and updates periodically with Lippincott Williams and Wilkins. The content of this publication, ACSM’s resources for scientific undertaking Physiology: Musculoskeletal, Neuromuscular, Neoplastic, Immunological, and Hematological situations (CEP Res-2) is complementary to ACSM’s instructions for recreation testing and Prescription and ACSM’s useful resource manual for exercise testing and Prescription. For the first time, all three new versions of these books are being released on a synchronized time table, with all copyright dates indicated as 2010, but attainable now. The average theme within the collection is to translate the latest in science and authoritative scientific event into follow guidelines and carrying on with training substances to be used by undertaking professionals and physicians global. while all of those texts are directed to the application of recreation evaluation and remedy for sufferers with cardiovascular and pulmonary sickness, CEP Res-2 is entertaining in providing assistance for working with patients who have continual situations and disabilities, not addressed by way of the other two books – specifically, orthopedic, neurological, metabolic, musculoskeletal, neoplastic, and immunodeficiency situations. These clinical populations are often mostly underserved. fitness experts gained’t be able to find such updated substances beneath one cover in other places that in particular tackle exercise remedy for situations comparable to melanoma, worrying mind damage, or immune issues.

    Q: How is the ebook concerning ACSM’s credentialing and certifications? A: The considerations addressed within the text are a must-have to the present or expertise ACSM Registered scientific recreation Physiologist� (RCEP), because the expected capabilities, advantage and skills covered handle medical and pathological situations the place endeavor has been proven to supply therapeutic or useful improvement. for that reason, CEP Res-2, together with ACSM’s guidelines for endeavor checking out and Prescription and ACSM’s aid manual for recreation trying out and Prescription supply the complete scope of illnesses and problems upon which the RCEP credential is primarily based.

    Q: What’s distinct during this 2nd version? A: All chapters from the primary edition had been updated. incredible advances have been made in analysis and scientific journey considering that the first version was posted eight years in the past; a scan of chapter bibliographies affirms the extent of these developments and how present the chapter contents in reality are. CEP Res-2 includes a wholly new area on “medical observe issues.” as the ACSM RCEP has become greater centered over the ultimate decade, this new area is primarily timely and important considering that it helps provide the RCEP and different fitness care authorities with an improved realizing of their role and the way they could have a crucial and vital location in nowadays’s health care atmosphere. This new section consists of chapters on the evolution of the medical pastime physiologist, processes to demonstrating useful outcomes for fitness and fitness courses, legal and ethical concerns, and client referral and consulting family members with allied professions.


    040-444 ACSM Registered Clinical Exercise Physiologist

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    ACSM Registered Clinical Exercise Physiologist

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    Salaries for Clinical Exercise Specialist Jobs | killexams.com real questions and Pass4sure dumps

    Exercise can help people prevent or manage heart problems.

    Exercise can help people prevent or manage heart problems.

    ULTRA F/Photodisc/Getty Images

    Clinical exercise specialists work in heart health clinics, cardiovascular rehabilitation facilities, fitness centers and doctor's offices to help people avoid or recover from heart health or metabolic problems through exercise. Exercise specialists design individualized exercise programs to help their clients change established patterns of behavior, improve their health and enhance their lives.


    ACSM: Registered Clinical Exercise Physiologist | killexams.com real questions and Pass4sure dumps

    Do you see exercise as an important element in the prevention and treatment of disease, and want to motivate people to practice healthy behaviors? ACSM Certified Exercise Physiologists® take training to an advanced level by conducting and interpreting physical fitness assessments and developing exercise prescriptions for people who are healthy or have medically controlled diseases.

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    Know the Risks: Lifestyle Management of Dyslipidemia | killexams.com real questions and Pass4sure dumps

    Abnormal blood lipids, known as dyslipidemia, are an increasing health problem in the United States and the world. Approximately 107 million American adults have borderline or high total cholesterol (1) (see Table 1 for cholesterol guidelines). Dyslipidemia is one of the major risk factors for heart disease (1-4). Excess cholesterol builds up in the walls of the arteries. Over time, this buildup contributes to atherosclerosis, a disease process in which arteries become narrowed and blood flow is impaired. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.

