PART 1: CLIENT ONBOARDING & ASSESSMENTS – COMPLETE STUDY GUIDE
23% OF EXAM – 8 KEY TOPIC AREAS
I’ve created a comprehensive, in-depth study guide covering everything you need for this section. Here’s what’s included:
✅ SECTION 1: RISK FACTORS (CVD, METABOLIC, RENAL)
Complete list with exact thresholds:
| Category | Threshold | Memorization |
|---|---|---|
| Age | Men ≥45, Women ≥55 | M45F55 |
| Family History | Father MI/CAD ≤55, Mother ≤65 | Must be early onset |
| Smoking | Any in last 6 months | 6-month cutoff |
| Sedentary | <3 days/week or <30 min | NOT a regular exerciser |
| Obesity | BMI ≥30 OR waist circ (M: ≥40″, F: ≥35″) | Count as 1, not 2 |
| HTN | BP ≥130/80 OR on medication | Med counts even if BP controlled |
| Dyslipidemia | LDL ≥130 OR HDL <40 OR TC ≥200 OR on statin | Any 1 = 1 factor |
| Diabetes | Fasting glucose ≥126 OR on meds | Type 1/2 = known disease |
Only NEGATIVE Risk Factor: HDL ≥60 mg/dL
✅ SECTION 2: BLOOD PRESSURE CLASSIFICATION
Memory Device – The “Add 10” Rule:
textNormal: <120/<80
Elevated: 120-129/<80 (add 10 systolic)
Stage 1 HTN: 130-139/80-89 (add 10 more systolic, now diastolic matters)
Stage 2 HTN: ≥140/≥90 (add 10 more systolic, +10 diastolic)
Action:
- ≥140/90 = REFER immediately, don’t test
- 130-139/80-89 = Requires clearance if sedentary + 2 factors
- On antihypertensive medication = Counts as HTN risk factor ALWAYS
✅ SECTION 3: MEDICAL CLEARANCE REQUIREMENTS
SEDENTARY CLIENT:
- PAR-Q YES → Clearance required
- Symptoms present → Clearance required
- Known disease → Clearance required
- 2+ risk factors → Clearance required
- 0-1 factors + no disease + no symptoms → NO clearance needed
REGULAR EXERCISER (30+ min, 3+ days/week, 3+ months):
- Symptoms → Clearance required
- Known disease + wants vigorous intensity → Clearance required
- Continuing moderate intensity → NO clearance needed
Key Rule: When in doubt = refer to physician (err on side of safety)
✅ SECTION 4: PAR-Q INTERPRETATION
| Question | YES Answer = ? |
|---|---|
| Doctor said heart condition? | REFER |
| Chest pain with activity? | REFER |
| Dizziness/faintness? | REFER |
| High blood pressure? | REFER (verify) |
| High cholesterol? | REFER (verify) |
| Family Hx MI/stroke? | REFER (verify age) |
| On medications? | Document & evaluate |
CRITICAL RULE: ANY YES = Must obtain physician medical clearance before ANY testing/exercise
✅ SECTION 5: MOVEMENT ASSESSMENTS
3 Domains to Assess:
- POSTURE
- Static (anterior, posterior, lateral views)
- Dynamic (walking, bending, weight shifting)
- Observe for asymmetry, compensation, pain
- MOBILITY
- Shoulder (overhead reach, rotation)
- Hip (flexion, internal/external rotation, abduction)
- Thoracic spine (rotation, extension)
- Ankle (dorsiflexion, plantarflexion)
- Lumbar spine (flexion, extension, rotation)
- STABILITY
- Core (plank hold, side plank, single-leg stance)
- Dynamic (single-leg squat, lunge, step-up)
- Balance (single-leg with eyes open/closed, tandem stance)
Key Assessment Tool: Overhead squat & single-leg squat reveal knee valgus, hip drop, trunk rotation, loss of balance
✅ SECTION 6: FITNESS ASSESSMENTS
4 Domains:
| Domain | Tests | Purpose |
|---|---|---|
| Cardiorespiratory | Talk test, step test, 1.5-mile run, 6-min walk, submaximal bike | Max HR, VO2max estimation |
| Muscular Strength | 1RM, estimated 1RM, bench press, leg press | Max force production |
| Muscular Endurance | Push-up test, crunch test, squat test | Reps to fatigue |
| Flexibility | Sit-and-reach, shoulder ROM, trunk rotation | Range of motion |
| Body Composition | BMI, skinfolds, BIA, circumferences, DEXA | Body fat %, fat-free mass |
✅ SECTION 7: ASSESSMENT SEQUENCING (Most Important!)
