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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 appellation : ACSM Registered Clinical Exercise Physiologist
Vendor appellation : ACSM
exam questions : 370 existent Questions

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ACSM ACSM Registered Clinical Exercise

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

Cardiorespiratory undertaking has historically been the emphasis of cardiac rehabilitation courses. however, resistance working towards (RT) has regularly swirl into a vital Part of cardiac rehabilitation on account of its gigantic health advantages and effective consequences on cardiac comorbidities (1). There are protection concerns that deserve to subsist considered when enforcing a RT application for the cardiac affected person. in consequence, selected RT guidelines maintain been relative for cardiac rehabilitation (2,3). this article will address the benefits of RT in cardiac rehabilitation. furthermore, defense concerns and guidelines and how to enhance, enforce, and video parade an RT software for sufferers in cardiac rehabilitation and after cardiac rehabilitation might subsist introduced.

RT advantages FOR CARDIAC patients

The benefits of RT for humans with heart problems are numerous. essentially the most time-honored capitalize of RT is extended sinewy energy and endurance (1,four-10). ordinary muscle electricity improvements of 25% to 30% are customarily considered (four,eight-10). additionally, a forty six% improvement in muscle vigour has been observed in frail people who effect RT (four).

here is censorious for cardiac patients as a result of many actions of every day alive require extra sinewy electricity and endurance than what's developed from cardiorespiratory pastime. in addition, the requisite accommodate to comprehensive these activities can moreover exceed medically imposed lifting restrictions placed on this patient inhabitants (11). These actions encompass rising from a chair, carrying groceries, mountain climbing stairs, and protecting/carrying children and grandchildren. Many cardiac sufferers moreover lack the self-confidence to operate many projects of every day alive (1,2). Resistance practicing can give them with each the sinewy electricity and self-confidence to are alive a extra lively and impartial lifestyle (1,four-6,10,eleven).

For cardiac patients returning to travail after rehabilitation, RT should subsist of particular activity, specifically for those with fleshly stressful occupations. Resistance practising reduces cardiac demands at given workloads via reducing the price-power product (RPP) (systolic blood accommodate × coronary heart expense) (2,4,6-10,12) and might fabricate initiatives corresponding to lifting heavy objects safer to perform. mixed cardiorespiratory undertaking and RT maintain been shown to multiply aerobic health greater than cardiorespiratory practicing by myself (8,13), further enhancing useful skill and first-rate of life (1,four,10).

Resistance working towards helps maneuver and cease a few coronary risk components (5,6,12) and different persistent diseases (5,6,10,12). These comprehend class 2 diabetes, hypertension, overweight/obesity, arthritis, frailty/sarcopenia, and osteoporosis. on the grounds that many cardiac rehabilitation patients are of expanded age, holding or bettering functional independence is a noteworthy advantage received from RT (1,4,5,11). view table 1 for a summary of RT advantages for cardiac patients.

RT PRECAUTIONS AND safeguard issues FOR CARDIAC patients

Resistance working towards become once concept to subsist unsafe for the cardiac patient. Cardiac patients maintain been (and infrequently nonetheless are) instructed no longer to carry the ease heavier than 5 to 10 lbs for an indefinite time length after a cardiac adventure or process (eleven). This, if anything, will inspire much less actual undertaking (1,11). however, research has shown RT to subsist protected in chosen cardiac patients (6-8,11-18). Many reviews maintain shown that low-risk (e.g., purposeful ability, ≥7 metabolic equivalents [METs]) and average-possibility (e.g., gentle to reasonable uncommunicative ischemia throughout pastime checking out or restoration) cardiac sufferers can engage in RT with out unreasonable myocardial pressure (6-12). This comprises inescapable individuals with congestive coronary heart failure who've confirmed the capability to tolerate RT (14,19,20). youngsters, high-risk cardiac patients (e.g., presence of complicated ventricular dysrhythmias) may silent now not effect RT. Circuit RT can result in decrease myocardial strain than an eighty five% exertion on a treadmill check (10,21,22) or stationary bicycling at 70% of oxygen consumption at peak exertion (7).