    There are a number of different forms of dyslipidemia. Hypercholesterolemia indicates elevated blood cholesterol levels (2). Hypertriglyceridemia implies elevated triglycerides (TGs). Hyperlipidemia indicates elevated cholesterol and TGs. Hyperlipoproteinemia is defined as elevated lipoproteins (2). Hypoalphalipoprotein syndrome denotes low high-density lipoprotein (HDL) cholesterol (2). Postprandial lipemia (PPL), discussed in greater detail later, is characterized by a postprandial rise in TG-rich lipoproteins after eating.

    One of the first steps in atherogenesis is the infiltration and entrapment of low-density lipoproteins (LDLs) in the blood vessel wall. This leads to a series of events (e.g., oxidation of LDLs, monocyte migration, macrophage uptake of modified LDLs, foam cells, fatty streaks, etc.) that result in the development of fibrous plaques within the walls of the intima.

    Dyslipidemia is caused by genetic and environmental factors that lead to problems with enzyme deficiencies, apolipoproteins, or lipoprotein particles. There are a number of factors that contribute to dyslipidemia (see Table 2 for a partial listing).

    Dyslipidemia also is a characteristic of the recently defined metabolic syndrome. The metabolic syndrome consists of a group of coronary heart disease (CHD) risk factors which includes glucose intolerance (fasting plasma glucose of 100-125 mg/dL), atherogenic dyslipidemia (TGs ≥150mg/dL and HDL cholesterol <40 mg/dL in men and <50 mg/dL in women), increased blood pressure (≥130/85 mm Hg), abdominal obesity (waist circumference of 102 cm or greater in men and 88 cm or greater in women), a prothrombotic state, and a proinflammatory state (5). A prothrombotic state is a condition that predisposes to venous or arterial thrombosis. A proinflammatory state is the presence of low-grade generalized inflammation within the body that increases cardiac risk.

    Lipoproteins are the carriers of lipids (primarily cholesterol and TGs) in the blood. Because fat and water do not mix, the body combines protein plus lipid so that the lipid substance can be transported in plasma. There are several lipoproteins in the body, with different functions (see Table 3). Some contribute to cardiovascular disease (e.g., LDLs) and some help prevent it (e.g., HDLs). In summary, dyslipidemia refers to an abnormality of lipoproteins, covering a variety of disorders relating to abnormal levels of total cholesterol, LDL cholesterol, HDL cholesterol, and/or TGs.

    Table 3

    Table 3

    Figure

    Figure

    Postprandial Lipemia

    Postprandial lipemia (PPL) refers to the rise in TG-rich lipoproteins (e.g., very low density lipoproteins [VLDLs]) after a meal. It is a dynamic condition in which humans spend the majority of their time (7). PPL reflects a combined measure of an individual's capacity to metabolize TGs. Elevated/prolonged PPL, defined as a delayed clearance of TGs after a high-fat meal, is a significant risk factor for the development of atherosclerosis (7, 8). The exchange of core lipids between postprandial lipoproteins and LDLs/HDLs increases during prolonged PPL in susceptible persons, resulting in elevated TGs; the production of small, dense LDL particles; and reduced HDLs (7). Smaller, denser LDLs are more atherogenic than the larger, less dense LDLs. Other atherogenic factors including clotting factors, platelet reactivity, and monocyte and cytokine expression, all of which contribute to endothelial dysfunction, may increase during PPL (7).

    Testing for PPL involves a 12-hour fast and initial blood collection. Subjects then ingest a high-fat beverage, and blood samples are collected every 2 hours for 8 hours. Triglyceride concentrations are measured by colorimetry (quantitative chemical analysis by color), and values are plotted over time. PPL is assessed using total area under the curve (AUC). A large value for TG area AUC indicates that the TGs were maintained in the blood longer than expected.