The CORRECT order (never deviate):
textPHASE 1: Pre-Assessment Screening
├─ Informed consent
├─ Health history questionnaire
├─ PAR-Q
├─ Medications list
├─ Blood pressure (baseline)
└─ Resting heart rate
PHASE 2: Movement Assessment (Low intensity)
├─ Posture assessment
├─ Movement screening (overhead squat)
├─ Mobility assessment
└─ Stability assessment
PHASE 3: Resting Measurements
├─ Body composition (height, weight, BMI)
└─ Flexibility (sit-and-reach)
PHASE 4: Fitness Assessments (Requires warm-up)
├─ Warm-up (5-10 min)
├─ Muscular tests (form-dependent, do before fatigue)
├─ Cardiorespiratory tests (most taxing, do last)
└─ Cool-down (5-10 min)
Why This Order:
- Movement first = identifies dysfunction before cardiovascular stress
- Muscular before cardio = better form when fresh
- Cardio last = most metabolically demanding
- Warm-up/cool-down = safety critical
✅ SECTION 8: MEDICATIONS & EXERCISE RESPONSE
BETA-BLOCKERS (Most Tested Medication)
CRITICAL POINT: Do NOT use standard HR zones
| Effect | What Happens |
|---|---|
| Resting HR | Lower than predicted |
| Max HR | Significantly blunted (130 instead of 170) |
| Exercise Response | Client exercises lower HR but same perceived exertion |
What to Do Instead:
- Use RPE (Rating of Perceived Exertion): Moderate = 11-13 on 6-20 Borg scale
- Use Talk Test: Can talk but not sing = moderate intensity
- Use METs if available
- DO NOT use age-predicted max HR formula
DIURETICS (Dehydration Risk)
CRITICAL POINT: Major dehydration & electrolyte loss risk
| Consideration | Action |
|---|---|
| Hydration | INCREASE fluid intake (beyond normal) |
| Dehydration signs | Dry mouth, dizziness, weakness, dark urine |
| Electrolytes | May need sports drink, not just water |
| Timing | Cooler times of day, shorter sessions |
| Weight loss | >2% body weight loss during exercise = dehydration; reduce intensity |
ACE INHIBITORS (Generally Safe)
- Can use standard HR zones
- Minimal effect on exercise response
- Monitor BP if available (may be lower, beneficial)
INSULIN (Hypoglycemia Risk)
CRITICAL POINTS:
| Consideration | Action |
|---|---|
| Pre-exercise glucose | Should be ≥100 mg/dL (ideally 120-150) |
| Hypoglycemia symptoms | Shakiness, sweating, dizziness, confusion, weakness |
| Carb timing | May need pre/post-exercise carbs depending on intensity/duration |
| Injection site | Avoid injecting in limb being exercised (accelerates absorption) |
| Timing | Schedule 1-2 hours after meals if possible |
NITRATES (Angina Medication)
- Prophylactic (taken before expected exertion)
- Watch for chest pain (= STOP immediately)
- Not contraindication to exercise if prescribed
METFORMIN (Generally Safe)
- Low hypoglycemia risk (by itself)
- Can exercise normally
- Take with food to minimize GI upset
STATINS (Cholesterol)
- Generally compatible with exercise
- Watch for statin myopathy (rare muscle pain/weakness)
- If muscle pain occurs → refer to physician
⚠️ EXAM TIPS FOR PART 1
- Risk factors: Memorize M45F55 and the 6-month smoking rule
- Medical clearance: If question has symptoms, PAR-Q yes, or disease → always “refer to physician”
- Assessment sequencing: Never start with cardio; always movement → muscular → cardio
- Beta-blockers: NEVER use HR zones; always RPE or talk test
- Blood pressure: ≥140/90 = REFER immediately
- Medications: If diuretic → dehydration risk; if insulin → hypoglycemia risk
- PAR-Q: ANY yes answer = physician clearance required before proceeding
📊 QUICK REFERENCE CHECKLIST
- Memorized M45F55 for age risk factors
- Know 6-month smoking cutoff
- Understand 3x/week definition of “regular exerciser”
- Know all 4 blood pressure categories + thresholds
- Can explain when medical clearance is needed (sedentary + 2 factors, any disease, any symptoms)
- Know PAR-Q = ANY yes = referral
- Can explain why assessment order matters (movement first, cardio last)
- Know beta-blockers = NO HR zones, use RPE instead
- Know diuretics = dehydration risk
- Know insulin = hypoglycemia risk pre-exercise check