Many cardiac sufferers maintain other cardiac- (e.g., hypertension, diabetes, implantable cardiac defibrillators [ICDs], and pacemakers) and noncardiac-linked (e.g., osteoarthritis, osteoporosis, and shoulder impingement) situations that should subsist considered when establishing an RT application. Most cardiac patients assume a brace of medicinal drugs for their coronary heart circumstance. The sidebar describes one of the most extra universal drugs taken by means of cardiac sufferers.

it is prudent that the health knowledgeable is watchful of the cardiac history of the affected person/client before initiating RT (1). desk 2 outlines the time course for initiating RT in low- to reasonable-possibility cardiac sufferers.

Resistance training is contraindicated and/or requires doctor clearance for inescapable better random patients (2,3,10). Absolute and relative RT contraindications had been centered for cardiac sufferers (desk 3). special RT precautions should subsist nosy about sufferers who've had myocardial infarction (MIs), coronary artery skip surgical procedure (CABG), implantable defibrillators (ICDs), pacemakers, diabetes, and hypertension (1-3,8-eleven). workouts involving gigantic shoulder girdle involvement and altitude are frequently limited for four and 6 weeks for patients having ICDs/pacemeakers and CABGs, respectively (2,three,eleven). Adams and colleagues (eleven) examined 13 typical RT workout routines for protection, efficacy, and typical usefulness for patients who had a history of MI, CABGs, and ICDs/pacemakers. They developed a list of commandeer exercises and a timeline for particular stream/endeavor restrictions. higher-body RT may silent subsist limited except the sternum has healed sufficiently (e.g., frequently three months) in patients receiving CABGs and unless physicians limpid recipients of ICDs and pacemakers (2,10,eleven). Repetitive movement actions akin to weight lifting can result in pacing lead fractures and dislodgement (2,10,11). Resting BP values should silent subsist less than 160/one hundred mmHg (three), and an activity BP cutoff of 220/105 mmHg could subsist prudent (2). computer screen rate-pressure product in sufferers with hypertension (10) by means of taking and paying attention to both heart rate and systolic blood pressure (eleven). correspond with using single-limb (in its residence of double limb) upper-extremity practising in sufferers who maintain an exaggerated upward push in blood drive or RPP during RT (1). This moreover can subsist effective in these patients with congestive coronary heart failure (eight).

extra RT safeguard precautions and information for selected conditions encompass right here:

Hypertension
  • combine RT with cardio training (3,6,10,12).
  • Use lighter weights (≤50% of 1-repetition optimum) (three,6,10,12).
  • choose 8 to 10 workout routines for the main muscle agencies (3).
  • choose a resistance enabling performance of 12 to fifteen repetitions (3).
  • steer limpid of tight gripping and breath retaining (Valsalva maneuver) (three).
  • Use a BP cutoff of 220/105 mmHg complete over RT (2).
  • Diabetes
  • keep away from speedy adjustments in cadaver residence to avoid dizziness and falls. Some people with diabetes maintain autonomic neuropathies (a apprehensive device disease) that may negatively impact circulation and stability.
  • Use the RPE scale (Borg) if autonomic neuropathies are present.
  • motivate fluid replacement complete the course through recreation, and steer limpid of dehydration.
  • beginning with RT a lot of between forty% and 60% of 1RM and operate 10 to fifteen repetitions.
  • steer limpid of non permanent muscle fatigue.
  • keep away from tight gripping and the Valsalva maneuver (2,10).
  • Implantable Defibrillators (ICDs) and Pacemakers
  • Repetitive motions dote RT can lead to pacing and lead fractures and dislodgement.
  • men and women with ICDs and pacemakers should keep their health professional's guidelines regarding raising their fingers above shoulder top.
  • upper-extremity electricity could subsist diminished from lack of use. return to or start upper-body RT steadily (2,10).
  • Osteoporosis
  • prevent spinal flexion (bending forward), twisting, operating, and leaping to slit back the dangers of vertebral fractures.
  • perform workout routines in an upright posture, and emphasize activities dote scapular retraction and melancholy (scapular rows), and hip and knee extension (partial squats and leg presses.
  • beginning with 1 set of 8 to 10 repetitions of workouts for complete most Important muscle corporations.
  • Use an RPE range of 13 to 15.
  • activity 2 days/week.
  • evade painful activities.
  • steer limpid of swift adjustments of cadaver position, and supply immediate supervision (some men and women with osteoporosis may moreover maintain postural alterations that may negatively influence their balance).
  • progress to 2 to 3 sets, if tolerated (2,23).
  • Arthritis
  • stay away from RT right through durations of worsening ache and swelling.
  • evade RT within the early morning in folks with rheumatoid arthritis.
  • Some folks with arthritis may additionally best tolerate 2 or three repetitions at a time with brief ease durations. Repetitions should silent subsist introduced as tolerated.
  • choose 8 to 10 exercises (1 exercise for every predominant muscle neighborhood).
  • dispose of workout routines that worsen or cause further ache.
  • endeavor inside a ache-free latitude of motion.
  • Isometric workout routines and resistance bands and machines are complete faultless alternatives, if tolerated.
  • stay away from repetitive exercises in people with unstable joints (2).
  • continual respiration right through RT is in particular Important for cardiac patients, to evade the Valsalva maneuver. Exhaling complete through the exertion (lifting) Part is informed. fending off tight gripping and sustained static (isometric) contractions additionally will champion steer limpid of unreasonable raises in blood power throughout RT (1-three,8,10,11). activity gurus may silent cease RT classes automatically if any of here hostile responses swirl up including:

  • diastolic BP of one hundred ten mmHg or bigger
  • lessen in systolic BP of 10 mmHg or greater
  • tremendous ventricular or atrial dysrhythmias (Dysrhythmia capacity an abnormal cardiac rhythm. It can moreover subsist both a unique beat or sustained beats and might near from both the atria or ventricles.)
  • 2nd- or third-degree heart obstruct (Two styles of obstructions or delays in the conduction of electrical activity between the atria and ventricles.)
  • signs/indicators of activity intolerance, including angina (chest pain), marked dyspnea (labored respiratory), easy-headedness or dizziness, and electrocardiogram changes suggestive of ischemia (inadequate oxygenated blood toddle to the heart muscle or myocardium) (2,3)
  • no longer complete fitness facilities can maintain electrocardiogram or blood accommodate device to monitor these essential signals. despite the fact, many ACSM licensed authorities (i.e., endeavor specialist, registered clinical pastime physiologist, and software administrators) maintain the scholarship to parade screen blood drive, assume a pulse, and figure RPP. it's prudent that fitness gurus working with this inhabitants possess or acquire these faculty sets.

    RT PROGRAMMING FOR CARDIAC patients

    as soon as a patient has been medically cleared to commence RT, a personalized software should silent subsist developed. it is essential to deem other fitness situations that might moreover alter the RT program design. A cardiac patient with osteoporosis should effect complete workouts with an upright attitude and preserve away from spinal flexion (ahead and lateral) and spinal rotation (twisting) (2,23). A affected person with a shoulder impingement should preserve actions under 90 degrees of shoulder abduction and flexion and hold arms just a itsy-bitsy in entrance of the cadaver in the scapular aircraft. emphasis should silent subsist placed on scapular retraction and melancholy and on shoulder inside and exterior rotation. Rows are an acceptable preference for patients with a shoulder impingement (24).

    There may silent subsist a balance amongst fundamental muscle agencies knowledgeable (5,6,10,12,25,26). this may preserve away from electricity imbalances between opposing muscle groups, which might outcomes in musculoskeletal injury. both lower- and higher-body muscle corporations should subsist informed on the identical day to preserve time (5,10,26). on account of their efficiency and practical results, multijoint workouts may silent subsist emphasised and consume single-joint exercises to acclaim the RT program (1,2,5,10,26). no longer complete cardiac rehabilitation classes maintain the time, house, and device to multiply wide RT programs. This amplifies the significance of performing multijoint workout routines. When lots of RT gadget is purchasable, opt for modes that might subsist most comfy for the patient (1).

    despite the fact there are informed 1RM percentages for lower- and upper-physique workout routines for cardiac sufferers (desk 4), 1RM testing commonly is not performed on account of protection considerations and a lack of RT event that is ordinary in cardiac patients. An RPE of 11 to 13 (fairly facile to a bit of challenging) on the Borg Scale is an acceptable components for identifying preparatory hundreds for RT workouts (2,3). A gradual boost in resistance (5%) should silent swirl up once the patient can finished 12 to 15 repetitions easily (3). a number of working towards tips encompass here:

  • operate a warm-up before the birth of complete RT periods; a close warm-up would consist of facile cardio pastime for 5to 10 minutes; a specific warm-up would comprehend gentle stretching and/or energetic range of movement workout routines with gentle or no resistance (2).
  • face up to the desired actions/synergies whereas preserving resistances (weights, bands, tubes, medication balls, and many others.) parallel to the plane of movement and ornery the reputed direction of their movement(s).
  • keep away from "throwing" or "shedding" the resistance; at complete times maintain control of the resistance.
  • Use a leisure interval period, which enables the affected person to glean well adequate to yield the favored repetitions/work for here set or pastime.
  • preserve revise cadaver and joint alignment consistently (e.g., ankles, knees, and hips in line during a leg press or squat) (26).
  • Machines usually permit for greater time-efficient RT periods, are more convenient to operate with suitable method, and stabilize the physique, reducing balance necessities (extra muscle isolation) (1,26).
  • Free weights typically consume extra muscle groups for stability and stabilization, present lots of manner manipulations (e.g., quite a few hand positions), and travail the sinewy tissues in a greater purposeful manner (1,26). view table 4 for a abstract of RT programming guidelines for cardiac patients.
  • RT FOR sufferers WHO achieved CARDIAC REHABILITATION

    The RT application design for the affected person after cardiac rehabilitation will rely upon the residence the affected person plans on exercising upon completion of their allotted cardiac rehabilitation sessions and what RT gadget (e.g., variable dynamic resistance machines, free weights, and variable resistance [or color] bands/tubing) an individual can maintain access to. In a noteworthy condition, upon completion of the monitored section of cardiac rehabilitation (frequently called Part II), an individual could subsist offered the possibility to proceed exercising within the identical facility as a member of their upkeep program (frequently called phases III to IV). ultimate in a close atmosphere will enhance each an individual's consolation and self-confidence plane in stirring forward with their activity application, specially RT. despite the fact, as is frequently the case, many sufferers necessity to locate a brand fresh vicinity to recreation with several paraphernalia and, simply as critical, a brand fresh workforce.

    With the a variety of modes of RT and recreation machine obtainable to the health and fitness skilled, every cardiac affected person maintain to subsist evaluated on a person foundation. figuring out the brand fresh client's clinical historical past (e.g., MI, CABG, and angioplasty) is elementary. In a Part IV atmosphere, the fitness and fitness knowledgeable along with the clinical software director can subsist charged with constructing the customer's undertaking prescription. although, in a nonclinical atmosphere (e.g., autochthonous fitness club or gymnasium), the fitness skilled necessity to contact and travail with the customer's health professional or healthcare professional in designing the client's pastime prescription (table four). for example, a cardiac affected person who had open-coronary heart surgery and participated in barely four weeks of supervised cardiac rehabilitation (part II) would no longer subsist able to duty the selfsame RT exercises that an individual who had an angioplasty with stent placement four weeks prior can subsist able to perform. during this inescapable case, each the open-heart surgery affected person and the fitness and health skilled must subsist cognizant of sternal precautions (curative constantly takes 12 weeks), which might essentially consist of limiting upper-body RT workout routines (table 2).

    health and fitness gurus working in the medical ambiance additionally maintain to subsist comfortable with making ready cardiac sufferers for exercising in their buildings. As is the case with many cardiac patients, they conclude not transition into one other formal surroundings, as a consequence they ought to subsist prepared to proceed their power-practicing software at domestic. Many cardiac rehabilitation courses will comprehend using colored tubing or resistance bands (distinctive colours point out a unique plane of resistance) into their RT courses. in addition to being a safe and useful benevolent of energy working towards, using this kind of RT machine is facile for the patient to gain scholarship of. furthermore, cardiac rehabilitation programs can continually accommodate distributing these resistance bands and colored tubing for consume by means of their customer's at home upon completion of their software.

    The number of cardiac sufferers isn't going to decrease in the years forward, for that judgement the cardiac rehabilitation programs and fitness facilities are charged with here: facilities ought to maintain the essential device (e.g., treadmills, higher-physique ergometers, variable dynamic resistance machines, free weights, and coloured tubing/bands) to elicit expected consequences; and group of workers should subsist appropriately knowledgeable/proficient (e.g., degreed, certified) to travail no longer most effective with cardiac patients however moreover with the increasing numbers of various particular populations.

    summary

    Resistance practising is protected for chosen cardiac rehabilitation sufferers and offers a few fitness and fitness merits. it is essential for each cardiac affected person to supervene the revise time direction for initiating RT and adhere to specific RT programming and safeguard guidelines. Cardiac patients should silent maintain their RT software tailored to their particular wants and capabilities. this can permit them to achieve the advantages of RT, whereas minimizing the possibility of opposed pursuits or harm. Resistance training, dote cardiorespiratory exercise, should silent subsist endured after the completion of a cardiac rehabilitation application to retain or extra multiply sinewy fitness.