    Exercise Effects on Lipid Metabolism

    The lowering of TGs is the most consistent effect exercise has on lipoproteins. HDLs often are increased with sustained aerobic exercise that results in an expenditure of >1,200 calories/week, but this effect is less consistent and may be genetically predetermined (9). The greater the exercise volume (and caloric expenditure), the more likely an exerciser will achieve a significant increase in HDL cholesterol. Lower TGs are typically observed with both acute exercise and sustained aerobic exercise training (3). TGs are used as energy by skeletal muscles during endurance exercise. The enzyme lipoprotein lipase (LPL) splits TGs from VLDLs, making them available for uptake by skeletal muscles. Chronic exercise training also increases hepatic HDL production and the conversion of HDL3 to HDL2 in the blood, both of which protect against heart disease (3).

    The evidence for exercise alone reducing LDLs and total cholesterol is less conclusive. It appears that weight loss/fat loss is required for significant reductions in LDLs and total cholesterol (3, 10). Regular aerobic exercise does, however, produce favorable changes in LDL subfractions, which will reduce the risk of CHD. For example, aerobic exercise has been shown to convert smaller LDLs to larger LDLs, reducing cardiac risk (3, 11).

    Exercise training also favorably alters lipid enzyme activity, resulting in improved lipid profiles. Table 4 lists and defines the major enzymes involved in lipid metabolism. LPL and lecithin-cholesterol acyltransferase are increased with aerobic exercise, whereas hepatic lipase is usually decreased (3). The effects of exercise training on cholesterol ester transport protein are inconclusive at this time (3). Genetic deficiencies can alter the exercise response for some individuals. For example, LPL activity will not be increased in those who have a LPL deficiency (2). It was recently demonstrated in 35 pairs of monozygotic twins (active twins ran a mean of 63 km/week vs. a mean of 7 km/week in the inactive twins) that low HDL cholesterol may be largely determined by genetic factors and is less effectively treated with vigorous exercise (12).

    Figure

    Figure

    Table 4

    Table 4

    Lifestyle Effects on Dyslipidemia

    National Cholesterol Education Program III recommends nutritional intervention, increased exercise/physical activity, and weight loss for many individuals with dyslipidemia (5). There is substantial evidence to support the profound beneficial effects of lifestyle changes on dyslipidemia (3, 4, 10, 11). Although there are a number of medications (e.g., statins) that are effective for treating dyslipidemia, lifestyle changes alone can often normalize lipid profiles. Lipid lowering typically results in modest plaque regression and stabilization, reducing the risk of a cardiac event (3).

    Regular aerobic exercise is an essential lifestyle component for improving/controlling blood lipids. The total amount of physical activity seems to be more important than the intensity to induce beneficial effects on lipoproteins (10, 11). Significant daily and weekly energy expenditures are recommended to produce notable changes in individuals with dyslipidemia (3, 4, 10). Cross-sectional studies have shown that lipids continue to improve across weekly running distances from <10 to >40 miles in a direct dose-response relationship (13).

    The effect of exercise on PPL also is significant. Individuals who regularly perform aerobic exercise typically display low levels of PPL (14). Vigorous aerobic exercise has been shown to reduce PPL in men with elevated TGs, even when performed 12 hours before a high-fat meal (15). In a recent study, intermittent exercise in young, normolipidemic men and women was shown to improve PPL significantly more than continuous exercise (16). The breakdown of blood TGs (and some TG-rich lipoproteins) is increased during exercise and continues well into the recovery phase. Exercise that stimulates fat use as a substrate during and after the activity helps clear TG from the blood. In addition, exercise stimulates the enzyme LPL and this enzyme may remain active for several hours. Thus, moderate intensity exercise attenuates PPL (17, 18). It is important to note that the favorable effects (e.g., TG lowering) of endurance exercise on PPL seem to be a result of acute metabolic changes as opposed to chronic exercise effects (14, 15). This encourages daily or near daily aerobic exercise to treat elevated PPL. Possible mechanisms for the exercise-induced TG reductions include increased muscle LPL activity and reduced hepatic TG secretion (14, 17).

    There only have been a couple of studies on resistance training and PPL, and the results were inconsistent (19, 20). Thus, there are no specific guidelines to recommend at the present time.

