Chapter 6 – Building Rapport and the Initial Investigation Stage

Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.

Rapport: personal interaction a trainer establishes and maintains with a client. Requires effective communication as well as mutual respect and understanding.

3 essential attributes:

  • Empathy – Understanding/experiencing someone else’s situation as if it were your own. Putting yourself in their shoes regardless of personal opinion
    • Separate the meaningful from the unnecessary
    • Identify emotional patterns (client becomes defensive when discussing weight challenges)
    • Be conscious of cultural differences in regards to communication
  • Warmth – unconditional positive regard, or respect, for another person regardless of their individuality and uniqueness. Communicates safety and acceptance.
  • Genuineness – authenticity, ability to be honest and open

Building Rapport

  1. Stages of building rapport
    1. Rapport – impressions, developing trust, demo warmth, empathy, and genuineness
    2. Investigation – identifying readiness to change behavior
    3. Planning – goal setting, programming, motivation and adherence strategies
    4. Action – instruction, demonstration, and execution of program. Proper feedback
  2. Style of communication
    1. Preaching – judgmental, lecture-type of communication by telling clients what they should do. Minimizes chance of rapport
    2. Educating – informative, allows client to make more informed decesions
    3. Counseling style – supportive, collaborative effort to proble-solve and help clients make informed decisions. MOST EFFECTIVE STYLE and recommended when implementing a plan and/or modifying a program design
    4. Directing stile – more instructive, trainer provides instructions and directions. Most effective when safety and proper form and technique are essential