    CONDENSED version AND final analysis

    proof now naturally demonstrates that cardiac rehabilitation patients should silent subsist performing RT. The merits received from RT will compliment the cardiorespiratory component of cardiac rehabilitation. once a cardiac patient has been deemed safe and ready to rouse RT, selected safeguard and programming guidelines may silent subsist adopted to maximize RT defense and efficacy. besides keeping their cardiorespiratory working towards after cardiac rehabilitation, cardiac sufferers should silent proceed to engage in RT to multiply their best of life.

    References 1. Spencer, J.L. Resistance working towards in outpatient cardiac rehabilitation. strength and Conditioning Journal 29(1):18-23, 2007. 2. ACSM's instructions for activity testing and Prescription. seventh 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. guidelines for Cardiac Rehabilitation and Secondary Prevention programs. 4th ed. Human Kinetics, 2004:36, 119, 182. four. Ades, P.A., P.D. Savage, M.E. Cress, et al. Resistance practising on actual efficiency in disabled older womanish cardiac sufferers. medication & Science in activities & undertaking® 35(eight):1265-1270, 2003. 5. American school of activities medication and the American heart association. physical activity and public health in older adults: strategies from the American faculty of sports medication and the American heart association. drugs & Science in activities & pastime® 39(eight):1435-1445, 2007. 6. Pollock, M.L., B.A. Franklin, G.J. Balady, et al. Resistance pastime in individuals with and with out cardiovascular disease: advantages, motive, security, and prescription. An advisory from the Committee on exercise, Rehabilitation, and Prevention, Council on medical Cardiology, American heart affiliation. Circulation one hundred and one:828-833, 2000. 7. Meyer, k. Resistance pastime in perpetual coronary heart failure: landmark experiences and implications for follow. medical and Investigative drugs. 29(3):166-169, 2006. 8. Volaklis, k.A., and S.P. Tokmakidis. Resistance activity practicing in sufferers with heart failure. activities drugs 35(12):1085-1103, 2005. 9. Volaklis, k.A., H.T. Douda, P.F. Kokkinos, et al. Physiologic ameliorations to detraining following prolonged combined electricity and aerobic practising in cardiac sufferers. European Journal of Cardiovascular Prevention and Rehabilitation 13:375-380, 2006. 10. Williams, M.A., W.L. Haskell, P.A. Ades, et al. Resistance training in individuals with and without cardiovascular disease: 2007 replace. A scientific update from the American heart affiliation Council on scientific Cardiology and Council on food, physical endeavor, and Metabolism. Circulation 116:572-584, 2007. eleven. Adams, J., M.J. Cline, M. Hubbard, et al. a fresh paradigm for submit-cardiac sustain resistance exercise instructions. American Journal of Cardiology 97:281-286, 2006. 12. Franklin, B.A., D.P. Swain, and R.J. Shephard. fresh insights within the prescription of activity for coronary patients. Journal of Cardiovascular Nursing 18(2):116-123, 2003. 13. Stewart, k., L.D. McFarland, J.J. Weinhoffer, et al. protection and efficacy of weight training quickly after acute myocardial infarction. Journal of Cardiopulmonary Rehabilitation 18:37-44, 1998. 14. Weber-Zion, G., E. Goldhammer, E. Shaar, et al. Left ventricular duty complete through electricity trying out and resistance recreation in patients with left ventricular dysfunction. Journal of Cardiopulmonary Rehabilitation 24(2):one hundred-109, 2004. 15. Maiorana, A.J., T.G. Briffa, and J. Hung. A managed tribulation of circuit weight working towards on aerobic faculty and myocardial oxygen claim in men after coronary artery pass surgical procedure. Journal of Cardiopulmonary Rehabilitation 17(4):239-247, 1997. 16. Vanbiervliet, W., J. Pélissier, B. Lédermann, et al. power practising with elastic bands: measure of its consequences in cardiac rehabilitation after coronary diseases. Annales de réadaptation et de médecine physique. 46(8):545-552, 2003. 17. DeJong, A.T., C.J. Womack, J.A. Perrine, et al. Hemostatic responses to resistance working towards in sufferers with coronary artery disorder. Journal of Cardiopulmonary Rehabilitation 26(2):80-83, 2006. 18. Beniamini, Y., J.J. Rubenstein, and A.D. Faigenbaum. high-intensity energy practising of patients enrolled in an outpatient cardiac rehabilitation program. Journal of Cardiopulmonary Rehabilitation 19:eight-17, 1998. 19. King, M.L., k.A. Dracup, G.C. Fonarow, et al. The hemodynamic outcomes of isotonic pastime using hand-held weights in patients with heart failure. Journal of coronary heart Lung Transplant 19:1209-1218, 2000. 20. Karlsdottir, A.E., C. Foster, J.P. Porcari, et al. Hemodynamic responses complete the course through cardio and resistance exercise. Journal of Cardiopulmonary Rehabilitation 22:one hundred seventy-177, 2004. 21. DeGroot, D., T. Quinn, R. Kertzer, et al. Circuit weight practicing in cardiac sufferers: opting for example workloads for safety and energy expenditure. Journal of Cardiopulmonary Rehabilitation 18(2):145-152, 1998. 22. Ebben, W.P., and D.H. Leigh. The results of resistance practicing on cardiovascular patients. strength and Conditioning Journal 28(2):fifty two-fifty eight, 2006. 23. national electricity 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. activity modifications and techniques to multiply shoulder feature. strength and Conditioning Journal 27(4):36-45, 2005. 25. country wide strength and Conditioning association. necessities of electricity working towards and Conditioning. 2nd ed. Baechle, T., and R. Earle (Editors). Champaign, IL: Human Kinetics, 2000:four hundred-401. 26. Sorace, P., and T. LaFontaine. Resistance training muscle energy: design classes that work. ACSM's fitness & health Journal® 9(2):6-12, 2005.