    Weight loss is another lifestyle factor that significantly improves dyslipidemia. Obesity typically elevates VLDL and LDL fractions, increases TG levels, lowers HDL cholesterol, increases blood pressure, and promotes insulin resistance. Weight loss typically lowers LDLs, TGs, and total cholesterol (2, 3). HDLs may increase, decrease, or remain the same (2, 3). If weight loss is combined with aerobic exercise, HDLs are more likely to be sustained or increase following training. Weight loss also lowers blood pressure, improves glycemic control, and reduces inflammation linked to metabolic and cardiac diseases (3, 5, 21, 22).

    Exercise training can improve lipid profiles either directly (without weight loss) by increased lipid enzymatic activity or indirectly (reduced body weight) (2). When weight loss occurs in conjunction with exercise, LDL and total cholesterol are usually lowered (2, 3). Weight loss also has beneficial effects on lowering PPL, as obesity increases PPL. When weight loss is indicated, a loss of 5% to 10% body weight from baseline is a starting goal (4). This amount of weight loss can significantly improve blood lipids. However, even when there is minimal or no weight loss, an improved lipid profile can still be achieved with adequate exercise (11).

    Exercise/Physical Activity Guidelines

    It is prudent that the fitness professional check with the individual's physician if he or she is taking lipid-lowering medications or other medications for any coexisting diseases (e.g., obesity, hypertension, type 2 diabetes) that may require medical clearance. Statins, for example, can cause muscle damage (myopathy) and this should be considered (4). Table 5 summarizes general exercise guidelines for dyslipidemia. The emphasis should be on aerobic exercise and total weekly caloric expenditure. A good initial goal is to perform aerobic exercise three to five times per week for 20 to 60 minutes, expending ≥1,200 calories/week. Ideally, aerobic exercise for dyslipidemia should gradually progress, as tolerated, to five to seven times per week for 40 to 60 minutes, creating an energy expenditure of >2,000 calories/week (4). A gradual increase in aerobic exercise intensity should also occur. Exercise programs with higher volumes and intensities have been shown to be most effective for increasing HDL cholesterol (11). These guidelines may also need adjusting based on coexisting diseases, current fitness level, and time constraints that may be present. The aerobic training may need to be performed intermittently throughout the day. It is important to remember that lifestyle physical activity (e.g., climbing stairs, lunchtime walks, housework) contributes to the total weekly energy expenditure. Also, for a well-rounded exercise program, resistance and flexibility training should be incorporated (see Table 5 for guidelines).

    Nutritional Guidelines

    Dietary modification is a powerful nonpharmacological strategy for improving blood lipids. Diets that are high in saturated and trans-fat and cholesterol increase TGs, LDL, and total blood cholesterol. Polyunsaturated fats (e.g., corn oil) seem to have a neutral effect on blood cholesterol, whereas monounsaturated fats (e.g., olive oil) seem to sustain HDLs and lower LDLs and TGs. Reducing saturated and trans-fats and cholesterol intake will usually improve blood lipids. Even though there is variability in individual responses to dietary changes, reducing total calories consumed, particularly saturated fat calories, which results in weight loss, typically lowers total and LDL cholesterol. HDL cholesterol is sometimes lowered as well, but when dieting is coupled with exercise, HDL cholesterol can be maintained (2, 3, 23, 24).

    High-carbohydrate diets can increase TG levels and decrease HDL cholesterol, but again, this effect is negated with aerobic exercise (2, 3, 23, 24). Dietary fiber, particularly soluble fiber, helps to lower blood cholesterol levels. Omega-3 fatty acids lower blood TG levels (3). Plant sterols also have been shown to favorably alter lipid profiles, particularly when combined with aerobic exercise (25). Moderate alcohol consumption (no more than one drink per day in women and lighter persons and no more than two drinks per day in most men) (4) may raise HDL cholesterol levels. It may also increase TGs, but its effect on LDL cholesterol appears to be minimal.

