Key Industry Updates

Health Updates

The following content was taken from key government and industry resources:

• National Cholesterol Education Program (NCEP)
• American Heart Association (AHA)
• National Institutes of Health (NIH)
• National Heart, Lung, and Blood Institute (NHLBI)
• American College of Obstetricians and Gynecologists (ACOG)

Cholesterol and Triglycerides Classifications Based on NCEP’s 2002 Guidelines

Updates to the ACE Personal Trainer Manual 4th Edition

Note: LDL = Low-density lipoprotein; HDL = High-density lipoprotein

National Cholesterol Education Program (2002).Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults: Summary of the second report of NCEP Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment31 Panel III). NIH Publication No. 02-5213. Journal of the American Medical Association, 285, 2486–249

 

Guidelines for the Identification of Metabolic Syndrome (MetS)

The AHA and the NHLBI recommend that MetS be identified as the presence of three or more of the following components (AHA/NHLBI, 2005):

• Elevated waist circumference
  • Men >= 40 inches (102 cm)
  • Women >= 35 inches (88cm)
• Elevated triglycerides
  • >= 150 mg/dL
• Reduced HDL cholesterol
  • Men < 40 mg/dL
  • Women < 50 mg/dL
• Elevated blood pressure
  • >= 130/85 mmHg
• Elevated fasting blood glucose
  • >= 100 mg/dL

Source: American Heart Association/National Heart, Lung, and Blood Institute (2005). Scientific statement: Diagnosis and management of the metabolic syndrome. Circulation, 112, e285–e290.

Blood Pressure Classification

* Not taking antihypertensive drugs and not acutely ill. When systolic and diastolic blood pressures fall into different categories, the higher category should be selected to classify the individual’s blood pressure status. For example, 140/82 mmHg should be classified as stage 1 hypertension, and 154/102 mmHg should be classified as stage 2 hypertension. In addition to classifying stages of hypertension on the basis of average blood pressure levels, clinicians should specify presence or absence of target organ disease and additional risk factors. This specificity is important for risk classification and treatment.

† Normal blood pressure with respect to cardiovascular risk is below 120/80 mmHg. However, unusually low readings should be evaluated for clinical significance.

‡ Based on the average of two or more readings taken at each of two or more visits after an initial screening.

Source: Chobanian, A.V. et al. (2003). JNC 7 Express: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No. 03-5233. Washington, D.C.: National Institutes of Health & National Heart, Lung, and Blood Institute.

Cardiopulmonary Resuscitation (CPR) Guidelines

Saving More Lives: Hands-only CPR

Interviews with people who witnessed a cardiac arrest have found that the major reason bystanders do not attempt to perform CPR is because they panic. Although more than half of the interviewees had CPR training at some time in their lives, many reported that they were afraid to cause harm or afraid they would not perform well. The fear of disease was not a factor because most were family members of the victim (Swor et al., 2006). In 2007, several AHA studies found that in some instances, CPR could be simplified to performing chest compressions only, which is referred to as “hands-only CPR” (Nagao et al., 2007; Bohm et al., 2007; Iwami et al., 2007). In this type of CPR, a bystander only needs to remember to push hard and fast on the center of the victim’s chest until trained help arrives. This is effective for victims who are adults and who have been witnessed going into cardiac arrest. When the collapse is witnessed and CPR begins immediately, the victim’s blood still contains oxygen, and oxygen remains in the lungs. By pumping the chest, this oxygenated blood can be distributed to the body. Because of its simplicity, hands-only CPR will hopefully encourage bystanders to do something—and any CPR is better than none for a victim of cardiac arrest (Sayre et al., 2008). Although it is just as effective in some circumstances, hands-only CPR does not replace traditional CPR in situations where oxygen is needed. When an adult is found unconscious (and when the blood is no longer oxygenated), and in emergencies involving infants or children, drug overdoses, drowning victims, or any adult who collapses due to a respiratory problem, a combination of breaths and compressions is needed. It is absolutely essential that fitness professionals keep their CPR provider cards current (Sayre et al., 2008). Note: Current CPR certification is required for all ACE-certified Fitness Professionals.