    ACSM: Registered clinical activity Physiologist | killexams.com existent Questions and Pass4sure dumps

    Do you view undertaking as an Important factor in the prevention and medicine of disease, and necessity to encourage individuals to supervene well behaviors? ACSM licensed activity Physiologists® assume practicing to an advanced degree by using conducting and interpreting actual fitness assessments and setting up pastime prescriptions for people who're match or maintain medically controlled illnesses.

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    exam questions : ACSM’S resources FOR medical endeavor PHYSIOLOGY | killexams.com existent Questions and Pass4sure dumps

    exam questions mp;A: ACSM’S materials FOR scientific endeavor PHYSIOLOGY

    ACSM is recognized globally for outlining science-based mostly framework for professionals who conduct fitness-connected activity evaluation, particular person actual endeavor plans, and activity programs for adults. Now, a brand fresh edition of ACSM’s substances for clinical exercise Physiology: Musculoskeletal, Neuromuscular, Neoplastic, Immunological, and Hematological situations is assisting scientists and clinicians transfigure research into practice. The pastime-based mostly innovations contained within the lead intently relate to the concepts of undertaking is medication™. study the exam questions mp;A with Jon Myers, Ph.D., FACSM, senior editor of the booklet.

    Myers and David Nieman, Ph.D., FACSM, maintain been the senior editors of the publication, and coordinated the writing with a host of contributing consultants. Myers is a clinical professor of cardiology at the Veterans Administration Palo Alto health keeping paraphernalia and Stanford institution. He chaired the publications subcommittee of ACSM’s committee on Certification and Registry Boards (CCRB) from 2001-07, and contributed content for several essential ACSM publications, together with diverse versions of ACSM’s instructions for exercise testing and Prescription.

    Q: What’s entertaining about this fresh medical undertaking physiology resource manual?A: here's one of three books in a sequence that ACSM publishes and updates periodically with Lippincott Williams and Wilkins. The content of this publication, ACSM’s materials for medical undertaking Physiology: Musculoskeletal, Neuromuscular, Neoplastic, Immunological, and Hematological conditions (CEP Res-2) is complementary to ACSM’s instructions for exercise checking out and Prescription and ACSM’s resource lead for exercise checking out and Prescription. For the first time, complete three fresh versions of those books are being released on a synchronized schedule, with complete copyright dates indicated as 2010, but obtainable now. The touchstone theme within the collection is to translate the latest in science and authoritative clinical sustain into apply guidelines and continuing schooling substances to subsist used by means of undertaking specialists and physicians global. while complete of those texts are directed to the application of activity assessment and remedy for patients with cardiovascular and pulmonary ailment, CEP Res-2 is absorbing in offering information for working with patients who've confirmed circumstances and disabilities, no longer addressed through the other two books – particularly, orthopedic, neurological, metabolic, musculoskeletal, neoplastic, and immunodeficiency circumstances. These medical populations are often mostly underserved. fitness gurus gained’t subsist capable of finding such up-to-date substances beneath one cover in different places that specifically ply recreation remedy for circumstances equivalent to cancer, traumatic brain harm, or immune problems.