    Table 6 summarizes the key components of a diet to help lower blood lipids. The emphasis should be on restricting fat, particularly saturated fats, and cholesterol intake while increasing intake of soluble fiber and other foods such as soy, almonds, walnuts, plant sterols and stanols, cold water fish (e.g., salmon), etc., which have been shown to have a beneficial effect on blood lipids. Here are some nutrition tips that favorably help impact blood lipids:

  • Eat fish two to three times per week. The fish should be baked, not fried.
  • Use healthy oils for cooking, such as olive oil and walnut oil.
  • Eat whole grain products. Avoid or limit starchy white pasta and bread.
  • Add or increase oats and oatmeal intake.
  • Increase consumption of green vegetables. Broccoli, spinach, lettuce, and green beans are all examples of healthy carbohydrate, low-calorie green vegetables.
  • Eat whole fruits and berries.
  • Avoid/reduce rich, fattening desserts.
  • The amount of each type of fiber varies in different plant foods. To receive the greatest health benefit, eat a wide variety of high-fiber foods.
  • Case Study

    In December of 2003, a 75-year-old man was referred for lifestyle management to lose body weight and manage cardiovascular risk factors. On medical history and physical fitness, he was found to have had a recent surgical repair of a left quadriceps muscle rupture and had gained 45 lbs over six to eight months of recovery and rehabilitation. He had a history of dyslipidemia and overweight but was not diabetic nor hypertensive. He was a nonsmoker, and his mother and father died of cardiovascular disease at age 78 and 84, respectively. He has been an avid golfer since retirement in 1995, walking nine holes, three days/week. He also has been very active in his daily life but had not been following a regular exercise program. His dyslipidemia was being treated only with Altaprev, 20 mg/day, started in April of 2001. He had had no advice in regard to weight loss, exercise, or other therapeutic lifestyle changes. He was enrolled in the INTERXVENTUSA Cardiovascular Risk Reduction Program (www.interventusa.com). After one year, he had lost 43 lbs (from 244 to 201 lbs). He was eating a low-fat, high-fiber diet (22% fat calories and 45 g of fiber per day by seven day food recall) and exercising 260 minutes/week on average (walking 200 minutes and Airdyne bicycle ergometer 60 minutes). Lipid changes with indicated therapy from 04/01 through 01/05 are summarized below:

    Summary

    Dyslipidemia is a condition that promotes the genesis and progression of atherosclerosis. Dyslipidemia and PPL can often be prevented or treated with lifestyle management of exercise/physical activity, proper nutrition, and weight loss (if needed). Having a sound knowledge of lipid disorders, their associated risks, guidelines for treatment, and understanding how lifestyle management can prevent/improve dyslipidemia will better enable the fitness professional to coach individuals to live healthier lives.

    Condensed Version and Bottom Line

    A large body of evidence suggests that dyslipidemia is directly related to the progression of coronary artery disease. Lifestyle changes, which include increased exercise/physical activity, dietary modifications, and weight loss (if needed) have profound effects on improving dyslipidemia and other lipid disorders such as PPL. This will result in a lower rate of coronary artery disease.