Sources:

Bohm, K. et al. (2007). Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation, 116, 25, 2908–2912.

Iwami T. et al. (2007). Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation, 116, 25, 2900–2907.

Nagao, K. et al. (1999). Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): An observational study. Lancet, 369, 920–926.

Sayre, M.R. et al. (2008). Hands-only (compression-only) cardiopulmonary resuscitation: A call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: A science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation, 117, 2162–2167.

Swor, R. et al. (2006). CPR training and CPR performance: Do CPR-trained bystanders perform CPR? Academy of Emergency Medicine, 13, 6, 596–601.

Diagnostic Criteria of Diabetes Mellitus

Contraindications and Risk Factors Associated With Pregnancy

Fitness Updates

The following content is from ACSM's Guidelines for Exercise Testing and Prescription (8th ed.), which was published in 2010.

Health-risk Evaluation

*Professional opinions vary regarding the most appropriate markers and thresholds for obesity; therefore, allied health professionals should use clinical judgment when evaluating this risk factor.
Note: VO2R = V O2reserve
Note: It is common to sum risk factors in making clinical judgments. If HDL is high, subtract one risk factor from the sum of positive risk factors, because high HDL decreases cardiovascular disease risk.
American College of Sports Medicine (2010). ACSM’s Guidelines for Exercise Testing and Prescription (8th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Moderate exercise:* Moderate intensity equivalent to 40–60% V O2max, 3–6 METs, or an intensity well within an individual’s capacity that can be comfortably sustained for ~45 minutes
Vigorous exercise:†Vigorous intensity equivalent to >60% V O2max, >6 METs, or a level of intensity sufficient enough to represent a substantial cardiorespiratory challenge
Not necessary: Reflects the notion that a medical examination, exercise test, and physician supervision of testing would not be essential in the pre-participation screening. However, this does not mean that it cannot be considered.
Recommended: Reflects the notion that a medical examination is strongly encouraged. Exercise testing with physician supervision indicates that a physician should be in close proximity and readily available should there be a need.
*†≥VT1 (zones 2 and 3) in ACE IFT Model
Note: GXT = Graded exercise test; METs = Metabolic equivalents; Cardiovascular disease = Cardiac, peripheral artery, or cerebrovascular disease; Pulmonary disease = Chronic obstructive pulmonary disease (COPD), cystic fibrosis, interstitial lung disease, or asthma; Metabolic disease = Diabetes mellitus (type 1 or 2), thyroid disorders, and renal or liver disease
American College of Sports Medicine (2010). ACSM’s Guidelines for Exercise Testing and Prescription (8th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

General Exercise Recommendations

*Continuous exercise or intermittent exercise in bouts of at least 10 minutes in duration to accumulate the minimum recommendation for the given intensity
Note: VO2R = VO2 reserve; HRR = Heart-rate reserve; 1 RM = One-repetition maximum; RPE = Ratings of perceived exertion; ROM = Range of motion;
PNF = Proprioceptive neuromuscular facilitation Source: American College of Sports Medicine (2010). ACMS’s Guidelines for Exercise Testing and Prescription (8th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Cardiorespiratory Training Recommendations

Note: MHR = Maximum heart rate; HRR = Heart-rate reserve; VO2max = VO2 maximum; VO2R = VO2 reserve
Adapted, with permission, from American College of Sports Medicine (2010). ACSM’s Guidelines for Exercise Testing and Prescription (8th ed.). Philadephia: Wolters Kluwer/Lippincott Williams & Wilkins.

Test Termination Criteria

General indications for stopping an exercise test in low-risk adults:

• Onset of angina or angina-like symptoms
• Drop in SBP of >10 mmHg from baseline BP despite an increase in workload
• Excessive rise in BP: SBP >250 mmHg or DBP >115 mmHg
• Shortness of breath, wheezing, leg cramps, or claudication
• Signs of poor perfusion: lightheadedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin
• Failure of heart rate to increase with increased exercise intensity
• Noticeable change in heart rhythm
• Subject requests to stop
• Physical or verbal manifestations of severe fatigue
• Failure of the testing equipment

Note: BP = Blood pressure; SBP = Systolic blood pressure; DBP = Diastolic blood pressure

Physical Activity Readiness Questionnaire (PAR-Q)

View the PAR-Q in PDF Format

Nutrition Updates

The following is ACE’s summary of the USDA’s 2010 Dietary Guidelines for Americans and the MyPlate Food Guidance System.