    Q: How is the booklet involving ACSM’s credentialing and certifications? A: The concerns addressed within the textual content are essential to the existing or advantage ACSM Registered clinical activity Physiologist� (RCEP), on account that the expected knowledge, capabilities and abilities covered address clinical and pathological instances where activity has been proven to supply therapeutic or practical benefit. accordingly, CEP Res-2, in conjunction with ACSM’s instructions for recreation trying out and Prescription and ACSM’s useful resource lead for undertaking testing and Prescription deliver the complete scope of diseases and problems upon which the RCEP credential is based mostly.

    Q: What’s several during this second version? A: complete chapters from the first version maintain been up to date. terrific advances were made in analysis and medical event on the grounds that the first version become published eight years in the past; a scan of chapter bibliographies affirms the extent of those advancements and the course present the chapter contents basically are. CEP Res-2 comprises an entirely fresh belt on “medical practice concerns.” as the ACSM RCEP has swirl into greater established over the remaining decade, this fresh section is specifically timely and Important seeing that it helps supply the RCEP and different health keeping authorities with a more robust knowing of their role and how they can maintain an Important and essential vicinity in nowadays’s health keeping ambiance. This fresh section contains chapters on the evolution of the clinical undertaking physiologist, tactics to demonstrating purposeful results for fitness and health classes, criminal and virtuous concerns, and client referral and consulting relations with allied professions.


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    ACSM Registered Clinical Exercise Physiologist

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    Exercise can champion
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    Exercise can champion people obviate or manage heart problems.

    ULTRA F/Photodisc/Getty Images

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


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

    Do you view exercise as an Important factor in the prevention and treatment of disease, and want to motivate people to practice well behaviors? ACSM Certified Exercise Physiologists® assume training to an advanced plane by conducting and interpreting physical fitness assessments and developing exercise prescriptions for people who are well or maintain medically controlled diseases.

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    Know the Risks: Lifestyle Management of Dyslipidemia | killexams.com existent 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 maintain 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 flood is impaired. If the blood supply to a portion of the heart is completely slit 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 climb 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 string of events (e.g., oxidation of LDLs, monocyte migration, macrophage uptake of modified LDLs, foam cells, fatty streaks, etc.) that result in the progress 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 moreover 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 circuit of 102 cm or greater in men and 88 cm or greater in women), a prothrombotic state, and a proinflammatory status (5). A prothrombotic status is a condition that predisposes to venous or arterial thrombosis. A proinflammatory status is the presence of low-grade generalized inflammation within the cadaver that increases cardiac risk.

    Lipoproteins are the carriers of lipids (primarily cholesterol and TGs) in the blood. Because replete and water conclude not mix, the cadaver combines protein plus lipid so that the lipid substance can subsist 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 champion obviate 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 climb in TG-rich lipoproteins (e.g., very low density lipoproteins [VLDLs]) after a meal. It is a dynamic condition in which humans expend 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 progress 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, complete of which contribute to endothelial dysfunction, may multiply during PPL (7).

    Testing for PPL involves a 12-hour rapidly 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 belt under the curve (AUC). A great value for TG belt 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 sequel exercise has on lipoproteins. HDLs often are increased with sustained aerobic exercise that results in an expenditure of >1,200 calories/week, but this sequel is less consistent and may subsist genetically predetermined (9). The greater the exercise volume (and caloric expenditure), the more likely an exerciser will achieve a significant multiply 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. confirmed exercise training moreover 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, yield propitious changes in LDL subfractions, which will reduce the risk of CHD. For example, aerobic exercise has been shown to transfigure smaller LDLs to larger LDLs, reducing cardiac risk (3, 11).

    Exercise training moreover 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 subsist increased in those who maintain a LPL deficiency (2). It was recently demonstrated in 35 pairs of monozygotic twins (active twins ran a imply of 63 km/week vs. a imply of 7 km/week in the dormant twins) that low HDL cholesterol may subsist 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 champion the profound advantageous 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 subsist more Important than the intensity to induce advantageous effects on lipoproteins (10, 11). Significant daily and weekly energy expenditures are recommended to yield notable changes in individuals with dyslipidemia (3, 4, 10). Cross-sectional studies maintain shown that lipids continue to improve across weekly running distances from <10 to >40 miles in a direct dose-response relationship (13).

