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1、Maintenance Strategies,Maintenance Strategies,Relapse prevention Prepare client for relapses Identify those factors that account for relapses and seek solutions Behavior rehearsal Reinforcement Positive reinforcement is most powerful Tangible and intangible Tie reinforcements to accomplishments Each
2、 short term goal should have a reinforcement,Maintenance Strategies,Monitoring Keeping a log, assessment data, etc. Allows client to see progress Contracting Formalizes the agreement to exercise Contract includes goals Should be realistic and achievable Goals should be updated regularly,Maintenance
3、Strategies,Essentials of the contract Agreement to exercise Times for exercise and agreements on missed sessions Agreement on monitoring and testing Long and short term goals Agreement to review goals and rewards regularly and to discuss problems related to exercise program A brief description of th
4、e exercise program Agreement on part of trainer to discuss problems and identify solutions Any other items considered essential to client-trainer relationship signatures,Instructor Qualities,Instructors are most effective if the client feels they are competent, likes them, and is interested in them
5、Instructors greatest frustration is a client who is unwilling to change. Overpersistance on the part of the instructor plays against the instructor Attempt to be sensitive to the clients needs and serve them as to the degree possible,Informed Consent,Important ethical and legal consideration Content
6、 and extent of consent forms vary but enough information must be present to ensure that the participant knows and understands purposes and risks. INFORMED CONSENT Most legal action results from a failure to obtain adequate informed consent Frequent complaint resulting in legal action Negligent in ex
7、planation of procedure including the risks Breach of confidentiality,Health History Questionnaire,Divided into three sections Known diseases Signs/symptoms Risk factors Assessment of risk is a two step process Starts with assessment of the aforementioned factors Proceeds to assignment of individual
8、to a risk strata and need for medical clearance/supervision,Health History Questionnaire,Purposes for screening ID those who need further testing ID those with contraindications ID those who need medically supervised programs ID those with special needs Determination of known diseases, signs/symptom
9、s,Health History Questionnaire,Determination of known diseases, signs/symptoms Known Diseases Cardiovascular cardiac, peripheral vascular, or ceerebrovascular disease Pulmonary COPD, asthma, interstitial lung disease, or cystic fibrosis Metabolic disease Type I or II diabetes mellitus, thyroid disor
10、ders, renal or liver disease,Signs and Symptoms,Pain or discomfort in the chest or surrounding area Manifestation of CAD Ischemic in nature Constricting, squeezing, burning, heaviness Substernal; in both arms and shoulders; up into neck and cheeks; in upper back; down into forearms and fingers Provo
11、ked by exertion, excitement, stress, cold weather, post-prandial Often misdiagnosed in women and diabetics Non-Ischemic Provoked by body position Stabbing pain in left submammary area,Signs and Symptoms,Shortness of breath with mild exertion Dyspnea define normal at high workloads Abnormal at levels
12、 of exertion not expected to cause shortness of breath Suggestive of left ventricular dysfunction or COPD Dizziness or Syncope Syncope define caused by loss of perfusion of the brain During exercise likely due to cardiac disorders restricting normal rises in cardiac output Causes severe CAD, enlarge
13、d heart, aortic stenosis, and dysrhythmias Can occur post-exercise due to post-exercise hypotension reducing venous return,Signs and Symptoms,Orthopnea and Paroxysmal Nocturnal Dyspnea Orthopnea sob in reclined or horizontal position Relieved by sitting upright or standing PND sob occurring when asl
14、eep; onset 2-5 hours Both can be signs of left ventricular failure PND may be caused by COPD,Signs and Symptoms,Ankle edema Progresses through day and is worse in evenings Bilateral may be sign of heart failure or chronic venous insufficiency Unilateral results from venous thrombosis or lymphatic bl
15、ockage Generalized edema (anasarca) may arise from heart failure or cirrhosis of the liver,Signs and Symptoms,Palpitations or Tachycarida Disorders of rhythm including sudden onset bradycardia Intermittent Claudication Pain in muscle due to inadequate blood flow Onset during exercise stopping 1-2 mi
16、n after cessation More severe when climbing a grade or stairs Sign of PVD,Signs and Symptoms,Known Heart Murmur May be harmless or may indicate valvular or other CVD Important to exclude enlarged heart or aortic stenosis Unusual fatigue or shortness of breath with usual activities May be benign but could indicate a change in status,Risk Factors,Positive RF Age Men 45yr, Women 55yr Family History 1st degree male relative before age 55 or 1st degree female relative befor