Federal Dietary Recommendations

Dietary Guidelines

People require varying amounts of nutrients depending on gender, age, activity level, health status, and other factors. The federal government has taken this into consideration when developing recommended intakes. The 2010 Dietary Guidelines and MyPlate provide individualized nutrition recommendations for a healthy diet. Published every five years, the Dietary Guidelines are the government’s best advice to Americans on how to eat to promote health. The 2010 Dietary Guidelines contain many of the same recommendations as the 2005 Dietary Guidelines with some notable updates ( ACE’s summary of the 2005 Dietary Guidelines and MyPyramid Food Guidance System for comparison ). For example, for the first time, the Guidelines recommend that Americans eat less. Following are the major themes of the 2010 Dietary Guidelines, which are elaborated upon in detail at www.dietaryguidelines.gov.

• Balancing calories to achieve and maintain a healthy weight: The Guidelines encourage Americans to prevent or reduce overweight by eating better and exercising more. This includes eating fewer calories for people who are overweight or obese; increasing physical activity; and decreasing time spent in sedentary behaviors like watching television or browsing the Internet.
• Foods and food components to reduce: The Dietary Guidelines advise Americans to reduce sodium intake to less than 2,300 mg/day for the general population and to less than 1,500 mg/day for higher-risk populations such as older adults, African Americans, and people with hypertension, diabetes, or chronic kidney disease; consume fewer than 10% of calories from saturated fat and instead consume monounsaturated and polyunsaturated fats; consume less than 300 mg/day of dietary cholesterol; minimize consumption of trans fatty acids; reduce caloric intake from sugar and solid fats; and consume alcohol in moderation (one drink per day for women and two drinks per day for men).
• Foods and nutrients to increase: The Dietary Guidelines advise that Americans eat more fruits and vegetables, especially dark-green and red and orange vegetables; consume at least half of all grains as whole grains; increase intake of fat-free or low-fat milk products; choose lean proteins and especially try to increase the amount of seafood eaten; replace high-fat proteins with leaner proteins; use oil instead of solid fat; and try to consume more of the often insufficiently consumed nutrients in the American diet, including potassium, fiber, calcium, and vitamin D.
• Building healthy eating patterns: A healthy eating pattern meets nutrient needs through consumption of nutrient-dense foods while staying within calorie limits. Some examples of well-known and effective healthy eating patterns include the Dietary Approaches to Stop Hypertension (DASH) eating plan, the Mediterranean diet, and a well-planned vegetarian diet. The Guidelines also advise Americans to follow food safety recommendations when preparing and eating foods so as to reduce the risk of foodborne illness.
• Helping Americans make healthy choices: The Guidelines charge all sectors of society to play an active role in the movement to make America healthier by developing coordinated partnerships, programs, and policies to support healthy eating. Food and activity behaviors should be viewed in the context of a social ecological model. The USDA describes this model as “an approach which emphasizes the development of coordinated partnerships, programs, and policies to support healthy eating and active living. In this framework, interventions should extend well beyond providing traditional education to individuals and families about healthy choices, and should help build skills, reshape the environment, and reestablish social norms to facilitate individuals’ healthy choices.” The social ecological model takes into consideration individual factors such as age, gender, socioeconomic status, and knowledge; environmental settings including homes, schools, workplaces, and other community venues; sectors of influence such as government, marketing and media, and industry; and social and cultural norms and values including belief systems, religion, lifestyle, and body image. The Dietary Guidelines issue a call to action to: (1) ensure that all Americans have access to nutritious foods and opportunities for physical activity; (2) facilitate individual behavior change through environmental strategies; and (3) set the stage for lifelong healthy eating, physical activity, and weight-management behaviors.