    The sequel of exercise on PPL moreover is significant. Individuals who regularly effect aerobic exercise typically parade 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 replete consume as a substrate during and after the activity helps limpid 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 propitious effects (e.g., TG lowering) of endurance exercise on PPL seem to subsist a result of acute metabolic changes as opposed to confirmed exercise effects (14, 15). This encourages daily or near daily aerobic exercise to deal elevated PPL. feasible mechanisms for the exercise-induced TG reductions comprehend increased muscle LPL activity and reduced hepatic TG secretion (14, 17).

    There only maintain been a brace of studies on resistance training and PPL, and the results were discordant (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 selfsame (2, 3). If weight loss is combined with aerobic exercise, HDLs are more likely to subsist sustained or multiply following training. Weight loss moreover 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 cadaver weight) (2). When weight loss occurs in conjunction with exercise, LDL and total cholesterol are usually lowered (2, 3). Weight loss moreover has advantageous effects on lowering PPL, as obesity increases PPL. When weight loss is indicated, a loss of 5% to 10% cadaver 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 silent subsist 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, kind 2 diabetes) that may require medical clearance. Statins, for example, can cause muscle damage (myopathy) and this should subsist considered (4). Table 5 summarizes universal exercise guidelines for dyslipidemia. The emphasis should subsist on aerobic exercise and total weekly caloric expenditure. A stately initial goal is to effect 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 multiply in aerobic exercise intensity should moreover occur. Exercise programs with higher volumes and intensities maintain been shown to subsist most effective for increasing HDL cholesterol (11). These guidelines may moreover necessity adjusting based on coexisting diseases, current fitness level, and time constraints that may subsist present. The aerobic training may necessity to subsist performed intermittently throughout the day. It is Important to recollect 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 subsist 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 multiply TGs, LDL, and total blood cholesterol. Polyunsaturated fats (e.g., corn oil) seem to maintain a neutral sequel 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 replete 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 subsist maintained (2, 3, 23, 24).

    High-carbohydrate diets can multiply TG levels and decrease HDL cholesterol, but again, this sequel 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 moreover maintain 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 moreover multiply TGs, but its sequel on LDL cholesterol appears to subsist minimal.

    Table 6 summarizes the key components of a diet to champion lower blood lipids. The emphasis should subsist 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, gelid water fish (e.g., salmon), etc., which maintain been shown to maintain a advantageous sequel on blood lipids. Here are some nutrition tips that favorably champion impact blood lipids:

  • Eat fish two to three times per week. The fish should subsist baked, not fried.
  • Use well oils for cooking, such as olive oil and walnut oil.
  • Eat whole grain products. Avoid or limit starchy white pasta and bread.
  • Add or multiply oats and oatmeal intake.
  • Increase consumption of green vegetables. Broccoli, spinach, lettuce, and green beans are complete examples of well carbohydrate, low-calorie green vegetables.
  • Eat whole fruits and berries.
  • Avoid/reduce rich, fattening desserts.
  • The amount of each kind of fiber varies in different plant foods. To receive the greatest health benefit, ingest 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 cadaver weight and manage cardiovascular risk factors. On medical history and physical fitness, he was create to maintain 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 moreover 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 recommendation in respect 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% replete calories and 45 g of fiber per day by seven day food recall) and exercising 260 minutes/week on incurious (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 subsist prevented or treated with lifestyle management of exercise/physical activity, proper nutrition, and weight loss (if needed). Having a sound scholarship 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 great cadaver of evidence suggests that dyslipidemia is directly related to the progression of coronary artery disease. Lifestyle changes, which comprehend increased exercise/physical activity, dietary modifications, and weight loss (if needed) maintain 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 contrivance 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: ingest Your course to Better Health With fresh Breakthrough Food Discoveries. Bantam, 1999. References 2. Durstine, J.L., and G.E. Moore. ACSM's Exercise Management for Persons with confirmed 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 replete 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 fresh 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 fresh 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. sequel 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. unique 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. sequel 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. sequel 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 sequel 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 keeping 27:1699-1705, 2004. 22. Esposito K., A. Pontillo, C. DiPalo, et al. sequel 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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