Pre-exercise questions

  • Ask how their typical week looks, what physical activities they do, business activities such as traveling, time spent away from work, recreational activities, pain during movement, etc…
  • Find out as much as possible about their lifestyle, habits, and exercise history
  1. Bringing changing and motivational interviewing
    1. Motivational interviewing – client-centered method for building intrinsic motivation to change by exploring and resolving mixed feelings about their health and exercise habits
      1. Helps determine if client is ready for change/current stage of change
  2. Health-risk appraisal
    1. Pre-participation screening
      1. Identify signs or symptoms for cardiovascular, pulmonary, or metabolic disease
      2. Identify risk factors
        1. Positive risk factors (bad things)
          1. Family history
          2. Coronary artery disease
        2. Negative risk factors (good things)
          1. HDL (high-density lipoprotein, good cholesterol) score at or above 60 mg/dl
        3. Determine if they need medical clearance
        4. Determine if they need medically supervised program
    2. PAR-Q (physical activity readiness questionnaire)
      1. Minimal health-risk appraisal prerequisite
      2. Quick, easy, non-invasive to administer
      3. Limited by lack of detail
Positive risk factors Criteria Points
Age Men 45+ years, Women 55+ years 1
Family history Myocardial Infarction, coronary revascularization, or sudden death before 55 in father or 1st degree male relative, before 65 in mother or 1st degree female relative 1
Cigarette smoking Current or quit within 6 months or exposure to environmental smoke (secondhand) 1
Sedentary lifestyle No doing at least 30 minutes of moderate-intensity physical activity at least 3 days per week for at least 3 months 1
Obesity BMI 30+ or waist firth 102cm+ (40 inches) for men and 88cm+ for women (35 inches) 1
Hypertension Systolic BP 140+ mmHg and/or diastolic BP 90+mmhg confirmed on at least 2 measurements or on antihypertensive medication 1
Dyslipidemia LDL cholesterol 130+ mg/dl or HDL cholesterol less than 40 mg/dl, or on lipid-lowering medication, or if total serum cholesterol is 200+ mg/dl 1
Prediabetes Fasting plasma glucose 100+ mg/dl but less than 125 mg/dl or impaired glucose tolerance (IGT) where a 2 hour oral glucose tolerance test (OGTT) vale is 140+ mg/dl but less than 199 mg/dl, confirmed on at least 2 separate occasions 1
Negative risk factors Criteria
HDL Cholesterol 60+ mg/dl -1
  1. Risk Classification
    1. Low risk
      1. Asymptomatic
      2. Less than 2 risk factors
      3. Medical exam before moderate or vigorous exercise not needed
      4. Exercise test before exercise not recommended
      5. Doctor supervision for exercise test not needed
    2. Moderate risk
      1. Asymptomatic
      2. 2+ risk factors
      3. Medical exam for moderate exercise not needed
      4. Medical exam for vigorous exercise IS needed
      5. Exercise test before exercise not recommended
      6. Doctor supervision for exercise test not needed
    3. High risk
      1. Symptomatic or know CV, pulmonary, renal, or metabolic disease
      2. Medical exam before moderate and vigorous exercise IS needed
      3. Exercise test before moderate and vigorous exercise IS recommended
      4. Doctor supervision for both submaximal and maximal exercise test IS recommended
    4. Moderate exercise = 40%-60% VO2R or 3 to less than 6 METs
    5. Vigorous exercise = 60%+ VO2R or 6+ METs
    6. Signs and symptoms to be noted
      1. Pain/tightness or discomfort (angina equivalent) in chest, neck, jaw, arms, or other areas that may result from ischemia
      2. Shortness of breath or difficulty breathing at rest or with mild exertion (dyspnea)
      3. Orthopnea (dyspnea in reclined position) or paroxysmal nocturnal dyspnea
      4. Ankle edema
      5. Palpations or tachycardia
      6. Intermittent claudication (pain or cramping in lower extremities associated with inadequate blood supply)
      7. Heart murmur
      8. Unusual fatigue or difficulty breathing with usual activities
      9. Dizziness or syncope, most commonly caused by reduced perfusion to the brain
  2. Evaluation forms
    1. Informed consent
      1. NOT a liability waiver
    2. Agreement and release of liability waiver
      1. Release trainer from liability for injuries
    3. Health-history questionnaire
    4. Exercise history and attitude questionnaire
    5. Medical release
    6. Testing forms
  3. Health conditions affecting exercise
    1. Cardiovascular
      1. Atherosclerosis – when fatty deposits from cholesterol and calcium build up on the walls of the arteries
        1. Causes thickening of arteries
        2. Loss of elasticity
        3. Can result in angina and possible myocardial infarction, or heart attack
      2. Respiratory (disease of the lungs possibly resulting in difficult or labored breathing)
        1. Bronchitis
        2. Emphysema
        3. Asthma
        4. Chronic obstructive pulmonary disease (COPD)
      3.  Musculoskeletal
        1. Consists of muscles, bones, tendons, and ligaments
        2. Sprains (involving ligaments which connect bone to bone) and strains (involving tendons which connect muscle to bone)
        3. Overuse injury (most common)
        4. Herniated discs
        5. Bursitis
        6. Tendinitis
        7. Arthritis
        8. Atrophy
      4. Metabolic
        1. Diseases that interfere with metabolism or the utilization or energy
        2. Diabetes
        3. Thyroid disorders
      5. Other conditions
        1. Hernia
          1. Contraindication, must be cleared by physician
          2. Aggravated by increased abdominal pressure (Valsalva maneuver)
        2. Pregnancy
        3. Illness or infection
  4. Medications (TABLE 6-2)
    1. Antihypertensive
      1. Beta blockers – limit sympathetic nervous system.
        1. Block effects of catecholamine (epinephrine and norepinephrine)
        2. Use RPE instead of target HR if client is on beta blockers
        3. Lowers resting, exercising, and max exercising HR
      2. Calcium channel blockers
        1. No significant change in max exercising HR
        2. Can increase, decrease or not effect resting and exercise HR
      3. Angiotensin-converting Enzyme (ACE) Inhibitors
      4. Angiotensin-II Receptor Antagonist
      5.  Diuretics
        1. Increase excretion or water and electrolytes through kidneys
        2. Can cause water and electrolyte imbalances leading to cardia arrhythmias
        3. May predispose an exerciser to dehydration
        4. No significant effect on HR
    2.  Bronchodilators
      1. Relax or open air passages to lungs
      2. Allows for better air exchange
    3. Cold medications
      1. Stimulate vasoconstriction
  5. Conducting cardiovascular assessments
    1. Taking a pulse manually
      1. Radial artery – anterior (ventral) aspect or wrist on thumb side
      2. Carotid artery – lateral to trachea on neck
    2. Resting heart rates
      1. Bradycardia (slow HR) = less than 60 BPM
      2. Normal = 60-100 BPM
      3. Tachycardia (fast HR) = over 100 BPM
      4. Overall average 70-72 BPM
        1. Males 60-70 BPM
        2. Females 72-80 BPM
          1. Smaller heart chamber size in women
          2. Lower blood volume in women
          3. Lower hemoglobin in women
      5. Body position affects RHR
      6. Digestion increases RHR
      7. Methods for measuring
        1. 12-lead electrocardiogram (ECG or EKG)
        2. Telemetry (commercial HR monitors)
        3. Palpation
        4. Auscultation with stethoscope
    3. Procedure for measuring exercise HR
      1. Measure pulse for 10 seconds and multiply counted beats by 6
      2. Measure pulse for 15 seconds and multiply counted beats by 4
    4. Blood pressure
      1. Korotkoff sounds
        1. Sounds made from vibrations as blood moves along the walls of the vessels
      2. Sphygmomanometer – BP cuff
  6. RPE (Rating of perceived exertion)
    1. Borg’s Scale
      1. 6-20
      2. 6 = nothing at all, HR of 60 BPM
      3. 12 = strong, HR of 120 BPM
      4. 20 = very, very hard, HR of 200 BPM



Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.