MyPlate

MyPlate is an interactive online tool (www.ChooseMyPlate.gov) designed to replace the sometimes confusing MyPyramid icon (Figure 1). The goal of MyPlate is to simplify the government’s nutrition messages into an easily understood and implemented graphic—a dinner plate divided into four sections: fruits, vegetables, protein, and grains, with a glass of 1% or non-fat milk—and to encourage Americans to eat a more balanced diet that is about 50% fruits and vegetables.

On the website www.ChooseMyPlate.gov, consumers can input their age, gender, height, weight, and physical-activity level to get an individualized eating plan to meet their caloric needs. The program will calculate estimated energy expenditure based on this demographic information. Within seconds, users will be categorized into one of 12 different energy levels (anywhere from 1,000 to 3,200 calories) and will be given the recommended number of servings—measured in cups and ounces—to eat from each of the five food groups (i.e., vegetables, fruit, protein, grains, and dairy). A set number of discretionary calories (i.e., the leftover calories available for sugar or additional fats or an extra serving from any of the food groups) will also be allocated for that individual. By following these recommendations, users will have the optimal diet for disease prevention and weight maintenance based on their personalized needs.

In general, MyPlate encourages people to:

• Balance calories. People should only eat the amount of calories that the body needs. Physical activity helps to balance calories (this is the only place where physical activity is discussed in the new MyPlate talking points). Individual calorie recommendations are available at www.ChooseMyPlate.gov.
• Enjoy your food, but eat less. The key here is to slow down while eating to truly enjoy the food (and key in to the body’s internal cues of hunger and satiety) and try to minimize distractions like television.
• Avoid oversized portions. MyPlate recommends smaller plates, smaller serving sizes, and more mindful eating.
• Eat more vegetables, fruits, whole grains, and fat-free or 1% milk dairy products for adequate potassium, calcium, vitamin D, and fiber.
• Make half your plate fruits and vegetables. Most Americans need nine servings of fruits and vegetables per day. Few get anywhere near that.
• Switch to fat-free or low-fat (1%) milk. Full-fat dairy products provide excess calories and saturated fat in exchange for no nutritional benefit over fat-free and low-fat versions.
• Make half your grains whole grains (ideally even more than that). This will help to ensure adequate fiber intake and decrease intake of highly processed foods.
• Eat fewer foods high in solid fat (typically saturated and trans fat), added sugars, and salt.
• Compare sodium in foods and then choose the lower sodium versions.
• Drink water instead of sugary drinks to help cut sugar and unnecessary calories.

These messages will be emphasized in turn during a multi-year campaign by First Lady Obama’s Let’s Move initiative and the USDA to promote better eating. Online tools and how-to strategies will also become available (see www.ChooseMyPlate.gov to identify the tools currently available). Table 1 shows recommended daily amounts of each of the five food groups for a 2000-calorie diet.

Dietary Reference Intakes

In the past, Recommended Dietary Allowances (RDAs) were published for the different nutrients based on age and gender. The RDAs were defined as “the levels of intake of essential nutrients that, on the basis of scientific knowledge, are judged by the Food and Nutrition Board to be adequate to meet the known needs of practically all healthy persons.” Newer reference values, known as Dietary Reference Intakes (DRIs), are more descriptive. DRI is a generic term used to refer to three types of reference values:

• RDA
• Estimated Average Requirement (EAR), an adequate intake in 50% of an age- and gender-specific group
• Tolerable Upper Intake Level (UL), the maximum intake that is unlikely to pose risk of adverse health effects to almost all individuals in an age- and gender-specific group

The term adequate intake (AI) is used when a RDA cannot be based on an EAR. Adequate intake is a recommended nutrient intake level that based on research appears to be sufficient for good health.

DRIs have been established for calcium, vitamin D, phosphorus, magnesium, and fluoride; folate and other B vitamins; antioxidants (vitamins C and E, selenium); macronutrients (protein, carbohydrate, fat); trace elements (vitamin A and K, iron, zinc); and electrolytes and water. The complete set of DRIs is available at www.iom.edu.

Fluid Intake Recommendations