    Recommended Readings Durstine, J. Larry, Ph.D. ACSM Action Plan for High Cholesterol. Human Kinetics, 2006. ACSM Fitness Book. 3rd ed. Human Kinetics, 2003. Cooper, Kenneth H., M.D., MPH. Controlling Cholesterol the Natural Way: Eat Your Way to Better Health With New Breakthrough Food Discoveries. Bantam, 1999. References 2. Durstine, J.L., and G.E. Moore. ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities. 2nd ed. Human Kinetics, 2003, pp. 142-148. 3. Roitman J.L. (Senior Editor). ACSM's Resource Manual for the Guidelines for Exercise Testing and Prescription. 4th ed. Baltimore: Lippincott Williams & Wilkins, 2001, pp. 263-276, 308-318. 4. Whaley, M.H., P.H. Brubaker, and R.M. Otto (Editors). ACSM's Guidelines for Exercise Testing and Prescription. 7th ed. Baltimore: Lippincott Williams & Wilkins, 2005, pp. 211-212, 217. 5. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). The Journal of the American Medical Association 285(19):2486-2497, May 16, 2001. 6. Grundy S.M., J.I. Cleeman, C.N.B. Merz, et al., for the Coordinating Committee of the National Cholesterol Education Program, Endorsed by the National Heart, Lung, and Blood Institute, American College of Cardiology Foundation, and American Heart Association. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 110:227-239, 2004. 7. Hyson D.C., J.C. Rutledge, and L. Berglund. Postprandial Lipemia and Cardiovascular Disease. Current Atherosclerosis Reports 5:437-444, 2003. 8. Parks E.J. Recent findings in the study of postprandial lipemia. Current Atherosclerosis Reports 3(6):462-470, November 2001. 9. Williams P.T., P.J. Blanche, R. Rawlings, et al. Concordant lipoprotein and weight responses to dietary fat change in identical twins with divergent exercise levels 1. American Journal of Clinical Nutrition 82(1):181-187, 2005. 10. Durstine J.L., P.W. Grandjean, C.A. Cox, et al. Lipids, lipoproteins, and exercise. Journal of Cardiopulmonary Rehabilitation 22(6):385-398, 2002. 11. Kraus W.E., J.A. Houmard, B.D. Duscha, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. The New England Journal of Medicine 347(19):1483-1492, 2002. 12. William P.T., P.J. Blanche, and R.M. Krauss. Behavioral versus genetic correlates of lipoproteins and adiposity in identical twins discordant for exercise. Circulation 112(3):350-356, 2005. 13. Williams P.T. High density lipoprotein cholesterol and other risk factors for coronary heart disease in female runners. The New England Journal of Medicine 334:1298-1303, 1996. 14. Gill J.M., and A.E Hardman. Exercise and postprandial lipid metabolism: an update on potential mechanisms and interactions with high-carbohydrate diets (review). The Journal of Nutritional Biochemistry 14(3):122-32, 2003. 15. Zhang J.Q., L.L. Ji, G. Nunez, et al. Effect of exercise timing on postprandial lipemia in hypertriglyceridemic men. Canadian Journal of Applied Physiology 29(5):590-603, 2004. 16. Altena T.S., J.L. Michaelson, S.D. Ball, et al. Single sessions of intermittent and continuous exercise and postprandial lipemia. Medicine & Science in Sports & Exercise ® 36(8):1364-71, 2004. 17. Herd S.L., B. Kiens, L.H. Boobis, et al. Moderate exercise, postprandial lipemia, and skeletal muscle lipoprotein lipase activity. Metabolism 50(7):756-762, 2001. 18. Zhang J.Q., T.R. Thomas, and S.D. Ball. Effect of exercise timing on postprandial lipemia and HDL cholesterol subfractions. Journal of Applied Physiology 85:1516-1522, 1998. 19. Petitt D.S., S.A. Arngrimsson, and K.J. Cureton. Effect of resistance exercise on postprandial lipemia. Journal of Applied Physiology 94(2):694-700, 2003. 20. Shannon K.A., R.M. Shannon, J.N. Clore, et al. Resistance exercise and postprandial lipemia: the dose effect of differing volumes of acute resistance exercise bouts. Metabolism 54(6):756-63, 2005. 21. Ryan A.S., and B.J. Nicklas. Reductions in plasma cytokine levels with weight loss improve insulin sensitivity in overweight and obese postmenopausal women. Diabetes Care 27:1699-1705, 2004. 22. Esposito K., A. Pontillo, C. DiPalo, et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. The Journal of the American Medical Association 289:1799-1804, 2003. 23. Koutsari C., F. Karpe, S.M. Humphreys, et al. Exercise prevents the accumulation of triglyceride-rich lipoproteins and their remnants seen when changing to a high-carbohydrate diet. Arteriosclerosis, Thrombosis, and Vascular Biology 21(9):1520-1525, 2001. 24. Koutsari C., and A.E. Hardman. Exercise prevents the augmentation of postprandial lipaemia attributable to a low-fat high-carbohydrate diet. British Journal of Nutrition 86(2):197-205, 2001. 25. Varady K.A., N. Ebine, C.A. Vanstone, et al. Plant sterols and endurance training combine to favorably alter plasma lipid profiles in previously sedentary hypercholesterolemic adults after 8 wk. The American Journal of Clinical Nutrition 80(5):1159-66, 2004. Keywords:

    Cholesterol; Dyslipidemia; Postprandial Lipemia; Exercise; Physical Fitness

    © 2006 American College of Sports Medicine Source

    ACSM's Health & Fitness Journal10(4):18-25, July-August 2006.

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    ACSM 040-444 Exam (ACSM Registered Clinical Exercise Physiologist) Detailed Information



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